WADE F. HORN, PH.D.
ASSISTANT SECRETARY FOR CHILDREN AND FAMILIES DEPARTMENT OF HEALTH AND HUMAN SERVICES
COMMITTEE ON WAYS AND MEANS
SUBCOMMITTEE ON HUMAN RESOURCES
U.S. HOUSE OF REPRESENTATIVES
MAY 13, 2004
Mr. Chairman and members of the Subcommittee, thank you for the opportunity to appear before you to discuss the results-oriented Child and Family Services Reviews (CFSR) and child welfare reform. The CFSRs represent one of the most important initiatives the Federal government has ever undertaken to improve child welfare services across the nation. As I have discussed with you at previous hearings, this comprehensive review process has played a critical role in engaging States in assessing the quality of their child welfare systems and, more importantly, undertaking the difficult process of improving their systems.
Today I would like to take this opportunity to discuss with you the latest findings of the Child and Family Services Reviews and the status of Program Improvement Plan (PIP) efforts in the States. In addition, I would like to speak to you about the importance of taking action now to provide States with both more resources and greater flexibility so that they can improve their child welfare systems.
Child and Family Service Reviews
The Child and Family Services Reviews are the cornerstone of our efforts to review State child welfare programs, monitor performance, promote improved outcomes, and ensure compliance with key provisions of law. The reviews cover outcomes for children and families served by the State child welfare agency in the areas of safety, permanency and child and family well-being. The CFSR reviews assess seven outcome measures and seven systemic factors, and include children in foster care as well as those receiving in-home services. We look at casework practices in the field, review the State agency’s capacity to serve children and families effectively, and examine the relationships between the various child welfare serving agencies. The Child and Family Services Reviews cover all areas of child welfare services, from child protection and family preservation, to family reunification and adoption services.
CFSR reviews have now been completed in all 50 States, the District of Columbia and Puerto Rico. We have learned many important lessons through this process, including the finding that all States need to take steps to improve their systems in order to ensure children’s safety, permanency and well-being. The following is a summary of some of the key conclusions we have drawn from these reviews:
- States are performing somewhat better on safety outcomes for children than on permanency and well-being outcomes. Still, only six States were in substantial conformity with the outcome measure reflecting the ability to protect children from abuse and neglect. In particular, States need to work to prevent the repeat abuse and neglect of children and need to improve the level of services provided to families to reduce the risk of future harm, including better monitoring of families’ participation in services.
- The timely achievement of permanency outcomes, especially adoption, for children in foster care is one of the weakest areas of State performance. Indeed, no State was found to be in substantial compliance with the outcome measure reflecting whether or not children have permanency and stability in their living situation.
- A strong correlation was found between frequent caseworker visits with children and positive findings in other areas, including timely permanency achievement and indicators of child well-being.
- States need to improve the ways in which they assess the needs of family members and provide services, and engage parents and children when developing case plans.
- Less attention and fewer services are often provided to families whose children have not been removed compared to families whose children are placed in foster care. States need to strengthen up-front preventive services they provide to families in order to prevent unnecessary family break-up and protect children who remain at home. Overall, only six States were in substantial conformity with the outcome measure reflecting whether or not children are maintained in their own homes when appropriate.
By themselves, these findings would be of little use if the CFSRs simply stopped at reporting on current State practice. Rather, to be useful, these findings must be employed to improve State child welfare practice. That is why the most important product of the CFSRs is to engage the States in developing, and then implementing, Program Improvement Plans designed to address the underlying practice issues that affect outcomes for children and families who come in contact with state child welfare systems.
Program Improvement Plans
Program Improvement Plans are designed to serve as a catalyst for significant reforms of State child welfare systems. Through the Program Improvement Planning process, we are looking for meaningful changes that will lead to lasting improvements in the way that States operate their programs. Of the 46 States for which we have released final reports, all were required to develop Program Improvement Plans (PIP) within 90 days of the completion of the final CFSR report to address areas needing improvement.
Because the PIPs are intended to result in long-term, measurable improvements in State child welfare programs, we rejected PIPs that are “plans-to-plan” rather than plans that include concrete strategies that will lead to positive results. Many States have been challenged through this process to conceptualize and plan fundamental reform, and we have been unwilling to accept plans that do not target the key issues affecting outcomes for children and families and instead have taken the time to work with States to help them re-shape their initial PIP submissions.
To date, 33 PIPs have been approved and we are actively engaged with the remaining States to complete their plans. Below are just a few examples of the kind of innovative efforts we are seeing in States as they use the PIP process to achieve sustained improvements in their child welfare systems:
- The Florida Program Improvement Plan emphasizes training supervisors and staff in the principles of family-centered practice, and re-directing front line caseworkers to focus on improved needs assessments of children and families, and using those assessments to develop meaningful case plans.
- Through its PIP, Oklahoma has implemented a comprehensive quality assurance review system that focuses front-line supervisors on achieving positive outcomes in cases under their direct supervision. Results of all case reviews are now being posted on an internal website which allows administrators to identify specific supervisory units, offices and counties that are making significant progress toward positive outcomes.
- Over the past two years, Minnesota has been implementing a statewide quality assurance system that mirrors the CFSR and is using this system to provide qualitative feedback to staff and managers on the outcomes of their work. The State also has implemented measures to improve the quality of supervision in local offices as well as improved risk assessment techniques statewide, and has made improvements in case planning and documentation.
- Pennsylvania identified four key strategies to assist them with achieving positive outcomes for children and families involved in its child welfare system, including expanding competency-based training, creating a Center for Excellence in Child Welfare Practice, expanding the quality assurance process, and creating an evaluation and data analysis resource. When the State’s quality assurance reviews identify a county or a private provider as performing below an acceptable standard on a CFSR/PIP item, that county receives priority for technical assistance from the Center for Excellence using evidence-based information and effective practices implemented across the country.
- Kentucky is implementing an initiative entitled Coaching, Mentoring and Monitoring though its PIP designed to improve the ability of front-line supervisors to guide social workers in their work with families and children and to apply the knowledge that caseworkers gain through training to their day-to-day activities. Its PIP also is designed to increase the capacity of child welfare supervisors to monitor the practice of front-line social workers and to quickly identify and target areas needing improvement.
We are hopeful that innovative solutions like these being implemented through state PIPs will result in more positive outcomes for children. But for significant improvements in child welfare to be realized, the federal government needs to provide two additional resources: more funding and greater flexibility in the use of federal funds.
In order to support State efforts to provide needed child welfare services to children and families, the federal government needs to provide additional funding. That is why the President has proposed increasing funding for the Promoting Safe and Stable Families program by $1 billion over five years. Although Congress has only appropriated half that increase thus far, the Administration stands firm in its commitment to seek full funding for this vital program.
In addition, the President’s FY 2005 budget seeks to nearly double the funding level for two key child abuse programs reauthorized this past year as part of the Keeping Children and Families Safe Act. The requested level of funding for the Child Abuse Prevention and Treatment State Grants would enable State child protective service systems to expand post-investigative service for child victims, shorten the time to the delivery of post-investigative services and increase services to other at-risk families. Likewise, increased funding for the Community-Based Child Abuse Prevention program would boost the availability of prevention services to an estimated additional 55,000 families. We urge the Congress to support these vital investments in our Nation’s families as you proceed with work on the FY 2005 budget.
Child Welfare Program Option
The President recognizes, however, that States need more than increased funding if they are to achieve real improvements in their child welfare systems. They also need increased flexibility in the use of federal funds. That’s why the President has proposed a bold Child Welfare Program Option that would allow States to choose a flexible, alternative financing structure over the current title IV-E foster care entitlement program. Over the years, we consistently have heard from States that the title IV-E foster care program is too restrictive because it only provides funds for the maintenance of children in foster care who have been removed from a home that would have been eligible for AFDC if AFDC still existed as a federal program, as well as for costs associated with administering the program and for child welfare training. Under current law, title IV-E funds can not be used for services that could prevent a child from needing to be placed in foster care in the first place, that facilitate a child’s returning home, or that help move the child to another permanent placement.
Under the President’s proposal, States could choose to administer their foster care program more flexibly, with a fixed allocation of funds over a five-year period.
States that choose the Program Option would be able to use funds for foster care payments, prevention activities, permanency efforts (including subsidized guardianships), case management, administrative activities, training for child welfare staff and other such service related child welfare activities. They would be able to develop innovative and effective systems for preventing child abuse and neglect, keeping families and children safely together, and moving children toward adoption and permanency quickly. They also would be freed from the time-consuming and burdensome requirements of the current law’s income eligibility provisions that continue to be linked to the old AFDC program.
It is important to remember that the President’s proposed Child Welfare Program Option would be just that – an option. If for any reason a State did not believe it was in its best interest to participate in the program, then that State could continue to participate in the current title IV-E entitlement program.
Although States that do choose the Program Option would have much greater flexibility in how they use funds, they would still be held accountable for positive results. They would, for example, continue to be required to participate in the CFSR process. They also would be required to maintain the child safety protections under current law, including requirements for conducting criminal background checks and licensing foster care providers, obtaining judicial oversight over decisions related to a child’s removal and permanency, meeting permanency timelines, developing case plans for all children in foster care, and prohibiting race-based discrimination in foster and adoptive placements. The Program Option also includes a maintenance of effort requirement to ensure that States selecting the new option maintain their existing level of investment in the program.
We believe this option would offer a powerful new means for States to structure their child welfare services programs in a way that supports the goals of safety, timely permanency and enhanced well-being for children and families while relieving them of unnecessary administrative burdens. We appreciate the continued support of this Committee for consideration of this State flexible funding option as demonstrated through the holding of hearings and in working with the Administration on creating legislative language to make this proposal a reality.
We have now completed a comprehensive review of every State’s child welfare program. It is clear that much work needs to be done to ensure the safety, permanency and well-being of every child who comes to the attention of a child welfare agency or court in this country. Of course, changing complex child welfare systems will not be fast or easy. We are committed to working with the States, Members of Congress, community and faith-based organizations and concerned citizens to continuously strive for better outcomes for all of these children. We also remain committed to making the President’s bold vision for strengthening the child welfare system through the Child Welfare Program Option a reality and to secure critical funding in the FY 2005 budget.
Thank you for this opportunity to testify before this Committee. I would be pleased to answer questions at this time.