D.C. Child And Family Services Agency: More Focus Needed on Human
Capital Management Issues for Caseworkers and Foster Parent
Recruitment and Retention (24-SEP-04, GAO-04-1017).
The District of Columbia's Child and Family Services Agency
(CFSA) is responsible for ensuring the safety and well being of
about 3,000 children in its care and ensuring that services are
provided to them and their families. In fiscal year 2003, CFSA's
total budget was about $200 million. Concerns have been raised
about CFSA's supply of caseworkers, the foster care and adoptive
homes, and the quality and timeliness of mental health services
for foster care children. To help address these issues, the
Congress appropriated $14 million in fiscal year 2004 to CFSA,
the Department of Mental Health (DMH), and the Metropolitan
Washington Council of Governments (COG) specifically for foster
care improvement. GAO examined CFSA's (1) strategies for
recruiting, retaining, and managing its caseworkers; (2) efforts
to license an adequate supply of safe foster and adoptive homes;
and (3) efforts to collaborate with DMH and the Family Court to
provide timely mental health services to foster care children.
GAO also reviewed plans for and use of the federal foster care
improvement funds.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-04-1017
ACCNO: A12767
TITLE: D.C. Child And Family Services Agency: More Focus Needed
on Human Capital Management Issues for Caseworkers and Foster
Parent Recruitment and Retention
DATE: 09/24/2004
SUBJECT: Appropriated funds
Budgets
Children
Families
Federal funds
Foster children
Mental health care services
Welfare benefits
Welfare recipients
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GAO-04-1017
United States Government Accountability Office
GAO
Report to Congressional Committees
September 2004
D.C. CHILD AND FAMILY SERVICES AGENCY
More Focus Needed on Human Capital Management Issues for Caseworkers and Foster
Parent Recruitment and Retention
GAO-04-1017
Highlights of GAO-04-1017, a report to congressional committees
The District of Columbia's Child and Family Services Agency (CFSA) is
responsible for ensuring the safety and well being of about 3,000 children
in its care and ensuring that services are provided to them and their
families. In fiscal year 2003, CFSA's total budget was about $200 million.
Concerns have been raised about CFSA's supply of caseworkers, the foster
care and adoptive homes, and the quality and timeliness of mental health
services for foster care children. To help address these issues, the
Congress appropriated $14 million in fiscal year 2004 to CFSA, the
Department of Mental Health (DMH), and the Metropolitan Washington Council
of Governments (COG) specifically for foster care improvement. GAO
examined CFSA's (1) strategies for recruiting, retaining, and managing its
caseworkers; (2) efforts to license an adequate supply of safe foster and
adoptive homes; and (3) efforts to collaborate with DMH and the Family
Court to provide timely mental health services to foster care children.
GAO also reviewed plans for and use of the federal foster care improvement
funds.
GAO recommends that CFSA address the human capital issues of its
caseworkers and assess its efforts to recruit and retain foster parents.
CFSA agreed with these recommendations.
www.gao.gov/cgi-bin/getrpt?GAO-04-1017.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cornelia M. Ashby,
202-512-8403, [email protected].
September 2004
D.C. CHILD AND FAMILY SERVICES AGENCY
More Focus Needed on Human Capital Management Issues for Caseworkers and Foster
Parent Recruitment and Retention
CFSA actively recruited caseworkers and implemented retention strategies;
however, caseworkers cited several management practices they said lowered
their morale and adversely affected their ability to perform their duties.
CFSA employed several recruitment approaches recommended by a number of
child welfare organizations and exceeded most of its staffing goals for
fiscal year 2003. Caseworkers cited high salaries and the training for new
caseworkers as factors that encouraged them to remain at CFSA. However,
GAO found a general consensus among the caseworkers with which GAO met
that some management practices-poor communication, a lack of resources,
poor supervision, and no rewards and recognition program-adversely
affected their performance and morale. Agency officials said they had made
some changes and were planning to take other actions to address these
issues.
CFSA has developed goals and strategies for recruiting new foster and
adoptive homes and improved licensing requirements. CFSA has made progress
licensing new families, although more families have stopped serving than
expected. Further, CFSA does not have processes for identifying the
reasons foster parents stop serving or for determining the effectiveness
of its recruitment strategies. CFSA has standardized and raised licensing
requirements for all foster and adoptive homes, but as of May 2004, 308
foster homes were unlicensed, with about 22 percent of CFSA's foster
children residing in them.
CFSA has begun collaborating with DMH and the Family Court to centralize
and track mental health services for foster care children, but challenges
remain to ensuring timely delivery. CFSA and DMH designed a standard
process for referring foster care children to DMH for assessment and
treatment and for tracking service delivery. DMH has also started
expanding its service capacity for foster care children. For example, it
has begun recruiting additional evaluators to perform assessments. While
CFSA began using a database to track service delivery in August 2004, it
has not analyzed the service delivery data collected on paper prior to
August 2004 to determine whether foster care children were receiving
timely services. Additionally, CFSA and DMH still face certain challenges,
such as integrating caseworkers and Family Court judges into the new
referral process.
CFSA, DMH, and COG have spending plans that are consistent with the
statutory language providing the federal funds, but only a small portion
of the foster care improvement funds had been obligated or spent as of
June 2004, in part because funding was not received until March 2004.
Further, it is unclear how the District and COG plan to support some of
these programs in the long-term because future funding is uncertain.
Contents
Letter
Results in Brief
Background
CFSA Has Actively Recruited Caseworkers and Implemented
Retention Strategies; however, Caseworkers Cited Management
Practices That Adversely Affected Their Performance and
Morale
CFSA Has Developed a Recruitment Plan and Established New
Licensing Standards for Foster and Adoptive Homes, but More
Foster Families than Expected Have Stopped Serving
CFSA Has Begun Collaborating to Centralize and Track Mental
Health Services for Foster Care Children, but Challenges Remain
to Ensuring Timely Delivery
Uncertainties Exist in the Long-Term and Short-Term Funding
Status for Some of the Projects Included in the Plan
Conclusions
Recommendations
Agency Comments and Our Evaluation
1
3 6
10
19
27
37 42 44 44
Appendix I Objectives, Scope, and Methodology
Appendix II Comments from the District of Columbia's Child and Family
Services Agency
Appendix III Comments from the District of Columbia's Department of Mental
Health
Appendix IV Comments from the Metropolitan Washington
Council of Governments 59
Appendix V GAO Contacts and Staff Acknowledgments 61
GAO Contacts 61
Staff Acknowledgments 61
Tables
Table 1: Monetary Recruitment Incentives for Caseworkers in Fiscal Year
2003 Table 2: Retention Incentives Offered to Caseworkers by CFSA in
Fiscal Year 2003 Table 3: Examples of Existing and Planned Services in the
District Mental Health System for Foster Care Children Table 4: Types and
Purposes of Assessments for Children in Foster Care Table 5: Purposes and
Plans for the Foster Care Improvement Funds Table 6: Funds Received and
Expended by CFSA, DMH, and COG as of June 30, 2004
12 15 33 36 38 42
Figures
Figure 1: Staffing Goals Set by CFSA and Achievement Levels for Fiscal
Year 2003 13 Figure 2: Recruitment and Attrition Pattern of CFSA's Foster
Families 21 Figure 3: CFSA's Standard Process for Referring Foster Care
Children to DMH 30
Abbreviations
BSU Behavioral Services Unit
BSW Bachelors of Social Work
CFSA Child and Family Services Agency
CFSR Child and Family Services Review
COG Council of Governments
CSSP Center for the Study of Social Policy
DMH Department of Mental Health
FAPAC Foster Parent Advocacy Center
HHS Department of Health and Human Services
MSW Masters of Social Work
NCIC National Crime Information Center
RFPs requests for proposals
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
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separately.
United States Government Accountability Office Washington, DC 20548
September 24, 2004
The Honorable Mike DeWine
Chairman
The Honorable Mary Landrieu
Ranking Minority Member
Subcommittee on the District of Columbia
Committee on Appropriations
United States Senate
The Honorable Rodney P. Frelinghuysen
Chairman
The Honorable Chaka Fattah
Ranking Minority Member
Subcommittee on the District of Columbia
Committee on Appropriations
House of Representatives
The District of Columbia's Child and Family Services Agency (CFSA) is the
agency with primary responsibility for the child welfare system in the
District of Columbia (the District). In fiscal year 2003, CFSA was
responsible for about 3,000 children, and its operating budget, which was
comprised of funds from the District of Columbia government, the federal
government, and private sources, was about $200 million. Many parties are
involved in the District's child welfare system, and several agencies
provide essential services. For example, the Department of Mental Health
(DMH) is responsible for arranging, among other things, evaluations to
determine the mental health status and treatment needs of children in
foster care. The D.C. Family Court was created as a court solely dedicated
to matters concerning the District's children and families and, as such,
it
has jurisdiction over cases involving child abuse and neglect. In
addition,
CFSA works with agencies in Maryland, Virginia, and other states to
arrange for placements of District children and also works with private
agencies to place children in foster and adoptive homes.
Because CFSA was plagued with mismanagement and had failed to protect
some of the children under its care, the U.S. District Court has been and
remains involved with the agency's management and operations. In
1995, the U.S. District Court placed CFSA in receivership.1 In 2001, the
receivership ended, and CFSA then served a 1-year probationary period. The
U.S. District Court appointed the Center for the Study of Social Policy
(CSSP) to monitor and assess CFSA's performance. CSSP worked with CFSA and
developed an implementation plan to help the agency achieve reforms
ordered by the court and meet professional standards of care for the
children it serves.2 This plan, which the court approved on May 15, 2003,
covers outcomes and activities for CFSA through December 31, 2006, and
sets performance benchmarks at 6-month intervals.
The court-appointed monitor and we have reported3 that the management and
operations of CFSA have improved since the receivership. Yet, there are
still concerns that the agency may not have an adequate supply of skilled
caseworkers or safe homes for foster care and adoptions and that mental
health services needed for some children in foster care have not been
provided in a timely manner. To help address these and other concerns
about the District's foster care program, the Congress appropriated $14
million in fiscal year 2004 to CFSA, DMH, and the Metropolitan Washington
Council of Governments (COG)-an organization of government officials from
the greater Washington, D.C., metropolitan area that works cross
jurisdictionally to address issues facing the area. CFSA received funds to
upgrade its technology, expand services to foster children, and implement
a student loan repayment program for caseworkers. DMH received funds to
help it provide mental health assessments and treatment to foster children
in a timely fashion. Finally, COG was appropriated funds to develop a plan
for recruiting new foster parents and a respite care program-a support
network of individuals to care for foster children when the foster family
needs to take a break or attend to other matters.
1The receivership was an arrangement in which the U.S. District Court
appointed a person to temporarily manage the agency with broad authority
to ensure full compliance with requirements established by the court in an
expeditious manner.
2On October 23, 2000, the court signed the LaShawn A. v. Williams Consent
Order (C.A. No. 89-1754), which outlined a process for terminating the
receivership upon the satisfaction of certain specified conditions.
3GAO, D.C. Child and Family Services: Better Policy Implementation and
Documentation of Related Activities Would Help Improve Performance,
GAO-03-646 (Washington, D.C.: May 27, 2003); Center for the Study of
Social Policy, LaShawn A. v. Williams: An Assessment of the District of
Columbia's Progress as of September 30, 2003 in Meeting the Implementation
and Outcome Benchmarks for Child Welfare Reform
(Washington, D.C.: Feb. 9, 2004).
Congress is interested in knowing whether CFSA's strategies, processes,
and operations will help it to sustain the improvements previously
reported and further improve the District's foster care system as well as
what steps are planned or have been taken to use the appropriated funds.
Specifically, we were asked to assess (1) CFSA's strategies for
recruiting, retaining, and managing its caseworkers; (2) CFSA's efforts to
license an adequate supply of safe foster and adoptive homes; (3) CFSA's
efforts to collaborate with DMH and the Family Court to provide timely
mental health services to foster care children; and (4) CFSA's, DMH's, and
COG's plans for and use of the federal foster care improvement funds.
To make these assessments, we reviewed and analyzed key documents and
discussed these issues with knowledgeable and affected parties. Our steps
included reviewing best practices and standards for child welfare agencies
developed by various child welfare organizations, CFSA's recruitment and
retention plans for caseworkers and for foster and adoptive parents,
licensing requirements for all foster and adoptive homes, as well as
relevant reports and data. We conducted discussion groups with CFSA's
caseworkers and supervisors; we also held a group interview with foster
and adoptive parents. For the discussion groups with caseworkers and
supervisors, we selected participants on a random basis, with
participation being voluntary. We also reviewed key DMH and COG documents,
and we analyzed the spending plans and budget data for CFSA, DMH, and COG.
Additionally, we interviewed CFSA, DMH, Family Court, and COG officials,
as well as national experts.
We conducted our work between October 2003 and September 2004 in
accordance with U.S. generally accepted government auditing standards. See
appendix I for more details on our scope and methodology.
Results in Brief
CFSA has carried out various strategies to recruit and help retain its
caseworkers; however, caseworkers told us that several management
practices adversely affected their ability to perform their duties and
lowered their morale. CFSA implemented several recruitment strategies
recommended by child welfare organizations and exceeded most of its
staffing goals for fiscal year 2003. For example, CFSA used the Internet
to post positions, advertised in nationally circulated publications, and
recruited at a number of schools of social work across the country. By
doing so, CFSA was able to hire 147 new caseworkers and exceed its goal to
have 300 caseworkers and 60 supervisors on board at the end of fiscal year
2003. Regarding retention efforts, CFSA has provided several incentives to
encourage caseworkers to remain with the agency, many of
which are suggested by national child welfare organizations. The agency
paid retention bonuses to staff that agreed to remain at the agency for 1
to 2 years and reimbursed required professional licensure fees. Further,
many of the caseworkers we spoke with said that the relatively high salary
CFSA paid played a big role in their decisions to remain at the agency.
However, we found a general consensus among these caseworkers that CFSA's
management practices hindered their performance and lowered their morale.
They said that the agency had not provided them with needed resources such
as reliable transportation needed to visit children or cell phones needed
to contact families or the office. Caseworkers also reported that CFSA's
management did not consistently communicate with them about policy changes
and that many supervisors had not fulfilled their responsibilities.
Further, caseworkers said and CFSA's management acknowledged that the
agency did not have a program to reward and recognize caseworkers for good
performance. Subsequent to our discussions with caseworkers, CFSA
purchased cell phones and cars. Also, CFSA officials told us they are
planning to improve their communication practices, establish requirements
to help improve the quality of supervision, and develop a rewards program.
CFSA has taken several steps to license an adequate supply of safe foster
and adoptive homes; however, more foster families stopped serving than
expected, and many homes remained unlicensed. In January 2004, the agency
developed a plan to recruit foster and adoptive families. In addition to
ongoing recruitment activities, such as public service announcements and
television advertisements, CFSA intends to establish a second unit in
October 2004 with staff dedicated to recruiting new homes. One of the
goals in CFSA's fiscal year 2004 recruitment plan is to license 100 new
foster families. According to agency officials, 170 new families had been
licensed as of July 7, 2004. Further, the plan estimated that 50 families
would leave the system during fiscal year 2004, but as of May 31, 2004, 77
families had left. CFSA does not have processes for evaluating its current
recruitment methods or learning why foster parents leave. In 2004, CFSA
also established temporary, 120-day licenses to accelerate placement of
foster children with their relatives when such placements are available in
the District. These homes, known as kinship homes, house about 30 percent
of CFSA's children. Additionally, CFSA closed certain foster care homes
that did not meet its licensing standards and established a process to
monitor homes where children have been placed outside the District. While
CFSA planned to have 80 percent of all children in licensed homes by June
2003, the court-appointed monitor reported that it fell short of that
goal. Nearly a year later, about 22 percent of children in foster care-495
children-remained in unlicensed homes.
In a further effort to improve services for children in foster care in the
District, CFSA is collaborating with DMH and the Family Court to
centralize and track the provision of mental health services, including
assessments and treatment. In March 2004, CFSA began implementing a
standard referral process, designed in concert with DMH, that links foster
care children to the mental health system when assessment or treatment is
ordered by the Family Court or requested by caseworkers. From March
through June 2004, the Behavioral Services Unit in CFSA manually tracked
referral data and was able to report on the number of assessments
completed and foster care children enrolled in the mental health system.
However, the agency did not analyze this referral information to determine
whether or not services were being initiated or assessments were being
completed and reported within the statutory timeframes. In August 2004,
CFSA began entering data into a database it developed to track the status
and timeliness of referrals of foster care children to DMH for mental
health services. Meeting these timeframes depends in part on DMH's ability
to expand its capacity to provide services to foster care children. To
this end, DMH has begun efforts to recruit new evaluators to complete
assessments, certify additional treatment providers, and contract with
providers for new types of treatment targeted to the needs of foster care
children. While CFSA's and DMH's reforms were designed to better link
foster care children to mental health services, the agencies continue to
face several challenges to ensuring the timely delivery of services,
including completing complex types of assessments that may take longer
than the specified statutory timeframes and integrating caseworkers and
Family Court judges into the new referral process.
CFSA, DMH, and COG have plans to expend the foster care improvement funds
on long-term projects for which future funding for some projects is
uncertain; and all three have obligated a small portion of these funds as
of June 30, 2004. In February 2004, as required by statute, the
organizations developed and submitted expenditure plans to the Congress
explaining how they intended to use the funds. Additionally, the
organizations developed detailed budgets based on the expenditure plans
that specify how much of the money is to be used for different types of
expenses. CFSA's major planned expenses include student loan repayments
for caseworkers, equipment and labor for technology upgrades, the hiring
of new personnel, and direct support services to children and families.
The major expenses budgeted at DMH include the hiring of psychologists and
psychiatrists to conduct psychological assessments of children, the
contracting of crisis intervention and support services to facilitate
mental health treatment, and the costs of training and mentoring by human
services support agencies. Most of COG's planned expenses will be used to
pay personnel and to provide funding to community organizations to provide
respite care services to foster parents. All three organizations' planned
expenditures are consistent with the stated purpose of the legislation.
However, most of these planned expenditures are for operating costs of
long-term programs, and the funding of some of these programs in the
future is uncertain. Only a small portion of the $14 million appropriated
for foster care improvements has been obligated, in part, because the
organizations did not receive funds until March 2004. Specifically, as of
June 30, 2004, about 90 percent of the $14 million remained unobligated.
We are making recommendations to the Director of CFSA that would (1) help
address human capital management issues for caseworkers by establishing
processes to ensure consistent and effective communication with
caseworkers about agency operations and developing strategies to help
ensure that supervisors fulfill their responsibilities, (2) provide a
process for evaluating the strategies used to recruit foster parents, and
(3) identify factors affecting foster parents' decisions to stop serving.
We received comments from the Acting Director of CFSA, the Director of
DMH, and the Executive Director of COG. CFSA agreed with our
recommendations and identified additional steps it has taken or plans to
take to address the issues raised in the report. Additionally, CFSA, DMH,
and COG provided information to help clarify the report, and DMH and COG
included information on their plans to sustain their programs in the
future. We incorporated this information as appropriate. See appendixes
II, III, and IV, respectively, for CFSA, DMH, and COG comments..
The child welfare system is designed to promote the well being of children
by ensuring their safety and permanency and by strengthening families to
enable them to successfully care for their children. Families become
involved with the child welfare system after a report of abuse or neglect
has been made and confirmed. When agency officials determine that a child
may be further harmed or mistreated if left in the home, the child may be
placed in foster care. The federal government has allocated about $7
billion each year to investigate abuse and neglect of children in this
country, provide placements to children outside their homes, and deliver
services to help keep families together. The federal Department of Health
and Human Services (HHS) is responsible for the administration and
oversight of federal funding to states to support the child welfare
system. Title IV-E of the Social Security Act, as amended, is a major
source of
Background
federal funding and is primarily used to pay for the room and board of
children in foster care.
While HHS is responsible for setting standards and monitoring the nation's
child welfare system, state child welfare agencies are responsible for
administering the programs and monitoring the children and their families.
Child welfare caseworkers, assisted by their supervisors, are at the core
of the child welfare system. They are responsible for the management of
individual cases and for performing many critical tasks. For example,
child welfare caseworkers investigate reports of abuse and neglect;
arrange placements when children must be removed from their homes; develop
plans for the care of individual children; conduct visits with the
children and foster families; attend court hearings; maintain records on
each case; and coordinate with other agencies to obtain services for the
children, including mental health care. The primary role of supervisors is
to help caseworkers perform these functions, thereby meeting the needs of
families and carrying out the agency's mission.
Child welfare agencies face a number of challenges in recruiting and
retaining caseworkers and supervisors. We previously reported that low
salaries hindered agencies' abilities to attract and retain child welfare
workers and their supervisors.4 Furthermore, we found that high caseloads,
administrative burdens, a lack of supervisory support, and insufficient
time to take training were issues that impacted caseworkers' abilities to
work effectively and their decisions about staying in the child welfare
profession.
CFSA manages the child welfare system for the District. CFSA receives
Title IV-E funding as well as other funds to support its programs. In
fiscal year 2003, CFSA's budget included $65 million primarily from two
federal sources-Medicaid5 and Title IV-E. The Medicaid funds are used to
cover various expenses related to services for children in foster care,
such as specific therapeutic and medically necessary care. Other sources
of funding for CFSA include the District government and private grants. In
fiscal year 2003, CFSA's operating budget was $208 million. CFSA's
strategic goals for 2002-2004 are to (1) recruit and retain caseworkers,
4GAO, Child Welfare: HHS Could Play a Greater Role in Helping Child
Welfare Agencies Recruit and Retain Staff, GAO-03-357 (Washington, D.C.:
Mar. 31, 2003).
5Medicaid is a joint federal-state health insurance program for certain
low-income, aged, and disabled people.
(2) investigate abuse and neglect reports, (3) expedite permanency for
children, (4) recruit and retain foster homes, (5) promote agency and
neighborhood-based resources, (6) enhance agency information system, and
(7) complete court requirements.
Like CFSA, the District's mental health service agency was placed in
receivership in the 1990s.6 When DMH was established in 2001, the mental
health system lacked the infrastructure to meet the needs of children,
youth, and their families.7 Among other problems, DMH lacked a sufficient
number of providers to accommodate the needs of the District's foster care
children. To better link foster care children to mental health services,
CFSA began to contract directly with mental health providers for services.
Consequently, the mental health service delivery system for foster care
children was fragmented with no single system of providers or service
standards and no centralized information system to track the provision of
services to foster care children. Further, the courts had no aggregate
information on court-ordered mental health services for foster care
children.
Mental health services are considered critical for children who have
suffered abuse or neglect. For children in the District, assessment and
treatment are among the mental health services available through DMH.
Assessments are evaluations conducted by mental health professionals to
determine the mental health status and treatment needs of an individual.
For children in foster care, assessments are generally requested or
ordered on a case-by-case basis. Treatment, such as individual or family
counseling and group therapy, can be initiated when the result of an
assessment indicates that it is needed.
Over the years, the Congress has enacted laws and provided funds to help
improve the District's child welfare system. The D.C. Family Court Act of
6The U.S. District Court for the District of Columbia placed the D.C.
Commission on Mental Health Services, DMH's predecessor agency, in
receivership in 1997. The first receiver was appointed in October 1997 and
resigned in March 2000. The court then issued a consent order establishing
a transitional receiver to develop a plan for the District to resume full
control of its mental health system. This transitional receivership was
terminated in May 2002, and the court appointed a monitor to oversee the
District's implementation of the plan.
7See GAO, District of Columbia: Receiver's Plan to Return Control of
Mental Health Commission Is Evolving, GAO-01-157 (Washington, D.C.: Oct.
30, 2000) and District of Columbia: Status of Reforms to the District's
Mental Health System, GAO-04-387 (Washington, D.C.: Mar. 31, 2004).
20018 established the D.C. Family Court and, among other things,
established procedures intended to improve interactions between the court
and social service agencies in the District. Also, the Congress authorized
funds to the District in fiscal year 2002 for the completion of a plan to
integrate the District's computer systems with those of the Family Court
and for CFSA's caseworks to help implement family court reform.9 On
January 23, 2004, the Congress passed the District of Columbia
Appropriations Act, 2004,10 (the act), which included an appropriation of
$14 million for foster care improvements in the District. Funds were
appropriated for fiscal year 2004 only, to CFSA, DMH, and COG for specific
programs.
The act appropriated the funds as follows
o $9 million for CFSA, of which $2 million would be to establish an
early intervention program to provide intensive and immediate services to
foster children; $1 million would be to establish an emergency support
fund to purchase necessary items to allow children to remain in the care
of a licensed, approved family member; $3 million would be to establish a
student loan repayment program for caseworkers; and $3 million would be to
upgrade CFSA's automated case management system, known as FACES, to a
Web-based system and to provide computer technology to caseworkers;
o $3.9 million for DMH to provide all court-ordered or agency-required
mental health screenings, assessments, and treatment to children in the
care of CFSA; and
o $1.1 million for COG to develop a program in conjunction with the
Foster and Adoptive Parents Advocacy Center11 to provide respite care for
and recruitment of foster parents.
8Pub. L. 107-114, 115 Stat. 2100 (Jan. 8, 2002).
9Pub. L. 107-96, 115 Stat. 929 (Dec. 21, 2001). For more details on the
planned reform practices in the District's Family Court see GAO, D.C.
Family Court: Additional Actions Should be Taken to Fully Implement Its
Transition, GAO-02-584 (Washington, D.C.: May 2002).
10Pub. L. 108-199, 118 Stat. 3, 111. Div. C, Tit. 1, (Jan. 23, 2004).
11The Foster and Adoptive Parents Advocacy Center (FAPAC) is an
organization that assists foster, kinship, and adoptive parents of
children in the District of Columbia.
The act also stipulates a timeframe for DMH to provide mental health
services to foster care children. The law requires the DMH Director to (1)
initiate court-ordered or agency-required mental health services within 3
days of notification, (2) complete court-ordered or agency-required
assessments within 15 days of the request, and (3) provide the court with
all assessments within 5 days of completion.
CFSA Has Actively Recruited Caseworkers and Implemented Retention
Strategies; however, Caseworkers Cited Management Practices That Adversely
Affected Their Performance and Morale
CFSA has implemented various caseworker recruitment and retention
strategies; however, caseworkers told us about several management
practices that adversely affected their ability to perform their duties
and lowered their morale. The recruitment strategies included posting
announcements on the Internet, visiting schools of social work across the
country, developing relationships with local schools of social work, and
offering monetary incentives. CFSA successfully hired 147 new caseworkers,
which enabled the agency to exceed most of its staffing goals and lower
caseworkers' caseloads. Additionally, CFSA has held discussions with
staff, established partnerships to allow caseworkers to pursue graduate
degrees, and offered monetary incentives to help recruit and retain
caseworkers. However, caseworkers and supervisors reported some human
capital management issues that were not contributing to a positive work
environment. CFSA caseworkers and their supervisors told us about a lack
of resources and poor communication and supervision, and that the agency
did not have a program to reward good performance. We heard these concerns
consistently from caseworkers with varying lengths of service and found
these same concerns in agency records of exit interviews.
CFSA Conducted Several Recruitment Activities and Exceeded or Met Its
Staffing Goals
In fiscal year 2003, CFSA conducted several recruitment activities, some
of which were new. These recruitment activities followed the
recommendations of the court monitor and included several of the
strategies endorsed by public and private child welfare organizations. The
recruitment activities CFSA used include the following:
o Recruiting on the Internet. CFSA posted job announcements on the
agency's Web site, and used Internet job sites such as "monster.com",
"ihiresocialworkers.com", and the Web site for the National Association of
Social Workers to recruit caseworkers.
o Recruiting at schools of social work across the country. CFSA targeted
a number of schools across the country by sending recruitment teams,
mailing announcements to the schools, and using schools' internal Web
sites to generate employment interest. According
to agency officials, targeted schools were located in Delaware, Maryland,
New Jersey, New York, North Carolina, Pennsylvania, South Carolina, and
Virginia.
o Advertising in media publications. CFSA advertised in media
publications such as the Washington Post, Social Work Today-a national
magazine for social workers seeking jobs and wanting to connect with
others in the social work profession-and the Employment Guide-a national
weekly employment magazine.
o Developing ongoing relationships with local schools of social work.
CFSA developed relationships with Howard University, the Catholic
University of America, the University of the District of Columbia, George
Mason University, Virginia Commonwealth University, and Bowie State
University-universities located in the Washington, D.C., metropolitan
area.
o Attending regional and local career fairs. CFSA attended career fairs
in New Orleans, New York, and Pennsylvania, and local job fairs in
Washington, D.C., and Maryland.
o Targeting universities and colleges for bilingual and/or bicultural
staff. CFSA conducted outreach activities directed to students at colleges
focused on producing licensed caseworkers that speak Spanish and are well
acquainted with the Latino/Hispanic culture. CFSA recruited at San Diego
State University and New Mexico State University-universities with large
Hispanic populations.
o Using monetary incentives. CFSA introduced a number of monetary
incentives to attract new caseworkers. CFSA awarded bonuses to newly
recruited caseworkers that had achieved a high academic grade point
average, needed to relocate, or had bilingual skills. CFSA also
established an employee referral program. CFSA employees can receive a
$1,000 or 2 days off, if they refer a licensed caseworker to CFSA who
joins the agency and completes 6 months of continuous service. Table 1
lists the monetary recruitment incentives CFSA offered and paid in fiscal
year 2003.
Table 1: Monetary Recruitment Incentives for Caseworkers in Fiscal Year 2003
Recruitment
incentive Description of incentive
Academic achievement bonus Designed to make CFSA more competitive with
other agencies. Eligible applicants must have a grade point average of 3.5
or above. The bonus amounts ranged from about $1,000 to $3,500.
Reimbursement for relocation Designed to attract qualified licensed
caseworkers that reside
expenses in areas outside the Greater-Washington-Baltimore Metropolitan
area. Candidates must agree to remain at least one year. The amount
reimbursed cannot exceed $3,000.
Bonus for bilingual caseworkers Designed to attract licensed caseworkers
that speak Spanish or any other language for which CFSA has a current or
projected need. The bonuses are for $500.
Employee referral fee Designed to encourage CFSA employees to refer
licensed caseworker applicants. The referred caseworker must complete six
months of continuous employment before the referral fee is paid. The
referring employee can receive $1,000 or a 2-day time off award.
Number Total dollar awarded value awarded
28 $59, 460
5 $6,857
2 $1,000
1 $1,000
Source: CFSA data.
CFSA's recruitment activities and the resulting new hires enabled the
agency to meet or exceed its staffing goals. CFSA hired 147 caseworkers in
fiscal year 2003 and by doing so was able to exceed its staffing goals of
300 caseworkers and 60 supervisors. At the end of fiscal year 2003, the
agency employed 309 caseworkers of which 285 had masters of social work
degrees (MSWs) and 24 had bachelors of social work degrees (BSWs).
Additionally, CFSA met its goal to double the agency's bilingual staff by
hiring 5 caseworkers that can communicate in English and other languages
such as Spanish and sign language. CFSA's staffing goals and achievements
are summarized in figure 1.
Figure 1: Staffing Goals Set by CFSA and Achievement Levels for Fiscal
Year 2003
Furthermore, according to CFSA managers, the new hires have facilitated
reduction of each caseworker's caseload, as required by the court monitor.
As of December 26, 2003, CFSA reported that the average caseload was 17
cases, down from the average of 27 in 2002. However, the court monitor
reported that some caseworkers had caseloads that exceeded the September
30, 2003, benchmark for caseload standards set forth in CFSA's
implementation plan.12 For example, while caseworkers responsible for
investigations should carry no more than 16 cases, the caseload ranged
from 1 to 39 cases, and 15 workers had caseloads higher than the
benchmark.
CFSA analyzed its caseworker recruitment effort and identified areas for
improvement. CFSA's June 2004 recruitment and retention plan identified
several fruitful recruitment efforts such as its efforts to advance
relationships with local schools of social work and its use of the
Internet to identify candidates. Also, the plan states that the agency
will revise its recruitment efforts based on further analysis of the
results.
12CFSA's Implementation Plan was developed in conjunction with CSSP, the
courtappointed monitor. The plan covers outcomes and activities for CFSA
through December 31, 2006, and sets interim performance benchmarks to
assess improvements at 6-month intervals.
CFSA Has Begun to Implement Strategies to Help Retain Caseworkers
Retaining caseworkers is a challenge that CFSA as well as other child
welfare agencies face. In fiscal year 2003, CFSA's attrition rate for
caseworkers was about 15 percent. We could not determine if this was an
improvement because CFSA did not have data for 200213. As of June 2004,
about 45 caseworkers had left CFSA in fiscal year 2004-just over 15
percent of the staff. Our previous work on child welfare caseworker
retention identified several causes of caseworker turnover and identified
practices to help improve retention, such as university training
partnerships and bonuses.14
In 2003, CFSA developed a work plan that included strategies to help
retain well-qualified caseworkers by improving the agency's work
environment. Experts in the child welfare community endorsed several of
these strategies. The plan's goals are to create a supportive and
professionally stimulating environment and promote continuing education
for its supervisors. To help meet these goals, the agency has done the
following:
o Sought employee feedback to identify good practices as well as areas
in need of improvement. CFSA officials conducted surveys, held discussions
with staff, and reviewed data from exit interviews to identify good
practices as well as areas for improvement. CFSA began conducting exit
interviews and issued an exit interview analysis report in fiscal year
2003. The report contained data on the employee's position, program
division, and the reasons given for leaving the agency. Agency officials
told us they used this information to improve recruitment and retention
efforts.
o Required supervisory training. Supervisors of caseworkers are required
to attend training classes for 12 days, over a 5-month period. The classes
cover topics such as leadership effectiveness, case consultation, and
other topics designed to improve supervisors' skills.
o Established partnerships to allow caseworkers to pursue graduate
degrees. CFSA has agreements with Howard University and the Catholic
University of America, two universities in the District of Columbia, to
allow its caseworkers to pursue master's level degrees in
13CFSA officials previously estimated that the agency lost about one-third
of its caseworkers between January 1999 and July 2000.
14GAO-03-357.
social work. CFSA, in partnership with these universities, will provide
scholarships, stipends, and other sources of financial support. Employees
who receive this benefit must agree to remain with the agency for a period
of time or repay any financial support provided. A pilot program is
scheduled to begin in September 2004.
o Developed financial incentives. To encourage workers to remain at the
agency, CFSA offered service agreement bonuses, reimbursement for
first-time licensure fees, and additional income allowances. Table 2
describes the financial retention incentives and the number awarded in
fiscal year 2003.
Table 2: Retention Incentives Offered to Caseworkers by CFSA in Fiscal Year 2003
Retention incentives Description of incentive
Service agreement Designed to encourage new caseworkers to remain at the
agency.
bonus This is a one-time bonus to licensed caseworkers that have been
with the agency for at least 90 days and sign a 1-or 2-year continued
service agreement. The bonus amount ranged from $800 to $2,500 and varied
based on the length of the service agreement and the caseworker's base
salary.
First-time licensure fee Designed to assist newly hired caseworkers with
the cost of
reimbursement obtaining licenses for the first time. CFSA reimburses the
application fee after the license is obtained. Caseworkers must sign a
1-year continued service agreement. The maximum fee reimbursement was
$176.
Additional income Designed primarily to retain experienced caseworkers in
case allowance management and supervisory positions who have been with the
Number Total dollar awarded value awarded
39 $62,300
22 $2,890
109 $512,705 agency for at least 1 year and agree to remain for 1 or 2
additional years. This allowance may be renewed. If employment is
terminated early the employee must repay the allowance. The amount of the
allowance depends on the caseworkers experience and the length of the
service agreement. Allowances ranged from $2,080 to $6,500.
Source: CFSA data.
In addition to these retention strategies, caseworkers told us that CFSA's
training program for new caseworkers and the higher than average salary
paid by CFSA were important factors that contributed to their decisions to
remain with the agency. CFSA's pre-service training for new caseworkers
was cited as a positive experience by several caseworkers that
participated in our discussion groups and several who completed exit
surveys. This training lasts 8- 1/2 weeks and greatly exceeds the average
training time of about 3- 1/2 weeks offered by most child welfare
agencies. CFSA's training program involves both classroom study and
on-the-job training, and gradual assumption of case responsibilities under
close
supervision. Caseworkers also cited CFSA's high salaries as a key
incentive for continuing to work with the agency. CFSA's current average
salary for a master's level caseworker is $41,440 compared with the
national average of $37,097 at other public agencies.
The student loan repayment program funded by the Congress in fiscal year
2004 may further help CFSA's retention and recruitment efforts, once the
program has been implemented. Caseworkers who have worked or will work
full-time for CFSA in a nonsupervisory capacity are eligible to apply for
CFSA's loan repayment program. In addition, CFSA states that it determined
caseworkers in a private agency under contract to CFSA will also be
eligible for the loan repayment program.15 According to agency officials,
the program offers up to $18,000 to caseworkers with MSWs and $10,000 for
those with BSWs toward repayment of student loans. The exact amount will
depend on the size of the loan and the number of qualified program
applicants. Caseworkers must complete 2 years of service before any loan
payments are made. CFSA pays one-half the total payment at the end of the
caseworkers third year and the remaining half at the end of the fourth
year. Initially, applications for the program were due August 16, 2004,
and candidates had to sign a continuing service agreement to work for CFSA
by September 3, 2004. According to agency officials, CFSA extended its
application deadline to September 16, 2004.
Many Caseworkers Cited Management Practices That Affected Their Ability to
Perform Their Duties and Their Morale
During discussion sessions and in exit interviews, caseworkers said that
they did not have adequate support in terms of resources to do their jobs.
The caseworkers said that they did not have cell phones needed to maintain
contact with foster families or with the office, and they did not have
enough cars to make needed visits to monitor children under their care.
Also, they reported not having adequate office space to hold confidential
discussions with families and others involved with their cases.
Supervisors also cited the lack of resources as a problem that hindered
caseworkers' abilities to perform their duties. According to CFSA
managers, in May the agency bought a fleet of new cars, and in June of
2004, the agency bought new cell phones for every caseworker.
Additionally, CFSA is planning on adding shuttles to drop and pick up
caseworkers from regularly traveled destinations to help reduce the need
for cars.
15As part of a related review on the use of federal foster care
improvement funds, we will review CFSA's expenditures of those funds.
CFSA caseworkers also told us that management did not consistently
communicate with them about issues affecting the agency and its
operations. We also reported on this concern in our December 2000
report.16 During our recent meetings with caseworkers and supervisors,
they said, for example, that changes in policy and procedures were not
always communicated effectively or consistently throughout the agency.
Many caseworkers said that they were not aware of such changes until they
were in the process of completing an essential task, such as requesting a
clothing voucher for a foster care family, and that caseworkers often
heard of policy changes from each other. In exit interviews from January
2003 through May 2004, some employees suggested that communication be
improved between all levels of management and staff, especially related to
policy changes. For example, one employee filling out the exit interview
form said that, "What is policy on Monday may not be policy on Friday....
CFSA must improve the way it communicates policy to its caseworkers.
E-mails do not appear to be effective. The trickle down method of
providing information to supervisors is also ineffective." National child
welfare organizations and other human capital experts suggest that
management should maintain clear lines of communication and involve
employees in the decision making process of changing policies. CFSA
managers explained that while they have a formal procedure for
communicating policy changes and routinely include caseworkers in the
decision making process, changes to practice standards that affect
day-to-day operational matters are communicated through less formal
methods. According to agency officials, these changes are communicated
during staff meetings, via e-mail messages, and newsletters.
In addition, caseworkers said that many supervisors had not fulfilled
their responsibilities. They cited examples of supervisors not being
available to help them during a crisis to provide guidance and support and
not providing answers to questions affecting their work. One caseworker
said in an exit interview, "My supervisor seldom kept our supervisory
conferences or team meetings scheduled. She pushed tasks down that were
managerial duties and failed to state priorities when assigning multiple
tasks." Several caseworkers said that their supervisors had not provided
them feedback about their performance. We reviewed a random sample of
caseworkers' personnel files and analyzed those for
16GAO, District of Columbia Child Welfare: Long-Term Challenges to
Ensuring Children's Well-Being, GAO-01-191 (Washington, D.C.: Dec. 2000).
31 caseworkers who were hired on or before December 31, 2000. According to
a CFSA official, these caseworkers should have had performance appraisals
in their files for 2001, 2002, and 2003. While nearly all of the
performance appraisals for 2003 were in the files, only 1 of the 31 files
included an appraisal for all 3 years. The primary role of child welfare
supervisors is to help caseworkers perform their duties. In addition to
assigning cases, supervisors should monitor caseworkers' progress in
achieving desired outcomes, provide feedback to caseworkers in order to
develop their skills, support the emotional needs of caseworkers, and help
make decisions about cases. The quality of supervision of caseworkers at
CFSA is not a new issue. We also reported that social workers cited the
quality of supervision as a reason for their decisions to resign in
December 2000. Subsequently, to help improve the quality of supervision,
CFSA required its supervisors to complete several training courses.
However, as of August 2004, 12 of CFSA's 59 casecarrying supervisors have
completed the training, as required. Furthermore, according to agency
officials, CFSA's supervisors were not held accountable for performing
their supervisory duties. CFSA officials indicated in 2000 that they
planned to take steps to help enhance accountability for management and
supervisory employees, including developing a new agency performance
appraisal system. CFSA's managers acknowledged in 2004 that the
performance of some of its supervisors still needed to improve. The
agency's 2004-2005 recruitment and retention plan includes a new goal that
focuses on providing supervisors and managers with more training and
support to help increase the quality of supervision. Also, agency
officials said that CFSA is developing new performance measures to better
hold caseworkers and supervisors accountable for performing their duties.
Furthermore, caseworkers said and CFSA managers confirmed that the agency
does not have a program to reward or recognize individuals who perform
well, make outstanding contributions, or achieve exceptional results. The
agency honors all of its caseworkers annually during the month of May for
Social Worker Appreciation Month with a Social Worker Appreciation Day
celebration. Human capital experts have said that an individual
recognition program is an important element and that workers who are
recognized and rewarded for hard work are more likely to achieve maximum
performance. Some caseworkers said in discussion groups with us and during
exit interviews that a formal rewards and recognition program would
enhance their morale, help create a positive work environment, and improve
staff retention. Agency officials said that they are planning to develop
policies and procedures for a formal rewards and recognition program.
CFSA Has Developed a Recruitment Plan and Established New Licensing
Standards for Foster and Adoptive Homes, but More Foster Families than
Expected Have Stopped Serving
CFSA has taken several steps to recruit and license an adequate supply of
safe foster and adoptive homes.17 The agency developed a recruitment plan
and intends to establish a second recruitment unit devoted to recruiting
new foster families18 and finding homes for children who are difficult to
place, including teens and children with special needs.19 Also, CFSA has
established new licensing requirements for congregate care20 and kinship
homes.21 While CFSA has placed new emphasis on recruitment of foster and
adoptive families, as of May 30, 2004, more foster families stopped
serving than expected. Further, CFSA does not have a process for
evaluating its recruitment strategies or the attrition of families from
the foster care program. In addition, according to CFSA data, about 22
percent of foster children in CFSA's care were residing in unlicensed
homes as of May 2004. Agency officials said that they were attempting to
license these homes on a case-by-case basis.
17Licensing requirements for foster homes in the District are the same as
those for adoptive homes with one exception-the social evaluation focuses
on questions relevant to adoption or providing foster care as appropriate.
A license approves both the family and the physical space of their home.
Licensed homes and families are used interchangeably in this section.
18Families are recruited to provide (1) traditional foster homes-families
who provide 24hour care, supervision, and support for children, or (2)
therapeutic foster care-24-hour care, supervision, and support for
children who require more structure and therapeutic services to address
their physical, emotional, and behavioral needs.
19Children with special needs include those who have physical or
developmental disabilities, who are 5 years old or older, or are adopted
with sibling groups.
20Congregate care homes include group homes, independent living placements
(ILPs), and therapeutic facilities. Group homes provide services to
children in large family-type settings, ILPs are monitored apartments for
teens who are preparing to live independently when they turn 18, and
therapeutic facilities offer specialized medical and mental health care
for children and teens. Congregate care homes are designed to provide
placement for children who have not done well in the family setting or for
those awaiting placement with traditional foster families.
21Kinship homes are those in which a relative or unrelated person with
longstanding ties to the child provides care for a child that has been
neglected, abused, or is at risk for neglect and abuse.
CFSA Has Developed Strategies and Goals for Recruiting New Homes, but Does
Not Have a Process to Evaluate Its Strategies
In January 2004, the CFSA created a recruitment plan that includes
strategies and goals for recruiting foster and adoptive homes. According
to agency officials, this is the first such plan. The recruitment plan
identifies specific strategies for recruiting new families. For example,
the agency plans to invite current foster parents to hold social
gatherings to interest others in becoming foster families and to continue
the "Wednesday's Child" program which uses television commercials to
feature individual District children who are available for adoption. In
addition, the plan calls for increasing the roster of licensed foster
families by 50 at the close of fiscal year 2004. For 2005, the agency
plans to increase its supply of foster families by another 100 homes. In
order to have an additional 50 families licensed, CFSA estimated that it
must bring approximately 1,000 interested families to its orientation
sessions since about one-tenth of the families who have attended past
sessions became licensed, and an average of 50 families have left the
program each year. Figure 2 summarizes the foster family recruitment and
attrition patterns.
Figure 2: Recruitment and Attrition Pattern of CFSA's Foster Families
Source: GAO analysis.
In addition to CFSA's own recruitment plan, COG prepared a report for CFSA
in 2003 that identifies specific, targeted recruitment strategies.22 This
report identifies strategies designed to attract potential foster and
adoptive parents with certain demographic characteristics from different
neighborhoods in the District. For example, the COG report suggests that
CFSA should partner with a local women's professional sports team to host
a "Foster Care Day" and conduct a presentation on foster parenting during
halftime. The report states that this recruitment strategy would reach
families from various District neighborhoods who would work well with
children who have special needs. In commenting on a draft of this report,
agency officials said that they have incorporated some of the suggestions
in the COG report, such as involving coaches and others
22Center for the Support of Families and the Metropolitan Washington
Council of Governments. Strategic Recruitment: Finding Foster and Adoptive
Families in Your Communities. Internal report produced for D.C. Child and
Family Services Agency, (Washington, D.C.: 2003).
working with children in sports by partnering with the District's
Department of Parks and Recreation.
CFSA also plans to establish a second unit dedicated to recruiting new
foster and adoptive parents. The agency currently has one recruitment unit
that includes a seven-person team-a supervisor, a social services
assistant, and five recruiters, each of whom carries a caseload of 20-30
hard-to-place children targeted for adoption. The team plans to recruit
new foster and adoptive parents through community outreach activities and
child-specific recruiting, a strategy used to find permanent homes for
children who are traditionally the most difficult to place. CFSA plans to
launch a second recruitment unit in October 2004. The new unit will also
have seven staff members and will focus on community outreach activities
and child-specific recruiting.
Although CFSA's plan calls for the evaluation of its foster parent
recruitment efforts, we found that CFSA had not developed a process to
measure the effectiveness of its recruitment strategies and to learn why
prospective families do not complete the licensing process. CFSA's
recruitment plan alludes to the agency's FACES database as a potential
tool for collecting such data, but agency officials told us that the
system does not capture the information. Such evaluation is commonly
considered good practice.
CFSA Established and Enforced Its Licensing Standards, Broadened Its
Oversight of Homes, and Has Taken Steps to Strengthen Contracts
In April 2004, CFSA established a process for issuing temporary licenses
for kinship foster homes in the District. Kinship homes house about 30
percent of the children in CFSA's care. Requirements for the temporary
license include a home study, criminal background check via the National
Crime Information Center (NCIC), and a health history of primary
caregivers. 23 Once a child is placed, the family must apply for a
nontemporary foster family license. Temporary licenses are good for 120
days and may be renewed once for 90 days as long as the family has made a
good faith effort to comply with the nontemporary licensing process.
According to agency officials, CFSA's goal is to be able to issue a
temporary license in 3 days. As of May 2004, two temporary licenses had
been issued and both took 2 weeks to process. Agency officials reported
that they are currently working with Maryland officials to develop a
temporary license for Maryland kinship placements-a step designed to
23NCIC is an information center managed by the Department of Justice.
further expand safety checks and decrease the length of time some children
spend in emergency placements.
In August 2001, CFSA instituted new licensing standards for congregate
care homes, and in 2003 CFSA closed those that did not meet these
standards. Prior to these new standards, congregate care facilities
received a facility inspection but were not licensed. The standards cover
the physical safety of the facility, staff credentials, staffing ratios,
and required background checks for staff. In 2002, just after the
publication of the new licensing standards, most of these facilities-25 of
the 28 facilities-were issued provisional licenses in order to allow them
time to make physical upgrades required in the new standards. However, as
of June 2003, 4 of the 25 congregate care homes had been closed because
they could not meet these licensing requirements. Like traditional foster
homes, congregate homes are monitored regularly and licenses must be
renewed each year. Agency officials reported that although some challenges
remain-for example, facilities have had difficulty finding staff with the
credentials needed to meet CFSA's requirements-the new licensing
requirements have greatly improved the quality of congregate care.
CFSA broadened its oversight of out-of-state and private agency placements
in order to help ensure a consistent level of safety. In 2003, the agency
added staff to a unit that reviews the licenses of out-of-state24 homes
and manages contracts with private agencies that help place CFSA's
children in neighboring states. This oversight process gives CFSA the
opportunity to remove a child from a home if it finds a serious problem
with a family's license and, in the case of a less significant licensing
issue, the agency can work with the private agency to help correct the
problem. Because of previous problems, CFSA began requiring out-of-state
private agencies to provide foster families with support
workers-caseworkers who make monthly visits and act as a liaison between
the agency and the foster parent. Foster parents who live in Maryland and
participated in our discussion groups told us that in the past they
experienced many problems obtaining a support worker but for the most part
these problems had been resolved.
Additionally, CFSA has taken steps to establish performance-based
contracts with congregate care providers and private agencies. Agency
24The majority of CFSA's out-of-state placements are in Maryland and
Virginia.
officials expect performance-based contracting to further improve the
quality of foster care homes by requiring contractors to achieve specific,
measurable outcomes on the level of safety and quality of care they
provide to foster children. As a first major step in moving toward
performance-based contracting, CFSA issued two requests for proposals
(RFPs). The first RFP, which closed in September 2003, sought contracts
for congregate care facilities that provide emergency care, group homes,
homes for teen parents and their children, and/or independent living
services. CFSA received 30 viable proposals for congregate care providers,
and agency officials planned to make awards for congregate care in August
2004. The second RFP closed in February 2004 and sought contracts to help
place children in traditional foster homes. As of August 2004, CFSA was in
the process of evaluating the proposals it received. The implementation
plan requires all CFSA contracts to be performance-based by September
2005, and officials said that CFSA plans to meet this requirement.
CFSA Has Made Progress in Licensing New Families; however, More Families
Stopped Serving than Expected, and CFSA Has Not Determined Reasons Why
While fewer families than expected have participated in CFSA's orientation
programs, more families than expected have been licensed but more stopped
serving. As of June 30, 2004, the agency reported having processed 448
families through orientation, just under 50 percent of its goal to have
1,000 interested families participate in an orientation session. CFSA also
reported that about 170 new families were licensed-exceeding its goal of
100 new families. However, agency officials also reported that as of May
30, 2004, 77 families stopped serving-significantly more than the agency's
projected loss of 50 families for fiscal year 2004. Nonetheless, as of
June 30, 2004, there was a net gain of about 90 families. If in the last
quarter of fiscal year 2004, the number of newly licensed families
continues to exceed or at least equals the number of families who stop
serving, CFSA should be able to exceed its goal to have a net increase of
50 newly licensed families. With respect to adoption, CFSA finalized 288
adoptions as of June 30, 2004, a number that exceeds the 208 adoptions
finalized as of June 2003. If CFSA continues to find adoptive homes for
children at its current rate, the agency should exceed the 315 adoptions
it finalized at the close of 2003. 25
However, CFSA has not determined why foster families stop serving each
year. Child welfare experts recommend that agencies conduct exit
interviews with foster families and use these data to help improve the
25According to agency officials, as of August 2004, CFSA finalized 368
adoptions.
program. Agency officials said that they believe the main reasons families
stop serving as foster parents are that they become adoptive families,
have served for many years, and are "retiring" from service, or cannot
meet licensing requirements because of issues such as a change in
employment status. However, agency officials could not provide documented
support for these statements and, therefore, cannot be certain that foster
parents do not stop serving for other reasons. In addition to
systematically identifying the reasons families leave the foster program,
agency officials can learn about ways to improve the program from exit
interviews. Foster parents we met with identified several ways that CFSA
could improve the program. For example, foster parents suggested that CFSA
change some of its training requirements and that CFSA improve the way
information about a foster child is maintained because information has
been lost when a child's caseworker changed. We previously reported that
CFSA's automated case management system, FACES, lacked data on many foster
care cases and noted that information missing from the automated systems
can be lost and that such missing information requires caseworkers to
spend more time to become familiar with children's cases that are
transferred.26
By increasing the net supply of foster homes available, the agency reports
that it expects to achieve other important benefits. If there are more
traditional foster homes, CFSA can reduce the number of children placed in
congregate homes as required by the implementation plan. Further, with
more traditional foster homes, CFSA reports that it will likely be able to
facilitate more adoptions, given that foster parents often decide to adopt
once they live with a child. For example, as of March 2004, 614 foster
children (about 62 percent of children under CFSA's care with a goal of
adoption) were living with a family who intended to adopt them.
Furthermore, the respite care program being developed by COG with the
foster care improvement funds may also help increase the net supply of
homes. Foster parents said during congressional hearings and group
interviews that a respite program would, in the long run, reduce attrition
because it would reduce stress and burn-out. COG has designed a respite
program that will recruit families from the District and other surrounding
jurisdictions who will voluntarily provide respite care. COG's goal is to
26GAO, D.C. Child and Family Services: Better Policy Implementation and
Documentation of Related Activities Would Help Improve Performance,
GAO-03-646 (Washington, D.C.: May 27, 2003).
make 700 respite care placements by March 2005; however, the organization
does not yet know how many respite families will be required to provide
this number of placements. As of August 9, 2004, COG officials reported
that 6 families already licensed as foster care providers had verbally
committed to serving as respite families. In addition, 10 families had
completed training but were not yet licensed. COG officials also reported
that on August 6, 2004, they began soliciting respite requests from foster
families and that they plan to begin offering respite services on August
30, 2004. In commenting on a draft of this report, COG officials said that
they were assessing the number of foster families that need respite and
will use that information to gauge the number of respite families required
to meet the need.
Some Foster Children Remain in Unlicensed Homes
CFSA has taken a number of steps to ensure that children are placed in
licensed foster care homes, yet as of May 2004, 495 children-about 22
percent of children in CFSA's care-were in unlicensed homes. It is the
agency's policy not to place children in unlicensed homes, and measures
such as the temporary license for kinship homes and greater oversight of
out-of-state placements have been taken to prevent children from being
placed in unlicensed homes. CFSA officials told us that the majority of
the 308 unlicensed homes that remained as of May 2004 entered the foster
care program before the new licensing standards were issued and that many
are kinship homes and homes located in Maryland. CFSA is working to
correct this situation by examining these homes on a case-by-case basis to
identify the specific barrier each home faces in becoming licensed and, if
possible, to resolve that issue. The emergency support fund made possible
by Congress's 2004 appropriation may help by providing money to help
families make improvements-such as, installing a ramp for a disabled child
or splitting a larger bedroom into two for greater privacy for
siblings-that will help them become licensed.
CFSA Has Begun Collaborating to Centralize and Track Mental Health
Services for Foster Care Children, but Challenges Remain to Ensuring
Timely Delivery
CFSA has begun implementing a centralized mental health referral process
in collaboration with DMH and the Family Court and has developed a
database to track service delivery; however, challenges remain in meeting
the statutory timeframes for initiating services and for completing and
reporting on assessments. To increase the continuity of care between the
foster care and mental health systems, CFSA and DMH designed a standard
process for referring foster care children to DMH for mental health
assessment and treatment and for tracking service delivery. In addition,
officials from each agency have met routinely with Family Court judges to
discuss the referral process and other issues that may affect efforts to
link foster care children to mental health services. CFSA and DMH began
using the referral process in March 2004, and CFSA began using its newly
developed database for tracking service delivery in August 2004. In
conjunction with CFSA's efforts to centralize and track mental health
services, DMH has started expanding its capacity to provide services to
foster care children. Efforts include recruiting additional evaluators to
perform assessments, certifying additional mental health providers to
deliver treatment, and contracting with providers for new types of
treatment. While progress has been made to better link foster care
children to mental health services, several challenges remain for CFSA and
DMH in order to meet the statutory timeframes, such as completing complex
and time-intensive assessments and integrating caseworkers and judges into
the new referral process.
CFSA Has Created a Referral Process and Designed a Database for Tracking
Service Delivery
In March 2004, CFSA-in concert with DMH-began implementing a standard
process for referring foster care children to mental health services. CFSA
and DMH staff developed the new referral process to increase continuity of
care between systems and to ultimately improve the effectiveness of mental
health services for foster care children. In an effort to collaborate on
the new referral process, CFSA and DMH officials have held regular
meetings and workgroups to plan, make decisions, and share information
regarding mental health services for foster care children. For example,
the agencies have made hiring and contracting decisions together and have
begun efforts to co-locate staff. These strategies are consistent with
those cited by a national expert as indicators of a state's commitment to
coordinate care for children across multiple public
systems.27 In addition to working together, both CFSA and DMH have been
meeting with Family Court judges to present information on the new
referral process and to discuss ways to ensure that judges are ordering
the most appropriate services and that services are delivered on a timely
basis.
Under the new referral process, CFSA's newly established Behavioral
Services Unit (BSU) coordinates referrals for mental health assessments or
treatment, which are then delivered primarily by DMH through its network
of evaluators and providers.28 A child's case is forwarded to BSU when a
Family Court judge issues an order for mental health services or when a
caseworker makes a request for services.29 In the case of assessments, a
BSU specialist determines whether the type of assessment requested or
ordered is clinically appropriate for the child.30 When the assessment
request or order is deemed appropriate, the caseworker submits a referral
package to BSU. After reviewing the package for quality and completeness,
BSU forwards it to DMH's Assessment Center, which is responsible for
coordinating assessments of foster care children for the Family Court and
CFSA.31 Unless an evaluator is specified in a court order, the Assessment
Center assigns the child to the first available evaluator to conduct the
assessment. Upon completion of the assessment, DMH sends
27This expert, who has worked with several states to coordinate care for
children across systems, outlined the following strategies as indicators
of commitment to collaboration: (1) state agencies have a mechanism to
make decisions together, (2) agencies are working together at the level of
care, (3) staff members are co-mingling either through co-location or
multiagency teams, (4) financial incentives support collaboration at the
level of care, and (5) agencies are measuring the effect of collaboration
on the child.
28In the event that DMH cannot accept the referral, BSU will forward it to
a CFSA contractor to complete the assessment or provide the treatment.
29In addition to requests from caseworkers, health professionals
participating in D.C. KIDS-a health program for children in the District's
foster care system-can contact BSU to make a referral for mental health
services. According to CFSA officials, all children should receive a
medical examination, which includes a behavioral screening, through D.C.
KIDS within 30 days of entering care. If the examination suggests the need
for a more in depth mental health assessment or treatment, the child is
referred to BSU to begin the process.
30BSU's determination of the clinical appropriateness of the assessment is
based on whether the type of assessment is age-appropriate, warranted by
the child's behavior, and will result in additional information about the
child's mental health needs. The determination also takes into account
whether the child had been assessed previously.
31In addition to providing evaluations of foster care children, the
Assessment Center completes assessments of children in the juvenile
justice system and some adults involved in child custody dispute cases.
the report to BSU and to the Family Court. When a child is referred for
treatment, BSU contacts DMH's Access Helpline-a telephone hotline
providing crisis emergency services, enrollment assistance and
information, and referral 24 hours a day and 7 days a week-to enroll the
child in the mental health system. Enrollment, which the Access Helpline
is to complete within 24 hours of referral, includes assigning the child
to a core services agency.32 The core services agency is notified of the
enrollment and is required to contact the child's caseworker within 7 days
of enrollment to set the first appointment for treatment. Figure 3
summarizes the referral process.
32Core services agencies are DMH-certified rehabilitative services
providers that are responsible for determining the needs of its
consumers-including adults and children and youth-working with consumers
to develop treatment plans, providing and/or coordinating services to meet
objectives of the treatment plans, and billing DMH for services.
Figure 3: CFSA's Standard Process for Referring Foster Care Children to
DMH
Family Court
CFSA, BSU
DMH
Case
Information about case
Source: GAO analysis of CFSA and DMH data.
aThe referral package for an assessment includes extensive information on
a child, such as demographic information; previous school, police, or
health reports; and a developmental history.
bIf the referral package for an assessment is incomplete, the Assessment
Center will send it back to BSU without assigning an evaluator.
cIn some cases, Family Court judges order that a specific DMH evaluator
perform an assessment. In addition, judges occasionally order specialized
assessments, such as neuropsychological evaluations, that are only
performed by some evaluators.
dDMH's contracts with evaluators require that an assessment be completed
and the final report on the assessment be submitted to DMH and the Family
Court, when applicable, within 14 days of when the evaluator last saw the
child.
eThe referral for treatment includes basic information on the child, such
as the child's Social Security number and assigned caseworker.
fThe child's caseworker is expected to accompany the child to the first
appointment for treatment.
To electronically track mental health service delivery, CFSA created a
database to capture data on new referrals for services for foster care
children and, began entering service delivery information in August
2004.33 Prior to the implementation of the database, BSU was using paper
referral forms to manually collect information on foster care children
being referred for mental health services. According to CFSA officials,
preliminary data showed that as of July 2004, BSU was receiving between 80
and 100 referrals for mental health services a week, 40 percent of which
were for assessments and 60 percent for treatment. CFSA and DMH also
reported that, from mid-March 2004 through May 2004, CFSA completed 141
assessments and DMH's Assessment Center completed 111 assessments.34 With
regard to treatment, from mid-March 2004 through May 2004, DMH enrolled
286 foster care children to begin treatment in a certified core services
agency, of which there are 13. According to CFSA officials, DMH's core
services agencies were able to accept 95 percent of the referrals of
foster care children for treatment. CFSA treatment providers accepted the
remaining 5 percent, which were for specialized services that a DMH
provider did not offer, such as attachment therapy.35 While officials were
able to report some of the data collected manually, CFSA had not analyzed
the information to determine whether foster care children were receiving
mental health services within the statutory timeframes. 36 However, Family
Court judges and a CFSA report noted that completed assessments could take
from 30 to 60 days.
BSU officials indicated that once CFSA's database is fully operational,
every child's electronic file would include information from caseworkers,
court orders, and DMH. For example, the file will capture demographic
data, the assigned caseworker, the child's mental health diagnosis, and,
where applicable, the judge assigned to the case. Additionally, the
33These data were not available through DMH's information system, which
tracks claims for reimbursement of treatment delivered but does not
separately identify children in foster care. Further, reimbursements for
assessments are not captured in DMH's system.
34From fiscal year 2001 to fiscal year 2003, CFSA increased its referrals
to the Assessment Center by 35 percent. DMH projected the increase in CFSA
demand for assessments to continue in fiscal year 2004.
35Attachment therapy is used to help children who experienced neglect or
abuse so that they can form healthy relationships and attachments to
others.
36These timeframes require DMH to initiate services within 3 days of
notification, complete assessments within 15 days of the request, and
provide the Family Court with all assessments within 5 days of completion.
database will allow BSU to establish an electronic record for each service
referral. According to CFSA officials, these electronic records would
reflect when the service was requested or court-ordered, the mental health
evaluator or treatment provider that accepted the referral, and the date
the service was delivered.37 To collect data on the first treatment
appointment, BSU staff plan to call the child's core services agency to
ensure that treatment was delivered. This approach may be burdensome for
BSU, since approximately 50 to 60 children are being referred to the core
services agencies on a weekly basis. CFSA officials anticipate that the
database will capture information on all referrals made after the initial
date of implementation. CFSA officials also said that temporary staff were
hired to enter the data for the referrals made since March 17, 2004. It
was also noted that the agency intends to link this database to FACES, the
District's automated case management system. As of September 2004, CFSA
officials said that revisions to FACES to allow the linkage was being
planned.
DMH Has Started Expanding Its Capacity to Serve Foster Care Children
Timely delivery of mental health services will largely depend on DMH's
ability to expand and sustain its existing capacity to provide services.
DMH plans to increase the number of evaluators available to conduct
assessments, certify and train additional providers to deliver treatment,
and contract for new types of treatment. The new types of treatment for
foster care children will add to the variety of services previously
available to foster care children in DMH's system. Table 3 identifies
examples of key existing and planned services for foster care children.
According to DMH officials, expanding its capacity to provide services to
foster care children is a formidable task. For example, recruiting
qualified evaluators is difficult due to the level of education needed to
perform assessments, as well as competition with neighboring jurisdictions
for qualified staff.
37To ensure the reliability of information in the database on a continuing
basis, a CFSA official said that DMH will co-locate a staff person who
will focus on data quality and integrity by overseeing the database and
monitoring the ongoing relationship between CFSA and DMH.
Table 3: Examples of Existing and Planned Services in the District Mental Health
System for Foster Care Children
Services/initiatives Description In operation as of July 2004a
School-based program Primary prevention strategies for all students; early
intervention provided at first occurrence of emotional, behavioral, or
social concerns; treatment for students with a variety of mental health
problems; crisis service for emergent needs; and family support.
Mental health rehabilitation services Nine services, including services
such as crisis and emergency care, medication treatment, and
community-based intervention, covered by Medicaid and intended to
facilitate a consumer's recovery from mental illness.
Alternative Pathways Intervention strategies implemented at truancy
centers, the courts, and police department processing centers that are
aimed at diverting children and youth with mental health concerns from the
juvenile justice system and preventing them from further penetration into
the justice system.
Crisis services Emergency response available 24 hours a day and 7 days a
week via the Access Helpline, on-site assessment within one hour of
referral by the Helpline, and coordination for hospitalization.
Acute care Inpatient care provided by private hospitals in the community.
Planned as of July 2004
Multisystemic therapy Family- and community-based treatment delivered in
homes, neighborhoods, schools, and communities for foster care youth with
complex clinical, social, and educational problems.
Mobile crisis Face-to-face mobile response and stabilization services
provided at the site of a child's escalating behavior available for
children in foster care.
Intensive home and community-based Intensive services provided in the home
and community where the child lives by a services team of professionals
available 24 hours a day and 7 days a week.
Trauma treatment Specialized traumatic stress treatment interventions,
such as cognitively based therapy.
Source: GAO analysis of DMH data.
aThe table lists examples of key services available for foster care
children as of July 2004, but is not a comprehensive list.
DMH has made some progress in expanding its capacity to meet the
assessment and treatment needs of foster care children. DMH officials
noted that efforts are underway to recruit additional evaluators and
transition CFSA evaluators to DMH's Assessment Center. For example, CFSA
officials meet with their evaluators to encourage them to contract
with DMH. Regarding treatment providers, as of June 2004, 10 organizations
specializing in serving children and families had applied for DMH
certification to be a core services agency, specialty provider, or
subprovider. In addition to new evaluators and treatment providers, DMH
has begun a competitive grant process to make several new types of
treatment available to foster care children. As of August 2004, DMH had
approved grants for providers to deliver multisystemic therapy, intensive
home and community-based services, and mobile crisis services and was
awaiting proposals to deliver trauma treatment. DMH estimated that 300 to
500 foster care children would be served under these grant programs within
1 year of the grant contracts being signed. DMH officials noted that
providers would not be able to begin delivering services before the end of
fiscal year 2004.
Initially funded by the $3.9 million in federal foster care improvement
funds, DMH has strategies in place aimed at sustaining the additional
assessment and treatment capacity. In terms of financing the increased
capacity for assessments, DMH's director said that the department would
continue to fund evaluators to provide assessments, which represents
approximately $1.1 million of the federal funds; however, the volume of
assessments presents a challenge to meeting the statutory timeframes after
fiscal year 2005. As for treatment, which represents approximately $2.5
million of the federal funds, DMH expects that Medicaid will largely cover
the cost of the new types of treatment under the mental health
rehabilitation services option.38,39
Challenges Remain to Ensuring the Timely Delivery of Mental Health
Services
While significant steps have been taken to better link foster care
children to mental health services, CFSA and DMH face challenges to
ensuring the timely delivery of these services due to the complex working
environment in which they operate. For example, before assessments can be
conducted, caseworkers must prepare referral packages, which include
extensive amounts of information on a child. The caseworkers' ability to
prepare and submit referral packages to BSU quickly can depend in part on
how well they know the child or can obtain access to information about
38This option, which expands the services reimbursable under Medicaid,
includes nine services, such as emergency and crisis care and
community-based interventions, intended to facilitate the recovery from
mental illness.
39In the District of Columbia, the federal government contributes 70 cents
of each Medicaid dollar spent.
the child's demographics; previous school, police or health reports; and
developmental history. A CFSA official estimated that it could take
caseworkers from 2 days to several weeks to prepare a referral package.
Further, the need for more intensive, complex assessments for some foster
care children can affect the extent to which services are provided on a
timely basis. In particular, DMH officials noted that meeting the
statutory timeframes for completing and reporting on assessments could be
problematic, because some complex assessments such as bonding studies,
which determine the extent to which a child has bonded with his or her
caregiver, require multiple appointments, and may take longer to complete
than other assessments. (See table 4 for a list of the types and purposes
of assessments for children in foster care.) Additionally, some types of
assessments have prerequisites that can lengthen the time needed for
completion. For example, to complete a neuropsychological assessment, the
child must first undergo a psychological assessment. To the extent that
some foster care children may require more complex, time-consuming
assessments than others, it may be difficult for DMH to meet the statutory
timeframes of completing the assessment within 15 days of the request or
court order and providing the results to the Family Court within 5 days of
its completion. According to one national expert in mental health system
reform, other jurisdictions generally have not legislated timeframes for
mental health systems to provide services, in part because different
assessments vary in the length of time required for completion.40
40Another expert also noted that while assessments and treatment must have
timeliness components to ensure that children receive needed services, the
definition of what is timely will vary according to the needs of the
child.
Table 4: Types and Purposes of Assessments for Children in Foster Care
Type Purpose
Behavioral To determine the cause or function of behavior to develop the
most effective treatment plan.
Bonding/attachment To report on the relationships that a child has with
biological and substitute caregivers by use of direct observation of
interactions and play.
Neuro-psychological To measure a person's cognitive, perceptual, and
motor performance to obtain clues to the extent and locus of brain damage.
Psychiatric To evaluate individuals based on their behavior in relation to
physical, genetic, environmental, social, cognitive, and emotional
components.
Psycho-educational To determine an individual's cognitive and educational
functioning.
Psychological To determine an individual's cognitive, emotional,
behavioral, and social functioning.
Sexual abuse To determine if sexual abuse occurred and victims' mental
health status as a result of the abuse.
Sexual offender To determine if an individual has a propensity towards
sexual abuse of a child.
Source: GAO analysis of CFSA and DMH data, as of May 2004.
In addition to operating in a working environment that has extensive
information requirements and variations regarding individual need, CFSA
and DMH are working to better integrate caseworkers and judges into the
new referral system. While BSU is in place to provide clinical expertise
in making mental health service referrals, caseworkers and judges may not
be aware of or understand how to use the office. For example, one Family
Court official said that some judges have ordered that a specific DMH
evaluator perform an assessment, which may delay its completion due to the
evaluator's availability. A CFSA official working as a liaison to the
Family Court also indicated that caseworkers continue to contact DMH
directly to link children to mental health services, which may delay the
court order going through BSU for processing. To help educate caseworkers
about the new referral process, officials from BSU created a fact sheet
providing caseworkers guidance on how to link children to mental health
services. In addition, in May 2004, a BSU official began meeting with
caseworkers to formally present the new process and answer questions. As
mentioned previously, CFSA has also presented the referral process to
Family Court judges, and DMH is exploring ways to have its staff available
during Family Court hearings to answer questions related to mental health
services.
Uncertainties Exist in the Long-Term and Short-Term Funding Status for
Some of the Projects Included in the Plan
In February 2004, CFSA, DMH, and COG submitted spending plans to the
Congress outlining how they intended to use the foster care improvement
funds, and in March 2004, they received the funds. As of June 30, 2004,
they reported obligations of about $1.5 million of their appropriated
funds, with about $419,000 of that total having been expended. Most of the
planned expenditures outlined in the spending plans are for operating
costs that would continue in the future once the programs are established.
How the District and COG plan to fund some of these initiatives in the
long term is uncertain.
CFSA, DMH, and COG Following the passage of the act on January 23, 2004,
the organizations Have Planned could not receive funding until 30 days
after they submitted a plan. The Expenditures for Purposes District
submitted a spending plan for CFSA and DMH on February 9, Identified in
the Act 2004, and COG submitted its spending plan on February 13, 2004.
The
expenditures included in the plans are consistent with the stated purposes
in the legislation. Table 5 summarizes the purposes for the funds as
designated in the law and the planned expenditures listed in the spending
plans.
Table 5: Purposes and Plans for the Foster Care Improvement Funds
Public Law 108-199 Spending plans
Organization and Appropriated Proposed Purpose of funding funds
expenditures Description
total funding
Child and To establish an early $2 million $700,000 Personnel costs
Family (salaries
Services intervention program to & benefits)
Agency
provide intensive and
$9 million immediate services to
foster
children.
$500,000 Training and communications
$200,000 Meeting expenses (e.g., facilities & transportation)
$530,000 Services for children and families that are not currently
available at sufficient levels (e.g., substance abuse treatment)
$70,000 Overhead
To establish an Emergency $1 million $920,000 Emergency expenses for
Support Fund to purchase relatives (e.g.,
furnishings
necessary items to allow & home repairs)
children to remain in the care
of a licensed, approved family
member.
$73,000 Personnel costs (salaries & benefits)
$7,000 Overhead
To establish a loan $3 million $2,750,000 Student loan repayments
repayment
program for social workers. for qualified social
workers with masters and
bachelors degrees to
accept and extend their
tenure in the District
$250,000 Contract for Loan Repayment Program design and administration
To upgrade (FACES) $3 million $2,170,000 Upgrade FACES to Web-
computer database and based architecture
technology as well as to
provide computer technology
for social workers.
$830,000 Computer technology for caseworkers (e.g., new laptops or tablet
PCs)
Public Law 108-199 Spending plans
Organization and Appropriated Proposed Purpose of funding funds
expenditures Description
total funding
Department of $300,000 Staffing of project team to
Mental Health oversee the
$3.9 million implementation and coordination of all
program services outlined
below
To provide all court-ordered or $1,030,000 Costs for expanded
agency-required mental health psychologists and
screenings and assessments psychiartrists
for children under the
supervision of CFSA.
$70,000 Staff and home visits/assessments
$47,000 Supplies and materials
To provide all court-ordered or $1,725,000 Mobile crisis and
agency required mental health community-based
treatments for children under intervention teams to
the supervision of CFSA. provide immediate
assistance
Community support teams to provide a range of interventions to high risk
children involved in multiple systems
Community treatment setting for older adolescents who are aging out of
care
Specialized therapy and child traumatic stress treatment
$150,000 Staffing coordination between DMH and CFSA
$578,000 Training
Metropolitan To develop a program in Although COG presented a detailed
spending plan, it did not include a Washington conjunction with the foster
and breakdown of expenditures. The plan indicated that COG would (1)
provide Council of adoptive parents advocacy services for resource parents
caring for children in the DC child welfare Governments center to provide
respite care system, (2) recruit and train respite care families to care
for foster children $1.1 million for and recruitment of foster covering
emergency, planned or ongoing respite care situations, and (3)
parents. assist CFSA in developing a recruitment video and purchasing
media ads
targeted to demographics most likely to foster children with special needs
Source: District of Columbia government and the Metropolitan Washington
Council of Governments.
CFSA's spending plan outlined a strategy for accomplishing the objectives
of each of its programs as established under the act. According to the
plan, CFSA would
o establish an early intervention program through the implementation of
Facilitated Family Team Meetings that would focus on permanency options
for foster children;
o create an emergency support fund for kinship caregivers to pay for
necessary expenses such as lead abatement, home repairs and renovation,
and child care, in order to help these caregivers become or remain
licensed foster homes;
o establish a student loan repayment program for caseworkers; and
o enhance CFSA's ability to share information within and outside the
agency by upgrading the agency's child welfare tracking database, FACES,
to a Web-enabled system, providing laptop computers for caseworkers and
enhancing CFSA's networking capabilities to enable this Web-based
initiative.
The budgets from the three organizations provided details about the
planned expenses. The major expenses detailed in CFSA's budget are related
to the hiring of new personnel for Facilitated Family Team Meetings,
student loan repayments to caseworkers, equipment and labor for technology
upgrades, and direct support services to children and families. DMH's
spending plan identified funding for expanded psychiatrist and
psychologist hours for assessment and mental health treatment, such as
that provided by mobile crisis intervention teams and specialized therapy.
DMH's budget confirmed these as the major portions of the federal funds.
COG's spending plan outlined programs for providing respite care for and
the recruitment of foster parents, but it did not provide a monetary
breakdown of how the funds would be spent. However, COG's budget
identified the expenditures for the respite care and recruitment programs,
and the major expenses budgeted were for personnel costs and funds that
would be passed through to contractors and community organizations to
provide respite, recruitment, and related training services. Furthermore,
COG officials indicated that they have until March 2005 to expend all of
its funds.
Future Funding for Some of the Long-Term Projects in the Plan Is Uncertain
While the expenditures proposed in the District and COG spending plans
appear to be in line with the intentions of the act, it is unclear how the
District and COG plan to support all of the programs and initiatives
outlined in the spending plan in the long-term. Although the District's
fiscal year 2005 proposed budget for CFSA reflects realignment of agency
funds as a means to continue the early intervention program that was
funded in fiscal year 2004 with federal funds, it does not address funding
for continuing the other CFSA programs. Also, CFSA has reported that the
student loan repayment program would be made available only to staff
currently on board due to the expiration of the funds on September 30,
2004, although these funds are intended to support a multiyear strategy
that would allow CFSA to retain highly qualified caseworkers over time.
The District's proposed budget for fiscal year 2005 for DMH includes a
realignment of funds to support some mental health treatment services. For
fiscal year 2005, the budget includes funds to support programs designed
to help foster care children, such as Multi-Systemic Therapy services.
Also, DMH officials said that they are working to include the new types of
treatment in the services reimbursed under the District's Medicaid program
as a longer-term mechanism to fund additional services. With regard to
assessment, it is unclear how the District plans to sustain the funding
necessary for the additional evaluators. According to the DMH director,
DMH would continue to fund evaluators to provide assessments. In addition,
COG officials told us that they would likely need an additional $500,000
from the federal government to continue their respite care initiative
through the end of fiscal year 2005 and hope that private sources would
support the respite program in the future. In commenting on a draft of
this report, COG officials said that they had received a partnership
commitment from a private source and would seek further funding as needed.
As of June 30, 2004, Only a Small Portion of the $14 Million Had Been
Obligated or Spent
The District and COG did not receive authority over their funding until 6
months into fiscal year 2004. Following passage of the act on January 23,
2004, the District and COG could not receive funding until 30 days after
they submitted a spending plan. On March 17, 2004, the District received
the $14 million payment, less a 0.59 percent rescission,41 for a total of
$13,917,400. The District's Office of Budget and Planning granted CFSA
budget authority for its share of funds, $8,946,900 on March 22, 2004, and
41The Consolidated Appropriations Act, 2004, Pub. L.108-199, included a
provision for an across-the-board 0.59 percent rescission to be deducted
from the budget authority provided for any discretionary accounting in the
act.
granted DMH budget authority for its funds totaling $3,876,990 on March
17, 2004. The District sent COG its payment of $1,093,510 on March 25,
2004.
As of June 30, 2004, CFSA, DMH, and COG reported a small portion of the
funds appropriated for foster care improvements were obligated or spent.
CFSA reported that it had outstanding contractual obligations of $183,105
and had expended $31,998, resulting in 2.4 percent of its funding under
the act being expended or obligated. DMH reported that it had $704,527 in
outstanding contractual obligations of the funds and had expended
$190,538, totaling 23.1 percent of its funding under the act. COG reported
that it had expended $196,307 of its funds, and that it had incurred
$145,043 in outstanding contractual obligations, representing 31.2 percent
of its funding under the act. In all, over $12.4 million of the foster
care improvement funds, appropriated for fiscal year 2004 only, remained
available 9 months into fiscal year 2004. Table 6 provides details on the
organizations' expenditures and obligations as of June 30, 2004.
Table 6: Funds Received and Expended by CFSA, DMH, and COG as of June 30, 2004
Expenditures and obligations
Total funds expended and obligated Funds remaining
Outstanding Contractual Obligations Amount Percent Amount
PercentOrganization
Funds received
Funds Expended
CFSA $8,946,900 $31,998 $183,105 $215,104 2.4 $8,731,796 97.6
DMH $3,876,990 $190,538 $704,527 $895,065 23.1 $2,981,925 76.9
COG $1,093,510 $196,307 $145,043 $341,350 31.2 $752,160 68.8
Total $13,917,400 $418,844 $1,032,675 $1,451,519 10.4 $12,465,881 89.6
Source: GAO analysis of data from the District of Columbia government and
the Metropolitan Washington Council of Governments and GAO analysis. Data
are unaudited. Differences are due to rounding.
Conclusions
Many steps have been taken to help improve the District's foster care
system, but most of the programs and initiatives will need sustained
attention and ongoing support. CFSA has implemented effective recruitment
strategies and established retention incentives to help recruit and retain
skilled caseworkers. CFSA has also developed a plan to recruit foster and
adoptive families and instituted practices to better ensure the safety of
foster and adoptive homes. While these efforts are promising, CFSA will
need to continue to support these initiatives and monitor their
effectiveness. Several other initiatives have just begun and will need
sustained attention to ensure they are fully implemented. COG has not yet
licensed families to provide respite or offered respite placements and is
not certain about the number of families that will be needed to support
the program. CFSA's and DMH's process for providing mental health services
for foster care children was recently initiated, and it is uncertain
whether these services are being provided in a timely fashion. In
addition, there are several challenges remaining to ensuring the timely
delivery of mental health services, including DMH's ability to expand its
capacity to provide services. Furthermore, while the expenditures proposed
in the District and COG spending plans appear to be in line with the
intentions of the act, it is unclear how the District and COG plan to
support some of the programs and initiatives outlined in the spending plan
in the long-term.
However, some of CFSA's management practices have not created a positive
work environment for its caseworkers. Caseworkers play a critical role in
the District's child welfare system, and CFSA needs its caseworkers to be
productive, motivated, and committed in order to make further improvements
to the District's child welfare system. Without making further changes in
its management practices, CFSA may experience decreases in productivity
and increases in attrition of its caseworkers. Further, low morale may
affect caseworkers efforts to fulfill their duties and provide adequate
care to the children they manage. Without consistent and effective
communication strategies, caseworkers may not be aware of what services
they can provide to foster care children and their families or the
processes for obtaining such services. Without supervisors fulfilling
their responsibilities, CFSA caseworkers are left without guidance and
direction on how to improve on their performance and fulfill their case
management duties. Additionally, caseworkers may not be making the best
decisions about their cases, which in turn can affect the care and
services provided to children and their families.
In addition to having a cadre of highly skilled and motivated caseworkers,
an adequate number of safe, foster, and adoptive homes is a critical
factor to improving foster care in the District. Despite CFSA's new
efforts and attention to recruiting foster and adoptive families, the
agency does not have a process for assessing the effectiveness of its
recruitment efforts. Therefore, the agency does not know which efforts are
most productive and which strategies should be continued or abandoned.
Additionally, CFSA does not have sufficient information about the reasons
foster families stop serving and leave the foster care system because it
does not have a process to solicit feedback from them. Such information
could help the agency improve its program and help reduce the attrition of
foster families.
Recommendations
Agency Comments and Our Evaluation
To build upon the improvements underway, we recommend that the director of
CFSA take the following three actions:
o Address human capital management issues that affect caseworkers by
establishing processes to consistently and effectively communicate
information about agency operations and developing strategies to help
ensure that supervisors fulfill their responsibilities.
o Develop a systematic method to evaluate its foster parent recruitment
efforts to help identify the most effective strategies.
o Conduct exit interviews with foster parents who stop serving to
identify the factors affecting their decisions and develop an action plan
to address those factors that relate to systematic issues.
We received written comments from CFSA on a draft of this report. These
comments are reprinted in appendix II. CFSA agreed with each of our
recommendations and said that it plans to implement them. CFSA provided
additional information to clarify the issues in the report, and we made
changes to the report to reflect several of these comments. Specifically,
we (1) revised the maximum student loan repayment amounts and the
application deadline, (2) updated the number of finalized adoptions, (3)
changed the new recruitment unit operational date from August to October,
(4) noted that CFSA has implemented some suggestions from the COG report,
(5) corrected the information on licensing for kinship homes, and (6)
noted that CFSA has begun entering data on mental health referrals made
since March 2004. CFSA provided other information and data that we did not
incorporate because the data could not be corroborated in time for this
report.
We also received written comments on a draft of this report from DMH.
These comments are reprinted in appendix III. DMH provided information to
clarify and provide context for three areas in the report: sustainability,
building provider capacity, and improving the timeliness of evaluations
and assessments. We made changes to recognize DMH's plan to sustain the
programs begun with federal funding. Specifically, we note a realignment
of funds to support various mental health services that could help the
District's foster care children. Also, we added information on DMH's plans
to include new types of treatment in the services reimbursed under the
District's Medicaid program. With regard to DMH's efforts to meet the
timeliness requirements for completing evaluations and assessments, we did
not change the report to reflect the new information provided. DMH did not
include supporting documentation for the timeframes reported,
and we could not verify the data on the timelines for completing
assessments.
Additionally, we received written comments on a draft of this report from
COG. These comments are reprinted in appendix IV. COG provided us with
information on its plans to obtain long-term funding for its program and
to assess the number of respite providers it will need. We modified the
report to reflect these comments.
We will send copies of this report to the Acting Director of CFSA, the
Director of DMH, the Executive Director of COG, appropriate congressional
committees, and other interested parties. We will also make copies of this
report available to others on request. In addition, the report will be
available at no charge on GAO's Web site at http://www.gao.gov
If you have any questions about this report, please contact me on (202)
512-8403. Other contacts and staff acknowledgments are listed in appendix
V.
Cornelia M. Ashby Director, Education, Workforce, and Income Security
Issues
Appendix I: Objectives, Scope, and Methodology
To identify Child and Family Services Agency's (CFSA) strategies for
recruiting, retaining, and managing its caseworkers, we reviewed key CFSA
documents, analyzed data, and interviewed several experts and agency
officials. Specifically, we reviewed CFSA's strategic and annual plans for
fiscal years 2003 and 2004 and CFSA's recruiting and retention plans for
fiscal years 2003, 2004, and 2005. We reviewed CFSA data, such as worker
caseload counts, attrition data, and exit interviews. To check the
frequency with which performance appraisals were being held, we reviewed
personnel folders for a random sample of 80 caseworkers, of which we
excluded 49 caseworker files to include only those hired on or before
December 31, 2000. We reviewed national standards for child welfare
agencies set by the Child Welfare League of America and the Council on
Accreditation. Additionally, we met with several CFSA program officials
and the court-appointed monitor, the Center for the Study of Social Policy
(CSSP). We also interviewed national child welfare experts from the Child
Welfare League of America, Council on Accreditation, the Department of
Health and Human Services (HHS) Children's Bureau, Institute for Social
Welfare Research, Council on Social Work Education, National Association
of Social Workers, and Casey Family Services.
We also used discussion groups to obtain the opinions and insights of CFSA
supervisors and caseworkers regarding their opinions of CFSA's recruiting,
retention, and management support of caseworkers. Discussion groups are a
form of qualitative research in which a specially trained leader, the
moderator, meets with a small group of people who have similar
characteristics and are knowledgeable about the specific issue. The
results from the discussion groups are descriptive, showing the range of
opinions and ideas among participants. However, the results cannot serve
as a basis for statistical inference because discussion groups are not
designed to (1) demonstrate the extent of a problem or to generalize
results to a larger population, (2) develop a consensus for an agreed-upon
plan of action, or (3) provide statistically representative samples with
reliable quantitative estimates. The opinions of many group participants
showed a great deal of consensus, and the recurring themes provide some
amount of validation.
After an initial group interview with supervisors selected by CFSA
officials, we conducted four discussion groups-one with supervisors and
three with caseworkers. We randomly selected participants to help ensure
that they represented a cross section of the organization. Attendance on
the part of invited participants was voluntary. For the three discussion
groups that were held with caseworkers, we had one with employees who
Appendix I: Objectives, Scope, and Methodology
had been at CFSA for 1 year or less, one discussion group with employees
who had been at CFSA 1-6 years, and one with employees who had been at
CFSA more than 6 years. A trained discussion group moderator led the
discussions while our analysts took notes. We developed a discussion group
guide to assist the moderator in leading the discussions.
To assess CFSA's efforts to license an adequate number of safe homes for
foster care placements and adoptions, we reviewed CFSA documents, analyzed
related data, interviewed agency officials, and held group interviews with
foster and adoptive parents. Specifically, we examined CFSA's plan for
foster and adoptive parent recruitment and retention and its resource
development plan. We also reviewed CFSA's licensing policies for
traditional foster, kinship, and congregate care placements. We analyzed
CFSA data on the number of children in unlicensed foster homes, people
attending orientation sessions, foster homes issued a license from October
2003 through June 2004, and the attrition rates for foster families from
October 2003 to May 2004. We also evaluated the number of foster families
with the intent to adopt their foster children as of March 2004, and the
number of children in CFSA's care waiting to be adopted as of March 2004.
We reviewed HHS' Child and Family Services Review (CFSR) on CFSA, the
Implementation Plan issued by CFSA's court-appointed monitor, and other
national studies on recruiting foster parents. We met with CFSA program
officials and the court-appointed monitor to discuss CFSA's processes and
goals for licensing foster parents. We coordinated with D.C.-based
organizations, the Foster Parent Advocacy Center (FAPAC) and the Foster
Parent Association, to hold group interviews with foster parents.
Additionally, we interviewed officials from the Adoption Resource Center
in Washington, D.C. and the Metropolitan Washington Council of Governments
(COG).
To determine how CFSA has collaborated with the Department of Mental
Health (DMH) and the D.C. Family Court to provide mental health services
to foster care children and what challenges remain, we analyzed CFSA and
DMH planning documents, notices of available funding, provider contracts,
and documentation of internal procedures for referring foster care
children to mental health services. Prior to its implementation, we
previewed CFSA's database for tracking mental health referrals and
reviewed the documents used to collect and log the data. We also reviewed
preliminary data on the number of assessments completed and the number of
children enrolled with DMH treatment providers from mid-March 2004 through
May 2004. We interviewed CFSA and DMH program officials and D.C. Family
Court judges. In addition, we interviewed national experts in coordinating
care for children across public systems,
Appendix I: Objectives, Scope, and Methodology
including the court monitors for the District's child welfare and mental
health systems, respectively.
To report on CFSA's, DMH's, and COG's plans and use of their fiscal year
2004 federal funds for foster care improvements, we reviewed the agencies'
spending plans, budget data, and unaudited reports of obligations and
expenditures. We interviewed financial and program personnel from all
three organizations and from within the District's central Chief Financial
Officer's office.
Appendix II: Comments from the District of Columbia's Child and Family
Services Agency
Appendix II: Comments from the District of Columbia's Child and Family
Services Agency Appendix II: Comments from the District of Columbia's
Child and Family Services Agency Appendix II: Comments from the District
of Columbia's Child and Family Services Agency Appendix II: Comments from
the District of Columbia's Child and Family Services Agency Appendix II:
Comments from the District of Columbia's Child and Family Services Agency
Appendix II: Comments from the District of Columbia's Child and Family
Services Agency
Appendix III: Comments from the District of Columbia's Department of
Mental Health
Appendix III: Comments from the District of Columbia's Department of
Mental Health
Appendix III: Comments from the District of Columbia's Department of
Mental Health
Appendix IV: Comments from the Metropolitan Washington Council of
Governments
Appendix IV: Comments from the Metropolitan Washington Council of
Governments
Appendix V: GAO Contacts and Staff Acknowledgments
GAO Contacts
Staff Acknowledgments
(130306)
Carolyn M. Taylor, (202) 512-2974, or at [email protected] Anjali
Tekchandani (202) 512-7149, or at [email protected]
The following individuals also made important contributions to this
report: Susan Barnidge, Joah Iannotta, JoAnn Martinez, Deborah Peay, James
Rebbe, Lori Ryza, Norma Samuel, Vernette Shaw, Zakia Simpson, Walter
Vance, and Carolyn Yocom.
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