D.C. Child and Family Services Agency: Performance Has Improved,
but Exploring Health Care Options and Providing Specialized
Training May Further Enhance Performance (28-SEP-06,
GAO-06-1093).
The District of Columbia's Child and Family Services Agency
(CFSA) has a history of serious performance problems. A court
case in 1989 set in motion sweeping efforts to improve the
District's child welfare system. Since then, CFSA has worked to
meet performance requirements ordered by the U.S. District Court.
However, recent reports by the court monitor show that CFSA is
not meeting performance requirements on many measures. To update
Congress, we assessed (1) whether CFSA is likely to meet
requirements by December 2006; (2) what factors, if any, hinder
the agency from meeting requirements; (3) how CFSA is monitoring
its progress; and (4) the extent to which CFSA has implemented
initiatives to achieve unmet requirements. To conduct this work,
we reviewed reports by CFSA and the court monitor and interviewed
stakeholders, including the court monitor and CFSA managers,
supervisors, and caseworkers.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-06-1093
ACCNO: A61685
TITLE: D.C. Child and Family Services Agency: Performance Has
Improved, but Exploring Health Care Options and Providing
Specialized Training May Further Enhance Performance
DATE: 09/28/2006
SUBJECT: Accountability
Child abuse
Child welfare
Children
Data integrity
Employee training
Foster children
Health care programs
Performance management
Performance measures
Social services
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GAO-06-1093
* Results in Brief
* Background
* CFSA Has Met Some Court-Ordered Requirements, but Is Not Lik
* Several Factors Hinder CFSA's Progress in Meeting Performanc
* CFSA Managers and Caseworkers Cited Complex Cases and a Shor
* In a Small Number of Cases, Coordinating with the Police Dep
* Shortage of Qualified Foster and Adoptive Homes Limits CSFA'
* CFSA Uses Routine Reports and Qualitative Studies to Monitor
* CFSA Generates Daily and Monthly Reports to Track Progress t
* Qualitative Studies Help CFSA Identify and Address Ongoing C
* Data Used to Report Agency Performance May Not Accurately Po
* CFSA Has Implemented Several Initiatives to Help Achieve Unm
* CFSA Has Increased Staff and Reorganized to Help Improve Per
* CFSA Has Implemented New Practices Designed to Improve Servi
* CFSA Is Holding Management, Foster Care Providers, and Contr
* Conclusions
* Recommendations for Executive Action
* Agency Comments
* GAO Contact
* Acknowledgments
* GAO's Mission
* Obtaining Copies of GAO Reports and Testimony
* Order by Mail or Phone
* To Report Fraud, Waste, and Abuse in Federal Programs
* Congressional Relations
* Public Affairs
United States Government Accountability Office
GAO
Report to the Chairman, Committee on Government Reform, House of
Representatives
September 2006
D.C. CHILD AND FAMILY SERVICES AGENCY
Performance Has Improved, but Exploring Health Care Options and Providing
Specialized Training May Further Enhance Performance
GAO-06-1093
Contents
Letter 1
Results in Brief 2
Background 4
CFSA Has Met Some Court-Ordered Requirements, but Is Not Likely to Meet
All Requirements by December 2006 7
Several Factors Hinder CFSA's Progress in Meeting Performance Requirements
10
CFSA Uses Routine Reports and Qualitative Studies to Monitor Its Progress
toward Meeting Court-Ordered Requirements, but Current Data May Not
Provide an Accurate Picture 14
CFSA Has Implemented Several Initiatives to Help Achieve Unmet
Requirements, but It May Be Too Soon to Know if They Will Yield Long-term
Results 17
Conclusions 23
Recommendations for Executive Action 24
Agency Comments 24
Appendix I Scope and Methodology 26
Appendix II Comments from D.C. Child and Family Services Agency 28
Appendix III GAO Contact and Acknowledgments 34
Related GAO Products 35
Tables
Table 1: Performance on Key Unmet Court-Ordered Requirements, April 2006 8
Table 2: CFSA Initiatives Addressing Key Unmet Court-Ordered Requirements
23
Figure
Figure 1: Timeline of CFSA's Key Initiatives 18
Abbreviations
CFSA Child and Family Services Agency
CSSP Center for the Study of Social Policy
QSR Quality Service Review
STAR Stabilization and Replacement
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separately.
United States Government Accountability Office
Washington, DC 20548
September 28, 2006
The Honorable Tom Davis Chairman Committee on Government Reform House of
Representatives
Dear Mr. Chairman:
Over the years, the District of Columbia's (the District) Child and Family
Services Agency (CFSA)-the city's agency responsible for protecting
children from abuse or neglect and, when necessary, placing them in
appropriate foster or adoptive homes-has had serious management and
performance problems that have hindered its ability to protect some of the
children in its care. In June 1989, a lawsuit was filed in the U.S.
District Court for the District of Columbia on behalf of children in the
District's foster care system and the thousands of children who had been
abused or neglected in the District. The court found that the District
failed to (1) investigate reports of abuse or neglect in a timely manner,
(2) make appropriate foster care placements, (3) monitor the care children
received, and (4) adequately ensure children had permanent homes. This
court case set in motion efforts to reform the District's child welfare
system, beginning with a federal takeover of the agency. In 1995 the court
placed the agency in full receivership, an arrangement in which the court
appoints a person with broad authority to temporarily manage the agency.
The agency has since been removed from receivership but continues to be
monitored by the Center for the Study of Social Policy (CSSP), which has
been acting in the capacity of court-appointed monitor since 1991. The
monitor is responsible for assessing CFSA's progress in meeting
performance requirements that cover the full range of CFSA's work. CFSA is
scheduled to exit from the court monitor's supervision in December of this
year if it is performing at an acceptable level on these court-ordered
requirements. The parties will attempt to agree on an acceptable level of
performance in negotiations this fall.
Prior GAO work and recent assessments by the court monitor indicate that
while CFSA has made progress in some areas, there remain concerns about
whether the agency will be able to meet all court-ordered requirements by
December 2006. The monitor reported that as of April 2006, CFSA had not
met most of the requirements, and the agency's performance had declined in
some areas. Additionally, the monitor was not able to determine whether
CFSA had made progress in several areas because no data were available. In
order to provide Congress with an update on CFSA's performance, we
assessed (1) whether CFSA is likely to meet court-ordered requirements by
December 2006; (2) what factors, if any, hinder the agency from meeting
requirements; (3) how CFSA is monitoring its progress toward meeting unmet
requirements; and (4) the extent to which CFSA has implemented initiatives
or developed plans to achieve unmet requirements.
In conducting this work, we held group interviews with a random sample of
CFSA caseworkers and supervisors, and we interviewed CFSA managers, the
court-appointed monitor, and other District child welfare experts,
including officials from the Consortium for Child Welfare-a coalition of
nonprofit service agencies established to improve child welfare services
in the District. We also reviewed the court-appointed monitor's progress
reports and various CFSA documents, such as handbooks, guidance, and
policies. Our review focused on key requirements related to managing child
welfare cases that remained unmet as of December 2005. We conducted our
work between May and September 2006 in accordance with generally accepted
government auditing standards. A complete description of our scope and
methodology is in appendix I.
Results in Brief
CFSA has made progress in meeting some of its court-ordered requirements,
but the agency is not likely to meet all of its requirements by December
2006, based on the recent court monitor's report and our work. From
December 2005 to April 2006, CFSA improved its performance and met
benchmarks for a number of requirements, such as ensuring that children
under age 12 are not routinely placed in group settings. In some areas,
the data show an improvement in performance even though CFSA has yet to
meet benchmarks. For example, 61 percent of children who are in
out-of-home placements were placed with some or all of their siblings as
of April, an improvement of 5 percentage points from December. However,
CFSA's performance on several requirements is well below benchmarks. For
example, as of April 2006 only 29 percent of children in foster care had
received medical evaluations within 30 days of placement despite a
court-ordered benchmark of at least 90 percent. This raises questions
about the agency's ability to meet all of the court-required benchmarks by
December and to sustain the improvement it has made.
Several factors-including complex caseloads, and shortages of health care
providers, and qualified foster and adoptive homes-hinder CFSA's ability
to meet court-ordered requirements, according to CFSA officials,
caseworkers, and the court monitor. CFSA's cases are complex, in part
because of the high proportion of hard-to-place teenagers and children
with medical or mental health needs in the District's child welfare
system. Caseworkers reported that they do not have enough specialized
training or adequate support from supervisors to help them develop the
skills they need to address the complexities of their caseloads,
particularly when cases involve children who have behavioral problems or
have experienced domestic violence. Furthermore, CFSA's effort to meet
time frames is complicated in a small number of cases by difficulty in
coordinating with the District's Metropolitan Police Department. At the
same time, CFSA officials told us there is a shortage of medical, dental,
and mental health care providers. Officials told us this is partly because
District reimbursement rates for Medicaid-the joint federal-state health
care financing program that covers low-income children, including certain
children in foster care and adoptive placements-are lower than the average
fees providers charge. Furthermore, a shortage of qualified foster and
adoptive homes in the District hinders CFSA's ability to meet some
requirements, such as giving children the most appropriate foster care
placements, placing siblings together, and ensuring timely adoptions.
Several factors, such as the changing demographics of the District,
contribute to this shortage, and a lack of border agreements with Maryland
and Virginia makes it difficult for CFSA to look across District
boundaries to place children with family members or in other homes in the
surrounding suburbs.
CFSA uses routine reports and qualitative studies to monitor its progress
toward meeting unmet requirements, but current data may not accurately
portray the agency's progress. CFSA generates a number of daily and
monthly data reports that allow managers to track performance on the
court-ordered requirements as well as develop strategies to improve
performance. In addition, CFSA uses information from interviews, focus
groups, and surveys of caseworkers, managers, and families to get a more
complete picture of how the agency is performing. However, the data CFSA
uses may not accurately portray progress toward meeting requirements,
because of challenges in implementing a new Web-based case management
system and caseworkers not always entering accurate and complete data. The
agency is working to resolve these issues by offering training and other
support for caseworkers and others using the new system. The court monitor
recently reported that data issues related to the implementation of the
Web-based system should be resolved soon.
Within the past few years, CFSA has implemented a number of initiatives to
address the challenges it faces and to help meet court-ordered
requirements, but it may be too soon to know if they will yield long-term
results. CFSA has hired new staff and reorganized existing staff to focus
resources in key areas. For example, CFSA has hired additional caseworkers
to improve its ability to conduct investigations in a timely manner, but
is not yet meeting benchmarks in this area. CFSA has also implemented new
practices, including a standardized process to screen calls to its
telephone hotline reporting child abuse or neglect. Caseworkers use
established risk factors, such as the number of children involved in a
case or the parent's criminal history, to screen calls and prioritize
investigations. This approach allows CFSA to better focus its resources on
its most urgent cases and refer others to community agencies to provide
appropriate services to assist the family. In addition, CFSA is beginning
to hold its management staff as well as private contractors accountable
for helping the agency meet specific performance requirements. For
example, CFSA found that private contractors who manage the cases of about
40 percent of CFSA's children and families were performing at a lower
level than CFSA caseworkers on certain requirements, such as making
frequent home visits to children and their families. The agency reported
that it has taken a number of steps to improve contractors' performance,
including holding monthly meetings to review expectations and resolve
problems. Agency officials told us they will link contractors' pay to
achieving specific outcomes in 2007. Many of these initiatives seem
reasonable, but it is too soon to tell whether these efforts will help
CFSA meet court-ordered requirements.
We are recommending that the Mayor of the District of Columbia direct CFSA
to provide caseworkers with specialized training to help them address the
complexities of their caseloads, and explore options for increasing the
number of providers for mental health, medical, and dental services. In
its written comments, CFSA agreed with our findings and recommendations.
Additionally, CFSA suggested several changes to help clarify the report,
which we incorporated as appropriate. The comments are shown in appendix
II.
Background
CFSA is responsible for ensuring the safety and well-being of children at
risk for abuse and neglect in the District, but many children in CFSA's
care languished for long periods of time due to managerial shortcomings
and long-standing organizational divisiveness in the District. In 1989,
the American Civil Liberties Union sued the District on behalf of children
who were in foster care and other abused and neglected children over the
quality of services the city was providing to them. In 1991 the U.S.
District Court for the District of Columbia heard the case, found the
District's child welfare agency liable and issued a remedial order in 1991
to improve performance. 1 When that remedial order and other orders did
not result in sufficient improvement, the court placed the agency under
full receivership in 1995.2 After 6 years under receivership, CFSA was
reorganized as a District cabinet-level agency, a change that gave the
agency more control over its staff and budget.
The court appointed CSSP to monitor the agency's compliance with the
court's orders, including the performance requirements set forth in the
court order releasing CFSA from receivership and the related plan for
implementing the order. In 2003, a final implementation plan was approved
by the District Court and included court-ordered requirements that cover
the full range of CFSA's work. Some of the requirements are related to
managing child welfare cases, such as initiating and conducting timely and
quality investigations of child abuse and neglect allegations, providing a
range of services to children and their families, and placing children in
appropriate foster or adoptive homes. There also are requirements related
to the administration and management of the agency, such as CFSA's
information systems and financial management. The implementation plan also
established court-ordered benchmarks-or expected performance levels-for
CFSA to meet on each requirement and, for most of the requirements, set
interim benchmarks that gradually increased over time until reaching full
compliance. For example, the court mandated that investigations of abuse
or neglect must be completed within 30 days. By June 30, 2003, 60 percent
of cases had to meet that time frame. This benchmark gradually increases
at 6-month intervals until reaching the benchmark of full compliance by
December 30, 2006. However, the court has not yet established a precise
performance level that defines full compliance; the court monitor expects
these negotiations to begin this fall.
Generally, families become involved with the child welfare system after
someone-a neighbor, teacher, or other individual-reports to CFSA through
its telephone hotline that the child has been abused or neglected. CFSA
then investigates to determine whether the report can be substantiated. If
agency investigators determine that it is safe for the child to remain at
home with his or her parents or guardians, CFSA relies on community
agencies, such as the Healthy Families/Thriving Communities
Collaboratives,3 to provide services to help the family, including
parenting skills classes, if needed. If required, the child may be removed
from the home, necessitating court proceedings.
1 LaShawn v. Dixon, 762 F. Supp. 959 (D.D.C. 1991).
2 LaShawn v. Kelly, 887 F. Supp. 297 (D.D.C. 1995).
CFSA caseworkers are responsible for managing foster care cases by
developing case plans; visiting the children; participating in
administrative review hearings involving CFSA officials, children,
parents, attorneys, and other officials; attending court hearings; and
working with other District government agencies. CFSA caseworkers are also
responsible for documenting in the agency's case management system the
steps taken and decisions made related to a child's safety, well-being,
and foster care placements, as well as those related to developing the
most appropriate goal for permanency. Depending on their circumstances,
children leave foster care and achieve permanency by being (1) reunified
with their birth or legal parents, (2) adopted, (3) placed in the legal
guardianship of a relative, or (4) declared independent at the age of 18.
Caseworkers are assigned to various units responsible for providing
services to children and families. CFSA program managers and supervisors
within those units are responsible for providing the necessary guidance
and support needed by caseworkers to manage their cases.
CFSA relies on other District agencies and private organizations to help
achieve its mission. For example, CFSA has a contract with Children's
National Medical Center, known as DC Kids, to provide medical evaluations
for children when they enter CFSA's care and for as long as they remain in
the system. In addition, CFSA relies on private dental and mental health
care providers to give children dental care and psychological or
psychiatric evaluations. Some private organizations, such as Catholic
Charities, manage about 40 percent of CFSA's cases, including preparing
case plans for children placed in foster care and those that remain in the
home, making home visits, or providing for visitations between siblings or
parent and child. CFSA also works with agencies in Maryland, Virginia, and
other states to arrange for placements for District children. CFSA is
responsible for licensing and monitoring organizations in the District
with which it contracts, including group homes that house foster care
children. Also, CFSA oversees the licensing and monitoring for
organizations outside of the District where children are placed.
3 Collaboratives are independent nonprofit organizations operating in
areas of the District of Columbia with at-risk children, adults, and
families. Collaboratives partner with CFSA to provide services and
support, such as housing and training, working toward a goal of reducing
or eliminating the possibility of children being removed from their
families or communities, or reunifying children with their families when
removal does occur.
CFSA Has Met Some Court-Ordered Requirements, but Is Not Likely to Meet All
Requirements by December 2006
CFSA has met some court-ordered requirements, but the agency is not likely
to meet all of its requirements by December 2006, according to the recent
court-monitor's report and our work. From December 2005 to April 2006,
CFSA showed progress, meeting court-required benchmarks in areas such as
limiting to five the number of caseworkers assigned to each supervisor,
ensuring that children age 12 and under are not routinely placed in group
settings, and ensuring that children do not stay in emergency placements
for more than 30 days. In addition, the data show an improvement in some
requirements, even though CFSA has yet to meet the court-required
benchmarks. For example, 61 percent of children who are in out-of-home
placements were placed with some or all of their siblings as of April, an
improvement of 5 percentage points from December. In other areas, CFSA's
performance was stagnant. For example, CFSA is required to initiate all
investigations within 48 hours after receiving a report of abuse or
neglect. CFSA did so in 70 percent of cases in December, and as of April
its performance was still at 70 percent.4
However, performance on the majority of requirements still did not meet
the court-required benchmarks, and in some cases fell seriously below
benchmarks.5 For example, despite a benchmark set at 90 percent,6 only 29
percent of children in foster care had received medical evaluations as of
April 2006, and data were not available for the percentage of children who
received dental evaluations. This raises questions about the agency's
ability to meet the court-required benchmarks by December and to sustain
the improvements it has made.7 Table 1 shows CFSA's performance on key
unmet requirements as of April 2006.
4 District law sets a stricter time frame for initiating investigations.
District law requires CFSA to initiate an investigation within 24 hours of
receiving a report of child abuse or neglect not involving immediate
danger to the child. However, for the purpose of the court-ordered
requirements, CFSA must meet the 48-hour time frame for initiating
investigations for the proportion of cases established in the benchmark.
5 CFSA's Web-based case management data system, FACES.net, is the primary,
and in some cases the only, source for data to measure the agency's
progress in meeting court-ordered requirements. However, FACES.net data
have some limitations that we discuss in the third section of this report.
See also appendix I for GAO's review of FACES.net data quality.
6 This is the last numeric benchmark set before full compliance,
established for the period beginning June 30, 2005.
Table 1: Performance on Key Unmet Court-Ordered Requirements, April 2006
April 2006
Key unmet Numeric Performance level achieved Whether met
requirements benchmark benchmark
Timeliness of 90 percenta 70 percent Not met
investigations
90 percenta 39 percent Not met
o
Investigations
initiated
within 48
hours.
o
Investigations
completed
within 30 days.
Comprehensive 95 percent 62 percent initiated within Not met
investigations of 48 hours
abuse and neglect
reports in foster 76 percent closed within 30
homes and days
institutions
Appropriate and 80 percent 53 percent (medical) Not met
timely physical
and psychological 90 percent 40 percent Not met
evaluations (psychological/psychiatric)
29 percent (medical)c
o Children
receive
appropriate
medical,
psychological,
or psychiatric
evaluations
when necessary
as part of an
investigation
of abuse or
neglect.
o Children in
foster care
receive a full
medical and
dental
evaluation
within 30 days
of placement.
Appropriate 0 percent of 40 percent have more than Not met
caseloads for case workers have 12 cases
workers and more than 12 Benchmark
supervisors cases 92 percent metb
o Workers 95 percent of 55 percent Not met
conducting supervisors
investigations
have no more 90 percent of
than 12 supervisorsa
investigations
at a time.
o Supervisors
are responsible
for no more
than five
caseworkers.
o Supervisors
do not manage
cases unless a
caseworker
leaves without
providing
notice, and in
such
circumstances,
only for a
5-day period.
Increased 90 percent 61 percent (once/month) 20 Not met
visitations for (once/month)40 percent (twice/month)
children and percent Not met
families (twice/month) 26 percent
Not met
o Caseworkers 70 percent 13 percent
visit homes in
which there has 85 percenta
been abuse and
neglect to
ensure children
can live with
birth parents
safely with
services.
o Children
placed apart
from their
siblings visit
some or all of
their siblings
at least two
times per
month.
o Children in
foster care and
their birth
parents visit
weekly, if CFSA
has a goal to
reunify them.
Appropriate 70 percent 8 percent Not met
referrals to
community agencies
o Families who
are the subject
of a report of
neglect/abuse
that is
determined to
be
unsubstantiated
are referred to
an appropriate
community
agency for
services.
Children are given 75 percent 61 percent Not met
the most
appropriate No more than 21 children Benchmark
out-of-home 20 children substantially
placements 10 children 80 percent metb
No more than 5 (foster homes) 97 percent
o Children in childrena 95 (group homes) 69 percent Not met Not
out-of-home percenta (independent living) 22 met
placement are children
placed with No more than Benchmark met
some or all of 25 children
their siblings.
o Children
under 12 are
not routinely
placed in
congregate care
settings.
o Children
under age 6 are
not placed in a
group setting
unless they
have
exceptional
needs.
o Foster
homes, group
homes, and
independent
living
facilities have
a current and
valid license.
o Children
will not stay
in emergency
facilities for
more than 30
days.
Reduce multiple No more than 5 18 percent Not met
placements of percent
children in foster
care
o Fewer
children in
foster care
have three or
more placements
in a 12-month
period.
Timely adoptions 85 percent 50 percent Not met
o Children are
in approved
adoptive
placement
within 9 months
after CFSA sets
a goal of
adoption.
7 At the end of our review, CFSA provided us with updated performance data
as of July 31, 2006. CFSA officials told us that the data show an
improvement from April. We did not analyze the data or assess its
reliability. The court monitor is currently assessing these data and will
be incorporating the data in its final report of CFSA's progress.
Source: Center for the Study of Social Policy. "An Assessment of The
District of Columbia's Progress as of April 30, 2006, in Meeting the
Implementation and Outcome Benchmarks for Child Welfare Reform."
(Washington, D.C: July 19, 2006).
aLast numeric benchmark before full compliance.
bAs determined by the court monitor.
cNo data available on dental care.
Several Factors Hinder CFSA's Progress in Meeting Performance Requirements
Complex cases and shortages of health care providers and qualified foster
and adoptive homes hinder CFSA's ability to meet court-ordered
requirements, according to CFSA officials, caseworkers, and the court
monitor. While caseworkers' caseloads have been reduced because of CFSA's
efforts to recruit and retain caseworkers, cases are complex, in part
because of the high proportion of teenagers and children with medical or
mental health needs. CFSA's efforts to meet court-ordered time frames is
further complicated in a small number of cases by difficulty in
coordinating with the District's Metropolitan Police Department. At the
same time, CFSA officials told us that there is a shortage of health care
providers to serve these children with health care needs, and the limited
number of qualified foster and adoptive homes hinders CFSA's ability to
give children the most appropriate and timely placements.
CFSA Managers and Caseworkers Cited Complex Cases and a Shortage of Health Care
Providers as Hindrances
The complexity of the caseload is hindering CFSA's efforts to meet court
ordered requirements, according to CFSA officials. While caseworkers'
caseloads have been reduced as a result of CFSA's efforts to recruit and
retain caseworkers, cases are complex for a number of reasons. First,
there is a high proportion of older children in the District's child
welfare system who are harder to place and may have different needs than
younger children. This high proportion is due to the fact that the
District serves children in its care until age 21 and, historically, CFSA
had not been successful finding permanent homes for these children when
they were younger. As a result, there are almost 800 youths aged 16 to
21-almost one-third of the city's current foster child population-many of
whom have grown up in foster care. Second, a large proportion of children
within the system have complex needs, such as the need for mental health
services or for foster parents that are licensed to support children with
severe medical conditions.
Caseworkers reported not having enough specialized training or adequate
support from supervisors to help them develop the skills they need to
address the complexities of their caseloads, including cases involving
children with behavioral problems or who have experienced domestic
violence. While CFSA has a comprehensive training curriculum, much of the
curriculum is focused on developing a base of knowledge, such as
understanding how children in foster care develop attachment
disorders-which make it difficult for them to develop healthy
relationships with primary caregivers-or understanding other separation
issues. The court monitor recently recommended that in addition to
focusing on what the caseworker should know and understand, the CFSA
curriculum needs to identify what the caseworker should do and help the
caseworkers develop a set of applicable skills.
CFSA officials told us there is a shortage of health care providers to
give necessary medical, dental, or mental health services to children in
the agency's care. These shortages are not unique to the District's child
welfare system, but they hinder CFSA's ability to meet a number of
court-ordered requirements. For example, caseworkers told us that not
having enough doctors and dentists to conduct screenings and examinations
made it difficult to complete investigations or provide routine
examinations within required time frames. Specifically, they told us that
there is not a sufficient number of dentists in the District who provide
services to CFSA's children. Furthermore, CFSA told us that in February
2006, the agency did a competitive request for proposals from all District
medical providers for a comprehensive medical system of care, but received
only one bid. While there may be a number of reasons for the lack of
providers, CFSA officials told us that low Medicaid reimbursement rates
for children who are residents of the District was a major factor. 8
In a Small Number of Cases, Coordinating with the Police Department Has
Complicated CFSA's Ability to Meet Time Frames
CFSA's ability to meet court-ordered time frames for conducting
investigations may be complicated in a small number of cases by difficulty
in coordinating with the District's Metropolitan Police Department, which
sometimes operates under different time frames and priorities. For
example, caseworkers told us that they cannot close out investigations
involving severe physical or sexual abuse without a report from the police
department. However, the court monitor noted that caseworkers and police
officials were not consistently collaborating in a timely manner as
required by a memorandum of understanding developed between the two
agencies or were not documenting their efforts properly in CFSA's data
system. While CFSA and the police department are required to coordinate on
these cases, the court monitor reported in February 2006 that, according
to CFSA's data, joint investigations were held in only 31 percent of such
cases. To assist with coordination, the monitor recommended that CFSA
enlist the assistance of the Deputy Mayor for Children, Youth, Families
and Elders to ensure joint investigations are performed in a timely
manner. CFSA officials told us that they are taking steps to improve this
coordination. Officials of the two agencies have begun holding weekly
meetings to discuss and resolve emerging issues, and CFSA has started
colocating staff at the police department. However, at this time it is too
soon to know whether these steps will be effective in helping CFSA meet
investigation time frames.
8 Most children in foster care or adoptive placements are eligible for
Medicaid-the joint federal-state health care financing program that covers
certain categories of low-income children. Like each state, the District
sets reimbursement rates for its Medicaid providers.
Shortage of Qualified Foster and Adoptive Homes Limits CSFA's Ability to Place
Children
A shortage of qualified foster and adoptive homes is also hindering CFSA's
ability to meet some requirements, such as giving children the most
appropriate foster care placements, placing siblings together, and
ensuring timely adoptions. Several factors are contributing to this
shortage. The demographics of the District are changing and there are
fewer qualified homes, according to CFSA and other officials we
interviewed. They cited an influx of young professionals who are less
likely to serve as foster parents or adopt children from the child welfare
system. Officials also reported that the average size of houses in the
District has decreased over time, with new condominium developments that
have fewer rooms, and these homes will not readily meet accommodation
guidelines, particularly when trying to keep siblings together. They noted
that older houses that are large enough to meet standards may require
significant investment of resources to remove lead paint, which would be a
danger for young children.
In addition, there is a shortage of facilities within the District to care
for children with special medical or mental health needs. The court
monitor's recent progress report notes that in April 2006, CFSA had placed
82 children in residential settings more than 100 miles away from the city
for medical or mental health treatment.9 The court monitor reported that
for 29 children in these facilities, CFSA had no plans to bring the
children back to the District because of the lack of homes and limited
availability of specialized services, including medical and mental health
care services. The court monitor recommended that CFSA explore the
possibility of developing additional resources in the District to serve
children with special needs.
Many children in the District's child welfare system have family members
living in neighboring states willing to take them in, but challenges exist
with placing children across state lines. Because of the District's
proximity to Maryland and Virginia, many of the children in CFSA's care
have relatives in these other states. However, even when children are
placed with relatives, the homes must be licensed for foster care if the
relatives are to be compensated by the District, and CFSA does not have
agreements with Maryland and Virginia that would remove barriers to
licensing homes and placing these children. For example, the state in
which the child would be placed would be required to expend its resources
to oversee the placement and manage the case, including conducting timely
home visits and providing services. Because the District lacks a border
agreement with Maryland and Virginia that would speed placements for
children with family members across state lines, these children may
experience multiple placements while waiting for the necessary paperwork,
including background checks, to be completed. CFSA reported that they have
recently presented new proposals to facilitate interstate placements in
Maryland and Virginia, and is awaiting a response.
9 As of June 2005, CFSA was required to have no more than 35 children
living in foster care more than 100 miles from the District. In June 2006,
the requirement is no more than 25 children.
Recent legislation, signed into law July 3, 2006, and intended to expedite
the placement of children across state lines, may provide some needed
assistance to the District. The Safe and Timely Interstate Placement of
Foster Children Act of 2006 requires both the receiving state and the
requesting state to act within specified time frames (generally 60 days
for the receiving state to conduct a study of the potential adoption or
foster care home and 14 days for the requesting state to determine whether
making a decision relying on the report would be contrary to the welfare
of the child). 10 Also, the act would provide a $1,500 incentive payment
to a state for every interstate study of an adoption and foster care home
completed within 30 days.
10 Pub. L. No. 109-239 (2006).
CFSA Uses Routine Reports and Qualitative Studies to Monitor Its Progress toward
Meeting Court-Ordered Requirements, but Current Data May Not Provide an Accurate
Picture
CFSA is generating a number of daily and monthly reports to show its
progress in meeting court-ordered requirements. In addition, CFSA is using
qualitative information from interviews, focus groups, and surveys of
caseworkers, managers, and families to get a more complete picture of how
the agency is performing and to address ongoing challenges. However, the
data CFSA uses may not accurately portray progress toward meeting
performance requirements, in part because caseworkers do not always enter
information completely and accurately in the case management data system.
CFSA provides training and other support for using the new Web-based
version of the data system and has begun to take steps to address early
implementation issues with the new system.
CFSA Generates Daily and Monthly Reports to Track Progress toward Meeting
Requirements
CFSA generates a number of daily and monthly reports to track cases and
monitor progress toward meeting court-ordered requirements using
information from FACES, the agency's automated child welfare information
system. Daily reports allow managers to review the agency's performance on
cases on a daily basis and contain information such as the number of cases
in the backlog awaiting investigation, as well as the number of children
that caseworkers were able to place and the nature of those placements. In
addition, CFSA produces monthly trend reports as required by the court
monitor to track progress toward meeting court-ordered benchmarks detailed
in the Implementation Plan. CFSA uses data from the monthly trend reports
to develop performance scorecards, which use graphics to provide a
snapshot of the performance of contract agencies and departments within
the agency. Each year, CFSA compiles these reports and other information
into an annual report addressing CFSA's progress and some of the
challenges faced in implementing the court-ordered requirements. As CFSA
develops new data reports, top CFSA managers told us they have begun to
focus less on simply complying with the court-ordered requirements and
more on using the data to develop strategies for program improvement. This
approach is consistent with that of many high-performing organizations,
which, as we have reported, continuously assess performance against
benchmarks and use this information to improve performance.11
11 GAO, Managing for Results: Enhancing Agency Use of Performance
Information for Management Decision Making, GAO-05-927 (Washington, D.C.:
Sept. 9, 2005).
Qualitative Studies Help CFSA Identify and Address Ongoing Challenges
CFSA also collects qualitative data through interviews, focus groups, and
surveys of caseworkers, supervisors, managers, and families that are
designed to provide insight as to why some court-ordered requirements
remain unmet. For example, data show that CFSA has been unable to meet the
requirement that children placed apart from their siblings visit some or
all of their siblings at least two times per month. CFSA examined the
issue further in a sibling placement report that used information from
interviews and focus groups of placement staff and siblings' families to
augment data on the number of children placed with siblings and how many
times they visited each other. The report helped CFSA learn some of the
underlying reasons that such visits may not be taking place-for example,
siblings were not placed in proximity to each other to easily facilitate a
visit. CFSA used the report to create strategies to address these issues,
such as placing children in the same or nearby neighborhoods, and
assigning one caseworker for all siblings whenever possible. In addition,
CFSA issues a Needs Assessment Report every 2 years that uses interviews
with foster parents and CFSA caseworkers to identify and provide
strategies for addressing the most urgent needs of CFSA clients.
Similarly, CFSA conducts Quality Service Reviews (QSR) twice a year, which
involve examining a sample of case files and interviewing as many people
involved in the cases as possible, including parents, children,
caseworkers, teachers, and others. The fall 2005 QSR, which examined 39
cases and included nearly 300 interviews, revealed that overall, the
children in the cases reviewed were safe, healthy, and living in
appropriate placements. However, the QSR report identified a number of
areas in need of improvement, many of which were related to court-ordered
requirements that CFSA has had difficulty meeting. For example, reviewers
found that sibling and parental visits were not consistently documented in
FACES. In response, CFSA developed a number of strategies to address these
areas, such as creating a caseworker peer review system in which
caseworkers review each other's work for overall quality.
Data Used to Report Agency Performance May Not Accurately Portray Actual
Progress Made toward Meeting Court-Ordered Requirements
The data that CFSA uses to monitor its progress in meeting the court's
requirements may not provide an accurate picture of the agency's current
performance. CFSA released a new, Web-based version of FACES in February
2006-FACES.net-to update its older case management system, and there have
been some challenges with the transition. Caseworkers told us that they
had found it frustrating to enter information in the system and that it
could take up to 4 hours to enter the data for a single case. Caseworkers,
as well as supervisors and CFSA's chief information officer, told us that
when the FACES.net system was initially implemented, it would often crash,
resulting in a loss of data or in delays in entering the data. Caseworkers
commented that because of these issues, they often entered less than fully
detailed case data into the system. These implementation issues may have
implications for the accuracy and completeness of data that have been
recorded in the system to date.
In addition to experiencing problems with the implementation of the new
system, caseworkers have not always entered some information into the
correct fields in the database, preventing data from being captured in
CFSA's progress reports. For example, the court monitor's most recent
report indicated that of the 444 children in foster care as of April 2006
with a goal of reunification with their families, more than half did not
have any documented visits with their parents. However, based on the
Quality Service Reviews, CFSA concluded that the visits were occurring,
but the caseworkers were not entering the information into FACES.net. In
addition, CFSA officials told us that some caseworkers have been entering
information into narrative case notes rather than the appropriate discrete
fields in the FACES.net screens. For example, a caseworker may visit a
child in the family's home and then take him or her to visit the doctor.
When entering this information in the database, the caseworker may record
only the family visit in the required screen and write up the medical
visit in the case notes, which cannot be captured in the progress reports.
As a result, reports would not indicate that the medical visit had
occurred.
CFSA is working to resolve issues with inaccurate or incomplete data in
FACES.net, and administrators meet monthly to discuss challenges and
potential resolutions. In addition, the chief information officer told us
there are several training measures in place for caseworkers and contract
agencies to receive assistance and training in recording data and using
the new FACES.net system. For example, CFSA created four teams to assist
caseworkers with recording case data, and to ensure that data are recorded
accurately and used appropriately in reports. The Child Information
Systems Administration also conducts FACES.net workdays for CFSA and
contract agency employees. These are regularly scheduled opportunities for
caseworkers to enter data into the FACES.net system with the assistance of
an information systems employee, who can ensure that caseworkers are
entering data in the correct fields. The Child Information Systems
Administration has also posted tip sheets for using FACES.net and
distributed training manuals to caseworkers.
In addition to training, CFSA is taking additional steps to improve
FACES.net that may help address some of the earlier implementation issues.
CFSA issues system upgrades to address identified problems every 2 to 3
weeks, and is developing a process to fully test these upgrades before
implementing them. In addition, CFSA has identified individuals from each
department within CFSA to act as liaisons between the system users and the
technical staff so that the system can be tested, and problems can be
identified early and quickly resolved. Officials now report that the
volume of help desk calls is below previous levels. Based on this
progress, the court monitor's most recent report anticipates that data
issues related to early system implementation should be resolved soon.
CFSA Has Implemented Several Initiatives to Help Achieve Unmet Requirements, but
It May Be Too Soon to Know if They Will Yield Long-term Results
In the last 2 years CFSA has implemented a number of initiatives to help
address hindrances in meeting court-ordered requirements. CFSA has hired
new staff and reorganized existing staff to focus resources in key areas.
For example, CFSA has hired additional caseworkers to ease caseloads,
reduce backlogs, and improve the timeliness of investigations of child
abuse or neglect. CFSA also has implemented new practices to better serve
children and families, such as holding family team meetings that bring all
parties together to make decisions about a child's care. In addition, CFSA
is beginning to take steps to hold its management staff as well as private
contractors accountable for helping the agency meet specific performance
requirements. Because many of these initiatives have been implemented only
recently, it is too soon to know whether the efforts will yield success
over time. Figure 1 shows the initiatives CFSA implemented or plans to
implement between January 2005 and summer 2007.
Figure 1: Timeline of CFSA's Key Initiatives
CFSA Has Increased Staff and Reorganized to Help Improve Performance in Key
Areas
CFSA has hired additional caseworkers to improve its ability to conduct
investigations in a timely manner. Historically, CFSA has not been able to
conduct prompt investigations because it did not have enough caseworkers
to manage all of its cases. According to a CFSA report, in September 2002
there was a backlog of 807 cases awaiting investigation. As we previously
reported, CFSA began a number of recruitment activities in fiscal year
2003 and has recently focused on recruiting staff to conduct
investigations.12 As of July 2006, CFSA officials reported only 1 vacancy
in the unit that is responsible for conducting investigations, down from
15 in January 2006, and 84 cases in the backlog, down from 318 cases in
January 2006. CFSA officials told us that having fewer cases has allowed
caseworkers to focus more attention on improving the quality of
investigations.
12 GAO, 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 (Washington, D.C.: Sept. 24, 2004).
While these efforts may have a positive impact on the way investigations
are conducted, CFSA still struggles to meet many of its court-ordered
requirements related to investigations. A review of CFSA investigation
case files conducted by the court monitor in June 2005 revealed that
investigations were not meeting quality standards, such as workers
routinely ensuring that families receive the services they need. Another
report in July 2006 showed little progress in this area. Moreover, in this
report the court monitor noted that leadership within the investigation
units has changed frequently as CFSA has tried to implement comprehensive
improvements in this area, and the agency has not been successful in
either fully implementing recommendations made by consultants to improve
operations or in sustaining advancements made.
In addition to hiring new staff, CFSA has reorganized existing staff to
focus resources and attention on key unmet requirements. Caseworkers have
told us that they did not always have support from their supervisors to
help them make decisions, such as those related to obtaining the
appropriate placement for children in their care. To address this, in 2005
CFSA created a centralized unit of employees to make decisions on the
placement of children. These staff members are on call around the clock to
help caseworkers match children with the placements that best meet their
needs. Staff in this unit are knowledgeable about various placement
options, such as placing children across state lines, finding foster care
placements for children needing medical attention, and arranging for
independent living services for older children. In 2006, the new placement
unit recruited six licensed District emergency foster homes with seasoned
foster parents, referred to as Stabilization and Replacement (STAR) homes.
These homes will be available at any time of the day to provide emergency
foster care for children for up to 5 days regardless of age, gender, or
behavioral difficulty. STAR foster parents will provide basic services for
children while caseworkers determine the child's needs, and placement
specialists will match the child with an appropriate, stable placement.
Although CFSA has made some progress in improving the placement process
for children, it is too soon to determine whether these efforts will yield
long-term success. According to the monitor's progress report, as of April
2006, placement issues remain in a crisis mode at CFSA-placements are
still too often based on bed space availability, rather than child need,
and too many children experience multiple placements during their time in
foster care.
CFSA has dedicated a number of caseworkers to specialize in making home
visits to ensure the safety of children living at home with their birth
parents. Previously, caseworkers could be assigned to provide services to
children who remained in-home along with those who were placed outside of
the home, such as with a foster family. However, in May 2006, after a
study found that children placed at home were not being visited frequently
by caseworkers, CFSA created a separate unit of caseworkers to focus on
these children. CFSA officials expect this unit to improve the frequency
and quality of caseworker's visits to children at home, and allow
caseworkers to thoroughly assess family situations, engage parents, and
diligently monitor and influence a family's stability and progress so that
the child can remain safely in the home. Although it is too soon to assess
the impact of this arrangement, the court monitor reported that as of
April 2006, CFSA had not met requirements for making in-home visits, but
the data show an improvement.
CFSA also reorganized the office that assists caseworkers with arranging
medical and mental health services for children and their families. CFSA
hired additional nurses and psychologists in its Office of Clinical
Practice to provide advice and counsel to caseworkers with cases requiring
medical expertise. CFSA officials expect that this will help the agency
meet requirements to provide appropriate physical and psychological
evaluations, since caseworkers are now able to seek professional guidance
on their cases and the services children might need.
CFSA Has Implemented New Practices Designed to Improve Services to Children and
Families
CFSA has implemented several new practices to improve services. It changed
how telephone hotline staff prioritize calls reporting child abuse or
neglect to improve the overall quality and timeliness of investigations
and to help them make appropriate referrals to community agencies. In
February 2006, CFSA implemented a standardized risk assessment tool for
screening hotline calls in order to better focus their resources by
helping caseworkers quickly assess the urgency of the case and whether or
not a referral to a community agency would meet the family's needs. The
tool prompts caseworkers to ask each caller a series of structured
questions to identify the level of risk to the child's safety and the
appropriate intervention based on certain risk factors, such as number of
prior investigations, number of children involved, and whether or not the
parent has a criminal history or a history of drug use. Cases are ranked
based on these factors and designated as either high, moderate, or low
risk. All high-risk cases are to be retained by CFSA and assigned to a
CFSA investigator. For those cases assessed to be of low or moderate risk,
children and their families are to be referred to one of CFSA's community
partners for intervention and support services, including housing and
employment information, parenting workshops, and referrals to other
services. CFSA has not yet met the court-ordered requirement to refer more
families to community agencies, and it is too soon to know whether the
initiative will improve its performance in this area.
CFSA also recently began using family team meetings, which bring together
immediate and extended family members and other support for the family to
discuss the child's needs and strategies for overcoming family problems
and to develop a plan for the child's safety. These meetings are held in
cases where children have been removed or are at risk of being removed
from their homes because of abuse or neglect. According to a June 2005
CFSA report,13 family team meetings may play a role over time in reducing
the number of children who are removed from their homes, placed in
nonfamily foster care, or placed in multiple foster homes. The court
monitor's April 2006 report indicates that CFSA is still not meeting the
requirement to reduce the number of children in foster care who have been
in three or more homes within a 12-month period, but the data show
improvement. However, the court monitor also cautioned that strategies
such as the family team meetings have not always been implemented at the
level of intensity needed to achieve the desired outcomes, saying
relatively few of the cases that might benefit from the approach have
actually used it.
CFSA Is Holding Management, Foster Care Providers, and Contractors Accountable
for Meeting Performance Requirements
CFSA is holding all unit managers and supervisors accountable for helping
caseworkers meet court-ordered requirements. The quality of supervision
has been a long-standing issue for CFSA. As we previously reported, many
CFSA caseworkers told us that supervisors had not fulfilled their
responsibilities to provide the guidance and support needed to help them
better perform their jobs, and agency officials told us that CFSA
supervisors were not held accountable for performing their supervisory
duties.14 To address this issue, CFSA requires supervisors to document in
FACES.net each time they interact with a social worker on a particular
case. In addition, CFSA has contracted with the Child Welfare Institute to
help provide management training for managers and supervisors.
CFSA is also holding external partners, such as foster care providers,
accountable for helping it meet court-ordered requirements. Although it is
the agency's policy not to place children in unlicensed homes, we
previously reported that about 22 percent of foster children in CFSA's
care were residing in unlicensed homes as of May 2004. To address this
issue, CFSA officials reported that they recently reviewed all unlicensed
foster homes to check for their compliance with basic health and safety
standards and are no longer placing children in unlicensed homes. As a
result of this review, CFSA licensed most homes and reduced the number of
unlicensed foster homes to 17, or 5 percent, by July 2006. While the most
recent court monitor's report found that CFSA had not met the requirement
that all foster homes, group homes, and independent living facilities have
a current and valid license, the data showed an improvement.
13 CFSA Quality Assurance Report, CFSA Quality Improvement Administration.
(Washington, D.C.: June 2005)
14 GAO-04-1017 .
CFSA has also begun to take steps to hold private contractors-who manage
the cases of approximately 40 percent of CFSA's children and
families--accountable for their performance. In June 2006, CFSA reported
that contractors managing cases were performing at a lower level than CFSA
caseworkers on certain requirements, such as making frequent in-home
visits. CFSA has taken a number of actions designed to improve the care
provided by contractors. CFSA officials told us that its contract monitors
meet with private agency staff on a monthly basis to review expectations
and resolve issues. And in March 2006, CFSA began to post monthly
scorecards on the Internet for the public to view that detail each
contracted agency's performance on the court-ordered requirements. CFSA
also reported that it sends each month's report directly to the executive
leadership of each contracted agency and secures corrective action plans
from private agencies that are not in compliance with the contract and
other performance requirements.
In addition, after lengthy delays, CFSA will soon begin to hold private
contractors accountable for meeting performance requirements by linking
contractor payments to specific outcomes for children and families through
performance-based contracting. Under the new performance-based contracting
agreements, contractors will be expected to attain specific outcomes for
children and families and will be financially rewarded for meeting the
outcomes and penalized for falling short. Moving toward performance-based
contracting has been difficult, and it has taken several years. While CFSA
began this process in 2003, it now anticipates awarding the first
performance-based contracts by spring 2007, and services under these
contracts are expected to begin by summer 2007.
See table 2 for a summary of CFSA's key unmet performance requirements as
of April 2006 and the initiatives developed to address them.
Table 2: CFSA Initiatives Addressing Key Unmet Court-Ordered Requirements
Key unmet requirements Initiatives to address unmet requirements
Timeliness of investigations o Hire more caseworkers to lower
caseloads
o Improve coordination with police
department and other investigative
stakeholders
o Implement standardized tool for
assessing risk and prioritizing hotline
calls
Quality of investigations o Increase qualification requirements
for hotline staff
o Hold supervisors accountable for
helping caseworkers with challenging
cases
o Use Family Team Meetings to bring
all relevant parties to the table
Comprehensive investigations of o Reduce caseloads to seven
reports of abuse and neglect in investigations per worker in the unit
foster homes and institutions handling institutional cases
o Develop the capacity to initiate
investigations during the weekend hours
as necessary
Appropriate and timely physical o Reorganize Office of Clinical
and psychological evaluations Practice to coordinate resources and
services
o Seek additional health care
providers to provide services
Increased visitations for o Dedicated social worker staff to
children and families focus on visiting children living with
birth parents
Appropriate referrals to o Uses hotline screening tool to refer
community agencies low and moderate-risk cases to
appropriate community agencies
Children are given the most o Create Placement Services
appropriate out-of-home Administration to centralize placement
placements decision making
o Develop new licensing and monitoring
standards for contract providers and
foster parents and expedited the
licensing process for homes located in
D.C.
o Retained short-term emergency foster
homes where families agree to take
children at any time while CFSA
identifies permanent placement
Reduce multiple placements in o Require family team meeting before
foster care moving a child
o Uses mobile crisis support and
stabilization service to help child and
foster family
Timely adoptions o Reconfigure case management teams to
include a permanency specialist early
in the case when children have adoption
as a goal
o Developing new recruitment
strategies to increase their pool of
available adoptive parents
Source: GAO analysis based on reviews of CFSA documents and interviews
with officials.
Conclusions
The District of Columbia's Child and Family Services Agency has had a
troubled history in its efforts to care for the city's abused and
neglected children-one that led the U.S. District court to step in and
take control of the agency. In the 5 years since CFSA left court-ordered
receivership, it has made considerable progress toward meeting the court's
requirements. But it has sometimes lost ground, too, perhaps because its
focus shifted away from sustaining the achievements, toward meeting other
pressing requirements. Current leadership, however, seems to be focused on
addressing the problems head on, with innovative approaches and strategic
use of data to resolve ongoing areas of concern. We are encouraged by the
progress made and the initiatives implemented in the last 2 years. Of
particular note are the efforts to build a collaborative relationship with
the police department and to use performance data to focus on program
improvement, not just on meeting the requirements imposed by the court.
However, continued success will require an unrelenting focus, not just on
requirements that remain unmet, but on sustaining the achievements already
in place. It will also require that efforts now in the pipeline, such as
family team meetings and performance-based contracting, are implemented
swiftly and sufficiently to ensure the maximum results.
There remain two issues of critical concern regarding CFSA's ability to
meet ongoing requirements and to provide needed services. First,
caseworkers may not have the specialized training they need to meet the
complex needs of the children they work with, particularly teenagers and
children with special medical or mental health needs. Without such
training, caseworkers may not have the skills and the tools they need to
make the best possible decisions for those in their care within
established time frames.
Second, adequately serving the children under the agency's care-and
meeting certain court-ordered requirements-necessitates sufficient
medical, dental, and mental health care. However, increasing the number of
providers willing to serve children in the District's child welfare system
will require help. In the absence of new solutions to the health care
problem, CFSA will be unable to achieve the court-mandated requirements.
Worse yet, the children who depend on CFSA's help will be unable to get
the care they need.
Recommendations for Executive Action
To improve CFSA's ability to serve the District's children and to help
meet court-ordered requirements, we recommend that the Mayor of the
District of Columbia:
o direct CFSA to provide caseworkers with specialized training to
help them develop the skills needed to address the complexities of
their caseloads and
o explore options for increasing the pool of providers for mental
health, medical, and dental services.
Agency Comments
We provided a draft of this report to CFSA for its review and comment. In
its comments, CFSA agreed with our findings and recommendations, noting
that the agency has made even greater progress since April 2006, the time
frame used for this report. At the same time, CFSA acknowledged that some
performance gaps remain that must be closed. CFSA also provided technical
comments, which were incorporated as appropriate. A copy of CFSA's formal
response is in appendix II.
As arranged with your offices, unless you publicly announce the contents
of this report earlier, we plan no further distribution of this report
until 30 days from the date of this report. At that time, we will send
copies of this report to the Honorable Anthony A. Williams, Mayor of the
District of Columbia, and other District officials, relevant congressional
committees, and others who are interested. Copies will also be made
available to others upon request. The report is also available at no
charge on GAO's Web site at http://www.gao.gov .
Please contact me at (202) 512-7215 if you or your staff have any
questions about this report. Key contributors to this report are listed in
appendix III.
Cornelia M. Ashby,
Director Education, Workforce, and Income Security Issues
Appendix I: Scope and Methodology
To conduct our review, we focused on court-ordered requirements that
remained unmet as of December 2005. We limited our scope to requirements
related to managing child welfare cases such as initiating and conducting
timely and quality investigations of child abuse and neglect allegations,
providing a range of services to children and their families, and placing
children in appropriate foster or adoptive homes. We did not review
requirements related to administration and management of the agency, nor
did we review requirements that were not tracked using FACES.net.
To assess whether the Child and Family Services (CFSA) is likely to meet
court-ordered requirements by December 2006, we reviewed the court
monitor's July 2006 progress report. To understand the hindrances that may
prevent CFSA from meeting its court-ordered requirements, we conducted
interviews with CFSA managers, supervisors, and caseworkers. To gain an
understanding of staff views on the hindrances in meeting performance
requirements, we conducted separate group interviews with caseworkers and
supervisors randomly selected to represent a cross section of CFSA
divisions and employment tenures. We also interviewed CFSA officials
responsible for recruiting and retaining foster and adoptive parents to
learn about the hindrances that CFSA faces with recruiting an adequate
number of foster and adoptive homes. Finally, we interviewed the
court-appointed monitor and other D.C. child welfare experts to get their
perspectives on what they believe to be CFSA's hindrances to meeting the
performance requirements.
Our sampling strategy for the group interviews included randomly selecting
participants to help ensure that they represented cross sections of the
organization. Attendance on the part of the invited participants was
voluntary. For our four discussion groups, we interviewed supervisors and
caseworkers whose work involved initiating and completing investigations
of child abuse and neglect, placing children through the use of adoptions
or foster care, and monitoring children at home or in out-of-home care
with a goal of returning to their family. The supervisors and caseworkers
from each group were randomly selected and included those who had been at
CFSA for 0-2 years, 2-6 years, and 6 or more 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 learn how CFSA monitors its progress in meeting the court-ordered
requirements, we reviewed CFSA data and reports that CFSA managers use to
assess the agency's performance in meeting its requirements. We also
interviewed (1) CFSA managers to learn about the strategies the agency has
used to help guide its decisions on what data to gather and how to use
these data; (2) CFSA's Chief Information Officer to learn about CFSA's
automated child welfare information system, FACES, and its capacity for
informing CFSA managers on the agency's progress in meeting its
performance requirements; and (3) the court-appointed monitor, the Center
for the Study of Social Policy (CSSP), to gain its perspective on what
CFSA has done and where it might improve in its efforts to develop data
needed to assess its performance.
To gather information on the extent to which CFSA has implemented
initiatives or developed plans to achieve unmet requirements, we reviewed
the court monitor's reports and identified key requirements related to
managing child welfare cases that had not been met as of December 2005. We
reviewed CFSA documents, handbooks, and guidance to document any new or
planned initiatives designed to satisfy unmet requirements. We also
interviewed CFSA managers, the court-appointed monitor, and other D.C.
child welfare experts to determine what initiatives CFSA plans to take or
has taken to meet these requirements.
Appendix II: Comments from D.C. Child and Family Services Agency
Appendix III: GAO Contact and Acknowledgments
GAO Contact
Cornelia M. Ashby; (202) 512-7215 or [email protected]
Acknowledgments
Dianne Blank, Assistant Director
Anjali Tekchandani, Analyst-in-Charge
In addition, the following staff made major contributions to this report:
Vernette Shaw, Jacqueline Harpp, and Lisa McMillen served as team members;
Walter Vance advised on design and methodology issues and conducted group
interviews; Rachael Valliere advised on report preparation; James Rebbe
advised on legal issues; Kevin Kumanga, Lise Levie, and Katharine Leavitt
verified our findings.
Related GAO Products
District of Columbia: Federal Funds for Foster Care Improvements Used to
Implement New Programs, but Challenges Remain. GAO-05-787 . Washington,
D.C.: July 22, 2005.
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 . Washington, D.C.: September 24, 2004.
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.
D.C. Child and Family Services: Key Issues Affecting the Management of Its
Foster Care Cases. GAO-03-758T . Washington, D.C.: May 16, 2003.
District of Columbia: Issues Associated with the Child and Family Services
Agency's Performance and Polices. GAO-03-611T . Washington, D.C.: April 2,
2003.
Foster Care: Recent Legislation Helps States Focus on Finding Permanent
Homes for Children, but Long-Standing Barriers Remain. GAO-02-585 .
Washington, D.C.: June 28, 2002.
District of Columbia Child Welfare: Long-Term Challenges to Ensuring
Children's Well-Being. GAO-01-191 . Washington, D.C.: December 29, 2000.
(130572)
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Highlights of GAO-06-1093 , a report to the Chairman, Committee on
Government Reform, House of Representatives
September 2006
D.C. CHILD AND FAMILY SERVICES AGENCY
Performance Has Improved, but Exploring Health Care Options and Providing
Specialized Training May Further Enhance Performance
The District of Columbia's Child and Family Services Agency (CFSA) has a
history of serious performance problems. A court case in 1989 set in
motion sweeping efforts to improve the District's child welfare system.
Since then, CFSA has worked to meet performance requirements ordered by
the U.S. District Court. However, recent reports by the court monitor show
that CFSA is not meeting performance requirements on many measures. To
update Congress, we assessed (1) whether CFSA is likely to meet
requirements by December 2006; (2) what factors, if any, hinder the agency
from meeting requirements; (3) how CFSA is monitoring its progress; and
(4) the extent to which CFSA has implemented initiatives to achieve unmet
requirements. To conduct this work, we reviewed reports by CFSA and the
court monitor and interviewed stakeholders, including the court monitor
and CFSA managers, supervisors, and caseworkers.
What GAO Recommends
GAO recommends that the Mayor of the District of Columbia (1) direct CFSA
to provide caseworkers with specialized training that addresses caseload
complexities, and (2) explore options for increasing the pool of health
care providers. In its comments, CFSA agreed with our findings and
recommendations, noting that the agency has made more progress since April
2006.
CFSA has made progress, but the agency is not likely to meet all of the
court-ordered requirements by December 2006, based on the recent court
monitor's report and our work. From December 2005 to April 2006, CFSA
improved its performance and met some benchmarks. However, CFSA's
performance on other requirements remains well below benchmarks, raising
questions about the agency's ability to meet all of the court-ordered
requirements by December and sustain the improvements it has made. For
example, only 29 percent of children in foster care received medical
evaluations within 30 days of placement in April 2006, despite a benchmark
of at least 90 percent.
Several factors-complex caseloads and shortages of health care providers
and qualified foster and adoptive homes-hinder CFSA's ability to meet
court-ordered requirements. CFSA's cases are complex, in part because of
the high proportion of hard-to-place teenagers and children with medical
or mental health needs in the District's child welfare system. Caseworkers
reported that they do not have enough specialized training to help them
develop the skills they need to address these caseload complexities.
CFSA's effort to meet court-ordered time frames is complicated in a small
number of cases-those involving severe physical or sexual abuse-by the
difficulty of coordinating with the District's Metropolitan Police
Department. At the same time, CFSA officials told us there is a shortage
of health care providers to serve these children, and the limited number
of qualified foster and adoptive homes hinders CFSA's ability to give
children the most appropriate and timely placements.
CFSA uses routine reports and qualitative studies to determine whether it
is meeting requirements, but current data may not provide an accurate
picture of the agency's progress. Implementing the agency's new Web-based
case management system has been challenging and caseworkers reported that
because of these implementation difficulties, they have not always entered
complete and accurate data on their cases into the system. However, CFSA
has recently taken a number of steps to resolve these issues, including,
for example, issuing frequent system upgrades to address identified
problems and developing enhanced system training for caseworkers.
Within the past few years, CFSA has implemented several initiatives to
address the challenges it faces and achieve remaining requirements, but it
may be too soon to know if they will yield long-term results. CFSA has
hired new staff and reorganized existing staff to focus on key areas. In
addition, CFSA has implemented new practices, such as a tool to prioritize
investigations based on risk. CFSA is also beginning to hold its
management staff and private contractors accountable for helping the
agency meet specific performance requirements. Many of these initiatives
seem reasonable, but it is too soon to tell whether these efforts will
help CFSA meet the remaining court-ordered requirements.
*** End of document. ***