Child Protective Services: Complex Challenges Require New Strategies
(Letter Report, 07/21/97, GAO/HEHS-97-115).
The child protective services system, which investigates reports of
child maltreatment, is plagued by a host of problems, including growing
caseloads, complex social problems underlying child abuse, and
weaknesses in day-to-day operations. Child protective services
operations have been hampered by difficulty in maintaining a skilled
workforce, inconsistency in following key policies and procedures
designed to protect children, the absence of useful case data and
recordkeeping systems, and the lack of good working relationships with
the courts. In response to this crisis, states and localities are
testing new strategies for service delivery. States and localities are
also forming partnerships with families, friends, churches, and
community groups to help keep children safe from maltreatment. For
example, in Missouri, caseworkers team with community partners to
deliver services to families in which the risk of harm to a child is
believed to be low, such as in child neglect. As state and local child
protective services units experiment with new strategies, they will need
more focused support and improved technical assistance from the federal
government.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-97-115
TITLE: Child Protective Services: Complex Challenges Require New
Strategies
DATE: 07/21/97
SUBJECT: Child abuse
Children
Child care programs
Crime prevention
Federal/state relations
Technical assistance
State/local relations
Clearinghouses (information)
Drug abuse
IDENTIFIER: California
Florida
Missouri
New York
Social Services Block Grant
******************************************************************
** This file contains an ASCII representation of the text of a **
** GAO report. Delineations within the text indicating chapter **
** titles, headings, and bullets are preserved. Major **
** divisions and subdivisions of the text, such as Chapters, **
** Sections, and Appendixes, are identified by double and **
** single lines. The numbers on the right end of these lines **
** indicate the position of each of the subsections in the **
** document outline. These numbers do NOT correspond with the **
** page numbers of the printed product. **
** **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced. Tables are included, but **
** may not resemble those in the printed version. **
** **
** Please see the PDF (Portable Document Format) file, when **
** available, for a complete electronic file of the printed **
** document's contents. **
** **
** A printed copy of this report may be obtained from the GAO **
** Document Distribution Center. For further details, please **
** send an e-mail message to: **
** **
** **
** **
** with the message 'info' in the body. **
******************************************************************
Cover
================================================================ COVER
Report to the Honorable
Nydia Velazquez, House of Representatives
July 1997
CHILD PROTECTIVE SERVICES -
COMPLEX CHALLENGES REQUIRE NEW
STRATEGIES
GAO/HEHS-97-115
Child Protective Services
(106711)
Abbreviations
=============================================================== ABBREV
CAPTA - Child Abuse Prevention and Treatment Act
CPS - Child Protective Services
GPO - Government Printing Office
HHS - Department of Health and Human Services
OCAN - Office on Child Abuse and Neglect
SIDS - Sudden Infant Death Syndrome
Letter
=============================================================== LETTER
B-271267
July 21, 1997
The Honorable Nydia Velazquez
House of Representatives
Dear Ms. Velazquez:
Each year, nearly 1 million American children are the victims of
abuse and neglect by their parents or other caregivers. For almost
20 years, the country has seen a steady rise in reports of child
abuse and neglect, including a 14-percent increase, from 1990 to 1994
alone, in the number of children who were the subject of maltreatment
reports.\1 These children--many from homes with multiple problems,
such as parents with serious substance abuse problems--are among our
nation's most vulnerable citizens. Tragically, an estimated 2,000
children die each year from maltreatment.
The responsibility for receiving and investigating reports of child
maltreatment falls primarily on a system of child protective services
(CPS) units within state and local child welfare agencies, which are
responsible for the day-to-day operation of these units. The rising
number of child maltreatment reports, the difficulties presented by
substance-abusing parents, and diminished resources have placed these
units and agencies under increasing stress. The federal government
has an important role in the nation's response to these problems.
Through the Child Abuse Prevention and Treatment Act (CAPTA), enacted
in 1974, and recent amendments, the federal government has
underscored its commitment to provide funding and technical
assistance for CPS to state and local governments, which are striving
to find the most effective ways to protect children.
Because of your concern over the increase in child maltreatment cases
and the barriers CPS units face when protecting children, you asked
us to identify (1) problems confronting CPS units that affect the
system's capacity to protect children from abuse and neglect, (2)
state and local responses to these problems, and (3) opportunities
for the federal government to assist in improving the system's
capacity to respond to the needs of abused and neglected children.
In conducting this work, we reviewed the literature on child
maltreatment and interviewed state and federal officials and other
experts. To obtain first-hand information on CPS practices, we
visited four states--California, Florida, Missouri, and New York--in
different stages of reforming their CPS systems. In addition, we
convened a panel of experts in the areas of child maltreatment and
CPS to examine what role the federal government can play in assisting
states and localities in improving their CPS activities. We
conducted our work between February 1996 and April 1997, in
accordance with generally accepted government auditing standards. A
complete discussion of our scope and methodology appears in appendix
I.
--------------------
\1 The term maltreatment refers to children who are the victims of
child abuse and neglect. Many types of abuse--such as physical,
sexual, or emotional--and neglect--such as educational or
medical--can occur.
RESULTS IN BRIEF
------------------------------------------------------------ Letter :1
The CPS system is in crisis, plagued by difficult problems, such as
growing caseloads, increasingly complex social problems underlying
child maltreatment, and ongoing systemic weaknesses in day-to-day
operations. The states we visited have experienced large increases
in maltreatment reports in recent years, thus increasing the CPS
caseload to an overwhelming level. In addition, states report that
families are entering the system with multiple problems, among the
most common of which is an increase in substance abuse. Experts
consider this increase to be a significant factor in maltreatment,
which has caught all parts of the CPS system unprepared. Moreover,
CPS units have been plagued by long-standing systemic weaknesses in
day-to-day operations, including difficulty in maintaining a skilled
workforce; consistently following key policies and procedures
designed to protect children; developing useful case data and
recordkeeping systems, such as automated case management; and
establishing good working relationships with the courts. Highly
qualified staff who have the necessary resources and support to carry
out the complex tasks involved in protecting children are essential
to ensure that maltreated children find safety in the CPS system.
Therefore, without these critical elements, the effectiveness of CPS
is undermined.
In response to this crisis, states and localities are testing new
strategies for service delivery. Given the increased volume and
severity of the cases, CPS units find that using traditional
approaches, they can no longer handle all reports alleging abuse or
neglect. As a result, states and localities are developing new
strategies, depending on the severity of the maltreatment, to respond
to CPS reports. States and localities are also focusing on forming
partnerships with families, friends, churches, and community
organizations to help keep children safe from maltreatment. These
partnerships enable CPS units to share responsibility for intervening
in various types of maltreatment cases. For example, in Missouri,
CPS caseworkers teamed with community partners to develop and deliver
services to families in which they consider the imminent risk of harm
to the child to be low, such as in child neglect. These new
strategies, however, are not without certain challenges. They
include such challenges as (1) adapting to new caseworker roles,
required by new responsibilities, and (2) the underlying systemic
weaknesses that diminish day-to-day operational effectiveness. For
example, without a highly trained and stable workforce to mobilize
and build trust among the diverse group of partners, realizing reform
goals may be difficult. More importantly, there is little or no
research to assess whether these new strategies effectively solve the
problems of abused and neglected children and their families.
As state and local CPS units experiment with new strategies aimed at
better coping with rising and complex caseloads, units will need more
focused support and improved technical assistance from the federal
government. Previous federal research has concentrated on the causes
of maltreatment and on ways to treat abused and neglected children
and their families, rather than on topics that support the states'
community-based response to the CPS crisis. Similarly, federally
provided technical assistance has also been limited in helping the
states develop new strategies to address this crisis. In addition,
dissemination of federal research findings and practical information
for improving daily CPS operations is lacking. By focusing its
efforts on the new strategies within states, the federal government
could provide states with much needed information on what other CPS
units have tried and the outcomes of these experiments.
BACKGROUND
------------------------------------------------------------ Letter :2
CPS units within local child welfare agencies serve as a community's
first line of defense for children whose families are having
difficulty caring for them or are no longer able to care for them.
CPS units represent the front-end of the child welfare system since
the majority of children receiving child welfare services (such as
foster care) first come to the attention of the system through CPS.
CPS caseworkers investigate reports of child abuse and neglect to
verify the alleged maltreatment, conduct assessments to determine
what services may help stabilize a family and reduce the risk of
further maltreatment, and coordinate the delivery of treatment
services by a variety of public and private providers. These
activities are often conducted under adverse and sometimes dangerous
circumstances. In addition, caseworkers must balance the often
conflicting roles of investigator and social worker. As
investigators, CPS caseworkers collect evidence and work with law
enforcement officials; as social workers, they work with families to
identify services needed to improve conditions in the home and
provide a safe environment for the child.
States generally follow a common set of procedures when investigating
a report that a family is either neglecting or abusing a child under
its care. Most reports of maltreatment are by telephone and are
received by staff trained to collect information concerning the
alleged incident. These staff then assess whether the circumstances
described in the telephone call match the state definition for
maltreatment and whether there is sufficient cause to believe that
the child is in danger of further harm.\2 If the report meets these
conditions, the staff refers the report to the CPS unit for
investigation.\3
--------------------
\2 State definitions of the various types of maltreatment are
generally based on definitions found in CAPTA, which defines abuse
and neglect as "at a minimum, any recent act or failure to act on the
part of a parent or caregiver, which results in death, serious
physical or emotional harm, sexual abuse or exploitation, or an act
or failure to act which presents an imminent risk of serious harm."
\3 Reports that do not meet state definitions for abuse or neglect
and are not referred to local CPS units can be referred to other
state or local information telephone numbers, local law enforcement
agencies, or other state social service agencies.
CPS ACTIVITIES
---------------------------------------------------------- Letter :2.1
Referred reports are generally categorized into two groups. In the
first group, CPS caseworkers are dispatched immediately for children
believed to be in imminent risk of harm. In the second group,
investigations are usually initiated within 24 to 72 hours, depending
on state statute. Caseworkers usually check if the child's family
has had a prior validated report of abuse or neglect. Caseworkers
then visit and interview the family, including initiating
face-to-face contact with the child, and begin collecting information
about the alleged maltreatment incident. This information includes
physical evidence, such as the results of a physical examination of
the child showing any marks or bruises, and statements from family
members and other individuals who may have information relevant to
the case. Law enforcement officials may be asked to accompany a
caseworker on this visit if the caseworker believes the child may
need to be immediately removed from the home or that the situation
may become dangerous or violent. Finally, caseworkers determine the
report's validity and record and summarize the information. These
determinations are based on the agency's criteria for an acceptable
level of risk to the child and caseworkers' training, prior
experience, and judgment. Since a faulty evaluation can endanger a
child's life, CPS protocols usually recommend specialized training
for caseworkers and regular and close supervisory review of these
difficult decisions.
If a CPS caseworker, during the initial investigation, believes that
a child has been maltreated and needs the court to protect the
child's safety, the caseworker must initiate judicial oversight of
the case, which can be time-consuming and complicated. The
caseworker begins by filing a petition with the court, detailing the
alleged maltreatment and how it meets the legal definition in that
state. Then, depending on the course of the CPS investigation and
state requirements, a series of court hearings may follow. First,
the court decides whether the risk to the child is great enough to
warrant removing the child from the home on a temporary basis. Next,
the court decides whether the alleged maltreatment occurred. This
determination is made based on evidence gathered by the caseworker
during the investigation, which usually must be completed within 30
days. Finally, the court decides who will have control over the
child and what steps must be taken by the family and the child
welfare agency to improve the family situation. The court can allow
the child to remain in, or return to, the home or place the child
with a foster family, in a group home, or with a relative.
While the caseworker is following the procedures involved in
investigating the alleged maltreatment, he or she is also developing
a tentative plan to address those conditions in the home that CPS
believes contributed to the maltreatment of the child. This plan
ultimately becomes the case plan that outlines treatment services for
the child and the family. The plan describes what actions are
required of all the parties involved to correct the conditions that
caused the maltreatment and, in some cases, the placement outside the
home, as well as the time frames for accomplishing them. In
addition, the plan must address a child's health and education needs,
including arrangements for any specialized treatment by health care
providers. The causes of child abuse and neglect are complex, and a
case plan can involve referrals to an array of individuals, including
caseworkers from other units in the child welfare agency, such as
adoption or foster care specialists; private service providers, such
as mental health and counseling professionals on contract with CPS to
provide treatment services; other public agencies that can assist
with nonhealth services, such as housing; and organizations providing
transportation or other support services. Maintaining the services
outlined in the case plan is key to avoiding further exacerbation of
the family's problems and a return to the crisis mode that often
precipitated the initial report.
FEDERAL INVOLVEMENT IN CPS
ACTIVITIES
---------------------------------------------------------- Letter :2.2
Federal activities directed specifically at child maltreatment
prevention and treatment began in 1974, with the passage of CAPTA.
This legislation and subsequent amendments have influenced CPS in
important areas. For example, CAPTA provides (1) federal guidelines
for states to use in their definitions of child abuse and neglect and
(2) for states to have in effect laws for the reporting of suspected
maltreatment.
The CPS activities of investigating and verifying suspected
maltreatment are almost entirely funded by state governments;
however, the federal government provides some funding for support
activities, such as research and technical assistance. CAPTA
authorizes and funds three key entities that support state CPS units:
(1) the Office on Child Abuse and Neglect (OCAN), within the
Department of Health and Human Services (HHS), which oversees federal
research on child abuse and neglect, demonstration projects, and
other activities; (2) The National Resource Center on Child
Maltreatment, under a contract with HHS, which provides technical
assistance to states on child welfare issues; and (3) The National
Clearinghouse on Child Abuse and Neglect, also under an HHS contract,
which gathers and disseminates information on child maltreatment. In
addition, CAPTA charges HHS with providing state and local agencies
with support and technical assistance, as well as ensuring that CPS
activities are executed and coordinated among all agencies involved
with CPS-related activities. For fiscal year 1996, CAPTA provided
over $50 million for federal research and demonstration grants,
program grants, and training and technical assistance. Other sources
of federal funding provide states with (1) support while a child is
in foster care or (2) the ability to make services available to help
prevent the removal of a child from the home.\4
--------------------
\4 The Social Security Act, Title IV-B, subpart 1 (Child Welfare
Services), provides funds for support services, to prevent abuse and
neglect, and for foster care services, to reunite families, arrange
adoptions, and ensure adequate foster care placements; Title IV-B,
subpart 2 (Family Preservation and Support), provides funds to
support families and prevent the need for foster care; Title IV-E
provides funds for food and shelter for children in foster care; and
Title XX (Social Services Block Grant) provides funds for support
services to families at risk of child abuse and neglect.
CPS SYSTEM PLAGUED BY DIFFICULT
PROBLEMS
------------------------------------------------------------ Letter :3
Increases in the number of maltreatment cases, the changing nature of
family problems, and long-standing systemic weaknesses have placed
the CPS system in a state of crisis and undermined its ability to
fully carry out the responsibilities for abused and neglected
children. First, child maltreatment reports have risen steadily
across the country. The caseloads of CPS units have grown
correspondingly, and CPS units often cannot keep pace with this
workload.\5 Second, these caseloads are increasingly composed of
families whose problems have grown more troubling and complicated,
with substance abuse a common and pervasive condition. Finally,
systemic weaknesses--such as difficulty maintaining a professional
and skilled workforce, inconsistently implementing policies and
procedures, a lack of automated case management in recordkeeping
systems, and poor working relationships between CPS and the
courts--have further weakened CPS units. The combined effect of
difficult caseloads and systemic weaknesses (1) overburdens
caseworkers and dilutes the quality of their response to families and
(2) may further endanger the lives of children coming to the
attention of CPS.
--------------------
\5 The Continuing Child Protection Emergency: A Challenge to the
Nation, U.S. Advisory Board on Child Abuse and Neglect, U.S.
Department of Health and Human Services, Administration for Children
and Families (Washington, D.C.: U.S. Government Printing Office
[GPO], Apr. 1993).
CPS CASELOADS ARE GROWING
---------------------------------------------------------- Letter :3.1
In 1990, the U.S Advisory Board on Child Abuse and Neglect concluded
that child abuse and neglect was a national emergency.\6 According to
the study, reports of child maltreatment steadily increased over the
years, from about 60,000 cases reported in 1974 to 1.1 million in
1980. Reports then doubled to about 2.4 million during the 1980s.
More recently, HHS reported that between 1990 and 1994, the number of
children that were the subject of reports of abuse and neglect rose
approximately 14 percent, to over 2.9 million.\7 Although reasons for
the high number of reports are complex, research indicates that the
number has risen, in part, due to (1) increased child maltreatment by
drug-dependent caretakers, as a result of the cocaine epidemic during
the 1980s, (2) the mandate for certain groups of professionals to
report suspected maltreatment, and (3) the stresses of poverty among
families. Since HHS began collecting data in 1990, neglect has been
the predominant type of maltreatment. For example, in 1995,
approximately 52 percent of the maltreated children were neglected,
while approximately 25 percent were physically abused. Sexually
abused children accounted for about 13 percent. HHS recently
reported that for the first time, a leveling off--in both the annual
number of reports nationwide and the annual number of confirmed
cases--is occurring. However, some state and local officials told us
they are concerned about the effect welfare reform will have on the
number of CPS reports.
The U.S. Advisory Board on Child Abuse and Neglect reported in 1995
that state and local CPS caseworkers are often overextended and
cannot adequately function under their current caseloads. As a
result, breakdowns occur in their ability to protect children. The
report also stated that in many jurisdictions, caseloads are so high
that CPS response is limited to taking the complaint call, making a
single visit to the home, and deciding whether or not the complaint
is valid, often without any subsequent monitoring of the family.
Of the four states we visited, three--Missouri, California, and New
York--also experienced a rise in maltreatment reports, which is
consistent with the national trend. In Missouri, child abuse and
neglect reports have increased over 18 percent since 1991. In
California, the total number of reports received by county CPS units
have increased approximately 25 percent since 1988. In New York,
reports to the state's child abuse and neglect central register have
increased almost 330 percent since 1974. Only in 1990 and 1994 did
the state see a slight drop in reports.
Likewise, all four sites we visited indicated that increased
caseloads affect the amount of time and resources that can be
invested in individual cases, which can result in insufficient
services for families and children. For example, in Florida, CPS
staff in the counties we visited stated that high caseloads delay
their initial response to new cases, hinder the quality of the work
they perform, and limit the ability of supervisors to review cases.
Service providers who work with CPS staff also noted that caseworkers
are unable to sufficiently monitor families and that they respond
only to crises. Similarly, a 1996 report\8
on Sacramento County, California--where calls to the CPS hotline have
tripled from 1980 to 1993, to over 3,000 calls per month--stated that
(1) the demand for CPS exceeds current capacity, (2) caseloads exceed
recommended levels,\9 and (3) caseworkers' decisions are strongly
influenced by the pressure to limit the number of active cases. High
caseloads require caseworkers either to accept greater levels of risk
to the child while with the family or to decide to remove the child
inappropriately, county staff said. In addition, county service
providers indicated that high caseloads can result in procedural
failures, such as an inadequate review of prior case history or
incomplete documentation of casework conducted.
--------------------
\6 Child Abuse and Neglect: Critical First Steps in Response to a
National Emergency, U.S. Advisory Board on Child Abuse and Neglect,
U.S. Department of Health and Human Services (Washington, D.C.:
GPO, Aug. 1990).
\7 Child Maltreatment 1994: Reports from the States to the National
Center on Child Abuse and Neglect, U.S. Department of Health and
Human Services, National Center on Child Abuse and Neglect
(Washington, D.C.: GPO, 1996). Data in this report are collected by
the National Child Abuse and Neglect Data System, a voluntary
reporting system, funded by HHS. Differing state CPS policies,
programs, designs of information systems, and resources influence the
capacity of states to provide child abuse and neglect data to the
system and, thus, affect the collection and interpretation of data at
the national level.
\8 Critical Case Investigation Committee Final Report, Office of the
County Executive, County of Sacramento (May 1996).
\9 The Child Welfare League of America, a professional organization
for child welfare officials, has developed guidelines for optimal
caseload size.
SUBSTANCE ABUSE IN FAMILIES
BECOMING COMMON
---------------------------------------------------------- Letter :3.2
CPS caseworkers must increasingly deal with families that suffer from
multiple problems, including substance abuse. The escalating cocaine
epidemic during the 1980s exacerbated the already challenging work of
CPS caseworkers. According to OCAN, the number of women who abuse
drugs has increased, resulting in a growing number of infants who are
exposed to illegal substances before birth. In addition,
intoxication is a precipitating factor for every kind of abuse; many
children experience neglect as a result of their parents' physical or
psychological absence while seeking alcohol and other harmful drugs
or being under the influence. The recognition of this link between
child maltreatment and substance abuse was identified in 1990 in the
first report of the U.S. Advisory Board on Child Abuse and
Neglect.\10 The board reported that the vast increase in child
maltreatment associated with substance abuse and the extent of the
problem caught CPS units unprepared. On the basis of a national
survey, HHS reported that the number of CPS cases involving substance
abuse can range from 20 to 90 percent, depending on the area of the
country. As a result, CPS units must not only develop more effective
ways to work with parents who use drugs, but must also address the
problems of substance-exposed infants and increasing concerns for
caseworker safety in the field.
Officials in the states we visited echoed the findings of research
and identified substance abuse of caregivers as one of the most
difficult problems CPS units address when responding to child abuse
and neglect cases. In New York City, for example, approximately
three-quarters of the confirmed cases involve drug addiction of at
least one caregiver. According to the Manhattan Field Office staff,
a majority of cases involve substance-abusing parents, many of whom
live in drug-infested and poor neighborhoods, intensifying family
problems. CPS caseworkers visiting these families do so at
considerable risk to their own safety. In Sacramento County, where
substance abuse affects an estimated 75 to 80 percent of the CPS
cases, a county official identified poverty and substance abuse as
the two biggest problems the CPS unit faces. Moreover, the presence
of these problems can delay case progress and limit clients' ability
to change their lives, the official noted. According to St. Louis
City and County supervisors, developing service plans for
drug-abusing mothers poses one of their greatest challenges.
Although substance abuse has increased among CPS cases, many
communities lack treatment services. Across the country, the demand
for drug treatment slots exceeds the supply. According to state and
local officials in the sites we visited, clients cannot obtain needed
services because of the shortage of appropriate treatment programs
and the waiting lists for many programs in their communities. In
addition, the more commonly available services are short-term rather
than long-term, and are less likely to have a lasting effect,
according to a 1993 HHS study of high-risk child abuse and neglect
groups. Finally, even when substance abusers do receive treatment,
the relapse rate is high. Both the lack of treatment services and
the likelihood of relapse may necessitate more involvement by CPS.
--------------------
\10 Child Abuse and Neglect: Critical First Steps in Response to a
National Emergency, p. 55.
SYSTEMIC WEAKNESSES
HAMPERING CPS EFFECTIVENESS
---------------------------------------------------------- Letter :3.3
Long-standing systemic weaknesses within CPS units further hamper
their capacity to protect children. These weaknesses have plagued
CPS units for a number of years, and we observed these problems to
varying degrees across all four sites we visited. These problems
include (1) difficulty maintaining a professional and skilled
workforce, (2) inconsistently implementing policies and procedures,
(3) a lack of case data and automated case management, and (4) poor
working relationships between CPS and the courts. Taken together,
these weaknesses can undermine the effectiveness of CPS's response to
child maltreatment. In particular, without a quality staff who have
the necessary resources and support to carry out the complex tasks
involved in protecting children, the CPS system will continue to lag
behind in dealing with the growing problem of child abuse and
neglect.
SKILLED WORKFORCE
DIFFICULT TO MAINTAIN
-------------------------------------------------------- Letter :3.3.1
Hiring, training, and retaining a skilled workforce is essential to
maintaining a professional and competent staff; however, CPS units
were often unable to attract and retain qualified staff and to
provide relevant training. CPS staff in sites we visited reported
that some new hires were not qualified for their positions, either
due to inadequate hiring policies or low entry-level salaries. For
example, in New York City, until recently, new hires were required to
have only a college degree, rather than a degree in social work or a
related field. In Sacramento County, some staff were hired without
the qualities needed to fulfill their job responsibilities, resulting
in poor performance, according to county staff. In addition,
training programs were often inadequate in terms of content and
frequency. In Missouri, for example, funding has limited the amount
of inservice training the state can provide, and some staff report
that training manuals are out-of-date and that trainers are not
up-to-date on the environment in which caseworkers operate today. In
New York City, experienced staff reported that new caseworkers did
not need to obtain passing grades in their entry-level training
classes. New York City, however, began taking steps to reform its
CPS system in 1996. Hiring and training requirements have been
improved, and the city is developing a system for providing all
personnel with needed inservice training.
Finally, in all the sites we visited, retaining an experienced
workforce was often cited as a problem. In Florida, Missouri, and
New York, low salaries contributed to staff leaving for better paying
positions. Likewise, in Florida, a 1995 panel appointed by the
governor found that Florida's salaries were too low to attract and
retain qualified CPS caseworkers. These conditions affect
caseworkers' ability to consistently serve clients and result in a
lack of experience among supervisory staff.
POLICIES INCONSISTENTLY
IMPLEMENTED
-------------------------------------------------------- Letter :3.3.2
In CPS, where staff are sometimes dealing with life-and-death issues,
the knowledge of and consistent application of appropriate policies
and procedures are critical. CPS policies and procedures--such as
those that define acceptable levels of risk to the child and those
that outline the time frames, methods, and protocols for sharing
information with local service providers, as well as documentation
requirements for collecting evidence during the investigation--are
important safeguards for children. These policies and procedures
provide structure in the stressful environment in which caseworkers
function and reduce the probability of making serious mistakes.
Clear policies and procedures can also provide important guidance
when staff receive inadequate or inconsistent supervision.
In some of the sites we visited, however, CPS staff were unable to
consistently apply existing policies. For example, a 1995 state
review of New York City's CPS operations found numerous problems in
implementing policies, such as inadequate safety assessments for all
children within the home in over 20 percent of the cases, inadequate
investigations in over 50 percent of the cases, excessive time frames
for conducting investigations in 50 percent of the cases, and missing
service plans in 18 percent of open cases for which abuse was
validated. Moreover, the review identified a lack of supervisory
involvement in determining the validity of alleged maltreatment in 21
percent of the cases. Bronx and Manhattan Field Office managers,
supervisors, and caseworkers reported that they lack knowledge on
policies and procedures, in part, because policies change frequently,
no procedures manual exists, and information is inconsistently
distributed to all staff. In addition, a 1996 report on Sacramento
County operations identified a need for clearer procedures and found
that consultation with supervisors appears to take place on an
informal, ad hoc basis. The report also stated that written policies
and procedures are not always consistent with verbal communications
and directions to staff.
LACK OF AUTOMATED CASE
MANAGEMENT LEADS TO
INEFFICIENCIES
-------------------------------------------------------- Letter :3.3.3
Lack of automated case management in recordkeeping systems can result
in inefficiencies, such as reliance on burdensome paper files and
lost or inaccessible client files. Although some CPS data are
automated for state and federal reporting purposes, these data are
not useful in the day-to-day management of cases, according to staff
we met with in Florida's District 12 and in Sacramento County. As a
result, CPS workers in all four sites we visited still work primarily
in a paper environment. They and their supervisors generally do not
have access to automated information systems for individual case
planning and monitoring, and must rely on paper files to conduct
their day-to-day activities. For example, New York City caseworkers
and supervisors relied on hand-written case information on 5"-by-8"
cards for the current status of cases and their history. Retrieving
case records from agency archives or transferring the files from one
field office to another can take weeks and files can become lost,
according to New York City caseworkers. Agencywide computerization,
which is being partially funded through federal grants, was not fully
operational at the time of our visits. In developing these systems,
CPS units will have the opportunity to add automated features that
could assist CPS staff in managing workload, identifying available
resources, and preparing and tracking court documents. If properly
implemented, these systems could provide caseworkers with essential
information for intervening in maltreatment situations, as well as
reduce paperwork and manual recordkeeping.
WORKING RELATIONSHIP WITH
COURTS POOR
-------------------------------------------------------- Letter :3.3.4
By necessity, CPS units should work efficiently and effectively with
the courts to protect children. However, the court system, like CPS,
also faces problems associated with the large volume of increasingly
complex cases. For example, according to the American Bar
Association, overcrowded dockets, inefficient case scheduling,
unprepared or overburdened attorneys, and frequent rotation of judges
who may or may not have expertise in child welfare law all contribute
to significant delays in making decisions about children. Linked, in
part, to these problems, all sites we visited noted poor working
relationships between CPS staff and the courts. CPS staff reported a
lack of respect for the caseworkers' experience, insufficient
preparation time with attorneys assigned to help them, and minimal
assistance in preparing court records in a professional manner. In
some cases, staff resorted to turning in court documents in
handwritten form. Because the courts do not schedule specific court
times for individual cases, a caseworker must often spend many hours
waiting for his or her case to be called on the day it appears on the
docket. Unnecessary time spent in court diverts the caseworker from
performing investigative activities on other open cases. Federally
funded initiatives, designed to address these problems, are just
beginning; thus far, they have focused on states' self-assessment of
problems.
STATES AND LOCALITIES FOCUS ON
NEW STRATEGIES TO COPE WITH
RISING AND COMPLEX CASELOADS
------------------------------------------------------------ Letter :4
Different types of maltreatment require dramatically different
prevention and treatment strategies. Each of the four states we
visited has been moving towards new strategies--in different stages
of development--in its CPS system. Missouri and Florida, for
example, have been developing responses to match the severity of
various types of maltreatment; they have been forming partnerships
between CPS and community service providers. These early
partnerships have been generally characterized by sharing physical
space with community agencies and including these organizations in
case planning.
Experts, state agency officials, and caseworkers believe that these
new strategies show promise, but their ultimate success will depend,
in part, on the CPS staff's ability to overcome certain challenges,
such as developing a willingness within the community to become more
active in protecting children from maltreatment and to adapt to new
roles and responsibilities. In addition, states reported that
regardless of reforms in place, systemic problems continue to affect
day-to-day operations and the quality of assistance provided to
families; these problems may threaten the success of any new
strategies.
STATES EXPERIMENT WITH NEW
SERVICE DELIVERY MODELS
---------------------------------------------------------- Letter :4.1
In two of the states we visited, Missouri and Florida, state child
welfare agencies have implemented new service delivery models. These
agencies and local CPS units have turned to the broader community of
churches, schools, mental health providers, and others to expand
their reach. By developing partnerships with these community groups,
CPS units are able to quickly increase the number of people available
to serve children and their families, without increasing CPS staffing
levels. The models in these two states are also based on the premise
that all CPS cases do not require the same traditional approach.
Instead, the models incorporate a flexible response, whereby CPS
cases can be grouped according to the nature of the allegation,
recognizing that different types of allegations require different
responses. For example, the level of investigation needed to clearly
establish facts and gather evidence in a sexual abuse case may be
unnecessary for a report of educational neglect.\11
In 1994, Missouri developed a new strategy to handle the overwhelming
number of reports coming into its CPS system. Missouri recognized
that state government, acting alone, had neither the resources nor
the local community, neighborhood, or family base to effectively
alter the cycle of abuse and neglect. In response, Missouri began a
demonstration initiative designed to divide incoming reports into two
categories. Cases in the first category, called investigations,
require law enforcement be contacted; these cases focus on reports of
serious physical or emotional abuse and all reports of sexual abuse.
CPS caseworkers conduct investigations jointly with law enforcement
officials and then refer the cases to other caseworkers, as
necessary, for foster care or services to preserve the family. All
other cases, such as reports of neglect and mild physical abuse,\12
are in the second category and handled differently, without a
traditional protective investigation. For these cases, for which the
risk of imminent harm is less, a caseworker conducts a thorough
assessment, called a family assessment, according to state
guidelines. The caseworker determines the degree of risk to the
child's safety and the family's need for assistance from the CPS unit
or the community. Family assessment staff are expected to
collaborate with their community partners.
Parts of St. Louis City and St. Louis County, Missouri, are
participating in this demonstration. In cases screened using the
family assessment model, caseworkers make the initial visit and then
work with the family, generally providing services for up to 90 days.
The majority of the incoming reports are placed in this category, and
family assessment caseworkers work closely with their community
partners. For example, some caseworkers are located with their
partners in a community education center, which provides on-site
services and linkages to a variety of community supports, such as
family counseling, housing assistance, and drug abuse prevention
programs. This arrangement allows for better communication and
collaboration among the caseworkers and service providers. At the
time of our review, Missouri was also considering developing a
process in which community partners could conduct family assessments
themselves, although the CPS units would still be ultimately
responsible and approve the final assessment. Evaluation of the
impact of Missouri's flexible response strategy is required by the
Missouri State Legislature, and a final report is due in January
1998.
Like Missouri, Florida has been reworking its approach to child
protection. In 1992, Florida's legislature and governor mandated
that the State Department of Health and Rehabilitative Services
develop a strategic plan to more clearly delineate how Florida would
protect its children. The resulting plan addressed a fundamental
lack of community involvement in CPS operations. For example,
historically, Florida's human services programs, such as CPS, were
designed and administered at the state level and thus were removed
from local community problems. Under the new plan, Florida
decentralized the management of CPS from the state to the district
level.
To further strengthen the link between child welfare services and
local communities, the governor signed legislation in 1993, directing
local child welfare officials to jointly develop a CPS program with
community agencies. Under this program, similar to Missouri's
strategy, incoming child abuse and neglect reports are separated into
two categories: (1) for the more serious cases, such as sexual abuse
and severe physical abuse, caseworkers use the traditional approach,
an investigation by CPS and law enforcement, and (2) for the
remaining cases, rather than using the traditional approach,
caseworkers assess the child's safety, as well as family strengths
and resources that could help to reduce risk.
Florida's District 12, where we focused our review, developed a
community-based strategy to enhance its handling of sexual and
serious physical abuse cases. The resulting Child Advocacy Center is
a collaborative effort between a not-for-profit agency that provides
treatment for child victims of abuse, CPS, law enforcement, the Young
Women's Christian Association, and the state attorney. The center's
goal is to provide a warm, nonthreatening environment for joint CPS
and law enforcement investigations, case reviews, medical
examinations and evaluation, mental health treatment, victim advocate
support services, training, and community education. Since all team
members are generally located together, the lag time between case
initiation and service provision is decreased.
--------------------
\11 Educational neglect includes permitting chronic truancy, failing
to enroll a child of mandatory school age, and not attending to a
special educational need.
\12 Child neglect is characterized by failure to provide for a
child's basic needs and can be physical, educational, or emotional.
Research has shown that neglect tends to be chronic and long-term,
and can result in long-term developmental consequences. Research
also shows that intervention does not always result in improvements
or fewer subsequent reports to CPS.
OTHER STATES MAKE EARLY
EFFORTS AT NEW MODELS
---------------------------------------------------------- Letter :4.2
Sacramento County, California, and New York City are making early
efforts to reorganize the delivery of CPS services. In both cases,
state and local officials have recognized the critical role
communities will play in the future effectiveness of CPS. At the
time of our visit, however, these sites had not fully developed their
new strategy to implement reforms. Sacramento County is beginning by
using a team approach. Team members include clinical experts from
CPS and other county departments--such as mental health, alcohol and
other drug treatment, and public health--as well as representatives
from the community and the state's Department of Social Services.
The goals of the team are to (1) protect children, by bringing
together county functions--such as mental health treatment, alcohol
and other drug treatment, public health services, and public
assistance--to provide a unified approach to planning interventions
and (2) ensure the community is involved in improving the county's
CPS system.
To overcome its history of ineffective approaches to protecting
children, New York City is undergoing major structural reforms,
designed to streamline and clarify its processes to ensure that all
efforts are directed to the safety and well-being of children. As
part of this reform, the city recently acknowledged that it must
galvanize its residents, neighborhoods, churches, and community-based
organizations to become partners in the drive to make certain that
every child is safe. One of New York City's first planned actions is
consistent with reforms observed in the other states we visited. New
York City plans to (1) realign the boundaries of its CPS offices to
coincide with community-district boundaries and (2) assign managers
and caseworkers to specific communities. This realignment will allow
staff to have greater access to individuals and institutions that are
familiar to the child and family, as well as to local services.
CHILD FATALITY PANELS HELP
BUILD COMMUNITY PARTNERSHIPS
---------------------------------------------------------- Letter :4.3
State and local officials are using the tragic circumstances of child
deaths to mobilize community resources. These officials realize the
value of reviewing the circumstances surrounding the death of a child
to determine not only whether the death was the result of abuse, but
also what can be learned to further improve how CPS cases are handled
and families are served. In all sites, either state or local
officials have established child fatality review teams, generally
composed of physicians, law enforcement officials, social workers,
and other child welfare experts; each member of the team brings his
or her own expertise and skills to each review. These child fatality
review teams are often the first step in recognizing the value of
building relationships between community partners.
In Missouri, representatives on county-based panels include the
prosecuting attorney or circuit attorney, the coroner or medical
examiner, law enforcement personnel, child welfare staff, public
health care service providers, juvenile court staff, and emergency
medical services staff. Conclusions drawn from fatality reviews are
used for targeting prevention strategies, identifying specific
community needs, and developing trend information, as well as
improving the services provided by each team member's discipline.
The multidisciplinary nature of the panels increases the likelihood
that the correct cause of death is identified. In St. Louis County,
for example, panel members reported that some deaths are initially
classified as Sudden Infant Death Syndrome (SIDS). However, when
these cases are reviewed by the fatality panel, information shared by
individual members may lead the panel to conclude that the death was
caused by abuse rather than SIDS.
Two fatality panels, also composed of team members from various
disciplines, operate in New York City. A few members are common to
both panels. One panel reviews deaths in cases known to the CPS
units, examining case practice and policies and making
recommendations when necessary. This panel is operated by the child
welfare agency and is composed of representatives from other local
government agencies, as well as external health and social work
experts. The other panel is independently operated by the Office of
the Chief Medical Examiner of New York City and has a broader
mission. This panel investigates all child deaths in New York City
that meet the panel's critieria to, among other things, (1) identify
broader social issues of child abuse and neglect, as well as public
health concerns relating to the safety of children, and (2) devise
policies and procedures that will decrease the likelihood of a
child's death. In addition, the state of New York reviews cases
involving the death of a child if the child was in the custody of an
authorized agency or if the child's death was reported to the state
central register.
NEW STRATEGIES SHOW PROMISE
BUT MANY CHALLENGES REMAIN
---------------------------------------------------------- Letter :4.4
While new strategies hold the promise of helping CPS units better
respond to increases in child abuse and neglect, with responsibility
for intervention shared with the community, little research has been
done to determine whether these new strategies result in improvements
in families and children or a reduction in the number of subsequent
referrals. A December 1996 evaluation of the Florida program, for
example, found improvements in service delivery, but noted some
differences based on a district's level of implementation of the new
strategies. For example, the study found that in those districts
that had more fully implemented the new strategy, early decisions to
place children were more consistent with later decisions on the
safest option for the child. On other measures of success, all
districts improved. These measures included the extent to which
caseworkers were able to resolve family issues without involving the
court.
However, this evaluation also confirms what officials during our site
visits said: Creating successful community partnerships is
difficult, and many challenges exist that can hinder progress. Some
of these challenges reflect the long-standing problems that CPS units
recognize as barriers to their overall effectiveness; others stem
from the new strategies being tested. One of the long-standing
problems CPS units will continue to struggle with is finding
appropriate treatment slots for substance-abusing parents. In
addition, states we visited have found that forging new community
partnerships represents a significant change in operations for both
CPS caseworkers and their new allies. These caseworkers
traditionally have operated independently and represent agencies with
their own sets of policies and priorities. The evaluation found that
some districts were successful in establishing partnerships across
both policy and practice levels; others had difficulty in clearly
delineating their relationships and roles with local partners.
Representatives of community organizations in St. Louis report that
these partnerships can be slow to form, as funding, teambuilding,
issues of developing trust among members, and agreement on sharing
information about children and families are gradually worked out.
St. Louis County staff reported that one community claimed child
abuse and neglect did not exist among its families and was reluctant
to become involved with the pilot program. In addition, some
community groups initially came to meetings seeking funding for
services they provide. Over time, however, their involvement has
reflected an increased level of commitment.
The Florida evaluation found that employees' attitudes and ownership
of the new philosophy, as well as the level of support received from
supervisors and administrators, affect the success of the program.
The transition can be difficult for CPS caseworkers since most
caseworkers were previously traditional CPS investigators. They must
adapt to their new roles, learning how to conduct family assessments.
Such new roles represent a fundamental change, requiring a new
perspective and a new set of skills. In addition, caseworkers must
sometimes manage their existing caseloads while transitioning to the
new method of delivering services. Caseworkers in St. Louis City
and St. Louis County, for example, report that they are responsible
for managing their ongoing cases using the traditional approach,
while at the same time managing new cases using the new strategy, the
family assessment model.
While new strategies to serve families may help CPS units reduce the
burden of addressing child abuse and neglect, these strategies should
not be expected to resolve the underlying systemic problems many CPS
units face. These problems remain and may jeopardize the future
success of these promising strategies. For example, regardless of
the new strategies taken to handle abuse and neglect reports, state
officials recognize that without skilled and trained caseworkers,
these strategies could flounder. In addition, these officials
reported that keeping new and existing staff abreast of changing
procedures and policies is difficult, given that training resources
are already stretched to capacity. In Florida, staff reported that
inconsistencies in practice still occur because of inadequate
supervision. A recent Florida Governor's Panel on Child Protection
Issues found that high staff turnover, unmanageable caseloads, poorly
trained staff, and inconsistent procedures continue to plague the CPS
system. Poorly trained staff or inconsistent policy implementation
can undermine the credibility of CPS caseworkers among their
community partners and hamper cooperation.
CHANGED FEDERAL RESPONSE WOULD
BETTER ASSIST THE STATES
------------------------------------------------------------ Letter :5
The new strategies of states and localities call for a new
partnership between state child welfare agencies and the federal
government. Although the federal government has played an important
role over the last two decades, opportunities exist to enhance and
refocus its assistance to states and localities. Important
legislation, such as CAPTA, generated federal mandates that are
responsible for many of the reforms of the past 20 years, including
mandatory reporting systems for child abuse and neglect, as well as
judicial review of decisions to remove children from their homes.
This legislation has enhanced state and local CPS systems. But HHS's
research agenda has not focused on new strategies of direct service
to families, and HHS's provision of technical assistance to CPS units
has been limited.
FEDERAL RESEARCH AGENDA TOO
BROAD
---------------------------------------------------------- Letter :5.1
Members of our expert panel believe the federal research agenda is
too broad and is not developed in conjunction with the needs of the
states. For example, they believe that the major research questions
that are relevant to CPS units today are inadequately addressed
because the total amount of funds authorized for research is low and
is spread among too many other projects. Such research can result in
findings that may apply only to limited locations and may not be
generalizable to the larger CPS community. CAPTA outlines topics for
research, such as the causes of maltreatment and its prevention and
the national incidence of child abuse and neglect. CAPTA also
recognizes emerging collaborative CPS and community partnerships as a
relevant field of inquiry. However, the final research agenda is
left in large part to the discretion of HHS, although legislation and
input from other organizations are considered. In our analysis, we
found that approximately two-thirds of the research and demonstration
grants, funded by HHS between fiscal year 1992 and the first quarter
of fiscal year 1997, focused on the various causes and effects of
sexual abuse, maltreatment prevention strategies, and the
relationship between substance abuse and maltreatment. The remainder
cover a broad spectrum of projects, ranging from funding a national
data archive to using children as witnesses in court cases. While
developing a research agenda is difficult in the face of limited
resources and competing needs, HHS has not funded projects that
reflect the emerging direction of CPS units, such as how to build
collaborative relationships with multiple community and local
government partners or the advantages, for some CPS cases, of using
family assessments over a traditional approach. An HHS research
official acknowledged that HHS has given many researchers a small
part of the available funding, thus attempting to keep a number of
researchers interested in the child abuse and neglect area and to
attract new researchers to the field.
DISSEMINATION OF RESEARCH
RESULTS CRITICAL
---------------------------------------------------------- Letter :5.2
Disseminating the results of research on child abuse and neglect to
practitioners in the field is critical. The National Clearinghouse
for Child Abuse and Neglect is charged with maintaining and
disseminating information on programs that show promise of success in
preventing, identifying, and treating child abuse and neglect.
However, members of our expert panel and state officials reported
that dissemination efforts are often not timely or do not meet state
needs. Although state officials were aware that the clearinghouse
disseminated information on maltreatment, they were unable to see a
connection between their work in developing new strategies in their
local communities and the information being offered. HHS agrees that
dissemination of information has been a problem, and an HHS official
attributes this situation to a lack of publishing and distribution
funds, as well as the lack, sometimes, of a requirement for the
researcher to produce a final report. Researchers funded under
CAPTA, however, must submit reports that include implications for
policy and practice.
TECHNICAL ASSISTANCE COULD
BE EXPANDED
---------------------------------------------------------- Letter :5.3
The federal government provides technical assistance to states,
through means such as The National Resource Center on Child
Maltreatment and HHS regional offices.\13 HHS defines the workplan
for the Resource Center, which includes developing a training and
technical assistance plan for each of HHS's regions, conducting
on-site training or technical assistance activities, sponsoring
symposia on relevant topics and, in cooperation with the
clearinghouse, compiling CPS assessment tools. However, center
documents state that the small amount of funding for each year
severely limits the amount of services that can be provided to each
state. For example, the center estimates that each state would be
entitled to only $17,000 of services, including administrative costs,
conference costs, and tribes and territories costs.
HHS regional offices also play a role in providing technical
assistance to the states. Under ordinary circumstances, these
offices do not work with county or local agencies. They are, rather,
charged with overseeing the programmatic and financial management of
child welfare programs, including ensuring compliance with applicable
laws and regulations and issuing grant awards. These offices are
also charged with assisting in the management of cross-cutting
initiatives and activities among the regions. Since regional office
personnel can have regular contact with local programs, these offices
are uniquely positioned to monitor the progress of various strategies
and share their insights with other state and local officials. These
offices, however, have not played a leadership role in providing
assistance to states on topics that are relevant to the changing
strategies in the states. Such topics include knowledge of the
reform efforts of other states and whether these programs have
achieved positive outcomes in child welfare. Because this type of
information is not readily available, states report that they
independently call other states for information when attempting to
design new programs.
Getting comprehensive information to CPS units on different state
initiatives, as well as on ways states are addressing systemic
problems, could greatly assist the child welfare community in areas
that are integral to developing new CPS strategies. CPS units could
benefit from information on such issues as the appropriate levels of
risk and child safety, ways to build and sustain community
partnerships, and appropriate outcomes by which to measure these
reform programs. The regional offices vary in how proactively they
assist their states, according to experts, HHS officials, and state
officials. HHS agrees that some regions perform better than others
and that they tend to act independently in developing ways of
interacting with their assigned states. But these offices, HHS
believes, provide considerable technical assistance to states. One
HHS official stated, however, that becoming more proactive in CPS
reform could be difficult for some regional offices. Existing
communication technologies offer enhanced opportunities to be more
proactive and widely share this information with a variety of
audiences. HHS told us it is beginning to take advantage of its
ability to communicate electronically.
--------------------
\13 HHS has 10 regional offices across the country that represent
HHS--to state, county, city or town, and tribal governments, as well
as to grantees and public and private local organizations--in the
administration of programs that assist vulnerable and dependent
children and families.
CONCLUSIONS
------------------------------------------------------------ Letter :6
Public agencies responsible for protecting children have faced
increased reports of child abuse and neglect, as well as a disturbing
increase in the number of families with severe and multiple problems.
The high incidence of substance abuse found in these families places
CPS caseworkers on the front line of one of our nation's biggest
social problems. While the commitment of these workers to protect
abused children is strong, the obstacles facing CPS units are
daunting. A decade of calls for reform by national advisory boards
and commissions has produced few improvements in many of the
fundamental problems found in CPS units.
The burden to improve the ways CPS units respond to children at risk
of abuse and neglect falls on state and local governments. However,
the responsibility for the safety and well-being of a community's
children cannot rest solely on an overwhelmed CPS system. CPS units
have recognized that the traditional approaches to child protection
cannot keep pace with the demand for services. CPS units are now
reaching out to communities to establish partnerships among service
agencies, attempting to share the responsibility for the safety of a
neighborhood's children among a community's service providers, as
well as its citizens, and increasing the attention given to support
services. However, state child welfare officials responsible for CPS
operations must not lose sight of the potential effect that
long-standing systemic problems may have on these reform efforts.
These officials must seek ways to correct deficiencies and to build
and maintain the personnel and information systems that will support
the new strategies. Without addressing these problems, reform goals
may not be fully realized. In addition, state officials must be
cautious about implementing new strategies for handling maltreatment
reports, given the limited information available on their
effectiveness.
A new era of federal partnership is needed to help CPS units respond
to the rising rates of child maltreatment. While the federal
government has funded research efforts on abuse and neglect, HHS
needs to better support the emerging needs of state and local CPS
units. Local governments can ill afford to independently develop,
test, and implement new strategies to protect our nation's children.
New federal strategies are needed to provide focused assistance to
CPS units and to evaluate and disseminate information about local
efforts. Without federal assistance, states and localities will
continue to find their own solutions to combat the problems of abuse
and neglect, not benefitting from the collective experience of the
entire nation.
RECOMMENDATIONS
------------------------------------------------------------ Letter :7
We recommend that the Secretary for Health and Human Services
-- use the current research agenda, allowed under CAPTA, to
facilitate better targeting of future funding for those areas
that support local efforts to explore collaborative partnerships
with other community agencies;
-- develop new cost-effective strategies to disseminate and deliver
the results of these local efforts and other related work
through the National Clearinghouse and the National Resource
Center; and
-- develop specific techniques, such as regional seminars, white
papers, and on-site technical assistance, to promote
community-based approaches to CPS.
AGENCY COMMENTS AND OUR
EVALUATION
------------------------------------------------------------ Letter :8
In commenting on a draft of this report, HHS noted that the CPS
system operates in the broader context of child welfare services and
is thus integrally related to other federal programs beyond those
authorized by CAPTA. HHS further stated that strategies taken from
these programs, such as a demonstration of the use of
multidisciplinary teams to provide intensive services to families
whose children might otherwise have to be placed or remain in foster
care, directly influence and benefit CPS. We agree that these
programs, whose primary purposes do not emphasize CPS, can also
assist states and localities find ways to become partners with
community and other governmental groups to help children. In our
work, however, we focus on the initial stages of report intake and
investigation, for abuse and neglect cases, and the associated
problems. We did not review community services available to prevent
or treat victims of child abuse and neglect.
HHS also commented that we did not address the issue of conflicting
confidentiality provisions among agencies that handle and treat
families that are brought to CPS's attention. HHS noted that these
conflicting policies, for example, can prohibit local CPS agencies
from obtaining information on a client's participation in substance
abuse treatment programs. We recognize the importance of developing
confidentiality policies that help, rather than hinder, social worker
access to important client information that may affect decisions
concerning a child's safety; we discussed this topic with state and
local CPS personnel, as well as with CPS experts. While they agreed
that confidentiality barriers exist, we focused on the systemic
issues that surfaced as the most pressing. In addition, social work
practices can be developed to help alleviate the magnitude of the
confidentiality problem, some experts said. For example, if a client
is not willing to sign a waiver to allow information on treatment to
be obtained, the client's participation in the drug program may not
be considered in CPS decisions affecting the child's safety.
As to our recommendation that the Secretary use the current research
agenda to better target funding for topics that support local efforts
to explore collaborative partnerships, HHS acknowledged the
importance of developing these partnerships and making system
improvements. HHS stated that current CAPTA legislation places
emphasis on CPS system functions and that HHS demonstration
priorities address the development of community networks and CPS
operations. At the time of this report, however, HHS had not
published its final research priorities. HHS concurred with our
remaining two recommendations and noted several strategies it is
implementing to enhance dissemination and communication and to expand
technical assistance.
HHS also made a number of technical comments, which we have
incorporated where appropriate. A copy of all HHS's comments, both
general and technical, is included in appendix II.
---------------------------------------------------------- Letter :8.1
We are sending copies of this report to the Secretary of Health and
Human Services, state child welfare agencies, and other interested
parties. Copies will also be made available to others on request.
If you or your staff have any questions about this report, please
call me at (202) 512-7215. Other major contributors to this report
are listed in appendix III.
Sincerely yours,
Jane L. Ross
Director, Income Security Issues
SCOPE AND METHODOLOGY
=========================================================== Appendix I
We reviewed the relevant literature on child maltreatment, as well as
national and state statistical data on child maltreatment, and
analyzed various reports and evaluations that examined CPS policies,
programs, and activities. In addition, we interviewed various
experts in the area of child maltreatment and CPS, representatives
from professional associations, and state and local officials. We
also interviewed officials at HHS's Administration for Children and
Families, including officials from the Childrens' Bureau and the
Office on Child Abuse and Neglect (OCAN).
We conducted field visits in New York City's boroughs of the Bronx
and Manhattan; Sacramento County, California; Florida's District 12
(Volusia and Flagler Counties); and the City and County of St.
Louis, Missouri. In addition, we visited the state child welfare
offices in each state capital. These sites were selected, in part,
to review states in different stages of changing their traditional
approaches to CPS. The CPS unit in New York City is making early
efforts at organizational change. The CPS unit in Sacramento County,
California, is making early efforts to reexamine its processes and
its links to the community. The CPS units in New York and California
were also selected because the two states represent a significant
portion of the population of children under 18 years old and the
population in the child welfare system. Florida and Missouri were
identified by experts as examples of states in which CPS units were
furthest along in efforts to change from traditional approaches to
new strategies based on community and family services. The CPS unit
in Florida's District 12 was selected to illustrate efforts to
improve the investigation and validation of abuse cases by
integrating CPS, medical, judicial, and law enforcement professionals
under a community-based nonprofit organization. The CPS unit in
Missouri had implemented a pilot program to test new ways of
responding to reports of abuse and neglect in five areas of the
state.
At each site, we interviewed officials responsible in the areas of
CPS policy, program activities, training and professional
development, quality assurance, budget, and information management.
In addition, we collected relevant evaluations, reports, and analyses
of CPS policies, operations, and practices. To develop a complete
understanding of CPS units' operations and the barriers that exist,
we interviewed groups of managers, supervisors, and caseworkers at
each site. We also interviewed private organizations that provide
child protection and child welfare services to these units. Lastly,
we interviewed local officials from community child advocacy groups
and child fatality review panels.
Finally, we convened a panel of six experts for a 1-day discussion to
solicit their perspectives on what role(s) the federal government can
play in assisting states and localities in improving their CPS
activities. The panelists were asked to identify areas in which the
federal government can provide leadership and strategies or specific
activities that can support state efforts to manage CPS systems.
This expert panel was held on December 3, 1996, and included Diana
English, Office Chief, Office of Children's Administration Research,
Department of Social and Health Services, Washington; Mark Hardin,
Director, Foster Care and Family Preservation, Center on Children and
the Law, American Bar Association, Washington, D.C.; Robert
Lindecamp, State Liaison Officer, Division of Family Services,
Department of Services for Children, Youth and Their Families,
Delaware; Robert McKeagney, Director, National Center for Excellence
in Child Welfare, Child Welfare League of America, Washington, D.C.;
Susan Notkin, Director, Program for Children, The Edna McConnell
Clark Foundation, New York, New York; and Michael Weber, Associate
Director, National Committee to Prevent Child Abuse, Chicago,
Illinois.
We conducted our work between February 1996 and April 1997, in
accordance with generally accepted government auditing standards.
(See figure in printed edition.)Appendix II
COMMENTS FROM THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES
=========================================================== Appendix I
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
(See figure in printed edition.)
GAO CONTACTS AND STAFF
ACKNOWLEDGMENTS
========================================================= Appendix III
GAO CONTACTS
Kay E. Brown, Assistant Director, (202) 512-3674
Diana M. Pietrowiak, Evaluator-in-Charge, (202) 512-6239
STAFF ACKNOWLEDGMENTS
In addition to those named above, David D. Bellis and John Vocino
contributed significantly to the writing of the report and all
data-gathering and analysis efforts.
RELATED GAO PRODUCTS
Child Welfare: Complex Needs Strain Capacity to Provide Services
(GAO/HEHS-95-208, Sept. 26, 1995).
Child Welfare: Opportunities to Further Enhance Family Preservation
and Support Activities (GAO/HEHS-95-112, June 15, 1995).
Foster Care: Health Needs of Many Young Children Unknown and Unmet
(GAO/HEHS-95-114, May 26, 1995).
Foster Care: Parental Drug Abuse Has Alarming Impact on Young
Children (GAO/HEHS-94-89, Apr. 4, 1994).
Residential Care: Some High-Risk Youth Benefit, but More Study
Needed (GAO/HEHS-94-56, Jan. 28, 1994).
Foster Care: Services to Prevent Out-of-Home Placements Are Limited
by Funding Barriers (GAO/HRD-93-76, June 29, 1993).
Foster Care: State Agencies Other Than Child Welfare Can Access
Title IV-E Funds (GAO/HRD-93-6, Feb. 9, 1993).
Child Abuse: Prevention Programs Need Greater Emphasis
(GAO/HRD-92-99, Aug. 3, 1992).
Child Abuse and Neglect: Progress of the National Center Since May
1991 (GAO/T-HRD-92-14, Mar. 6, 1992).
Child Abuse and Neglect: NCCAN's Implementation of CAPTA of 1988
(GAO/T-HRD-91-29, May 9, 1991).
Child Abuse Prevention: Status of the Challenge Grant Program
(GAO/HRD-91-95, May 9, 1991).
Foster Care: Children's Experiences Linked to Various Factors;
Better Data Needed (GAO/HRD-91-64, Sept. 11, 1991).
Child Welfare: Monitoring Out-of-State Placements (GAO/HRD-91-107BR,
Sept. 3, 1991).
*** End of document. ***