# Presentation: 853485

## Results of the 2001 & 2002 Child and Family Service Reviews

- Children’s Bureau
- Administration for Children and Families
- Department of Health & Human Services

## The 17 States Reviewed in FY 2001

- Arizona
- Arkansas
- Delaware
- District of Columbia
- Florida
- Georgia
- Indiana
- Kansas
- Massachusetts

- Minnesota
- New Mexico
- New York
- North Carolina
- North Dakota
- Oregon
- South Dakota
- Vermont

**Notes:**
These are the 17 States that ACF reviewed in Federal fiscal year 2001.

## The 15 States Reviewed in FY 2002

- Alabama
- Alaska
- California
- Colorado
- Connecticut
- Michigan
- Montana
- Nebraska

- Ohio
- Oklahoma
- Pennsylvania
- Tennessee
- Texas
- West Virginia
- Wyoming

**Notes:**
These are the 15 States that ACF reviewed in Federal fiscal year 2002.

## Scope of Child and Family Service Reviews

-    7 outcomes in the areas of safety, permanency, and child and family well being

- 7 systemic factors

**Notes:**
The reviews address 7 outcomes and 7 systemic factors.

## Determining Substantial Conformity

- Outcomes
- Case Record reviews and data indicators
- 90% of cases substantially achieved
- Meet national standards on data indicators

- Systemic Factors
- Stakeholder interviews and statewide assessment
- State plan requirements in place
- State plan requirements function as required

**Notes:**
These are the sources of information and the criteria that ACF uses to determine if the outcomes and systemic factors are in substantial conformity.

## Changes in Rating Criteria from 2001 to 2002

- Foster Care Re-Entries:  Changed definition to correspond to data indicator
- Recurrence of Maltreatment:  Changed definition to correspond to data indicator
- Achieving Reunification, Guardianship, or Permanent Relative Placement:  Added an indicator to onsite review of cases
- Independent Living:  Incorporated into other items

**Notes:**
Following the 2001 reviews, ACF made the changes noted above to the onsite review indicators that make comparison of findings across 2001 and 2002 impossible in some areas.  The changes are:
A change in the onsite review definitions of recurrence of maltreatment and foster care re-entries to correspond more closely to the definition of the statewide data indicators for recurrence of maltreatment and foster care re-entries.
The addition of a specific item to evaluate the timely achievement of reunification, guardianship, or permanent relative placement.  This replaced the independent living indicator which was previously treated as an outcome, rather than as a set of services.

## Number of Cases Reviewed

- Total number of cases =  1584

**Notes:**
For the two years, ACF has reviewed a total of 1584 cases, including 936 foster care cases, and 648 in-home services cases.  

## Percentage of African-American & White Children in  the 2002 Cases 

-    African-American children were more likely to be in foster care than served in their own homes, when compared to white children.

**Notes:**
Children of color in the 2002 cases were more likely to be in foster care than in the in-home services cases.  Of the 198 African-American children in the 2002 sample, 38% were in the in-home cases, and 62% were in the foster care cases.
Of the 298 White children in the 2002 sample, 47% were in in-home cases and 53% were in foster care cases.   
Of the additional cases reviewed in the 2002 sample, data on race/ethnicity were missing for 66 cases, 75 were classified as “two or more races,” and 6 were Asian/Pacific Islanders.

## Over-Representation of Children of Color in the 2002 Foster Care Cases

**Notes:**
Of the four largest race/ethnic groups represented in the 2002 cases (White, African American, Hispanic and Native American), African American, Hispanic, and Native American (including Alaska Native) children are all over-represented in the foster care cases, compared to in-home cases.  
The breakdowns are as follows:
Of the White children in the 2002 cases:  47% were in the in-home cases, and 53% were in foster care cases.
Of the African-American children in the 2002 cases:  38% were in in-home cases, and 62% were in foster care cases.
Of the Hispanic children in the 2002 cases:  36% were in in-home cases and 64% were in foster care cases.
Of the Native American children in the 2002 cases:  31% were in in-home cases and 69% were in foster care cases. 

## Relationship between Race/Ethnicity and Adoption Ratings - 2002 reviews

- Ratings for adoption (item 9) were not significantly associated with race/ethnicity of children
- 50% of cases with Native American children were rated “strength” for adoption, compared to 39% of all other cases
- 36% of cases with White children were rated “strength” for adoption, compared to 41% of all other cases

**Notes:**
This information relates to the 2002 reviews only and applies to a total of 681 cases reviewed.

Information on race/ethnicity data was not collected in one State (50 cases).  Among States in which race/ethnicity data were collected, a total of 16 cases had missing data.  

## Relationship between Race/Ethnicity and Preserving Connections Ratings

- Ratings for preserving connections (item 14) were not significantly associated with race/ethnicity of children.
- Preserving connections was rated “strength” for 68% of Native American children, compared to 80% of all other children
- 81% of cases with white children were rated “strength” for this item, compared to 78% of all other children

**Notes:**
This information relates to 2002 reviews and applies to 681 cases reviewed.

Information on race/ethnicity was not collected in one State (50 cases).  Among States in which race/ethnicity data were collected, a total of 16 cases had missing data.

Item 14 on the onsite review instrument, “preserving connections”, examines the way in which children’s primary connections and characteristics are preserved in the foster care placement.  These include connections such as relationships with extended family members, previous foster families, schools, communities, tribes/tribal customs, and religion/religious observances.  For Native American children, this item also examines timely notification to the tribe and placement with the child’s extended family or tribe.     

## Number of States in Substantial Conformity on the 7 Outcomes

**Notes:**
This chart shows the number of States that met the criteria for substantial conformity on each of the seven outcomes.  Seven States achieved substantial conformity on Well Being Outcome 2 (providing educational services)  Five States each achieved substantial conformity on Safety Outcome 1 and Permanency Outcome 2.  None of the 32  States achieved substantial conformity on Permanency Outcome 1 and Well Being Outcome 1.  One State achieved substantial conformity on Well Being Outcome 3.

## Safety Outcomes

- 1.  Children are, first and foremost,
-      protected from abuse and neglect
- 2.  Children are safely maintained in their own homes whenever possible and appropriate

**Notes:**
These are the two safety outcomes covered in the review.

## Case Ratings for the Two Safety Outcomes

-    Cases were rated stronger in achieving Safety Outcome 1 (86% of 1447 cases) than Safety Outcome 2 (80% of 1403 cases)

**Notes:**
Among all cases reviewed in the 32 States, 86% of the cases were in substantial conformity on Safety Outcome 1 and 80% were in substantial conformity on Safety Outcome 2. 

## Ratings on Safety Outcome 2 for In-Home and Foster Care Cases

-    Safety outcome 2 was substantially achieved for only 71% of children receiving services in their own homes, compared to 85% of children in foster care.

**Notes:**
Safety outcome 2 examines the services that States provide to protect children in their own homes where it is appropriate to do so, and the effectiveness of services in reducing the risk of harm for children in foster care and at home.  Among the cases reviewed in 2001 and 2002, the outcome was substantially achieved in 85% of the foster care cases, and in 71% of the in-home services cases. 
Note: One reason for the difference in ratings is that the “risk of harm” ratings that are included in this outcome were almost always rated as strengths for children in foster care.  Also, where children in foster care entered care prior to the period under review, reviewers could not evaluate the services that were provided to protect them in their own homes.

## Risk of Harm Ratings for In-Home and Foster Care Cases

-    The risk of harm was managed effectively for 74% of children receiving services in their own homes, vs. 87% of children in foster care

**Notes:**
For all cases reviewed in the 32 States, reviewers determined the risk of harm to be managed effectively for 74% of cases of children receiving services in their own homes, compared to 87% of the children in the foster care cases.

## Common Concerns in “Risk of Harm” Ratings in 2002 States

-     Common reasons why “risk of harm” was rated “area needing improvement” include:
- The services provided to the family were not always sufficient to reduce the risk of harm        (10 States)
- The agency did not consistently monitor families to assess participation in services and associated changes in risk  (10 States)

**Notes:**
These are the two most commonly noted reasons by reviewers for rating the indicator, risk of harm, as an area needing improvement, and the number of States in which these reasons were present.  

## Compliance with National Standards for Safety

-    13 of 32 States met the repeat maltreatment standard
-    17 of 32 States  met  the maltreatment in foster care standard

**Notes:**
Among the 32 States, thirteen met the national standard for the recurrence of maltreatment, and seventeen met the national standard for maltreatment of children in foster care.
The national standards for these two indicators are as follows:
6.1% or fewer of all children who were victims of a substantiated or indicated report of maltreatment had a subsequent substantiated or indicated report of maltreatment within a six-month period
0.57% or fewer children in foster care were the victims of substantiated or indicated maltreatment where the foster caregivers were the perpetrators

## Permanency Outcomes

- 1.  Children have permanency and
-      stability in their living arrangements
- 2.  The continuity of family relationships and connections is preserved for
-      children

**Notes:**
These are the two permanency outcomes covered in the review.  These two outcomes apply only to children who are in foster care.

## Permanency Goals for Children in 2002 Cases

- Reunification - 39.1%
- Adoption - 28.0 %
- LTFC/Emancipation - 20.1%
- Guardianship - 7.1%
- Perm.Place.W/ Relatives - 5.2%
- Other/Not Specified - .5%

**Notes:**
This chart represents the permanency goals for the 422 foster care cases reviewed in 2002. 

## Common concerns in 2002 States regarding permanency goals

- The goal of LTFC is often established without thorough consideration of adoption or guardianship (11 States)
- Appropriate concurrent planning efforts were not being implemented on a consistent basis (11 States)

**Notes:**
These are the most commonly noted concerns by reviewers with regard to establishing the appropriate permanency goal for children in foster care, and the number of States in which these concerns were present.

## Common permanency concerns - continued

- The goal of reunification was maintained for too long before reconsidering/reviewing the goal (10 States)
- Agency did not routinely file for TPR in a timely manner and reasons for not filing were often not documented in the case files (6 States)

**Notes:**
(continuation of previous slide)

## Case Ratings for Permanency Outcomes 1 & 2

-   Cases were rated much higher in achieving Permanency Outcome 2 (79%) than Permanency Outcome 1 (63%)

**Notes:**
Of all foster care cases reviewed in the 32 States, reviewers determined that Permanency Outcome 1 was substantially achieved in 63% of the cases, and that permanency Outcome 2 was substantially achieved in 79% of the cases. Permanency Outcome 1 measures the timely and appropriate achievement of the child’s permanency goal, while permanency outcome 2 measures the preservation of the important connections of children in foster care.

## Strength Ratings for Permanency Outcome 1 Indicators

**Notes:**
The indicators displayed here are used to evaluate Permanency Outcome 1 in the onsite review, and are as follows:
Re-entries into foster care: For the cases reviewed in 2002 only, this indicator was determined to be a strength by reviewers in 85% of the cases. 
Stability of foster care placements:  For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 78% of the cases.
Permanency goal for the child:  For cases reviewed in both 2001 and 2002, reviewers determined that the agency had established the appropriate permanency goal in a timely manner in 67% of the cases.
Timeliness of achieving reunification, guardianship, or permanent relative placement: For cases reviewed in 2002 only, reviewers determined that the indicator was a strength in 71% of the cases.
Timeliness of achieving adoption: For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 57% of the cases.  Among the cases reviewed in 2002 only, reviewers determined the indicator to be a strength in 40% of the cases.
Permanency goal of other permanent planned living arrangement (OPPLA):  For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 70% of the cases.

## 2002 CasesOf all indicators in the 2002 cases, adoption was the least likely indicator to be rated a strength 

**Notes:**
The chart above shows the percentage of cases reviewed in 2002 in which each indicator was determined by reviewers to be a strength in the case.  The numbered indicators on the category axis of the chart correspond to the numbered indicators on the onsite review instrument.  Among the 24 indicators, achieving adoption for children with a permanency goal of adoption within 24 months of the child’s entry into foster care (Item 9) was the indicator least likely to be rated as a strength among the 2002 cases.  Reviewers determined that adoption had either been achieved for the child within 24 months of the child’s entry into foster care, or that the necessary efforts to achieve adoption within that time frame had been made, in 41% of the 121 applicable cases.

## Additional Adoption Information 

-     Number of States with
-     adoption as a strength
-     2001 - 4 States
-     2002 - 1 States
-                               Number of States
-                               meeting adoption
-                               national standard
-                               2001-  5 States
-                               2002 - 4 States

-     Percentage of cases with adoption as a strength
-     2001 - 68 %
-     2002 - 41 %

**Notes:**
Additional information on the adoption indicator includes the following: 
Among the 17 States reviewed in 2001, reviewers determined the adoption indicator to be a strength in four States and determined that the adoption indicator was a strength in 68% of all applicable cases reviewed.  Five of the States reviewed in 2001 met the national standard for the adoption data indicator.
Among the 15 States reviewed in 2002, reviewers determined the adoption indicator to be a strength in one State and determined that the adoption indicator was a strength in 41% of all applicable cases reviewed.  Four of the States reviewed in 2001 met the national standard for the adoption data indicator.

## Common Concerns Regarding Adoption Delays in 2002 States

- Agencies did not consistently conduct home studies or complete adoption-related paperwork in a timely manner  (9 States)
- Lengthy appeals of TPR (9 States)
- Agencies and/or courts were reluctant to establish a goal of adoption or seek TPR unless an adoptive family had been identified  (6 States)

**Notes:**
These are the most commonly noted concerns by reviewers with regard to achieving the goal of adoption for children in foster care with a permanency goal of adoption, and the number of States in which these concerns were present.

## Strength Ratings for Permanency Outcome 2 Indicators

**Notes:**
These indicators are used to evaluate Permanency Outcome 2 in the onsite review, and are as follows:
Placing children in foster care placements in close proximity to their parents: For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 96% of the cases.
Placing children in foster care with their siblings: For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 87% of the cases.
Visiting between children in foster care and their parents: For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 78% of the cases.
Preserving children’s connections while in foster care: For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 84% of the cases.
Placing children with relatives: This indicator also includes the appropriate identification and evaluation of relatives as prospective placements for children entering foster care, even if the agency determines that an alternate placement is more appropriate. For cases reviewed in both 2001 and 2002, reviewers determined the indicator to be a strength in 84% of the cases. For cases reviewed in 2001 only, reviewers determined the indicator to be a strength in 92% of the cases.  However, for cases reviewed in 2002 only, when the onsite review instrument was modified to address maternal and paternal relatives separately, reviewers determined the indicator to be a strength in 74% of the cases. 
Maintaining the relationship of the child in care with parents: For cases reviewed in both 2001 and 2002, reviewers determined this indicator to be a strength in 80% of the cases.

## States Conforming to National Standards for Permanency

**Notes:**
These are the four data indicators with national standards used to evaluate Permanency Outcome 1:
Foster care re-entries:  Of the 32 States, sixteen met the following national standard: of all children who entered care during the year under review, 6.1% or fewer re-entered foster care within 12 months of a prior foster care episode.
Stability of foster care placement: Of the 32 States, nine met the following national standard: of all children who have been in foster care less than 12 months from the time of the latest removal, 86.7% or more had no more than two placement settings. 
Length of time to achieve adoption goal: Of the 32 States, nine met the following standard: of all children who exited foster care during the year under review to a finalized adoption, 32% or more exited care in less than 24 months from the time of the latest removal from home.
Length of time to achieve reunification:  Of the 32 States, eleven met the following standard: of all children who were reunified with their parents or caretakers at the time of discharge from foster care, 76.2% or more were reunified in less than 12 months from the time of the latest removal from home.

## Well Being Outcomes 

- 1.  Families have enhanced capacity to provide for their children’s needs
- 2.  Children receive appropriate services to meet their educational needs
- 3.  Children receive adequate services to meet their physical and mental health needs

**Notes:**
These are the three Child and Family Well Being Outcomes evaluated in the review.

## Percentage of Well Being Outcomes Rated Substantially Achieved

-    Cases were rated stronger in  WB Outcome 2 (83%) than in WB Outcome 1 (62%) or WB Outcome 3 (71%)

**Notes:**
For all cases reviewed in both 2001 and 2002, reviewers determined that Well Being Outcome 1 was substantially achieved for 62% of the cases, that Well Being Outcome 2 was substantially achieved for 83% of the cases, and that Well Being Outcome 3 was substantially achieved for 71% of the cases.

## Strength Ratings for Well Being Outcome 1 Indicators for 2001 & 2002 by Cases

**Notes:**
These four indicators used to evaluate Child and Family Well Being Outcome 1, and are as follows:
Assessment of needs and provision of services to the child, parents, and foster parents:  Among all the cases reviewed in 2001 and 2002, reviewers determined that the the agency had performed comprehensive needs assessments  and provided the needed and appropriate services in 66% of the cases.
Involvement of parents and child in case planning activities: Among all the cases reviewed in 2001 and 2002, reviewers determined that the agency had actively involved the parents and age-appropriate children in case planning activities in 66% of the cases.
Caseworker visits with children: Among all the cases reviewed in 2001 and 2002, reviewers determined that caseworkers had visited the child(ren) in the cases in accordance with the child(ren)’s needs for visits, or at least monthly, in 75% of the cases.
Caseworker visits with parents: Among all the cases reviewed in 2001 and 2002, reviewers determined that caseworkers had visited the parent(s) in the cases in accordance with the parent(s)’s need for visits, or at least monthly, in 70% of the cases.

## Strength Ratings for Well Being 1 Indicators for 2002 Only by States

- Assessing Needs and Providing Services (Item 17) - 0 States
- Family Involvement in Case Planning (Item 18) - 0 States
- Caseworker Visits with Children (Item 19) -   4 States
- Caseworker Visits with Parents (Item 20) -     0 States

**Notes:**
This slide shows each of the four indicators used to evaluate Child and Family Well Being Outcome 1  and the number of States reviewed in 2002 in which the indicators were determined to be strengths in the State. 

## Relationship of Caseworker Visits with Children and Other Outcomes in 2002 Cases

- A “strength” rating for Item 19 (caseworker visits with child) was significantly associated with “substantially achieved” ratings for 5 of the 7 outcomes.

**Notes:**
Among the cases reviewed in 2002, there was a statistical relationship between “strength” ratings on the indicator Caseworker Visits with Children (Item 19 on the onsite review instrument) and five of the outcomes, as follows:
In 84% of the cases where Caseworker Visits with Children was rated as a strength, Safety Outcome 2 was rated as substantially achieved in the case. In 59% of the cases rated as Areas Needing Improvement for Caseworker Visits with Children, Safety Outcome 2 was rated as substantially achieved.
In 53% of the cases where Caseworker Visits with Children was rated as a strength, Permanency Outcome 1 was rated as substantially achieved in the case.
In 78% of the cases where Caseworker Visits with Children was rated as a strength, Permanency Outcome 2 was rated as substantially achieved in the case.
In 88% of the cases where Caseworker Visits with Children was rated as a strength, Well Being Outcome 2 was rated as substantially achieved in the case.
In 76% of the cases where Caseworker Visits with Children was rated as a strength, Well Being Outcome 3 was rated as substantially achieved in the case. 

## Relationship between Caseworker Visits with Children and Other Indicator Ratings in 2002 Cases (1)

- Significant relationships were found between caseworker visits  with children          and .  .  .

-       Providing services to protect children in the home and prevent removal
-       Managing the risk of harm to children
-       Establishing permanency goals
-       Achieving reunification, guardianship and permanent placement with relatives

**Notes:**
Among the cases reviewed in 2002, there was a statistical relationship between “strength” ratings on the indicator, Caseworker Visits with Children (Item 19 on the onsite review instrument), and 14 of the 23 indicators used to evaluate the outcomes, as noted on the slide above, and the two following slides.

## Relationship between Caseworker Visits with Children and Other Indicator Ratings in 2002 Cases (2)

- Significant relationships were also found between caseworker visits  with children          and .  .  .

-       Achieving goal of other    planned living arrangement
-       Placement with siblings
-       Preserving children’s    connections while in foster care
-       Maintaining the child’s relationship with parents
-      Assessing needs and providing services to children and families

**Notes:**
(continuation of previous slide)

## Relationship between Caseworker Visits with Children and Other Indicator Ratings in 2002 Cases (3)

- Finally, significant relationships were also found between caseworker visits  with children          and .  .  .

-       Involving children and parents   in case planning
-      Caseworker visits with parents
-       Meeting the educational       needs of children
-       Meeting the physical health  needs of children
-       Meeting the mental health    needs of children

**Notes:**
(continuation of previous slide)

## Well-Being Outcome 1 Ratings for In-Home and Foster Care Cases

-    Well-Being Outcome 1 was substantially achieved for only 56% of in-home cases, compared to 67% of foster care cases

**Notes:**
Among cases reviewed in both 2001 and 2002, Child and Family Well Being Outcome 1 was more likely to be substantially achieved in the foster care cases than in the in-home services cases.  Among foster care cases, the outcome was substantially achieved in 67% of the cases.  Among in-home services cases, it was substantially achieved in 56% of the cases.

## Physical & Mental Health Ratings for In-Home and Foster Care Cases

-    Children in foster care received services to meet their physical and mental health needs more often than children who were served in their own homes.

**Notes:**
Among cases reviewed in both 2001 and 2002, children in the foster care cases were more likely to have their needs addressed with regard to physical and mental health, than children in their own homes.
With regard to the physical health indicator (Item 22 on the onsite review instrument), reviewers determined the indicator to be a strength in 85% of the foster care cases, and in 78% of the in-home services cases.
With regard to the mental health indicator (Item 23 on the onsite review instrument), reviewers determined the indicator to be a strength in 80% of the foster care cases, and in 65% of the in-home services cases. 

## Comparison of item strengths for in-home cases vs. foster cases in the 2002 cases

- (Permanency indicators are not represented)

**Notes:**
This slide compares the strength ratings for foster care and in-home cases on the eleven indicators common to both in-home and foster care cases among the cases reviewed in 2002, as follows:
Item 1 (Timeliness of initiating CAN investigations): The item was rated as a strength in 81% of the foster care cases and in 75% of the in-home services cases.
Item 2 (Recurrence of maltreatment): The item was rated as a strength in 94% of the foster care cases and in 91% of the in-home services cases.
Item 3 (Services to protect children in their own homes): The item was rated as a strength in 81% of the foster care cases and in 84% of the in-home services cases.
Item 4 (Risk of harm): The item was rated as a strength in 87% of the foster care cases and in 73% of the in-home services cases.
Item 17 (Needs and services of child, parents, foster parents): The item was rated as a strength in 66% of the foster care cases and in 61% of the in-home services cases.
Item 18 (Child and family involvement in case planning): The item was rated as a strength in 63% of the foster care cases and in 59% of the in-home services cases.
Item 19 (Caseworker visits with child): The item was rated as a strength in 77% of the foster care cases and in 69% of the in-home services cases.
Item 20 (Caseworker visits with parents): The item was rated as a strength in 63% of the foster care cases and in 65% of the in-home services cases.
Item 21 (Educational services to child): The item was rated as a strength in 88% of the foster care cases and in 74% of the in-home services cases.
Item 22 (Physical health of child): The item was rated as a strength in 84% of the foster care cases and in 80% of the in-home services cases.
Item 23 (Mental health of child): The item was rated as a strength in 77% of the foster care cases and in 64% of the in-home services cases.

## Statistically Significant Differences in Case Ratings for In-Home and Foster Care Cases

**Statistically Significant Differences in Case Ratings for In-Home and Foster Care Cases**

**Notes:**
Among the cases reviewed in 2002, there were statistically significant differences in the ratings for in-home services cases and foster care cases on four indicators, as follows:
Risk of harm (Item 4): 73% of the in-home cases were rated as strengths, compared to 87% of the foster care cases.
Caseworker visits with children:  69% of the in-home cases were rated as strengths, compared to 77% of the foster care cases.
Providing educational services to children: 74% of the in-home cases were rated as strengths, compared to 88% of the foster care cases.
Providing mental health services to children:  64% of the in-home cases were rated as strengths, compared to 77% of the foster care cases.

## Statistically Significant Differences in Ratings for Fathers & Mothers in the 2002 Cases

**Notes:**
Among the cases reviewed in 2002, there were five areas where the reviewers’ responses to individual indicators were statistically different for fathers and mothers in the families.  The slide above depicts these differences in those cases where both the mother and the father were actually known to the agency.
Evaluation of relatives as placement resources for children (Item 15):  Maternal relatives were sought as placements in 76% of the cases, compared to paternal relatives being sought as placements in 59% of the cases.
Assessing needs (Item 17):  Mothers’ needs were assessed in 77% of the cases and fathers’ needs were assessed in 58% of the cases.
Providing services (Item 17):  Services were provided to mothers in 73% of the cases and to fathers in 55% of the cases. 
Parents’ involvement in case planning (Item 18):  Mothers were actively involved in case planning activities in 70% of the cases, compared to fathers being involved in case planning in 52% of the cases.  
Caseworker visits with parents (Item 20):  Mothers were visited at least monthly by the caseworker in 61% of the cases, compared to fathers being visited at least monthly by the caseworker in 34% of the cases. 

## Rank Order of Outcomes Across All Cases from Strongest to Weakest

- 1.  Safety 1 (86%)
- 2.  Well Being 2 (83%)
- 3.  Safety 2 (80%)
- 4.  Permanency 2 (79%)

- 5. Well Being 3 (71%)
- 6.  Permanency 1 (63%)
-  7. Well Being 1 (62%)

**Notes:**
This slide rank orders the seven outcomes for all cases reviewed in both 2001 and 2002, according to the percentage of cases reviewed in which the outcome was substantially achieved.  For example, in 86% of the cases reviewed across the two years, reviewers determined that Safety Outcome 1 was substantially achieved in 86% of the cases. 

## Strongest and Weakest Outcome Indicators Across All Cases

- _Strongest Indicators_
- Placement Proximity (96%)
- Recurrence of Maltx (92%)
- Placement with siblings (87%)
- Relative Placements  (85%)

- _Weakest Indicators_
- Adoption (57%)
- Needs & Services (66%)
- Family Involvement (66%)
- Permanency Goal (67%)

**Notes:**
This slide rank orders the individual indicators used to evaluate the outcomes for all cases reviewed in both 2001 and 2002, according to the percentage of cases reviewed in which the indicator was rated as a strength in the case.  For example, among all the cases reviewed across the two years, reviewers determined that Placement Proximity was substantially achieved in 96% of the cases. 
These results only include indicators where the results from the 2001 cases and the 2002 cases could be combined meaningfully.  For those indicators where the definitions were changed in 2002, the results are not combined.

## Systemic Factors

- Statewide Information System
- Case Review System
- Quality Assurance System
- Training
- Service Array
- Agency Responsiveness to the Community
- Foster & Adoptive Parent Licensing, Recruitment, & Retention

**Notes:**
This slide lists the seven systemic factors covered in the review.

## Determining Substantial Conformity for Systemic Factors

- Are State plan requirements and other program requirements attached to the systemic factor actually in place in the State?
- Are State plan requirements and other requirements attached to the systemic factor functioning as described in the applicable regulation or statute?

**Notes:**
These are the criteria used to rate the systemic factors and to determine if they are in substantial conformity with applicable Federal requirements

## Substantial Conformity Ratings for Systemic Factors

**Notes:**
This chart depicts the number of States reviewed in both 2001 and 2002 (total of 32 States) that were in substantial conformity on each of the seven systemic factors, as follows:
Statewide Information System:  28 States
Case Review System: 12 States
Quality Assurance System:  27 States
Staff and Provider Training:  23 States
Service Array:  21 States
Agency Responsiveness to the Community:  31 States
Licensing, Recruitment, and Retention of Foster and Adoptive Parents:  27 States  

## Number of States in Substantial Conformity  on Systemic Factors

_**Strongest Factors**_
- Agency Responsiveness (31)
- Information System (28)
- Licensing/Recruit/Retention (27)
- Quality Assurance (27)

**     **_**Weakest Factors**_
-      Case Review System (12)
-      Service Array (21)
-      Training  (23)

**Notes:**
This slide rank orders the number of States that achieved substantial conformity on each of the seven systemic factors across both 2001 and 2002 reviews.

## Case Review System

**Notes:**
Fewer States achieved substantial conformity on the systemic factor, Case Review System, than on any of the other systemic factors (12 of 32 States).  This slide depicts the number of States in which each of the five indicators used to evaluate Case Review System was rated as a strength, as follows:
Developing case plans jointly with parents: This indicator was a strength for 6 of the 32 States.
Periodic reviews for children in foster care: This indicator was a strength for 28 of the 32 States.
Permanency hearings for children in foster care: This indicator was a strength for 16 of the 32 States.
Termination of parental rights provisions: This indicator was a strength for 19 of the 32 States.
Providing notice of hearings and reviews and opportunity to be heard to foster and pre-adoptive parents and relative caretakers: 21 of 32 States.

## Relationship of Systemic Factors & Case Ratings in 2002 Cases: Case Review System

- States in substantial conformity with **Case Review System** had  more cases rated as substantially achieved for:
**Permanency Goal for child (P1)** and
**Families have enhanced capacity (WB1)**.

**Notes:**
Among the States reviewed in 2002, there was a significant relationship between the State achieving substantial conformity on the systemic factor, Case Review System, and achieving substantial conformity on two outcomes, as follows:
Permanency Outcome 1:  Among States that achieved substantial conformity on Case Review System, 76% of the cases were also substantially achieved for Permanency Outcome 1.  Among States that did not achieve substantial conformity on Case Review System, 57% of the cases were not substantially achieved for Permanency Outcome 1.
Child and Family Well Being Outcome 1: Among States that achieved substantial conformity on Case Review System, 70% of the cases were also substantially achieved for Child and Family Well Being Outcome 1.  Among States that did not achieve substantial conformity on Case Review System, 58% of the cases were not substantially achieved for Child and Family Well Being Outcome 1.

## Relationship between Case Plans and Outcome Achievement

- The indicator, “developing case plans jointly with parents,” was determined to be a strength for only 6 of the total 32 States reviewed
- States where this indicator was a strength had a significantly higher percentage of cases rated “substantially achieved” for Permanency Outcome 1, and all three Well-Being Outcomes.

**Notes:**
Additional information on the relationship between the indicator Developing Case Plans Jointly with Parents, and outcome achievement.

## Relationship of Systemic Factors & Case Ratings in 2002 Cases: Case Review System

-     States with Substantial Conformity ratings on Case Review System had higher ratings on:

-       Adoption
-       Proximity of placement
-       Preserving connections
-      Needs/services of child,
-      parents and foster parents
-      Child/family involvement in
-      case planning
-      Worker visits with parents

**Notes:**
Among the States reviewed in 2002, there was a significant relationship between the State achieving substantial conformity on the systemic factor, Case Review System, and “strength” ratings for individual indicators, as follows:
Item 9, Adoption
 Item 11, Proximity of placement
 Item 14, Preserving connections
 Item 17, Needs/services of child, parents and foster parents
 Item 18, Child/family involvement in case planning
 Item 20, Worker visits with parents

## Service Array

**Notes:**
This slide depicts the ratings for the three indicators used to evaluate the systemic factor, Service Array, as follows:
Having an adequate service array in place in the State: 22 States achieved strength ratings, and 10 States were rated as area needing improvement.
Having services accessible to the families who need them:  9 States achieved strength ratings, and 23 States were rated as area needing improvement.
Ability to individualize services to children and families:  21 States achieved strength ratings, and 11 States were rated as area needing improvement.

## Agency Responsiveness to the Community

**Notes:**
This slide depicts the ratings for the three indicators used to evaluate the systemic factor, Agency Responsiveness to the Community, as follows:
Collaboration/consultation with other partners: 31 States achieved strength ratings, and one State was rated as area needing improvement.
Developing annual reports of progress on the CFSP: 25 States achieved strength ratings, and 7 States were rated as area needing improvement.
Coordinating services:  27 States achieved strength ratings, and 5 States were rated as area needing improvement.

## Foster and Adoptive Parent Licensing, Recruitment, and Retention

**Notes:**
This slide depicts the ratings for the five indicators used to evaluate the systemic factor, Foster and Adoptive Parent Licensing, Recruitment, and Retention , as follows:
Standards for foster family homes and child care institutions: 31 States achieved strength ratings, and one State was rated as area needing improvement.
Standards are applied equally to all homes or institutions:  27 States achieved strength ratings, and 5 States were rated as area needing improvement.
Ability to individualize services to children and families:  30 States achieved strength ratings, and 2 States were rated as area needing improvement.
Diligent recruitment of foster and adoptive families:  12 States achieved strength ratings, and 20 States were rated as areas needing improvement.
Effective use of cross-jurisdictional resources:  28 States achieved strength ratings, and 4 States were rated as areas needing improvement.

While the systemic area of licensing, recruiting, and retaining foster and adoptive parents was generally strong among States, one of the weakest overall indicators was the diligent recruitment of foster families who represent the diversity of children needing placement.  Only 12 of the 32 States were doing well in this area.  Most of the States had an inadequate supply of foster families, forcing their reliance on inappropriate placements for children in foster care, temporary shelter care for initial and emergency placements, and overcrowding of some foster homes.  This will be an important area for States to address in their PIPs if they are to see improvements in the permanency outcomes.

## Other Relationships Between Systemic Factors and 2002 Case RatingsSubstantial Conformity on          Higher Ratings on

-     Quality Assurance
-     Foster & Adoptive Parent Licensing, Recruitment, and Retention

-    Well being outcome 1
-     Placement stability for children in foster care

**Notes:**
Among the States reviewed in 2002, there were significant relationships between two additional systemic factors and performance on an outcome and an individual indicator, as follows:
States that achieved substantial conformity on the systemic factor, Quality Assurance System, were more likely to be in substantial conformity on Child and Family Well Being Outcome 1.
States that achieved substantial conformity on the systemic factor, Foster and Adoptive Parent Licensing, Recruitment, and Retention, were more likely to achieve strength ratings on the indicator, Placement Stability for Children in Foster Care (Item 6 on the onsite review instrument).

## Strongest and Weakest Systemic Indicators

-       _Strongest Indicators_
- Collaboration (31)
- Licensing Standards (31)
- Criminal B’ground Checks (30)
- Cross-Juris placements (28)
- Periodic reviews (28)

-      _Weakest Indicators_
- Case Plans (6)
- Services are  accessible (9)
- Diligent  Recruitment (12)
- Ongoing Staff Training (19)

**Notes:**
This slide rank orders the individual indicators used to evaluate the systemic factors for the 32 States reviewed in both 2001 and 2002, according to the number of States in which the indicator was rated as a strength in the case.  For example, among the 32 States, the indicator, Collaboration/consultation with other partners, was rated a strength in 31 States.

## Summary of Major Points

- Better performance on safety outcomes than other outcomes
- Much need for improving permanency achievement and well being of children
- Adoption is least likely indicator to be achieved

- Status of Case Review System and it’s relationship to other areas
- Relationship of Caseworker Visits with Children to other findings
- Difference in findings for In-home and Foster Care Cases
- Implications for casework practice

**Notes:**
This slide summarizes some of the major points of the foregoing slides, as follows:
States showed relatively strong performance on the safety outcomes compared to other outcomes.
The two outcomes most in need of improvement across all States reviewed are Permanency Outcome 1 and Child and Family Well Being Outcome 1.
Among all individual indicators used to evaluate the outcomes, achieving adoption within 24 months of the child’s entry into foster care (for children with a goal of adoption) is the least likely indicator to be rated a strength among the 2002 cases. 
Among the States reviewed in 2002, achieving substantial conformity on the systemic factor, Case Review System, is significantly related to positive performance on Permanency Outcome 1 and Child and Family Well Being Outcome 1. 
Among cases reviewed in 2002, “strength” ratings for the individual indicator, Caseworker Visits with Children, is significantly related to 14 other individual indicators across all the outcomes.
Among the cases reviewed in 2002, there were significant differences in ratings between in-home and foster care cases in several important areas. 
The findings suggest important implications for improving case work practice through program improvement plans, such as:  increased attention to needs assessments, engaging families in case planning, service delivery, visiting with children and parents, greater efforts to identify and engage fathers, and more timely and expeditious case planning and decision making with regard to achieving permanency.