# Presentation: 134424

## 52 Program Improvement Plans

**Strategies for Improving Child Welfare Services and Outcomes**

## Goals of the PIP Process

- Improve outcomes for children and families
- Strengthen delivery of effective services
- Coordinate partnerships throughout child welfare
- Establish ongoing self-monitoring and continuous improvement

**Notes:**
This slide describes the broad goals that ACF has for the Program Improvement Plan process.

## Cross-Cutting Themes

- Strengthened agency capacity
- Strengthened professional development
- Improved social work interventions
- Enhanced quality assurance
- Expanded community resources
- Stronger partnerships

**Notes:**
This slide shows the common cross-cutting themes in the strategies used by States to address areas needing improvement in their PIPs.

## Limitations of PIP Analysis

- Linking progress with specific strategies
- Various stages of PIP completion
- Numbers are approximate

**Notes:**
This analysis is limited as follows:
Percentages of improvement in the CFSR data indicators cannot be linked to specific programmatic strategies used by States.
States are at various stages of implementing/completing their PIPs, so the information reported herein is incomplete.
The numbers quoted herein pertaining to progress and numbers of States using specific strategies, are approximate.

## Analysis of Program Improvement Plans

- Outcomes
- Systemic Factors
- Data Indicators
- Contextual Factors

**Notes:**
This analysis addresses selected components of the 3 CFSR outcomes, of 3 of the 7 CFSR systemic factors, and the 6 CFSR data indicators with national standards.  This information was taken from an analysis of State PIPs conducted by ACF and entered into a data base.  The section regarding contextual factors was derived from interviews with ACF Regional Office and Central Office staff, based on their perceptions of work with specific States on PIPs.

## OUTCOMES

## Safety

## State Performance on Safety Outcomes

|  | Low | Median | High |
| --- | --- | --- | --- |
| Safety 1 | 62% | 85.8% | 100% |
| Safety 2 | 48% | 80.8% | 93.5% |

- Substantial Conformity:  6 States each for both Safety Outcomes
- Case Ratings:

**Notes:**
This slide presents a brief summary of how the States performed on the safety outcomes during the first round of CFSRs.  Six States were in substantial conformity for each of the safety outcomes.  The chart depicts the range of the States’ performances on the two safety outcomes based on the percentage of cases reviewed in which each outcome was determined to be substantially achieved.  

## Common Safety Concerns from Initial CFSRs

- Lower risk reports not investigated timely
- Reports on open cases not investigated
- Insufficient risk or safety assessments
- Inconsistent services to protect children at home
- Inconsistent services to address risk, especially in in-home cases
- Inconsistent monitoring of families

**Notes:**
This slide depicts the most commonly cited concerns with regard to safety from the initial 52 CFSRs. Some concerns pertain only to the 35 States reviewed in the years 2002-2004.  The full report of findings, along with the number of States with these identified concerns is posted on the Children’s Bureau website.

## Common Safety Strategies in Program Improvement Plans

**Develop new practices or processes (47 States)**
- focus on revising risk and safety assessments
- alternative/differential response systems
- engagement and planning with families
- enhance practices and processes to improve practice and consistency (focused on practice models)
- create special units or reorganize units
**Develop or enhance policies (38 States)**
- clarify policies around investigations, such as timeframes
- disposition process

**Notes:**
This slide depicts the broad categories of strategies most commonly used by States to make improvements in safety for children and families being served in their own homes and also in foster care.  The numbers are approximate. 

## Common Safety Strategies in  Program Improvement Plans (continued)

**Training (38 States)**
- focus on developing skills of staff
- supervisors
- cross-train community partners, foster parents, residential staff and law enforcement
**Info Systems (25 States)**
**Services ( 21 States)**
- develop new services
- enhance existing services

**Notes:**
This is a continuation of the previous slide.

## Common Safety Strategies in  Program Improvement Plans (continued)

**Research and evaluation ( 21 States)**
- study areas of substance abuse, juvenile justice, and domestic violence
- analyze specific populations
- pilot specific practices
**Collaboration (16 States)**
- focus on collaboration with community partners, other State agencies
- implement strategies to work with tribes to cross-train and provide services
**Supervision ( 11 States)**** **
- focus on supervisors’ role and oversight responsibilities related to safety/risk assessments, in-home services cases, etc.

**Notes:**
This is a continuation of the previous slide.

## What strategies address risk and safety assessments?

- Build skills of workers and supervisors to engage families effectively in assessment and planning
- Provide specialized training regarding substance abuse, domestic violence, mental illness, etc.
- Focus on consistency in practice through supervision and quality assurance
- “Best practice”models that provide framework for practice

**Notes:**
This slide identifies common strategies used by States in their PIPs to address risk and safety assessments.

## What strategies address safety in foster care placements?

- Revise policies to require background checks on relative placements
- Develop policies to standardize response to abuse and neglect allegations made on foster families and residential care facilities
- Support of foster parents (services, training)
- Supervisory oversight of safety/risk assessments
- Use of QA to monitor quality of practice (caseworkers and residential facilities)

**Notes:**
This slide identifies common strategies used by States in their PIPs to address safety of children while in foster care placements.

## What strategies address safety in intact families?

- Focus on quality and frequency of worker visits
- Provide oversight through supervisors and QA
- Focus on assessments, both risk/safety and comprehensive family assessments
- Enhance and expand available services to intact families to prevent removal, including aftercare services
- Implement best practice models
- Emphasis on closing cases safely
- Use of prevention and early intervention services

**Notes:**
This slide identifies common strategies used by States in their PIPs to address safety issues in their work with intact families.

## Permanency

## State Performance on Permanency Outcomes

|  | Low | Median | High |
| --- | --- | --- | --- |
| Permanency 1 | 7.1% | 50.9% | 92% |
| Permanency 2 | 37.9% | 77.3% | 94.3% |

- Substantial Conformity:
- 0 States in substantial conformity on Permanency Outcome 1.
- 7 States in substantial conformity on Permanency Outcome 2.
- Case Ratings:

**Notes:**
This slide presents a brief summary of how the States performed on the permanency outcomes during the first round of CFSRs.  No State was in substantial conformity for Permanency Outcome 1, and 7 States were in substantial conformity on Permanency Outcome 2. The chart depicts the range of the States’ performances on the two permanency outcomes based on the percentage of cases reviewed in which each outcome was determined to be substantially achieved.  

## Common Permanency Concerns in Initial CFSRs 

- Case goal of LTFC established without ruling out options
- Inconsistent concurrent planning efforts
- Maintaining goal of reunification too long
- Not filing for termination of parental rights timely
- Adoption studies and paperwork not completed timely
- Lengthy TPR appeals process
- Reluctance of courts to terminate parental rights
- Overcrowded court dockets

**Notes:**
This slide depicts the most commonly cited concerns with regard to permanency from the initial 52 CFSRs. Some concerns pertain only to the 35 States reviewed in the years 2002-2004.  The full report of findings, along with the number of States with these identified concerns is posted on the Children’s Bureau website.

## Common Permanency Strategies in Program Improvement Plans

- Develop or enhance policies (all States)
- Case planning, procedures, hearings, etc.
- Legislation
- Practice guidelines
- Develop new practices/procedures (all States)
- General casework practices
- “Best practice” models
- Targeted services
- Quality assurance and monitoring activities (at least 45 States)
- Improvements in data/systems
- Improvements in supervision
- Review of specific populations
- Establishing new practice standards

**Notes:**
This slide depicts the broad categories of strategies most commonly used by States to make improvements in permanency for children in foster care.  The numbers are approximate. 

## Common Permanency Strategies in Program Improvement Plans (continued)

- Collaborative activities (at least 38 States)
- Memoranda of Understanding (MOU) or interagency agreements
- Courts/legal/judicial issues
- Tribes, youth, other stakeholders
- Training (at least 38 States)
- Cross training
- Worker and supervisor training
- Foster and adoptive parent training
- Policy training
- Increase or Enhance Resources (at least 35 States)
- Staff hiring/retention
- Funding
- New/expanded services

**Notes:**
This is a continuation of the previous slide.

## What strategies address reduction in time to achieve permanency?

- Improve court functions related to permanency
- Monitor through use of QA case reviews
- Monitor through use of data
- Establish State and local stakeholder groups to identify barriers to permanency achievement
- Identify and disseminate best practice models and guidelines for permanency
- Revise policies, procedures, and court rules
- Establish State-level permanency specialist positions
- Joint training of agency/judicial/legal parties
- Decrease caseloads
- Improve case transfer process

**Notes:**
This slide identifies common strategies used by States in their PIPs to address reduction in time frames for children in foster care to achieve their permanency goals.

## What strategies address improvements in permanency planning?

- Concurrent planning
- Establish statewide or local permanency units
- Develop and implement new case plans
- Develop or strengthen policies and procedures
- Review processes for appropriateness and timeliness of permanency goals
- Family group decision-making
- Comprehensive child and family assessments
- New training for staff on permanency planning

**Notes:**
This slide identifies common strategies used by States in their PIPs to address improvements in permanency planning procedures.

## What strategies address permanency for youth in foster care?

- Expand services to youth (at least 9 States)
-       -  Recruit/identify new service providers
-       -  Expand specific services (housing, mentoring, life skills)
-       -  Establish stabilization centers (one State)
- Strengthen staff capacity  (at least 4 States)
-       -  Add youth specialists
-       -  Train existing staff
- Improve case planning/transitional plans (at least 7 States)
-       -  Implement new assessment tools/strategies to complete them
-       -  Focus on transitioning Native youth (one State)

**Notes:**
This slide identifies common strategies used by States in their PIPs to address permanency for older youth in foster care.  The numbers are approximate.

## What strategies address permanency for youth in foster care? (continued)

- Collaborate with youth/other stakeholders (at least 6 States)
-        -  Youth Advisory Boards
-        -  Other agencies, e.g., mental health
- Disseminate information on services (at least 4 States)
-      -  Chaffee information/educational opportunities
-       -  Handbooks
- Efforts to preserve youth connections (at least 2 States)
-      -  Primarily through relative searches and permanent placements
- Policy and procedural changes (at least 2 States)
-      -  Staffings, new case planning strategies

**Notes:**
This slide is a continuation of the previous slide.

## What strategies address permanency for Native American children?

- Train staff and courts on ICWA and its relationship to achieving permanency (5 States)
- State/Tribal partnership jointly review quarterly data and address barriers to permanency (2 States)
- Train State staff on practice that promotes strengthened partnerships with Tribes (2 States)
- Joint foster parent and staff training with Tribes (1 State)

**Notes:**
This slide identifies common strategies used by States in their PIPs to address permanency for Native American children in foster care placements.  The numbers are approximate.

## What strategies address permanency for Native American children? (continued)

- Develop agreements/protocols with bordering states promoting permanency and ICWA
- Recruit Native American foster and adoptive homes in communities with high entry rates
- Involve Tribes in developing/implementing family group decision making
- Work with Court Improvement Programs (CIP) to develop inquiry process at hearings to determine Tribal affiliation

**Notes:**
This slide is a continuation of the previous slide.  

## What strategies address the use of relatives as placement resources?

- Locate and identify relatives at the point of intake (11 States)
- Change in policy, procedures, or practice
- Collaborate with courts to locate/identify
- Ongoing identification and assessment of relatives (5 States)
- Implementation of practice models or processes, such as Family Centered Practice or family group decision making
- Assess and identify barriers to use of relatives as placement resources (8 States)
- Waivers for criminal history or training
- Disseminating information to relatives
- Strengthen supervisory and management oversight (5 States)

**Notes:**
This slide identifies common strategies used by States in their PIPs to address the use of relatives as placement resources for children in foster care.  The numbers are approximate.

## Well-Being

## State Performance on Well Being Outcomes

|  | Low | Median | High |
| --- | --- | --- | --- |
| WB 1 | 18% | 60% | 86% |
| WB 2 | 64.7% | 83% | 100% |
| WB 3 | 51.2% | 69.9% | 92.1% |

- Substantial Conformity:
- 0 States in substantial conformity on Outcome 1
- 16 States in substantial conformity on Outcome 2
- 1 State in substantial conformity on Outcome 3
- Case Ratings:

**Notes:**
This slide presents a brief summary of how the States performed on the well being outcomes during the first round of CFSRs.  No State was in substantial conformity on Well Being Outcome 1; 16 States were in substantial conformity on Well Being Outcome 2; and 1 State was in substantial conformity on Well Being Outcome 3.  The chart depicts the range of the States’ performances on the two safety outcomes based on the percentage of cases reviewed in which each outcome was determined to be substantially achieved.  

## Common Well Being Concerns in Initial CFSRs

- Inconsistent match of services to needs
- Inconsistent in conducting needs assessments
- Lack of support services to foster and relative caretakers
- Parents and children not involved in case planning
- Inadequate caseworker visits with children and parents
- Failure to engage fathers

**Notes:**
This slide depicts the most commonly cited concerns with regard to well being from the initial 52 CFSRs. Some concerns pertain only to the 35 States reviewed in the years 2002-2004.  The full report of findings, along with the number of States with these identified concerns is posted on the Children’s Bureau website.

## Common Well Being Concerns in Initial CFSRs (continued)

- Multiple school changes for children entering foster care
- Lack of services to address education, physical health, dental health, or mental health
- Lack of health and mental health assessments
- Few doctors/dentists that accept Medicaid

**Notes:**
This slide is a continuation of the previous slide.

## Comprehensive Needs Assessments

## Finding: Assessment of needs and provision of services were associated with the following: 

- Permanency Outcome 1
- Permanency Outcome 2
- Safety Outcome 1
- Safety Outcome 2

- Placement stability
- Meeting educational needs
- Meeting physical health needs
- Meeting mental health needs

**Notes:**
This slide depicts the statistical association of comprehensive needs assessments of children and families and subsequent provision of services to safety, permanency, and well being measures and outcomes in the CFSR.   This information is based on findings from the initial round of CFSRs and a full report of the findings is posted on the Children’s Bureau website.

## What strategies address comprehensive needs assessments?

- Practice change strategies (34 States)
- Revisions to tools
- Consistency in practice
- Improve engagement of family members and stakeholders
- Implement practice models and/or processes
- Training of staff (16 States)
- Revise policy and procedures/strengthen existing policies (7 States)
- More frequent visits to children and families and designating a visit to be spent on assessment and developing service plans
- Focus on consistency between counties and POS
- Oversight of practice through supervisors and managers (3 States)

**Notes:**
This slide identifies common strategies used by States in their PIPs to address the use of comprehensive needs assessments in working with children and families.  The numbers are approximate.

## Caseworker Visits with Children and Parents

## Finding:  Caseworker visits with children and parents were strongly associated with:

- Risk of harm to children
- Needs & Services for children, parents, foster parents
- Child and parent involvement in case planning
- Services to protect children at home
- Safety Outcome 1
- Safety Outcome 2

- Timely permanency goals
- Timely reunification
- Child’s visits with parents and siblings
- Relative placements
- Meeting educational needs
- Meeting physical health needs
- Meeting mental health needs

**Notes:**
This slide depicts the statistical association of caseworker visits with children and parents to safety, permanency, and well being measures and outcomes in the CFSR.   This information is based on findings from the initial round of CFSRs and a full report of the findings is posted on the Children’s Bureau website.

## What strategies address caseworker visits with children and parents?

- Establish minimum visit requirements (30 States)
- Provide supervisory oversight and monitor performance through QA/CQI (30 States)
- Train managers, staff and providers (16 States)
- Focus on quality of visits (14 States)
- Recruitment and retention of staff  (14 states)
- Streamline documentation of visits (3 States)
- Clarify roles and responsibilities of multiple parties involved in a case (3 States)

**Notes:**
This slide identifies common strategies used by States in their PIPs to address caseworker visits with children and parents.  The numbers are approximate.

## Engagement of Fathers

## Finding:There were significant differences in serving fathers and mothersin these areas:

- Seeking out relatives
- Assessing needs
- Providing services
- Engagement in case planning
- Caseworker contacts

**Notes:**
This slide depicts the statistical differences identified in the initial round of the CFSR between findings regarding fathers and mothers in the cases reviewed.  This information is based on findings from the initial round of CFSRs and a full report of the findings is posted on the Children’s Bureau website.

## What strategies address engagement of fathers in case planning and service provision?

- Develop or revise existing policy and practice to locate absent parents (4 states)
- Implement models of practice to assess, engage and plan with fathers (4 states)
- Enhance and implement policy or procedures to better engage and assess fathers (5 states)
- Enhance training and training curriculum to better engage and plan with fathers (3 states)

**Notes:**
This slide identifies common strategies used by States in their PIPs to improve engagement of fathers in case planning and service provision.  The numbers are approximate.

## SYSTEMIC FACTORS

## Case Review System

## State Performance on Case Review System

- Substantial Conformity:
- 13 of 52 States in substantial conformity
- Indicator Ratings:
- Most strength ratings on six-month reviews
- Most ANI ratings on developing case plans with parents and TPR proceedings
- About even on permanency hearings, and notification of foster caretakers

**Notes:**
This slide presents a brief summary of how the States performed on the systemic factor, Case Review System, in the first round of CFSRs.  Thirteen States were in substantial conformity on Case Review System.  Performance on individual indicators within the Case Review System are noted. 

## Finding:  Components of the case review system were associated with the following:

- Six-month reviews
- Permanency hearings
- TPR

- Adoption
- Well Being 1
- Adoption
- Adoption
- Reunification
- Permanency 1

**Notes:**
This slide depicts the statistical association of certain components of the Case Review System with certain permanency and well being measures and outcomes in the CFSR.   This information is based on findings from the initial round of CFSRs and a full report of the findings is posted on the Children’s Bureau website.

## Common Case Review Concerns in Initial CFSRs

- Failure to engage parents, especially fathers, and children in case planning
- Case plans not individualized
- Ineffective case reviews
- Lack of timely permanency hearings
- Inconsistency in seeking timely TPR
- Reluctance to TPR without identified resource
- Crowded court dockets
- Inconsistent notification of caretakers and providing opportunity to be heard

**Notes:**
This slide depicts the most commonly cited concerns with regard to Case Review System from the initial CFSRs. Some concerns may pertain only to the 35 States reviewed in the years 2002-2004.  The full report of findings, along with the number of States with these identified concerns is posted on the Children’s Bureau website.

## Common Case Review Strategies in Program Improvement Plans

- Practice and Policy
- Collaboration
- Quality Assurance
- Training

**Notes:**
This slide depicts the broad categories of strategies most commonly used by States in their PIPs to make improvements in Case Review System.  

## Case Review SystemPractice and Policy

- Develop and implement a new protocol, approach, or practice (22 States)
- Develop policy and/or procedure (19 States)
- Revise or refine policy (16 States)
- Develop/disseminate information/materials (11 States)
- Increase compliance with an existing policy  (9 States)
- Seek legislative action (8 States)
- Improve supervisory oversight (5 States)
- Develop a 12-month permanency planning hearing process (3 States)

**Notes:**
This slide depicts the strategies most commonly used by States in their PIPs to make policy and practice improvements in Case Review System.  The numbers are approximate.

## Case Review System Collaboration

- Collaborate with Courts (address barriers) (18 States)
- Collaborate with CIP  (10 States)
- Collaborate across State agencies and/or with service providers and community partners (8 States)
- Collaborate with Tribes (address barriers) (5 States)
- Collaborate with external partners to monitor activities (courts, etc.)  (4 States)

**Notes:**
This slide depicts the strategies most commonly used by States in their PIPs to make improvements in Case Review System through collaborative activities.  The numbers are approximate.

## Case Review SystemQuality Assurance

- Monitor agency performance (12 states)
- Develop/implement a new QA process (8 States)

**Notes:**
This slide depicts the strategies most commonly used by States in their PIPs to make improvements in Case Review System through quality assurance activities.  The numbers are approximate.

## Case Review SystemTraining 

- Train/cross-train external parties (10 States)
- Train all child welfare agency staff  (9 States)
- Revise or develop training curriculum (8 States)
- Train front-line staff (5 States)
- Train supervisors (5 States)

**Notes:**
This slide depicts the strategies most commonly used by States in their PIPs to make improvements in Case Review System through training activities.  The numbers are approximate.

## What strategies address the frequency and quality of permanency hearings, 6-month reviews, and of TPR proceedings?

- Use information to schedule/track hearings
- Use reports from information system to track hearings
- Coordinate efforts through CIP re-assessments
- Make policies, laws, rules ASFA compliant

**Notes:**
This slide identifies common strategies used by States in their PIPs to address the frequency and quality of permanency hearings, six-month reviews, and termination of parental rights proceedings.

## What strategies address the frequency and quality...(continued)

- Clarify policy
- Monitor timeliness of hearings and reviews
- Identify barriers to timeliness
- Joint training of agency/judicial/legal parties
- Focus 6-month reviews on family-centered practice
- Improve access to legal representation

**Notes:**
This slide is a continuation of the previous slide.

## What strategies address notification of foster and adoptive caretakers?

- Develop rights/responsibilities information
- Review/revise policies and procedures
- Implement best practice standards
- Automatic notification through information system
- Automate schedule of hearings/reviews Provide alternate means of being heard in court
- Monitor notification and participation
- Train courts, agency staff, FCRBs, and/or caretakers

**Notes:**
This slide identifies common strategies used by States in their PIPs to address notification of foster and adoptive caretakers.

## What strategies address developing case plans jointly with parents?

- Use case planning model and/or approach (including automation)
- Develop rights/responsibilities information
- Develop or revise protocols and policies (incl. family-friendly documents, caseworker contacts)
- Monitoring by supervisors or QA
- Recruit, train, and/or hire staff
- Diligent search for parents

**Notes:**
This slide identifies common strategies used by States in their PIPs to address the requirement for agencies to develop case plans jointly with parents.

## What strategies address the role of the courts in improving Case Review System?

- Coordinate efforts through CIP re-assessments
- Use information systems to track events and identify barriers/backlogs
- Court/agency task forces and interagency agreements to address barriers
- Review/revise policies, procedures, and court rules
- Joint training of agency/judicial/legal parties
- Implement best practices (standards, case planning)

**Notes:**
This slide identifies common strategies used by States in their PIPs to address the role of the courts in developing and implementing strategies for improving the Case Review System.

## Service Array

## State Performance on Service Array

- Substantial Conformity:
- 23 of 52 States in substantial conformity on Service Array.
- Indicator Ratings:
- Most strength ratings on individualizing services
- Most ANI ratings on accessibility of services
- About even on availability of service array

**Notes:**
This slide presents a brief summary of how the States performed on the systemic factor, Service Array, in the first round of CFSRs.  Twenty-three States were in substantial conformity on Service Array.  Performance on individual indicators within the Service Array are noted.

## Finding:  Positive performance on Service Array was associated with:

- Positive performance on Well Being Outcome 1

**Notes:**
This slide depicts the statistical association of State performance on the systemic factor, Service Array, to State performance on Well Being Outcome 1. This information is based on findings from the initial round of CFSRs and a full report of the findings is posted on the Children’s Bureau website.

## Common Service Array Concerns in Initial CFSRs

- Insufficient mental health assessment and treatment services
- Insufficient number of doctors/dentists that accept Medicaid
- Key services lacking, e.g., substance abuse treatment, domestic violence, home-based services
- Few services in rural areas
- Wait lists for services
- Insufficient culturally appropriate services

**Notes:**
This slide depicts the most commonly cited concerns with regard to Service Array from the initial CFSRs. Some concerns may pertain only to the 35 States reviewed in the years 2002-2004.  The full report of findings, along with the number of States with these identified concerns is posted on the Children’s Bureau website.

## Common Service Array Strategies in Program Improvement Plans

- Collaborate with community partners (25 states)
- Enhance/expand existing services (21 states)
- Implement a new practice or policy (21 states)
- Research/Conduct demonstration projects (18 states)
- Develop new services (13 states)

**Notes:**
This slide depicts the broad categories of strategies most commonly used by States in their PIPs to make improvements in Service Array.  The numbers are approximate. 

## Service ArrayState-Specific Examples

- Develop single point of entry for foster parents to access 24/7 crisis intervention services (Illinois)
- Enhanced capacity of local service provision (Massachusetts & Kentucky)
- Establish uniform definition of culturally responsive services and self assessment instrument  (Washington)
- Reallocate State foster care funds to placement prevention services (Wyoming)

**Notes:**
This slide depicts some State-specific examples of PIP strategies designed to improve Service Array.

## What strategies address expanding the service array?

- Identifying service needs and available resources
- Focus efforts on recruiting/retaining foster care resources
- Develop services focused on problems contributing to involvement in the child welfare system
- Encourage community involvement to serve families in the child welfare system
- Develop a comprehensive approach to service development and delivery

**Notes:**
This slide identifies common strategies used by States in their PIPs to address expanding the array of services for children and families served by child welfare agencies.

## What strategies address accessibility of services?

- Modify provider contracts to enhance availability/accessibility
- Expand services to previously unserved or underserved areas/populations
- Respond to identified barriers to service delivery
- Develop new service approaches/practice

**Notes:**
This slide identifies common strategies used by States in their PIPs to improve the accessibility of services to children and families.

## What strategies address mental health assessments and services?

- Improve the quality of mental health services through strategic planning
- Increase the accessibility of mental health services to reduce wait lists
- Monitor service delivery
- Implement policy and practice change

**Notes:**
This slide identifies common strategies used by States in their PIPs to address mental health assessments and services.

## Quality Assurance

## State Performance on Quality Assurance

- Substantial Conformity:
- 35 of 52 States in substantial conformity on Quality Assurance
- Indicator Ratings:
- Most strength ratings on standards to assure quality services
- Most ANI ratings on having an identifiable QA system in place

**Notes:**
This slide presents a brief summary of how the States performed on the systemic factor, Quality Assurance, in the first round of CFSRs.  Thirty-five States were in substantial conformity on Quality Assurance.  Performance on individual indicators within the Quality Assurance are noted.

## Finding:  Positive performance on Service Array was associated with:

- Positive performance on Well Being Outcome 1

**Notes:**
This slide depicts the statistical association of State performance on the systemic factor, Quality Assurance, to State performance on Well Being Outcome 1. This information is based on findings from the initial round of CFSRs and a full report of the findings is posted on the Children’s Bureau website.

## Common Quality Assurance Concerns in Initial CFSRs

- The most common concern was that there was no statewide quality assurance system in place.

**Notes:**
This slide depicts the most commonly cited concern with regard to Quality Assurance from the initial CFSRs. The full report of findings, along with the number of States with this identified concern is posted on the Children’s Bureau website.

## Common Quality Assurance Strategies in Program Improvement Plans

- Develop/revise quality assurance process (26 states) / 19 states modeled after CFSR
- Develop/enhance supervisory review process (11 states)
- Develop/enhance peer review process (8 states)
- Develop system designed to obtain family/youth feedback regarding agency performance (Families-5 states; Youth-1 state)

**Notes:**
This slide depicts the broad categories of strategies most commonly used by States in their PIPs to make improvements in Quality Assurance.  The numbers are approximate.

## QA State-Specific Examples

- Develop a county-based self-assessment and program improvement plan process (California)
- Utilize technology in the case review process (Oklahoma)
- QA process developed by the courts to review court issues in a sample of cases (Wisconsin)
- Implement data based decision making at the supervisory level (Arizona)
- Review both public and private agency cases (Illinois)

**Notes:**
This slide depicts some State-specific examples of PIP efforts to make improvements in Quality Assurance.

## What strategies address improvements in quality assurance?

- Develop clearly-defined QA unit
- Develop assessment tool for TA needs
- Develop QA system based on national models
- Use statewide and community QA committees
- Implement Local Improvement Plans
- Develop QA system utilizing Council of Accreditation standards

**Notes:**
This slide identifies common strategies used by States in their PIPs to improve the quality assurance process.

## What strategies address front line supervision?

- Involve supervisory staff in QA process
- Focus supervisory oversight on specific issues
- Develop standardized supervisor review instrument
- Increased clinical supervision of case management
- Use regional supervisory groups as support

**Notes:**
This slide identifies common strategies used by States in their PIPs to improve front line supervision of casework staff.

## What strategies enhance use of QA information to monitor and guide work?

- Develop feedback process
- Partnerships among program, QA, and data staff
- Compare key practice areas among offices
- Share successful strategies
- Monitor progress on PIP goals at various levels
- Develop and management reports of QA results (to target key areas of concern)

**Notes:**
This slide identifies common strategies used by States in their PIPs to enhance the use of information from quality assurance in monitoring and guiding the agency’s work.

## What strategies address Tribal quality assurance?

- Develop case review systems to assess tribal performance (Oklahoma)
- Quarterly meetings  between State and Tribal representatives to review re-entry data (North Dakota)
- Regional State/Tribe forums to address re-entry (Washington)
- Include Tribal representatives in CQI meetings (Louisiana)
- Child Welfare Agency, Tribal, and Community groups monitor in-home cases (Alaska)

**Notes:**
This slide identifies examples of State PIP strategies designed to address quality assurance related to Tribal issues and concerns.

## DATAINDICATORS

## States Conforming to National Standards in Initial CFSR

**Notes:**
This slide depicts the number of States that met and did not meet national standards for the six data indicators used in the initial 52 CFSRs.  A full report of the findings of the initial 52 CFSRs is located on the Children’s Bureau website.

## Number of States with Improvement on Data Indicators 2002 to 2004

**Notes:**
This slide shows the number of States that improved from FFY02 to FFY04 for each of the national standard indicators. The recurrence of maltreatment and maltreatment in foster care only counts states that reported child file NCANDS for both years. 

## National Median Percent Change on Data Indicators 2002 - 2004

**Notes:**
This slide charts the national median percent change from FFY2002 to FFY2004 for each of the indicators. The recurrence of maltreatment and maltreatment in foster care only includes states that reported child file NCANDS for both years. All percent improvement has been converted to positives

## Number of States Addressing Each National Standard Data Indicator (31 States with a completed PIP)

**Notes:**
This slide shows the number of States addressing each of the data indicators in approved PIPs for the first 31 States that reached the end of the 2 year PIP implementation period. Completed States on this slide and the following slides refer only to the end of the 2 year implementation period. 

## Months from PIP Approval to End of 2004 Data Period – First 31 States

**Notes:**
This slide shows the number of months after PIP approval to the end of the FFY2004 data period measured  for each of the first 31 states to reach the end of their PIP implementation period. The 31 States ranged from 33 months after PIP implementation to 9 months. ACF recognizes change officially for up to 36 months

## Performance on Relevant Permanency Indicators in 31 States with Completed PIP Implementation

**Notes:**
This slide shows the number of States, of the first 31 completing PIP implementation, that improved and did not improve for each of the permanency data indicators from 2002 to 2004. 
This slide shows the number of states that improved and did not improve from 2002 to 2004 of the first 31 states completing PIP implementation. Only those states that were required to address the indicator are included 

## Performance Above National Top Quartile on Adoption Measure for 23 States with PIP focus on Adoption(Percent Change from FY 2002 to FY 2004)

- Top Quartile
- 26%

**Notes:**
This slide charts the first 23 States completing PIP implementation and addressing the data indicator measuring adoptions within 24 months measure that were at or above the national third quartile percent change from FFY2002 to FFY 2004. 

## States with Highest Improvement on Adoption Measure (Among 23 States with PIP focus on Adoption)

| State | % Improvement | Range |
| --- | --- | --- |
| Arizona | 33 | 28.5 – 38.0 |
| California | 35 | 20.9 – 28.3 |
| Connecticut | 87 | 10.6 - 19.9 |
| Delaware | 96 | 14.0 – 27.4 |
| Kentucky | 50 | 14.9 - 22.4 |
| New Mexico | 35 | 32.7 – 44.2 |
| Oregon | 41 | 12.5 – 17.6 |
| Tennessee | 78 | 11.8 – 21.0 |
| Vermont | 34 | 23.0 – 30.8 |

**Notes:**
This slide lists the States that were above the national third quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring adoptions within 24 months. The range column shows the FFY2002 measure for the indicator and the FFY2004 measure. 

## Strategies for Addressing Adoption  of Most Improved States 

- Training for judges and/or courts on TPR and concurrent planning (8 of the 9 States)
- Concurrent planning policy development implementation or training (8 of the 9 States)
- Focus on supervision of permanency planning (8 of the 9 States)
- Use of specialized teams reviewing adoption progress (4 of the 9 States)
- Strengthened capacity of information systems measuring progress to adoption (8 of the 9 States)

**Notes:**
This slide depicts a general summary of the common strategies found associated to timely adoption for States listed on the previous slide. The fourth bullet about specialized teams was found in 3 of the States. The strategy descriptions are approximate.

## Performance Above National Top Quartile on Reunification Measure for 19 States with PIP focus on Reunification(Percent Change from FY 2002 to FY 2004)

- Top Quartile 4.2%

**Notes:**
This slide charts the first completed PIP States that were above the national third quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring reunification within 12 months. Note that the improvement on re-entry for states should be considered along with the relationship of performance in re-entry.

## States with Highest Improvement on Reunification Measure(Among 19 States with PIP focus on reunification)

| State | % Improvement | Range |
| --- | --- | --- |
| Alabama | 11 | 61.4 – 68.0 |
| Connecticut | 29 | 40.5 – 63.0 |
| Kansas | 6 | 42.3 – 45.1 |
| Tennessee | 18 | 65.0 – 76.0 |
| Vermont | 9 | 60.8 – 66.5 |

**Notes:**
This slide lists the States that were above the national third quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring reunification within 12 months. The range column shows the FFY2002 measure for the indicator and the FFY2004 measure. 

## Strategies Addressing Reunification for Most Improved States

- Strengthen supervision on permanency planning
-    (2 of the 5 States)
- Concurrent Planning (3 of the 5 States)
- Developing  data reports to monitor reunification (3 of the 5 States)
- Enhancing quality of parental visitation (1 of the 5 States)

**Notes:**
This slide depicts a general summary of the strategies found associated to reunification timeliness for the four States listed on the previous slide. The numbers in brackets indicate the number of States that had a similar strategy. The strategy descriptions are approximate.

## Performance above Top Quartile on Stability Measure for States with PIP focus on Stability(Percent Change from FY 2002 to FY 2004)

- Top Quartile 2.1

**Notes:**
This slide lists the five States that were above the national third quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring the percent of children in care less than 12 months with no more than 2 placements. 

## States with Highest Improvement on Placement Stability (Among 22 States with PIP focus on Placement Stability)

| State | % Improvement | Range |
| --- | --- | --- |
| Tennessee | 13 | 64.9 - 73.7 |
| Kentucky | 11 | 79.0 - 87.5 |
| Vermont | 7 | 63.9 – 68.5 |
| Oklahoma | 6 | 72.3 – 76.7 |
| Massachusetts | 5 | 75.8 – 79.6 |
| Minnesota | 3 | 87.5 – 89.8 |

**Notes:**
This slide lists the States, of the first 31 completing PIP implementation with a PIP focus on the placement stability indicator, that were above the national third quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring the percent of children in care less than 12 months with no more than 2 placements. The range column shows the FFY2002 measure for the indicator and the FFY2004 measure. 

## Strategies Addressing Placement Stability for Most Improved States

- Build on promising practice from more successful counties (2 of the 6 States)
- Use of foster parent teams or support groups (2 of the 6 States)
- Training on partnerships with foster parents, agency staff, service providers (2 of the 6 States)
- Expanded and targeted Foster Family recruitment (2 of the 6 States)
- Data reports on stability distributed to county level (5 of the 6 States)

**Notes:**
This slide depicts a general summary of the strategies found associated to placement stability for the four States listed on the previous slide. The strategy descriptions are approximate.

## Performance Above National Top Quartile on Re-entry Measure for 16 States with PIP focus on Re-entry (Percent Change from FY 2002 to FY 2004)

- Top Quartile 18.6%

**Notes:**
This slide charts the first completed PIP States that were above the national top quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring the percent of children that re-entered care within 12 months of a prior episode. Note that the improvement on re-entry for states should be considered along with the relationship of performance in reunification.

## States with Highest Improvement on Re-entries (Among 16 States with PIP focus on Re-entry) 

| State | % Improvement | Range |
| --- | --- | --- |
| Arizona | 20 | 12.2 – 9.7 |
| Indiana | 22 | 11.6 – 9.0 |
| North Dakota | 38 | 19.5 – 12.1 |
| Oregon | 23 | 10.8 – 8.3 |
| South Dakota | 33 | 19.9 – 13.2 |
| Tennessee | 23 | 11.1 – 8.6 |

**Notes:**
This slide lists the States that were above the national third quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring the percent of children that re-entered care within 12 months of a prior episode. The range column shows the FFY2002 measure for the indicator and the FFY2004 measure. 

##  Strategies Addressing Re-entry for  Most Improved States

- Training on clinical skills and supervision related to discharge planning (3 of the 6 States)
- Policy, training on enhancing input from families prior to discharge (3 of the 6 States)
- Examination of data and reasons children re-enter (3 of the 6 States)
- Implement multidisciplinary review prior to reunification (2 of the 6 States)
- Improve access to services post discharge (3 of the 6 States)
- Training on needs of older foster children (2 of the 6 States)

**Notes:**
This slide depicts a general summary of the strategies found associated to foster care re-entry for the six States listed on the previous slide. The numbers in brackets indicate the number of States that had a similar strategy. The strategy descriptions are approximate.

## Safety Indicators

**Notes:**
This slide shows the number of States, of the first 31 completing PIP implementation and addressing the indicator, that improved and did not improve for each of the safety data indicators. The 2004 data is preliminary and has not been reviewed by all States. States not reporting NCANDS Child File information for 2002 and 2004 are excluded.

## Performance Above National Top Quartile on Recurrence of Maltreatment for 15 States with PIP focus on the Measure(Percent Change from FY 2002 to FY 2004)

- Top Quartile 17. 3%

**Notes:**
This slide charts the only 2 of the 4 completed PIP States that were above the national top quartile percent change from FFY2002 to FFY 2004 and addressing the data indicator measuring recurrence of maltreatment. States not reporting NCANDS Child File information for 2002 and 2004 are excluded. Two States (CA,WY) was excluded because of known data submission issues that impacted the measurement of improvement over the time period Percent change converted to positive

## States with Highest Improvement on  Recurrence of Maltreatment (Among 15 States with PIP focus on Recurrence of Maltreatment) 

| State | % Improvement | Range |
| --- | --- | --- |
| Connecticut | 25 | 11.8 – 8.9 |
| Vermont | 18 | 5.5 – 4.5 |

**Notes:**
This slide lists the 2 most improved States that were above the top quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring recurrence of maltreatment. States not reporting NCANDS Child File information for 2002 and 2004 are excluded. Percent change converted to positive The range column shows the FFY2002 measure for the indicator and the FFY2004 measure. States not reporting NCANDS Child File information for 2002 and 2004 are excluded. Two States (CA,WY) was excluded because of known data submission issues that impacted the measurement of improvement over the time period

## Strategies Addressing Recurrence of Maltreatment for  Most Improved States

- Develop and implement or revise Structured Decision Making (2 of the 2 States)
- QA System used to examine causes and address through supervision (1 of the 2 States)
- Monitoring progress and reports to local staff (2 of the 2 States)

**Notes:**
This slide depicts a general summary of the strategies found addressing recurrence of maltreatment for the 3 States listed on the previous slide. The numbers in brackets indicate the number of States that had a similar strategy. The strategy descriptions are approximate.

## Performance In National Top Quartile on Maltreatment in Foster Care for 13 States with PIP focus on the Measure(Percent Change from FY 2002 to FY 2004)

- Top Quartile
- 38%

**Notes:**
This slide charts the percent change for the first 13 States addressing the data indicator for maltreatment in foster care and the relationship to the national percent change from FFY2002 to FFY 2004 for the data indicator. States not reporting NCANDS Child File information for 2002 and 2004 are excluded. 

## States with Highest Improvement on Maltreatment in Foster Care (Among 13 States with PIP focus on Measure ) 

| State | % Improvement | Range |
| --- | --- | --- |
| Oklahoma | 42 | 1.62 – 0.93 |
| Florida | 39 | 0.52 – 0.32 |
| New York | 38 | 0.87 – 0.54 |

**Notes:**
This slide lists the 4 most improved States that were at or above the top quartile percent change from FFY2002 to FFY 2004 for the data indicator measuring maltreatment in foster care. The range column shows the FFY2002 measure for the indicator and the FFY2004 measure. States not reporting NCANDS Child File information for 2002 and 2004 are excluded. 

## Strategies Addressing  Maltreatment in Foster Care for  Most Improved States

- Implemented system of care for foster care providers (1 of the 3 States)
- Training to staff on conducting foster parent risk assessments and investigations (1 of the 3 States)
- Supervisors trained on high risk protocol (1 of the 3 States)
- Training on continuous family assessment (1 of the 3 States)
- Training manual/CD to all foster parents on expectations (1 of the 3 States)

**Notes:**
This slide depicts a general summary of the strategies found addressing maltreatment in foster care for the 4 States listed on the previous slide. None were common across the states. The strategy descriptions are approximate.

## CONTEXTUAL FACTORS ANDAPPROACHES TOPIP DEVELOPMENT AND IMPLEMENTATION

## How have States engaged their local offices in PIP development and implementation?

- Implementation of quality assurance systems
- Developing local program improvement plans
- Improved communication techniques
- Use of data
- Expanding practice changes or piloting new approaches in the PIP
- Providing enhanced technical assistance to counties

**Notes:**
This slide depicts common strategies that States used in their PIPs to engage local offices, e.g., county or area agencies, in PIP development and implementation.   

## How have States engaged courts in PIP development and implementation? 

- Use PIP to increase communication with court
- Coordinate PIP/CIP strategic plan efforts
- Chief Judge support change and/or leads change efforts
- Cross-train judges, attorneys, child welfare staff
- Judges and CIP leaders participate as partners in the CFSR and PIP process
- Governor promotes collaboration between courts and the agency

**Notes:**
This slide depicts common strategies that State agencies used in their PIPs to engage courts in PIP development and implementation.   

## What are the challenges to collaboration with courts?

- Lack of  statewide focus of CIP
- Lack of communication and information-sharing between the agency and the CIP
- Courts not involved in the CFSR/PIP development process
- Inconsistency in commitment  to making court improvements

**Notes:**
This slide depicts common challenges associated with agency/court collaboration in PIP development and implementation.

## How have States collaborated with Tribes in PIP development and implementation?

- Inclusion in quality assurance process
- Clarification of roles and responsibilities
- Establishment of State/Tribal agreements, incl. IV-E
- Implementation of new or improved services
- Improve ICWA compliance, including tribal liaisons
- Training, including an academy for tribal CPS staff
- Sharing information and improving communication
- Included tribes in CFSR and PIP development

**Notes:**
This slide depicts common strategies that State agencies used in their PIPs to engage Tribes in PIP development and implementation.   

## How have States collaborated with youth in PIP development and implementation?

- Youth advisory boards
- Add staff to work with youth
- Development of youth handbooks or other communication materials
- Expansion of services to youth

**Notes:**
This slide depicts common strategies that States used in their PIPs to engage youth who are currently in foster care or were formerly in foster care in PIP development and implementation.   

## How have the following areas affected PIP development and implementation?

- Leadership and Agency Culture
- Consent Decrees or litigation
- Use of Training and Technical Assistance
- Budget and resources, etc.
- Change at the local level

**Notes:**
This slide depicts selected domains that have affected PIP development and implementation in the initial CFSRs.

## How has leadership affected PIP development and implementation?

- Governor’s and legislature’s support and involvement in spearheading improvements
- Embraced the CFSR/PIP process – used it to create a vision for change
- Supported involvement and responsibility at the county and local levels, including supervisory staff
- Promoted and demonstrated receptivity for change
- Commitment to the PIP was sustained through administration changes

**Notes:**
This slide depicts some common effects of agency leadership on PIP development and implementation among the first 52 CFSRs.

## What are the challenges to effective PIP leadership?

- Institutional instability; one or more changes at director/commissioner level
- PIP not integrated with consent decrees
- Inability to model a positive attitude toward change and systems improvement
- Did not support systemic change
- Agency leadership not involved in PIP process

**Notes:**
This slide depicts some common challenges to PIP implementation and development with regard to agency leadership.

## How did consent decrees impact PIPs?

- Design the PIP to align with Consent Decree exit strategies
- Use the PIP action steps to reach resolution of the Consent Decree
- Did not integrate the Consent Decree and the PIP
- The lawsuit diverted attention away from the PIP process
- Prioritize the Consent Decree and left some PIP goals unaddressed

**Notes:**
This slide depicts some common effects of consent decrees (or settlement agreements) on PIP implementation and development in the initial 52 CFSRs.

## How did States use  Training/Technical Assistance?

- Forge a relationship with one or more trainers from an NRC
- Use NRCs as part of an overall T/TA plan
- Use T/TA to motivate agency change
- Use T/TA to address specific issues, such as court/legal, recruitment, adoption, QA
- Request T/TA but did not follow-through with NRC recommendations
- Ask for T/TA very late in the PIP process
- Utilize T/TA only to satisfy a PIP requirement

**Notes:**
This slide depicts some common uses of technical assistance and training used by States in the initial 52 CFSRs to develop and implement their PIPs.

## What resource issues were frequently cited?

- Hiring freezes and/or slowdowns
- Increased caseloads
- Issues with staff retention
- Need to promote less-experienced staff due to high turnover
- Inability to meet basic family needs for housing, employment, etc.
- Temporary cutbacks in services
- Cutbacks in supports to foster and adoptive families

**Notes:**
This slide depicts some common resource issues faced by States in developing and implementing their PIPs in the initial 52 CFSRs.

## How did States manage economic setbacks?

- Approximately half of the States overcame barriers through creative means and were able to complete PIP initiatives
- Approximately half of the States obtained restored or increased funds for PIP initiatives
- Some States used the PIP as a mandate to leverage funds from their legislature

**Notes:**
This slide identifies some common approaches of States in dealing with the economic issues that affected PIP development and implementation.

## How are States managing and sustaining change?

- Local and State QA systems
- Promote supervisory development
- Use QA results and data with local offices and supervisors to change practice
- Use forums and stakeholder input to analyze and correct problems
- Open communication between administration and the field

**Notes:**
This slide depicts some common approaches of States to managing and sustaining improvements made through PIP implementation.

## What are the challenges to sustaining change?

- Not institutionalizing QA efforts or starting QA reviews late in the PIP process
- PIPs that focus on “plan-to-plan” and do not fully implement change
- Not addressing the need to change agency culture
- Not engaging stakeholders, particularly other State entities, to assist with systems change

**Notes:**
This slide depicts some common challenges faced by States in sustaining improvements made through PIP implementation.

## What were examples of State successes in PIP implementation?

- Agency is speaking “the same language”
- Use data in daily practice
- Institute a learning organization via CQI
- Change agency culture
- Align CW, JJ, mental health through communication and common vision
- Improve collaboration with community partners, connect  planning at local level
- Improve supervision to direct and monitor casework
- Obtain additional funding for new staff
- Train the field on best practice initiatives

**Notes:**
This slide depicts some examples of State successes in implementing PIPs.

## What were examples of the challenges to PIP implementation?

- Economic/resource issues
- Unanticipated complexity of implementing some strategies
- Lack of leadership
- Challenges in State/county relationships
- Low morale in the field and staff turnover
- Lack of collaboration with other State agencies and other key stakeholders

**Notes:**
This slide depicts some examples of challenges faced by States in implementing PIPs.

## What were examples of the challenges to PIP implementation? (continued)

- Issues with data quality and quality assurance systems
- Over-reliance on training and policy changes as a strategy
- Lack of alignment with consent decree and other plans
- Failure to involve all levels of the agency in PIP

**Notes:**
This slide is a continuation of the previous slide.

## Sustaining Change

## How can States sustain the improvements they make?

- Invest in values, belief, vision
- Strengthen the practices that are linked to outcomes
- Engage external stakeholders
- Engage counties
- Engage State legislatures
- Implement and use quality assurance

**Notes:**
This slide summarizes some strategies that States may choose to use in sustaining improvements made through PIP implementation.

## Children’s Bureau Website

**www.acf.hhs.gov/programs/cb**