Department of Health and Human Services

OFFICE OF 

INSPECTOR GENERAL 

S S
TATE  TANDARDS AND 

P C
RACTICES FOR  ONTENT OF 

C V W
ASEWORKER  ISITS  ITH 

C F C
HILDREN IN  OSTER  ARE

Daniel R. Levinson 

Inspector General 

December 2005

OEI-04-03-00351
 Office of Inspector General 

http://oig.hhs.gov 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, 
as amended, is to protect the integrity of the Department of Health and Human Services 
(HHS) programs, as well as the health and welfare of beneficiaries served by those 
programs.  This statutory mission is carried out through a nationwide network of audits, 
investigations, and inspections conducted by the following operating components: 
Office of Audit Services 
The Office of Audit Services provides all auditing services for HHS, either by conducting 
audits with its own audit resources or by overseeing audit work done by others. Audits 
examine the performance of HHS programs and/or its grantees and contractors in 
carrying out their respective responsibilities and are intended to provide independent 
assessments of HHS programs and operations in order to reduce waste, abuse, and 
mismanagement and to promote economy and efficiency throughout HHS. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) conducts management and program 
evaluations (called inspections) that focus on issues of concern to HHS, Congress, and 
the public.  The findings and recommendations contained in the inspections generate 
rapid, accurate, and up-to-date information on the efficiency, vulnerability, and 
effectiveness of departmental programs.  OEI also oversees State Medicaid Fraud 
Control Units which investigate and prosecute fraud and patient abuse in the Medicaid 
program. 
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries 
and of unjust enrichment by providers.  The investigative efforts of OI lead to criminal 
convictions, administrative sanctions, or civil monetary penalties. 
Office of Counsel to the Inspector General 
The Office of Counsel to the Inspector General (OCIG) provides general legal services to 
OIG, rendering advice and opinions on HHS programs and operations and providing all 
legal support in OIG's internal operations. OCIG imposes program exclusions and civil 
monetary penalties on health care providers and litigates those actions within HHS. 
OCIG also represents OIG in the global settlement of cases arising under the Civil False 
Claims Act, develops and monitors corporate integrity agreements, develops compliance 
program guidances, renders advisory opinions on OIG sanctions to the health care 
community, and issues fraud alerts and other industry guidance.    E X E C U T I V E   S U M M A R Y  

OBJECTIVE 
To determine (1) the written standards States have implemented for the 
content of caseworker visits with children in foster care and (2) the 
practices of States without written standards. 
BACKGROUND 
Caseworker visits are a critical element in maintaining the safety and 
well-being of children in foster care.  There are no Federal requirements 
regarding specific activities that caseworkers must perform during 
visits with children in foster care.  However, the Administration for 
Children and Families (ACF) reviews caseworker visits as part of its 
Child and Family Service Reviews (CFSRs).  ACF reviewed all  
50 States, the District of Columbia, and Puerto Rico between 2001 and 
2004. During CFSRs, ACF determines, for approximately 50 cases per  
State, whether the frequency of caseworker visits with children was 
sufficient to ensure adequate monitoring of the childs safety and well-
being and whether visits were focused on issues pertinent to case 
planning, service delivery, and goal attainment.  States are either given 
a positive assessment (a strength rating) if visits were of sufficient 
frequency and content or are assessed as needing improvement.  ACF 
reported that a strength rating for caseworker visits is associated with 
positive outcomes of achieving permanency and ensuring child safety.   
ACF summarized the results of all States receiving CFSRs, and 
included additional information for the 35 CFSRs that were completed 
during 2002 through 2004.  For these 35 States, the ACF summary 
included details about caseworker visitation for the child welfare cases 
reviewed, which included both children in foster care and those 
receiving in-home services.  Fourteen of the 35 States were cited as 
needing improvement in the content of caseworker visits. 
The difference between the CFSRs and this evaluation is that the 
CFSRs include a detailed review of approximately 50 child welfare cases 
per State (a combination of foster care cases and those receiving  
in-home services), whereas OIGs evaluation focused exclusively on 
State standards for children in foster care. OIGs report provides an 
analysis of States written standards for the content of visits, as well as 
reported content activities for States without written standards.   
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ACF also funded a caseworker training initiative by the National 
Resource Center for Family Centered Practice and Permanency 
Planning in 2004; the resulting training materials state that caseworker 
visits are . . . not a friendly visit or an opportunity to chat about how 
the kids are doing.  Instead, visits should be well planned and focused 
on childrens safety and well-being, as well as permanency. 
At the beginning of our evaluation in 2004, ACF staff requested that we 
review the standards and practices related to the content of caseworker 
visits, emphasizing that the value of frequent caseworker visits is 
greatly diminished if visits do not focus on substantive content issues.  
The information in this report should enhance ACFs oversight of State 
foster care programs related to the content of caseworker visitation.  We 
define the content of caseworker visits as specific activities that 
caseworkers perform during visits with children in foster care.  These 
activities include observations and assessments to help ensure the 
safety and well-being of children for whom care is provided.    
This report is the second in a series of three reports about caseworker 
visits with children in foster care. In the first report, State Standards 
and Capacity to Track Frequency of Caseworker Visits with Children in 
Foster Care, OEI-04-03-00350, OIG examined standards States have 
established related to the frequency of caseworker visits.  The third 
report in the series, Compendium of State Standards: Content of 
Caseworker Visits With Children in Foster Care, OEI-04-03-00353, 
provides State written standards guiding the content of caseworker 
visits with children in foster care.  The compendium includes standards 
provided by 38 States. 
A primary component of this evaluation was a document review of 
States written standards regarding the content of caseworker visits 
with children in foster care.  Another key component, for States without 
written standards, was analysis of State-reported activities typically 
performed during visits.  We collected information from all 50 States 
and the District of Columbia (referred to as 51 States throughout this 
report).  Our data collection, conducted during February through July 
2004, consisted of an e-mail data collection instrument and a structured 
telephone interview with each States child welfare program officials.   
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FINDINGS 
Forty-one out of fifty-one States reported implementing statewide 
written standards for the content of caseworker visits with children 
in foster care.  Thirty-eight of these States had written standards 
specific to caseworker visits.  The most commonly cited activities 
recommended in the standards were related to building relationships 
and/or communication between the child and caseworker, and 
addressing the needs of and services for the child.  Three of the forty-
one States reported having written documents addressing the content of 
caseworker visits, but as part of broader program areas such as case 
planning and family service plans. Since these documents were not 
specific to caseworker visits, we did not analyze them.   
Of the 10 States without written standards, 8 of the States reported 
the types of activities typically performed during caseworker visits. 
Generally, the activities reported by the eight States were similar to 
those of States with written standards.  Three of the most commonly 
cited categories of activities were adjustment to the foster care 
placement, child safety, and physical health of the child. The remaining 
two States reported that visitation activities either depended on the 
case or were determined by local policy.  The 10 States reported various 
reasons for not having content standards.  For example, three States 
reported that they were exploring development of content standards or 
guidelines, or use of a contact sheet or checklist. 
CONCLUSION 
Caseworker visitation with children in foster care is a critical element 
for ensuring child safety and well-being.  Through its oversight of the 
foster care program, ACF has underscored the importance of 
substantive content during caseworker visitation.  The information in 
our report has never been provided on a national level before our 
evaluation. We hope it will be useful to ACF in its review of State 
activities and to the States as they carry out and consider ways to 
improve their own foster care programs. 
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EXECUTIVE SUMMARY ........................................ i

INTRODUCTION ................................................ 1 

FINDINGS ....................................................... 8 

States with written content standards. . . . . . . . . . . . . . . . . . . . . . .  8

States without writtencontent standards  . . . . . . . . . . . . . . . . . .  10

CONCLUSION .................................................. 12

AGENCY COMMENTS ......................................... 13

ENDNOTES ..................................................... 15 

APPENDIXES .................................................. 16 

Appendix A:  Categories and Definitions for Content of Visits  . .  16 

Appendix B:  Content Categories for States With Written 

Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  20

Appendix C:  Content Categories Reported by States Without 

Written Standards  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  24

ACKNOWLEDGMENTS ......................................... 26
   I N T R O D U C T I O N  

OBJECTIVE 
To determine (1) the written standards States have implemented for the 
content of caseworker visits with children in foster care and (2) the 
practices of States without written standards. 
BACKGROUND 
Caseworker visits are a critical element in maintaining the safety and 
well-being of children in foster care.  There are no Federal requirements 
regarding specific activities that caseworkers must perform during visits 
with children in foster care.  However, the Administration for Children 
and Families (ACF) reviews caseworker visits as part of its Child and 
Family Service Reviews (CFSRs).   ACF reviewed all 50 States, the 
District of Columbia, and Puerto Rico between 2001 and 2004.  During 
CFSRs, ACF determines, for approximately 50 cases per State, whether 
the frequency of caseworker visits with children was sufficient to ensure 
adequate monitoring of their safety and well-being and whether visits 
focused on issues pertinent to case planning, service delivery, and goal 
attainment.  States are either given a positive assessment (a strength 
rating) if visits were of sufficient frequency and content or are assessed as 
needing improvement. ACF reported that a strength rating for 
caseworker visits is associated with positive outcomes of achieving 
permanency and ensuring child safety.   
ACF summarized the results of all States receiving CFSRs, and included 
additional information for the 35 CFSRs that were completed during 2002 
through 2004. For these 35 States, the ACF summary included details 
about caseworker visitation for the child welfare cases reviewed, which 
included both children in foster care and those receiving in-home services. 
Fourteen States were cited as needing improvement in the content of 
caseworker visits.1 
The difference between the CFSRs and this evaluation is that the CFSRs 
include a detailed review of approximately 50 child welfare cases per 
State (a combination of foster care cases and those receiving in-home 
services), whereas OIGs evaluation focused exclusively on State 
standards for children in foster care. OIGs report provides an analysis of 
States written standards for the content of visits, as well as reported 
content activities for States without standards.   
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ACF also funded a 2004 initiative by the National Resource Center for 
Family Centered Practice and Permanency Planning to develop training 
materials for States to guide the content of caseworker visits.  The 
training materials state that caseworker visitation is . . . not a friendly 
visit or an opportunity to chat about how the kids are doing.  Instead, the 
visit should be well planned, purposeful, and focused on childrens safety 
and well-being, as well as permanency. 
At the beginning of our evaluation in 2004, ACF staff requested that we 
review the standards and practices related to the content of caseworker 
visits, emphasizing that the value of visits is greatly diminished if they do 
not focus on substantive content issues. The information in this report 
should enhance ACFs oversight of State foster care programs related to 
the content of caseworker visitation.  We define the content of caseworker 
visits as specific activities that caseworkers perform during visits with 
children in foster care. These activities include observations and 
assessments to help ensure the safety and well-being of children for whom 
care is provided.   
The Foster Care Program 
The Title IV-E Foster Care Program is an entitlement program 
administered by the Childrens Bureau within ACF.  According to ACF, 
foster care is defined as twenty-four-hour substitute care for children 
placed away from their parents or guardians and for whom the State 
Agency has placement and care responsibility.2  Children in foster care 
live in a variety of placement settings, including family foster homes, 
foster homes of relatives, group homes, emergency shelters, residential 
facilities, child care institutions, and preadoptive homes.3 
The Federal budget for the Foster Care program in fiscal year (FY) 2005 
is $4.9 billion.4  The Department of Health and Human Services (HHS) 
anticipates that it will provide funding monthly for 233,000 children 
eligible for assistance under Title IV-E during FY 2005.  States receive 
Federal matching funds under Title IV-E for children in foster care whose 
families meet income requirements. 
Federal Role 
As part of its Federal oversight role, ACF conducts reviews to assess 

States compliance with Federal requirements.  These reviews include 

Title IV-E Eligibility reviews, Adoption and Foster Care Analysis and 

Reporting System reviews, Statewide Automated Child Welfare 

Information System reviews, and CFSRs.5  Of those reviews, only the 

CFSRs address the frequency and content of caseworker visits.  

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Pursuant to 45 CFR  1355.31-37, promulgated under section 1123A of 
the Social Security Act (the Act), ACF conducts CFSRs to ensure 
conformity with Federal child welfare requirements and to measure 
compliance with State plan requirements under Titles IV-B and IV-E.  
CFSRs are a joint Federal and State process.  Three categories of child 
welfare outcomes are reviewed:  safety, permanency, and well-being.  In 
addition, the reviews address systemic factors affecting the child welfare 
system. If States are not found to be in substantial conformity, they must 
submit to ACF within 90 days a Program Improvement Plan (PIP) 
outlining steps to correct deficiencies.  All States not in substantial 
conformity in the first round of CFSRs begin a full review 2 years after 
approval of their PIP.  None of the States (including the District of 
Columbia and Puerto Rico) were in substantial conformity after the first 
round, and therefore ACF will schedule each States subsequent review 
upon State completion and ACF evaluation of the PIP. 
As part of the CFSRs, a total of approximately 50 child welfare cases (a 
combination of foster care cases and those receiving in-home services) are 
reviewed in each State from selected sites.6  One of the items assessed is 
caseworker visits with children.  Each case is given either a positive 
assessment (a strength rating) or is rated as needing improvement, and 
the State is given an overall rating for all cases reviewed. 
State Role 
Although all States must comply with Federal regulations to receive 
Federal funding, each State determines how services are provided to 
children in foster care. The structure of foster care systems varies from 
State to State and often varies within States.  Some have State- 
administered systems in which the State directly provides foster care 
services to children. Other States have county-administered systems in 
which the State retains responsibility for the safety and well-being of 
children in foster care, while counties provide the services.  Adding a 
further layer of complexity, some State and county-administered 
programs contract a portion of or all foster care services to private 
agencies. 
To be eligible for foster care payments, States must submit a plan to be 
approved by the HHS Secretary.  Section 471(a)(22) of the Act requires 
that the plan include standards to ensure that children in foster care 
placements in public or private agencies are provided quality services that 
protect the safety and health of the children.  In addition, the State plan 
must provide for the development of a written case plan for each child and 
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provide for a case review system (section 471(a)(16)).  The case plan must 
include steps for ensuring that the child receives safe and proper care and 
that services are provided to the child, parents, and foster parents to 
address the needs of the child while in foster care (section 475(1)(B)).  
State case review systems must include procedures for ensuring that the 
status of each child is reviewed at least every 6 months either by a court 
or by administrative review (section 475(5)(B)). 
Related Work  
This report is the second in a series of three reports about caseworker 
visits with children in foster care. In the first report, State Standards 
and Capacity to Track Frequency of Caseworker Visits with Children in 
Foster Care, OEI-04-03-00350, OIG examined standards States have 
established related to the frequency of caseworker visits.  The third report 
in the series, Compendium of State Standards: Content of Caseworker 
Visits With Children in Foster Care, OEI-04-03-00353, provides State 
written standards guiding the content of caseworker visits with children 
in foster care.  The compendium includes standards provided by 38 
States. 
In addition to OIG work, the Government Accountability Office examined 
the CFSRs in a 2004 evaluation and found that ACF and States viewed 
the CFSRs as a valuable process. The report offered several 
recommendations to further improve the CFSRs.7 
METHODOLOGY 
For the purpose of our report, we define standards as written 
procedures providing guidance for caseworker visits with children in 
foster care.   Standards are included in State laws, regulations, policies, 
and other guidance.  Our primary data source was State standards for the 
content of caseworker visits.  We requested that the 50 States, the 
District of Columbia, and Puerto Rico provide State standards for 
caseworker visits.  Puerto Rico did not respond.  To gain a comprehensive 
picture of how the content of caseworker visits was addressed, the 50 
States and the District of Columbia (referred to as 51 States throughout 
this report) also completed a structured data collection instrument via e-
mail and participated in a structured telephone interview.  We also 
interviewed organizations with expertise in child welfare and conducted 
site visits in two States. 
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Documentation Review, E-Mail Data Collection Instrument, and Phone 

Interview

A critical component of our data collection and analysis was our review of 
State standards related to the content of caseworker visits. 
States with written content standards. To determine which States had 
content standards, we asked all 51 States, via the e-mail data collection 
instrument, to provide any State-written content standards about 
caseworker visits with children in foster care.  We conducted a document 
review of standards to identify specific activities that the standards 
indicated should occur during caseworker visits. 
We systematically grouped activities outlined in State standards into 
categories.  As we constructed our categories, we developed category 
definitions to guide our qualitative analysis by utilizing common language 
found in State documents.  Once we defined our categories, we 
consistently applied those definitions to the written standards and 
categorized all States standards.   
While categorizing the State standards, we identified key words or 
phrases associated with the categories. After completing our initial phase 
of categorization, we performed text analysis by conducting word searches 
within State standards to ensure that the standards were categorized 
appropriately.  For example, for the safety category, we searched for the 
following key words in State standards:  safe, safety, harm, and risk. If 
State standards included one of the identified words or phrases, we would 
review the specific standards again to ensure that the language was 
appropriate to the category.  If the language addressed that category area, 
then we would include that area as one of the States categories.  Two of 
the twenty-four activity categories were associated with assessing the 
overall safety and well-being of children.  In addition, many categories 
addressed more specific elements of child well-being, such as physical and 
mental health.  We reported category areas found in at least two States 
standards. For a complete listing of the categories of activities as well as 
the definitions we developed, see Appendix A.  
To ensure consistency, we had two analysts with subject matter expertise 
code the standards and come to agreement on each categorization.  We 
also had a third party (who was not involved in the study) review all of 
our coding decisions to ensure consistent application of our definitions.  
States without written standards. For States that did not provide written 
content standards, we gathered two types of information.  First, via our  
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e-mail data collection instrument, we asked States to describe content 
activities that typically occur during caseworker visits.  Because the 
activities reported by the States without written standards corresponded 
to the activities in the States with written standards, we categorized the 
data using the same groupings and performed similar text analysis.  In 
addition, during our structured telephone interview, States described 
reasons for not having written content standards.  We present categories 
reported by at least two States. 
We developed automated databases to compile survey and documentation 
information collected from States. We aggregated the data based on State 
responses using qualitative analysis to derive our results.  
Our data collection instruments and interviews were completed between 
February and July 2004.  When State information was incomplete, we 
continued to follow up with States throughout the fall of 2004.  We 
confirmed with all States that we received and analyzed the correct 
written standards. The information presented in this report represents 
standards in effect between February and July 2004. 
Interviews With Organizations and Site Visits to States 
To gain a richer understanding of how caseworker visits are addressed in 
States, we interviewed organizations and conducted site visits in two 
States prior to designing our evaluation.  The organizations included:  
Chapin Hall, the Center for Law and Social Policy, Childrens Defense 
Fund, Childrens Rights, Inc., Child Welfare League of America, the 
Heritage Foundation, and the Urban Institute. In addition, we visited 
one predominately urban State and one State that was more rural 
(Florida and Kentucky) to:  examine foster care records and determine the 
format in which caseworker visits were recorded, interview State and 
local administrators, conduct a focus group with foster parents (Kentucky 
only), interview caseworkers, collect State regulations and policies 
regarding caseworker visits, and review computer data systems. We also 
solicited input from ACF staff. 
Limitations 
Our content analysis was systematic in developing specific categories with 
definitions for each category to guide our analysis.  However, by its very 
nature, content analysis requires judgment in the selection and definition 
of categories.  We made such judgments based on our expertise in the 
subject matter and our careful examination of the State data.  Once we 
made these judgments, we took steps to consistently apply the criteria we 
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had developed.  However, others could have made different judgments on 
the selection and definition of categories.  
We selected standards specifically related to caseworker visits with 
children in foster care as our area of analysis because visits between 
caseworkers and children are a critical element in maintaining child 
safety and well-being. However, we recognize that visitation with 
children is one of many factors in the complex child welfare system that 
may affect child safety. We analyzed only those documents specifically 
related to caseworker visits with children in foster care. A few States 
documents pertained to program areas such as case planning and family 
service plans (not specific to caseworker visits).  However, we did not 
review these documents because they did not specifically address visits 
with children, and therefore were outside the scope of our evaluation.  
Similarly, some States submitted documents related to caseworker visits 
with the foster caregiver, in addition to those related to visits with 
children.  Although documents specific to caseworker visits with foster 
care providers could outline activities similar to those related to visits 
with children, this was not the focus of our review, and therefore these 
documents were not included in our analysis.    
Our review focused exclusively on standards and related information from 
the State level.  We did not examine standards from local or county levels 
of State child welfare systems, nor did we examine standards that private 
agencies may have in place.  We did not review States performance 
relative to their content standards, nor did we assess the quality of those 
standards. We recognize that States may be performing other activities 
that were not outlined in written standards.  However, since our 
evaluation focused on documented standards, we did not ask States with 
written content standards if there were any other content activities 
typically performed by caseworkers in addition to their standards.  
Additionally, we did not examine how States without written standards 
conveyed expected content activities to caseworkers (e.g., caseworker 
training). 
Standards 
We conducted this inspection in accordance with the Quality Standards 
for Inspections issued by the Presidents Council on Integrity and 
Efficiency and the Executive Council on Integrity and Efficiency. 
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Forty-one States reported implementing  There are no Federal standards 
statewide written standards for the content of  regarding specific activities that 
caseworker visits with children in foster care  caseworkers must perform during 
visits with children in foster care. 
However, 41 out of 51 States reported implementing standards 
addressing the content of caseworker visits at the State level. Thirty-
eight of these States had written standards specific to caseworker visits. 
Three of the forty-one States reported having written documents 
addressing the content of caseworker visits, but as a part of broader 
program areas such as case planning and family service plans.  
Thirty-eight of the forty-one States had implemented written standards 
specific to caseworker visits 
These States had standards that specified activities that should take 
place during caseworker visits.  To emphasize the importance of content 
of caseworker contact, one States standards described the content of 
caseworker visits in this manner: worker visits are to be of such 
substance and duration as to promote strong assessment, help children 
see that their well-being is a priority to the social worker, and ensure the 
workers professional awareness of childrens safety and circumstances. 
The most commonly cited visitation activities were related to 
relationships and/or communication between the caseworker and the 
child, and caseworkers addressing the needs of and services to the child. 
States addressed relationships and/or communication with the child in a 
variety of ways.  One States standards detailed that caseworkers must 
develop and maintain a good working relationship with the child, while 
another State outlined that caseworkers should have open, age-
appropriate communication with the child during visits.  States often 
addressed needs of and services to the child in similar ways.   For 
example, one States standards directed caseworkers to assess the 
effectiveness of services provided to meet the childs needs. 
In addition to relationships and/or communication with the child and 
needs of and services to the child, other categories of visitation activities 
were commonly found in State standards.  What follows are the most 
common categories and excerpts from State standards to illustrate how 
States address these activities:   
o 	 Safety of the child: Maintains monthly face-to-face contact with 
each foster child for the purpose of assessing appropriateness and 
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safety of the placement, including the monitoring of questionable 
illness, incidents, or injuries. 
o 	 Case planning: The worker should assess and document whether or 
not . . . [the] child, if of appropriate age, [is] actively participating in 
case planning; there are effective services in place to address areas 
of need outlined in the case plan agreement . . . or, if there is lack of 
progress, identification of specific barriers that are impeding 
progress.  
o 	 Physical health of the child: Determine the extent to which the 
childs . . . medical . . . needs are being met. 
o 	 Private discussion with the child: All contacts with a child (age 
three and older) should include an opportunity to meet privately 
with the child out of the presence of the foster parent or facility staff 
person. This private time allows the child to more openly share 
any concerns . . . as well as to discuss the treatment and care the 
child is receiving. 
o 	 Adjustment of the child to the foster care placement:  Face-to-face 
visits shall be made as frequently as is necessary to assure the 
childs adjustment to the placement. 
o 	 Addressing the childs concerns:  Address the childs concerns, 
including issues of separation and loss as well as any other issues. 
o 	 Progress of the child: The childs worker must regularly see the 
child in person to assess the childs progress . . . 
o 	 Mental health needs of the child:  Arrange for . . . services including, 
but not limited to . . . psychiatric [or] psychological services . . . 
o 	 Educational needs of the child: Assess and monitor the care the 
child receives, including the childs . . . education progress. 
o 	 Childs relationships or visits with parents, siblings, and other 
relatives: The assigned worker will inquire about the frequency, 
duration, and any issues related to parent and sibling visitation 
[with the child]. 
o 	 Well-being of the child: During the interview with children, the 
worker shall seek to determine . . . whether [the childs] safety and 
well-being needs are being met. 
Appendix A describes how we categorized State content standards.  In 
Appendix B, Table 1 lists the most commonly cited content categories and 
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which States standards are included in these categories. Appendix B, 
Table 2, lists additional, less common categories and the States with 
these categories.  
Three of the forty-one States reported having written documents addressing 
the content of caseworker visits as part of broader program areas   
The remaining three StatesFlorida, Michigan, and New Hampshire 
reported that they had documents addressing content.  However, these 
States addressed content as a part of documents related to broader areas 
such as case planning and family service plans. Case planning and 
service planning documents may address similar areas found in 
standards specific to visitation.  For example, in Michigan, the service 
plan directs caseworkers to describe the current status of the child  
(e.g., significant events since the last assessment, relevant medical/dental 
and optical information).  However, since these documents were not 
specific to caseworker visits, we did not analyze this information, and 
Florida, Michigan, and New Hampshire are not included in the tables in 
Appendixes B and C.   
Ten States did not provide written 
Of the 10 States without written standards, 
content standards for caseworker 
8 of the States reported the types of activities 
visits with children in foster care. 
typically performed during caseworker visits 
However, 8 of these 10 States 
reported that caseworkers performed certain activities routinely during 
visits with children.  These eight States reported performing activities 
generally similar to those of States with written standards.  The three 
most common activity categories were related to adjustment to the foster 
care placement, child safety, and physical health of the child.  For 
adjustment to the foster care placement, States most often reported that 
caseworkers should discuss with the child how he/she is adjusting or if 
there are any problems in the placement. For the other two most common 
categories, States reported that caseworkers should assess safety during 
visits and observe or assess the physical health of the child. 
In addition to adjustment to the foster care placement, child safety, and 
the physical health of the child, other areas of activity were commonly 
reported by States.  What follows are excerpts of the remaining most 
common categories:  
o 	 Educational needs of the child: During contact with children, 
caseworkers may discuss with the child how the child is doing . . . in 
school. 
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o 	 Addressing the childs concerns: The worker speaks with the child 
and inquires as to any problems in the placement, school, or other 
aspects of the childs life.  They then document any observations, 
problems, or concerns found. 
o 	 Relationships and/or communication between caseworker and the 
child: Discussion [with child] regarding progress . . . 
o 	 Case planning: Discussion regarding progress toward case goals. 
In Appendix C, Table 1 shows the most common categories reported by 
States. Table 2 lists additional, less-common categories reported by the 
States. Please refer to Appendix A for a complete listing of categories and 
definitions. 
Two of the ten States reported that visitation activities either depended on the 
case or were determined by local policy 
One State reported that content activities vary from case to case.  The 
other State reported that typical procedures are determined by local 
department policy.  However, that State reported it was drafting State 
parameters for the content of visits. 
The 10 States reported various reasons that they did not have written content 
standards 
States could report more than one reason; therefore the total number of 
reasons is higher than 10. States gave the following reasons: 
o 	 The State is exploring development of content standards or 
guidelines or use of a contact sheet or checklist (three States); 
o 	 Caseworkers are expected to follow best practice or conduct certain 
activities; therefore, specific content standards are not needed (two 
States); 
o 	 Content is or will be addressed in the States CFSR PIP (three 
States); 
o 	 Content depends on the individual case, purpose of visit, and/or 
similar factors (two States); 
o 	 Caseworkers and supervisors meet and discuss the activities that 
are expected to be performed during visits (one State); and  
o 	 The State declined to implement standards that would impose 
additional work on caseworkers (one State). 
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   C O N C L U S I O N  

Caseworker visitation with children in foster care is a critical element 
for ensuring child safety and well-being.  ACF staff requested that we 
review the standards and practices related to the content of caseworker 
visits, emphasizing that the value of visits is greatly diminished if they 
do not focus on substantive content issues.  The information in our 
report has never been provided on a national level before our 
evaluation. We hope it will be useful to ACF in its review of State 
activities and to the States as they carry out and consider ways to 
improve their own foster care programs. 
AGENCY COMMENTS 
In its comments to the draft report, ACF underscored the importance of 
the content of caseworker visitation.  The results of the first round of the 
CFSRs demonstrated the strong association between the frequency and 
quality of caseworker visitation with positive outcomes of safety, 
permanency, and well-being.  ACF stated that the findings of the OIG 
report will be a useful tool for States working on program improvements.  
OFFICE OF INSPECTOR GENERAL RESPONSE  
We appreciate ACFs comments to this report. We agree with ACFs 
statement that the findings of this report are an excellent companion to 
the CFSR results, and look forward to any future program improvements 
States implement based on this report.  
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1  http://www.acf.hhs.gov/programs/cb/cwrp/results/statefindings/ 
genfindings04/index.htm, accessed November 1, 2005. 
2 http://www.acf.hhs.gov/programs/cb/publications/cm01/appendb.htm, 
accessed April 25, 2005. 
3 http://www.acf.hhs.gov/programs/cb/publications/cm01/appendb.htm, 
accessed April 25, 2005.  
4 http://www.hhs.gov/budget/05budget/acf.html, accessed April 25, 2005.   
5 http://www.acf.dhhs.gov/programs/olab/legislative/testimony/2004/cw_ 
testimony.htm, accessed April 25, 2005.   
6 The cases reviewed onsite are selected from a random oversample of no 
more than 150 foster care and 150 in-home services cases.  45 CFR 
1355.33(c)(6).  The onsite review may take place in several political 
subdivisions of the State, but must include a States largest 
metropolitan subdivision.  45 CFR 1355.33(c)(2). 
7 http://www.gao.gov/new.items/d04333.pdf.    
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CARE    A P P E N D I X   ~   A  

Categories and Definitions for Content of Caseworker Visits 
This appendix consists of categories and definitions of caseworker content 
activities we developed to analyze State standards for the content of 
caseworker visits.  We developed the categories to systematically guide our 
qualitative analysis; the categories are based on the activities found in 
States written standards. They can be used as a reference for Appendix B, 
which provides an analysis of States written content standards.  Many of 
the categories found in States standards were consistent with content 
activities reported by States without written standards.  Therefore, these 
categories and definitions can also be used as a reference for the analysis of 
State-reported activities from those States without standards in  
Appendix C. 
Relationships and/or communication between the caseworker and the child: 
If States had language in their standards including caseworkers 
establishing a relationship or communicating with the child, then they were 
included in this category. 
Needs of and services to the child:  If States had language in their 
standards including caseworkers addressing the needs of or services or 
supports for the child, then they were included in this category.  This 
category includes standards with general references to addressing child 
needs, services, or supports.  If States had only specific references to 
particular types of needs such as safety, mental health, or physical health 
needs, then States were not included in this category as credit for these 
standards was given in the appropriate, more specific category(ies) (i.e., 
safety, mental health needs, physical health of the child). 
Safety of the child: If States had language in their standards including 
caseworker assessment of child safety or risk from harm, they were 
included in this category. 
Case planning:  If States had language in their standards including 
caseworkers addressing case, service, or treatment plans/goals, or progress 
towards permanency, then they were included in this category. 
Physical health of the child:  If States had language in their standards 
including caseworker assessment of the childs physical, medical, or health 
needs, then they were included in this category. 
OEI-04-03-00351  STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER  16 
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Private discussion with child:  If States had language in their standards 
indicating that the caseworker is to have discussions with the child alone, 
separately, or out of the presence of the provider, then they were included 
in this category. 
Adjustment of the child to the foster care placement:  If States had 
language in their standards including caseworkers addressing whether the 
child is adjusting specifically in the placement, then they were included in 
this category. 
Addressing the childs concerns:  If States had language in their standards 
including caseworkers addressing the childs concerns of any kind 
(including those related to the placement, safety, separation, and/or 
discipline issues), or if the child was having problems (including those in 
the placement), then they were included in this category. 
Progress of the child:  If States had language in their standards including 
caseworkers addressing general child progress, then they were included in 
this category.  If States had only specific references to particular types of 
progresssuch as progress toward mental health, educational, physical 
health, or social needs; or progress toward case, service, treatment plans, or 
permanencythen States were not included in this category.  These 
standards were addressed in the appropriate, more specific category(ies) 
(e.g., case planning, mental health needs, educational needs, physical 
health needs, social and/or emotional needs). 
Mental health needs of the child:  If States had language in their standards 
including caseworkers addressing childrens mental, developmental, 
psychological, or psychiatric health needs, then they were included in this 
category.   
Educational needs of the child:  If States had language in their standards 
including caseworkers addressing the childs educational, academic, school, 
or intellectual needs, then they were included in this category. 
Childs relationships and visits with parents, siblings, and other relatives: 
If States had language in their standards including caseworkers addressing 
the relationship or visitation between the child and parents, siblings, and 
other relatives, then they were included in this category.    
Well-being of the child: If States had language in their standards including 
caseworker assessment of child well-being, then they were included in this 
category. 
OEI-04-03-00351  STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER  17 
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Social and/or emotional needs of the child: If States had language in their 
standards including caseworkers addressing child emotional or social 
needs, then they were included in this category. 
Needs of and services to the foster care provider:  If States had language in 
their standards including caseworkers addressing any needs, services, 
respite, or support for the foster care provider, then they were included in 
this category. 
Observing interactions or relationships between the child and foster care 
provider: If States had language in their standards including caseworkers 
addressing the observation of the interactions or relationships of the child 
and foster care provider or family, then they were included in this category. 
Addressing the foster providers concerns:  If States had language in their 
standards including caseworkers addressing any foster providers concerns 
and problems (including placement or discipline problems), then they were 
included in this category.  
Informing the child of upcoming events:  If States had language in their 
standards including caseworkers informing the child of upcoming or future 
events, then they were included in this category. 
Adequacy of the foster care environment:  If States had language in their 
standards including caseworkers assessing the physical environment or 
clothing of the child, then they were included in this category.  
Supporting the childs values: If States had language in their standards 
including caseworkers supporting issues related to the childs values, 
identity, culture, and religion, then they were included in this category. 
Childs relationships with foster provider or foster family:  If States had 
language in their standards including caseworkers addressing the 
relationship between the child and the foster provider or family, then they 
were included in this category. 
Developing a childs lifebook:  If States had language in their standards 
including caseworkers addressing beginning or updating a lifebook with the 
child, then they were included in this category. 
Visual assessment of where the child sleeps:  If States had language in their 
standards including caseworker visual assessment of where the child sleeps 
or sleeping arrangements, then they were included in this category.   
OEI-04-03-00351  STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER  18 
CARE  Changes in household composition: If States had language in their 
standards including caseworkers addressing changes in household 
composition or changes in the family system, then they were included in 
this category. 
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CARE  Table 1: Most Common Content Categories by States With Written Standards as of July 2004
State Relationships and/or Needs of Safety Case Physical Private Adjustment Addressing the Progress of Mental health Educational Child' Well-being
communication and of the planning health discussion ofthe child child's concerns the child needs of the needs of relationships of the child
between caseworker services child of the with child to the foster (e.g., separation, child the child and/or visits
and child to the child care discipline, or
with parents,
child placement problems) siblings,
and other
relatives
OEI.04-03.00351 STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER CARE '8' v,'':  =-1 
State I Relationships and/or Needs of Safety Case Physical Private Adjustment Addressing the Progress of Mental health Child' Well-being
communication and of the planning health discussion ofthe child child's concerns the child needs ofthe relationships ofthe child
between caseworker services child of the  with child to the foster (e.g., separation, child and/or visits
and child to the child care discipline, or with parents,
child placement problems) siblings,
and other
relatives
23 
13 
23  22  20  18  17 
Total
Please refer to Appendix A for definitions of each category. For a detailed description of how we categorized State written standards, including the limitations to
our methodology, refer to page 4.
Source: Analysis of content standards compiled by OIG.
OEI-04.03.00351 STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER CARE Table 2: Less Common Content Categories for States With Written Standards as of July 2004
State Social Needs of and Observing Addressing the Informing Adequacy of  Supporting the Child' Developing a Visual Changes in
and/or services to the interactions or foster care the child of the foster care child's values relationship with child's life book  assessment of household
emotional foster care relationships provider upcoming environment (e.g., culture, foster care where the child composition
needs ofthe provider between child concerns events religion, identity) provider or foster sleeps
child and foster care family
orovider
OEI.04.03.00351 STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER CARE ff.n.8Di(
Observing Addressing the Supporting the Child'
interactions or foster care child's values relationship with
relationships provider upcoming (e.g., culture, foster care
between child concerns events religion, identity) provider or foster
and foster care family
rovider
10 
5 1 4 1 4 1
Total 
Please refer to Appendix A for definitions of each category. For a detailed description of how we categorized State written standards, including the limitations to
our methodology, refer to page 4.
Source: Analysis of content standards compiled by OIG.
OEI.04.03.00351 STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER CARE ..'
Addressing child's concerns Relationships and/or
(e.g., separation, discipline, or communication between
problems) the caseworker and the
child
WY*
Total
*WY reported implementing State standards for the content of caseworker visits after July 2004.
Please refer to Appendix A for definitions of each category. For a detailed description of how we categorized State responses, including the limitations to our
methodology, refer to page 4.
Source: Analysis of content standards compiled by OIG.
OEI-04-03.00351 STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER CARE A P P E N D I X ~ C  

Table 2:  Less Common Content Categories Reported by States Without Written Standards as of July 2004 
State  Adequacy of the foster care  Childs relationships and/or visits  Needs of and services to the child  Social and/or emotional needs of the 
environment  with parents, siblings, and  child 
other relatives 
MA  X 
MD  X  X 
MS 
MT  X  X 
NC 
NM  X 
WI  X  X 
WY*
 Total  2  2  2  2 
*WY reported implementing State standards for the content of caseworker visits after July 2004. 

Please refer to Appendix A for definitions of each category. For a detailed description of how we categorized State responses, including the limitations to our 

methodology, refer to page 4. 

Source:  Analysis of content standards compiled by OIG.

OEI-04-03-00351  STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER CARE  25    A C K N O W L E D G M E N T S  

This report was prepared under the direction of Ann OConnor, Regional 
Inspector General for Evaluation and Inspections in the Atlanta regional 
office, and Graham Rawsthorn, Assistant Regional Inspector General. 
Other principal Office of Evaluation and Inspections staff who contributed 
include: 
Stacey Bloomer, Co-Team Leader 
Peggy Daniel, Project Lead 
Linda Hall, Program Specialist 
Gerius Patterson, Data and Statistical Analyst 
Elander Phillips, Program Analyst 
Elise Stein, Director, Public Health and Human Services 
Joe Townsel, Co-Team Leader 
Michala Walker, Program Analyst 
OEI-04-03-00351  STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER  26 
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