ACCREDITATION  OF  PUBLIC  CHILD  WELFARE  AGENCIES 
Prepared  by 
Office  of Inspector  General

Office  of Evaluation  and  Inspections

U.S. Department  of Health  and  Human  Services

March  1994

OEI-O4-94-OOO1O
 PURPOSE 
To  describe  the  accreditation  process  and  possible  implications  of accreditation  for 
public  sector  child welfare  agencies. 
BACKGROUND 
This  is a companion  memo  report  to  an  OIG  report  on oversight  of State  Child 
Welfare  Programs  (OEI-01-92-O0770).  That  report  suggested  that  the  Administration 
for Children  and  Families  (ACF)  find new ways to work  with States  to make  program 
improvements  and  solve problems.  One  option  we suggested  was to require  State 
child welfare  agencies  to be  accredited,  using accreditation  bodies  overseen  by the 
ACF.  This  memo  report  is intended  to supplement  that  report  and  provide  more 
detailed  information  on the  accreditation  of child welfare  agencies  in general. 
TheAccraiiiwionProcess 
Accreditation  is a voluntary  review  process  in which  outside  observers  - peer  reviewers 
who  are  trained,  experienced  professionals  - survey and  assess  an agencys total 
operation  using recognized  criteria  in the  field. 
Accreditation  differs  from  licensing.  Licensing  is mandatory  for private  organizations, 
and  is not  a peer-review  process.  Accreditation  goes beyond  the  requirements  of State 
licensing,  which  normally  establishes  service  minimums.  According  to the  Council  on 
Accreditation  of Sewices  for Families  and  Children  (Council),  accreditation  establishes 
a provider  as a deliverer  of quality service.  While  a licensing  process  generally 
occurs  annually,  accreditation  reviews  occur  less frequently,  e.g., every four  years. 
Government-run  child welfare  agencies  are  not  required  to be licensed  or accredited. 
Accreditation  of child welfare  agencies,  both  public  and  private,  has been  performed 
since  1977 by the  Council.  The  Council  was created  to establish  an independent, 
objective  process  of agency  review  in the  field of mental  health  and  human  services. 
The  Council  establishes  requirements  for  accreditation  that  include  standards  which 
address  all aspects  of any agencys administration,  organization,  and  program.  The 
~ requirements  are  established  through  a process  of consensus  building  in the  field. 
As of November  1993, the  Council  had  accredited  26 public  agencies,  of which  25 
were  American  and  1 was Canadian.  Two  of the  accredited  public  agencies  are  State 
child welfare  agencies,  the  South  Carolina  Department  of Social  Services,  Office  of 
Children,  Family  and  Adult  Semites,  and  the  Oklahoma  Department  of Human 
Services,  Childrens  Services  Unit. 
2
 TheCouncilon Accruihtion 
A grant  from  the  U. S. Department  of Health,  Education  and  Welfare  for  $330,000 
helped  finance  the  founding  of the  Council.  Since  then,  however,  the  Council  has 
been  essentially  a private  sector  organization  and  is now supported  by seven  national, 
private  sponsors.  Thesponsoring  organizations  are: 
o  Association  of Jewish  Family  and  Childrens  Agencies 
o  Catholic  Charities  USA 
o  Child  Welfare  League  of America 
o  Family  Service  America 
o  Lutheran  Social  Ministry  System 
o  National  Committee  for Adoption 
o  National  Association  of Homes  and  Services  for Children 
METHODOLOGY 
The  information  presented  in this memo  report  was obtained  through  a literature 
review  and  interviews  with recognized  experts  in the  field  of child welfare.  Experts 
interviewed  represented  the  following  organizations: 
o  Administration  for  Children  and  Families,  HHS

0  Council  on Accreditation

0  University  of Iowa

0  Child  Welfare  League  of America

0  American  Humane  Association

0  National  Governors  Association

0  American  Bar  Association

0  Annie  E. Casey  Foundation

0  Child  Welfare  Institute

0  Youth  Law Center,  San Francisco

0  Edna  McConnel  Clark  Foundation

0  American  Public  Welfare  Association  (APWA)

0  Child  Protective  Services,  State  of Georgia

0  Office  of the  Assistant  Secretary  for Planning  and  Evaluation,  HHS

0  Families  First,  a private  child welfare  agency

0  Adoption  Services,  Department  of Family  and  Children  Services,  Fulton

County,  GA 
0  Prevention  of Unnecessa~  Placements  Program,  State  of Georgia 
3  Interviews  with these  experts  addressed  the  process  of accreditation  per  se, its effects, 
and/or  the  impact  of accreditation  on outcomes  of child welfare  cases. 
FINDINGS 
l%e Council  On Accre.dikztionh Btwntly  1%.eOn/yAccreditingBody For ChildWeljare 
& encies 
Any child welfare  agency  seeking  accreditation  must  meet  the  Councils  standards  and 
pay  their  established  fee  for  an accreditation  review. 
AccreditationIs A DemandingAnd D@ded  Rmxss 
An agency  must  apply  to the  Council  for an accreditation  review.  After  the 
application  has been  approved,  the  Council  determines  the  time  necessa~  for  and  the 
scope  of the  review.  The  accreditation  process  perfornied  by the  Council  is comprised 
of the  seven  steps  listed  below. 
1.	 The  agency  seeking  accreditation  conducts  a self study, using guidelines 
supplied  by the  Council. 
2.	 A team  of Council  peer  reviewers  conducts  an on-site  review  lasting  at least 
tsvo days, resulting  in a report  of compliance  with the  standards. 
3.  The  agency  prepares  a response  to the  report. 
4.	 A specialized  Council  committee  considers  the  agencys response  and  makes  a 
recommendation  to the  Councils  trustees. 
5.	 The  trustees  act  upon  the  recommendation  by approving  or denying 
accreditation  or  deferring  a decision  pending  remedial  action. 
6.	 Upon  approval,  the  Council  publishes  the  agencys name  and  notifies  relevant 
individuals  and  organizations  in the  community  of the  approval. 
7.	 The  agency  conducts  a yearly  review, based  on the  same  standards  used  in the 
original  re~ew,  and  transmits  the  review material  to the  Council. 
The  entire  review  process  must  be  repeated  every four years. 
Public  sector  agencies  and  private  agencies  holding  all applicable  State  and  local 
licenses  that  have  been  in operation  for at least  one year,  delivering  services  in one  or 
more  of the  areas  included  in the  Councils standards,  are  eligible  to apply  for 
accreditation.  The  Standards  for Agency  Management  and  Service  Delive~  are 
divided  into  three  broad  categories: 
4  o  Generic  Organizational  Standards 
o  Generic  Service  Delivery  Standards 
o  Specialized  Service  Standards 
~eNocategoties  ofgenetic  standards  apply to all organizations.  The  specialized 
service  standards  set forth  additional  requirements  for each  specific  service  area. 
In each  of the  three  broad  categories  of standards  there  are  three  levels.  At  the 
primary  level  is a general  statement  summarizing  the  requirement  of the  standard.  At 
the  secondary  and  tertiary  levels, the  standards  detail  in increasing  specificity  how that 
requirement  is to be  met.  A list of the  titles  of the  primary  level  standards  and  some 
examples  of secondary  and  tertiary  standards  are  provided  in Appendix  A. 
At  the  primary  level there  are  38 standards  in all three-categories  combined.  At the 
tertiary  level  there  are  more  than  1,000 standards  in all three  categories  combined. 
However,  an organization  would  not  have  to meet  all 1,000 tertiary  standards  to be 
accredited.  An  organization  would  have  to meet  all of the  standards  in the  two 
generic  categories,  and  the  specialized  standards  for just  its particular  service  area. 
For  example,  an  agency  providing  day care  services  for the  aging would  have  to meet 
all generic  standards  and  14 service-specific  standards.  An  agency  providing  adoption 
semices  would  have  to meet  all generic  standards  and  51 sefice-specific  standards. 
OpinionsVa~ On TheEffecfi OfAccreditationForR.dlic ChildWe~areAgencks 
The vast  majority  of accredited  agencies  are  in the  private  sector.  Approximately  604 
agencies  are  currently  accredited  by the  Council.  As of November  1993, only 25 of 
those  (4 percent)  were  in the  public  sector  in the  United  States.  One  additional 
public  sector  agency  was accredited  in Canada. 
The  Councils  literature  states  certain  benefits  derived  from  accreditation.  Those 
benefits  are  as follows. 
o	 Assurance  to clients,  the  public,  funding  bodies,  governmental  agencies,  other 
professionals  and  agency  volunteers  that  an agency  meets  rigorous  standards. 
Further,  accreditation  demonstrates  that  an agency 
has  effective  management,

is fiscally sound,

designs  programs  to meet  community  needs,

continually  monitors  and  evaluates  service  quality,

has  qualified  personnel,  and

has  safe,  accessible  facilities.

5
 o	 A declaration  that  an agency  cares  deeply  about  its reputation  as a provider  of 
quality  services  and  wants  others  to know  of that  achievement. 
Of the  experts  we interviewed,  one  believed  that  accreditation  per  se had  an effect  on 
quality  of semices.  That  individual  stated  that  accreditation  has a positive  effect  on 
quality,  but  said that  the  effect  was hard  to measure. 
On the  other  hand,  most  of the  other  experts  we interviewed  regarding  the  effects  of 
accreditation  raised  questions  about  the  benefits  of accreditation  for public  agencies  or 
expressed  concern  that  the  effect  of accreditation  on case  outcomes  could  not be 
determined.  They  contended  that  accreditation  makes  no  difference  in how an agency 
performs.  Some  claimed  that  accreditation  is sought  primarily  by organizations  which 
have  been  successful  and  are  performing  well.  Further,  most  of these  experts  agreed 
that  accreditation  does  not  guarantee  positive  outcomes  in any child welfare  case. 
Accreditation  is more  appealing  to the  private  sector,  they  said, because  it improves 
their  chances  of obtaining  funding  from  organizations  such as United  Way. 
CwTentAccreditationStandkrakMightBe More Stringentl%an i%ose Used@  Pidilc 
Child We@re Agencies 
The  Councils  accreditation  standards  are  possibly  more  stringent  than  those  of some 
State  merit  systems,  particularly  those  that  govern  public  child welfare  agencies 
personnel  policies  and  procedures.  The  Director  of the  Council  stated  that  he 
believes  there  is a reluctance  on the  part  of public  agencies  to seek  accreditation 
because  of a general  fear  that  they  cannot  meet  the  standards,  especially  those 
regarding  qualifications  of their  staff.  To  illustrate,  the  Councils  personnel  standards 
require  that  the  head  of each  program  have  an advanced  degree  in a field  such as 
social work  education,  another  mental  health  discipline,  medicine,  nursing,  family life, 
early  childhood  education,  geriatrics,  or another  human  service  field.  However,  some 
State  merit  systems  may  allow a person  to head  up  a program  based  on a combination 
of their  education  and  experience.  Where  there  are  significant  differences  between 
State  and  Council  education  requirements,  an agency  might  not  be  able  to obtain 
accreditation  without  restructuring  the  State  merit  system. 
Likewise,  the  Councils  standards  for quality  assurance  might  be  difficult  for most 
public  child welfare  agencies  to meet.  To  illustrate,  the  Councils  standards  require  a 
quarterly  internal  review  to assure,  among  other  factors,  the  quality  of case  outcomes. 
The  standards  do not,  however,  specify how to measure  outcomes. 
Experts  we intetiewed  stated  that  there  is presently  no consensus  in the  child welfare 
field  regarding  how to measure  outcomes.  They  said that  measuring  outcomes  is 
currently  more  art  than  science,  and  that  there  is no single common  core  of outcome 
measures  in the  field.  Requiring  accreditation  would  necessitate  all public  child 
welfare  agencies  to devise  methods  for measuring  outcomes  to meet  the  Councils 
standards,  or the  Department  to develop  and  mandate  standardized  measures. 
6  An Accrdikztion Revkw Generdy  Cash Atnind $5,(XM 
The  fee  for accreditation  is calculated  from  a fee  schedule.  According  to a Council

official,  accreditation  generally  costs around  $5,000 per  organizational  unit.  The

review  must  be  conducted  every four years.

The  Councils  policy on what  is a distinct  organizational  unit  is not  precise,  however.

It states  that  the  organizational  unit  seeking  accreditation  must  demonstrate  that  it is

autonomous  and  independent.  Autonomy  and  independence  are  established  by a unit

having  significant  influence  over the  establishment  of policy, independent

management,  budgetary  control,  an appearance  of autonomy,  and/or  a separate

geographic  identity.

How  an  accrediting  organization  would  define  a State  child welfare  system  would

determine  how much  an  accreditation  review would  cost in any given  State.  To

illustrate,  all State  child welfare  agencies  are  organized  differently.  Some  are  divided

administratively  into  State,  county,  area,  field or district  components.  As a result,  it is

possible  to have  over  one  hundred  individual  organizations  in a State  that  would  need

to be  accredited  under  the  present  system,  each  at a cost  of approximately  $5,000 per

organization  every  four  years.  With  the  data  currently  available,  we are  unable  to

estimate  with  any precision  the  cost to accredit  all public  child welfare  agencies

nationwide.

7
 CONCLUSION 
At  this time,  no one  has  sufficient  information  to ascertain  fully the  benefits  of and 
barriers  to accreditation  for public  child welfare  agencies.  Accreditation  might  be  a 
valuable  mechanism  for improving  the  performance  of State  child welfare  agencies; 
however,  the  barriers  to accreditation  for public  child welfare  agencies  should  be 
weighed  against  the  benefits. 
PoNJibiB2?en@is 
Mandato~  accreditation  for public  child welfare  agencies  could  possibly  accomplish 
the  following. 
o	 Require  public  child welfare  agencies  which  are  presently  operating  below 
accreditation  standards  to make  changes  to meet  those  standards. 
o	 Provide  public  child welfare  agencies  with an explicit  set of resource 
requirements.  Such information  would  enable  State  legislatures  to better 
determine  costs  and  decide  on an appropriate  level  of support. 
o	 Necessitate  development  of outcome  measures  in all public  child welfare 
agencies  which  do not  currently  have  them. 
PassibkBanim 
Requiring  State  child welfare  agencies  to become  accredited  could  potentially  meet 
with  some  barriers,  such  as the  following. 
o	 Create  conflicts  or discrepancies  between  personnel  standards  and  State  merit 
systems,  requiring  modifications  in State  merit  systems. 
o	 Require  State  agencies  to develop  outcome  measures  to meet  all quality 
assurance  standards  for accreditation,  or require  the  Department  to  develop 
standardized  measures  which  all public  child welfare  agencies  would  have  to 
use. 
o	 Cause  States  or the  Department  to incur  a considerable  expense  for 
accreditation  reviews  of all child welfare  agencies  nationwide,  based  on current 
fees. 
o	 Failure  to support  public  child welfare  agencies  might  cause  loss of 
accreditation.  A loss of accreditation  and  failure  to pass  an  accreditation 
review  might  increase  vulnerability  to lawsuits.  Iswes Re@ikg  Fmher Study 
Prior  to making  a commitment  to accreditation,  more  information,  both  pro  and  con, 
is needed.  Areas  of concern  which  need  to be addressed  follow. 
o	 Does  accreditation  as presently  performed  by the  Council  lend  itself  to public 
sector  child welfare  agencies. 
o	 What  benefits  or barriers  have  been  experienced  by the  25 public  sector 
agencies  in the  United  States  which  already  have  obtained  accreditation. 
o	 Would  it be  desirable  for each  State  to develop  its own outcome  measures,  if 
accreditation  were  mandatory. 
o	 How would  accreditation  relate  to reviews  of public  child welfare  agencies 
currently  conducted  by States  or the  Department. 
o	 Would  it be worthwhile  or preferable  to encourage  another  organization 
besides  the  Council  to perform  accreditation  of child welfare  agencies. 
o	 To what  extent  would  State  child welfare  agencies  require  accreditation  of 
private  agencies  with which  they  contract  for child welfare  services. 
ACF  can  obtain  needed  information  and  begin  to resolve  these  issues by 
o	 analyzing  the  benefits  of accreditation  for those  public  sector  child welfare 
agencies  which  already  have  obtained  it, 
o  evaluating  possible  barriers  to accreditation,  and 
o	 developing  a consensus  on appropriate  outcome  measures  for child welfare 
cases which would  satisfy both  public  and  private  advocacy  organizations.  The 
Council  has  expressed  an interest  in collaborating  with the  Department  in 
developing  outcome  measures  in any of the  areas  of service  they  accredit, 
including  child welfare. 
9
 APPENDIX  A

Titlesfor PrimaryLevel Standards 
and Examplesof SecondaryandTertiaryStandards 
This  list contains  the  headings  for the  38 primary  level  standards.  Some  examples  of 
secondary  and  tertiary  level standards  follow the  prima~  headings,  and  a complete  list 
may be  found  in the  Councils  publication,  Standards  for Agency  Management  and 
Service  Delivery. 
GENERIC 0RGANlZA770N&  ST~ARDS 
o  The  Agency  in the  Community 
o  Agency  Governance  and Administration 
o  Personnel 
o  Quality  Assurance 
o  Fiscal  Management 
o  Facilities  and  Equipment 
GENER?C SERVICE DELIVERY ST~b4.RDS 
o  Intake  and  Assessment 
o  Service  Planning 
o  Implementation  of the  Service  Plan,  Termination  and  Aftercare 
o  Client  Information  and  Confidentiality 
SPECL4LIZED SERl?lCE ST~ARDS 
o  Community  Organization  Service/Social  Advocacy  Service 
o	 Information  and  Referral  Service;  Crisis Intervention  Service;  Emergency 
Telephone  Response  System 
o	 Emergency  Shelter  Service  for Abused  and  Neglected  Children;  Emergency 
Shelter  Service  for Homeless  Individuals  and  Families 
A-1
 o  Foster  or Group  Care  for Unaccompanied  Minor  Entrants  or Refugees 
o  Group  Home  Service;  Residential  Center  Service  for  Children  and  Youth 
o  Residential  Treatment 
o  Pregnancy  Counseling  and  Supportive  Sexvice 
o  Adoption  Service 
o  Independent  Living Service  for Youth 
EXAMPLES  OF SECONDARY  LEVEL  STANDARDS 
Each  of the  38 primary  standards  have  a set of secondary  level  standards.  To

illustrate,  the  fourth  primary  standard  above  is quality  assurance.  The  secondary  level

standards  for quality  assurance  are  .

Management

Information

System:  The  agency  maintains  information  necessary  to plan,  manage,  and

evaluate  its programs  effectively. 
Planning  and 
Evaluation:	 The  agency  determines  whether  the  agencys services  are  needed 
and  evaluates  the  effectiveness  and  efficiency  of the  agency  in 
achieving  its purposes  and/or  mission. 
Quality

Assurance

Program:  The  agency  has a quality  assurance  program  to assure  that

individual  client  semices  meet  the  agencys expectations  as to 
sem-ice quality  and  outcomes. 
Remediation:	 Action  is taken  to eliminate  or ameliorate  problems  identified  in 
program  evaluation  and  in review  of the  quality  of individual 
client  services,  including,  as appropriate: 
o  Revision  of policies  and/or  operational  procedures; 
o	 Changes  in personnel  assignments,  personnel  supemision, 
or in-service  training  and 
o  Modification,  addition  or deletion  of a program  or service. 
A-3
 . 
Client

Protections

in Research:  When  an agent  participates  in human  subject  research,  the  agency

exhibits  due  regard  for client  privacy  and  the  right  of the  client  to 
participate  on a voluntary  basis. 
EXAMPLES  OF TERTIARY  LEVEL  STANDARDS 
Each  seconda~  level  standard  has  a set of tertiary  level  standards.  For  example,  the 
following  tertiary  level  standards  are  established  for the  secondary  standard  Quality 
Assurance  Program., 
Written  Plan  or 
Outline:  The  overall  scope  of the  quality  assurance  program  is described  in 
a written  plan  or outline  which  sets forth: 
o	 mechanisms,  committees,  or other  means  of assigning 
responsibility  for carrying  out  and  coordinating  quality 
assurance  activities; 
o  objectives  and  scope  of the  activity; 
o  methods  of monitoring  used; 
o  reporting  of results;  and 
o  follow-up  mechanisms. 
Quarterly  Internal 
Review:	 On  a quarterly  basis,  agency  management,  designated  supervisory 
personnel,  or a peer  team  conducts  an internal  review  of 
randomly  selected  open  cases  for the  quality  of the  client 
assessments,  case  or service  planning,  services  provided  or 
obtained,  outcomes,  and  aftercare  planning. 
Written  Criteria:	 The  agency  has established  written  criteria,  such  as thresholds, 
benchmarks,  or timeliness,  which  trigger  further  review  or 
evaluation  of problem  areas  by management  when  a case  or cases 
are  not  in compliance  with those  criteria. 
A-4