Department of Health and Human Services


OFFICE OF 

INSPECTOR GENERAL 

STATE STANDARDS AND 


PRACTICES FOR CONTENT OF 


CASEWORKER VISITS WITH 


CHILDREN IN FOSTER CARE


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. 
Δ EXECUTIVE SUMMAR 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 child’s safety and wellbeing 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 OIG’s evaluation focused exclusively on 

State standards for children in foster care. OIG’s 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 children’s 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 ACF’s 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 State’s child welfare program officials. 

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EXE CUTIVE S U MMAR Y

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 fortyone 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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Δ T ABLE OF CONTENTS 

EXECUTI VE SUMMARY ........................................ i

INTRODUCTI ON ................................................ 1 

FINDI NGS ....................................................... 8 

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

States without written content standards .................. 10

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

AGENCY COMME NTS ......................................... 13

ENDNOTE S ..................................................... 15 

APPENDI XES .................................................. 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

ACKN O W LEDGMENTS ......................................... 26
Δ INTRODU C TION 

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 OIG’s evaluation focused exclusively on State 

standards for children in foster care. OIG’s 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 children’s 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 ACF’s 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 Children’s 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 State’s 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 Stateadministered 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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INTROD UCT ION 

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 email 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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INTROD UCT ION 

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 State’s 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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INTROD UCT ION 

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, Children’s Defense 

Fund, Children’s 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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INTROD UCT ION 

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 President’s Council on Integrity and 

Efficiency and the Executive Council on Integrity and Efficiency. 

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Δ FINDINGS

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. Thirtyeight 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 State’s 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 

worker’s professional awareness of children’s 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 State’s standards detailed that caseworkers must 

“develop and maintain a good working relationship with the child,” while 

another State outlined that caseworkers should have open, ageappropriate communication with the child during visits. States often 

addressed needs of and services to the child in similar ways. For 

example, one State’s standards directed caseworkers to “assess the 

effectiveness of services provided to meet the child’s 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 

child’s . . . 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 

child’s adjustment to the placement. 

o Addressing the child’s concerns: Address the child’s concerns, 

including issues of separation and loss as well as any other issues. 

o Progress of the child: The child’s worker must regularly see the 

child in person to assess the child’s 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 child’s . . . education progress. 

o Child’s 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 child’s] 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 States—Florida, 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. 

Of the 10 States without written standards, 

8 of the States reported the types of activities 

typically performed during caseworker visits 

Ten States did not provide written 

content standards for caseworker 

visits with children in foster care. 

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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F I NDING S 

o Addressing the child’s concerns: The worker speaks with the child 

and inquires as to any problems in the placement, school, or other 

aspects of the child’s 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 State’s 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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ΔR E C O MMENDA T I O N S CONCLUSION 

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 ACF’s comments to this report. We agree with ACF’s 

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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Δ AGENCY COMMENTS 

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A G E N C Y CO MMENT S

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Δ ENDNOTE S 

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 State’s largest 

metropolitan subdivision. 45 CFR 1355.33(c)(2). 

7 http://www.gao.gov/new.items/d04333.pdf. 

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Δ APPENDIX ~ 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 child’s physical, medical, or health 

needs, then they were included in this category. 

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APP E N D I X ~A 

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 child’s concerns: If States had language in their standards 

including caseworkers’ addressing the child’s 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 

progress—such as progress toward mental health, educational, physical 

health, or social needs; or progress toward case, service, treatment plans, or 

permanency—then 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 children’s 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 child’s educational, academic, school, 

or intellectual needs, then they were included in this category. 

Child’s 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. 

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APP E N D I X ~A 

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 provider’s concerns: If States had language in their 

standards including caseworkers’ addressing any foster provider’s 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 child’s values: If States had language in their standards 

including caseworkers’ supporting issues related to the child’s values, 

identity, culture, and religion, then they were included in this category. 

Child’s 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 child’s 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. 

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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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Table 1: Most Common Content Categories by States With Written Standards as of July 

State Relationships and/or Needs of Safety Case Physical Private Adjustment Addressing the Progress of Mental health E

communication and of the planning health discussion ofthe child child' s concerns the child needs of the n

between caseworker services child of the with child to the foster (e.g., separation, child th

and child to the child care discipline, or 

child placement problems) 

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

communication and of the planning health discussion ofthe child child' s concerns the child needs ofthebetween caseworker services child of the with child to the foster (e.g., separation, childand child to the child care discipline, or

child placement problems)

Total 23 23 22 20 18 17 13 

Please refer to Appendix A for definitions of each category. For a detailed description of how we categorized State written standards, including 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 20

State Social Needs of and Observing Addressing the Informing Adequacy of Supporting the Child' Developing 

and/or services to the interactions or foster care the child of the foster care child' s values relationship with child' s life bo

emotional foster care relationships provider upcoming environment (e.g., culture, foster care 

needs ofthe provider between child concerns events religion, identity) provider or foster 

child and foster care family orovider

OEI. 04. 03. 00351 STATE STANDARDS AND PRACTICES FOR CONTENT OF CASEWORKER VISITS WITH CHILDREN IN FOSTER CARE
Observing

interactions orrelationships

between childand foster care

rovider

ff.n.8Di(

Addressing the

foster care

providerconcerns

upcomingevents

Supporting thechild' s values(e.g., culture,religion, identity)

Child'relationship withfoster care

provider or fosterfamily

Total 10 

Please refer to Appendix A for definitions of each category.our methodology, refer to page 4.

5 1 4 1 4 

For a detailed description of how we categorized State written standards, including 

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

(e.g., separation, discipline, orproblems)

Relationships and/orcommunication between

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 limita

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
APP E N D I X ~C 

Table 2: Less Common Content Categories Reported by States Without Written Standards as of July 200

State Adequacy of the foster care 

environment 

Child’s relationships and/or visits with parents, siblings, and other relatives 

Needs of and services to the child Social and/or emotional n

child 

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 limita

methodology, refer to page 4. 

Source: Analysis of content standards compiled by OIG.

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Δ ACKNOWLEDGMENTS 

This report was prepared under the direction of Ann O’Connor, 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 

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