United States Government Accountability Office

GAO Report to the Chairman, Committee on 

Government Reform, House of 

Representatives 

D.C. CHILD AND 

FAMILY SERVICES 

AGENCY 

Performance Has 

Improved, but 

Exploring Health Care 

Options and Providing 

Specialized Training 

May Further Enhance 

Performance 

September 2006 

 

GAO-06-1093 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

September 2006

D.C. CHILD AND FAMILY SERVICES 

AGENCY 

Performance Has Improved, but 

Exploring Health Care Options and 

Providing Specialized Training May 

Further Enhance Performance 

Highlights of GAO-06-1093, a report to the 

Chairman, Committee on Government 

Reform, House of Representatives

The District of Columbia’s Child 

and Family Services Agency

(CFSA) has a history of serious 

performance problems. A court 

case in 1989 set in motion sweeping

efforts to improve the District’s 

child welfare system. Since then, 

CFSA has worked to meet 

performance requirements ordered 

by the U.S. District Court.

However, recent reports by the 

court monitor show that CFSA is 

not meeting performance 

requirements on many measures. 

To update Congress, we assessed 

(1) whether CFSA is likely to meet 

requirements by December 2006; 

(2) what factors, if any, hinder the 

agency from meeting requirements; 

(3) how CFSA is monitoring its 

progress; and (4) the extent to

which CFSA has implemented 

initiatives to achieve unmet 

requirements. To conduct this

work, we reviewed reports by 

CFSA and the court monitor and 

interviewed stakeholders, including

the court monitor and CFSA

managers, supervisors, and 

caseworkers.

What GAO Recommends

GAO recommends that the Mayor 

of the District of Columbia (1) 

direct CFSA to provide 

caseworkers with specialized 

training that addresses caseload 

complexities, and (2) explore 

options for increasing the pool of

health care providers. In its 

comments, CFSA agreed with our 

findings and recommendations,

noting that the agency has made

more progress since April 2006. 

CFSA has made progress, but the agency is not likely to meet all of the courtordered requirements by December 2006, based on the recent court 

monitor’s report and our work. From December 2005 to April 2006, CFSA 

improved its performance and met some benchmarks. However, CFSA’s

performance on other requirements remains well below benchmarks, raising 

questions about the agency’s ability to meet all of the court-ordered 

requirements by December and sustain the improvements it has made. For 

example, only 29 percent of children in foster care received medical

evaluations within 30 days of placement in April 2006, despite a benchmark 

of at least 90 percent. 

Several factors—complex caseloads and shortages of health care providers 

and qualified foster and adoptive homes—hinder CFSA’s ability to meet 

court-ordered requirements. CFSA’s cases are complex, in part because of 

the high proportion of hard-to-place teenagers and children with medical or 

mental health needs in the District’s child welfare system. Caseworkers 

reported that they do not have enough specialized training to help them 

develop the skills they need to address these caseload complexities. CFSA’s

effort to meet court-ordered time frames is complicated in a small number of 

cases—those involving severe physical or sexual abuse—by the difficulty of 

coordinating with the District’s Metropolitan Police Department. At the same 

time, CFSA officials told us there is a shortage of health care providers to 

serve these children, and the limited number of qualified foster and adoptive 

homes hinders CFSA’s ability to give children the most appropriate and 

timely placements. 

CFSA uses routine reports and qualitative studies to determine whether it is

meeting requirements, but current data may not provide an accurate picture 

of the agency’s progress. Implementing the agency’s new Web-based case

management system has been challenging and caseworkers reported that 

because of these implementation difficulties, they have not always entered 

complete and accurate data on their cases into the system. However, CFSA

has recently taken a number of steps to resolve these issues, including, for 

example, issuing frequent system upgrades to address identified problems 

and developing enhanced system training for caseworkers. 

Within the past few years, CFSA has implemented several initiatives to 

address the challenges it faces and achieve remaining requirements, but it 

may be too soon to know if they will yield long-term results. CFSA has hired 

new staff and reorganized existing staff to focus on key areas. In addition, 

CFSA has implemented new practices, such as a tool to prioritize 

investigations based on risk. CFSA is also beginning to hold its management 

staff and private contractors accountable for helping the agency meet 

specific performance requirements. Many of these initiatives seem

reasonable, but it is too soon to tell whether these efforts will help CFSA 

meet the remaining court-ordered requirements. 

www.gao.gov/cgi-bin/getrpt?GAO-06-1093.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Cornelia Ashby 

at (202) 512-7215 or ashbyc@gao.gov. 
Contents 

Letter 1

Results in Brief 2 

Background 4

CFSA Has Met Some Court-Ordered Requirements, but Is Not 

Likely to Meet All Requirements by December 2006 7 

Several Factors Hinder CFSA’s Progress in Meeting Performance 

Requirements 10

CFSA Uses Routine Reports and Qualitative Studies to Monitor Its 

Progress toward Meeting Court-Ordered Requirements, but 

Current Data May Not Provide an Accurate Picture 14 

CFSA Has Implemented Several Initiatives to Help Achieve Unmet 

Requirements, but It May Be Too Soon to Know if They Will 

Yield Long-term Results 17 

Conclusions 23

Recommendations for Executive Action 24 

Agency Comments 24 

Appendix I Scope and Methodology 26 

Appendix II Comments from D.C. Child and Family Services 

Agency 28 

Appendix III GAO Contact and Acknowledgments 34 

Related GAO Products 35 

Tables 

Table 1: Performance on Key Unmet Court-Ordered Requirements, 

April 2006 8 

Table 2: CFSA Initiatives Addressing Key Unmet Court-Ordered 

Requirements 23

Page i GAO-06-1093 D.C. Child and Family Services
Figure 

Figure 1: Timeline of CFSA’s Key Initiatives 18 

Abbreviations 

CFSA Child and Family Services Agency 

CSSP Center for the Study of Social Policy 

QSR Quality Service Review 

STAR Stabilization and Replacement 

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately. 

Page ii GAO-06-1093 D.C. Child and Family Services
United States Government Accountability Office

Washington, DC 20548 

September 28, 2006 

The Honorable Tom Davis 

Chairman 

Committee on Government Reform 

House of Representatives 

Dear Mr. Chairman: 

Over the years, the District of Columbia’s (the District) Child and Family 

Services Agency (CFSA)—the city’s agency responsible for protecting 

children from abuse or neglect and, when necessary, placing them in 

appropriate foster or adoptive homes—has had serious management and 

performance problems that have hindered its ability to protect some of the 

children in its care. In June 1989, a lawsuit was filed in the U.S. District 

Court for the District of Columbia on behalf of children in the District’s 

foster care system and the thousands of children who had been abused or

neglected in the District. The court found that the District failed to (1) 

investigate reports of abuse or neglect in a timely manner, (2) make 

appropriate foster care placements, (3) monitor the care children received, 

and (4) adequately ensure children had permanent homes. This court case 

set in motion efforts to reform the District’s child welfare system, 

beginning with a federal takeover of the agency. In 1995 the court placed 

the agency in full receivership, an arrangement in which the court 

appoints a person with broad authority to temporarily manage the agency. 

The agency has since been removed from receivership but continues to be

monitored by the Center for the Study of Social Policy (CSSP), which has 

been acting in the capacity of court-appointed monitor since 1991. The 

monitor is responsible for assessing CFSA’s progress in meeting 

performance requirements that cover the full range of CFSA’s work. CFSA 

is scheduled to exit from the court monitor’s supervision in December of 

this year if it is performing at an acceptable level on these court-ordered 

requirements. The parties will attempt to agree on an acceptable level of 

performance in negotiations this fall. 

Prior GAO work and recent assessments by the court monitor indicate that 

while CFSA has made progress in some areas, there remain concerns 

about whether the agency will be able to meet all court-ordered 

requirements by December 2006. The monitor reported that as of April 

2006, CFSA had not met most of the requirements, and the agency’s 

performance had declined in some areas. Additionally, the monitor was 

Page 1 GAO-06-1093 D.C. Child and Family Services
not able to determine whether CFSA had made progress in several areas 

because no data were available. In order to provide Congress with an 

update on CFSA’s performance, we assessed (1) whether CFSA is likely to

meet court-ordered requirements by December 2006; (2) what factors, if 

any, hinder the agency from meeting requirements; (3) how CFSA is 

monitoring its progress toward meeting unmet requirements; and (4) the 

extent to which CFSA has implemented initiatives or developed plans to 

achieve unmet requirements. 

In conducting this work, we held group interviews with a random sample 

of CFSA caseworkers and supervisors, and we interviewed CFSA 

managers, the court-appointed monitor, and other District child welfare 

experts, including officials from the Consortium for Child Welfare—a 

coalition of nonprofit service agencies established to improve child 

welfare services in the District. We also reviewed the court-appointed 

monitor’s progress reports and various CFSA documents, such as 

handbooks, guidance, and policies. Our review focused on key 

requirements related to managing child welfare cases that remained unmet 

as of December 2005. We conducted our work between May and 

September 2006 in accordance with generally accepted government 

auditing standards. A complete description of our scope and methodology 

is in appendix I. 

CFSA has made progress in meeting some of its court-ordered 

requirements, but the agency is not likely to meet all of its requirements by 

December 2006, based on the recent court monitor’s report and our work. 

From December 2005 to April 2006, CFSA improved its performance and 

met benchmarks for a number of requirements, such as ensuring that 

children under age 12 are not routinely placed in group settings. In some 

areas, the data show an improvement in performance even though CFSA 

has yet to meet benchmarks. For example, 61 percent of children who are 

in out-of-home placements were placed with some or all of their siblings 

as of April, an improvement of 5 percentage points from December. 

However, CFSA’s performance on several requirements is well below 

benchmarks. For example, as of April 2006 only 29 percent of children in 

foster care had received medical evaluations within 30 days of placement 

despite a court-ordered benchmark of at least 90 percent. This raises 

questions about the agency’s ability to meet all of the court-required 

benchmarks by December and to sustain the improvement it has made. 

Results in Brief 

Several factors—including complex caseloads, and shortages of health 

care providers, and qualified foster and adoptive homes—hinder CFSA’s 

Page 2 GAO-06-1093 D.C. Child and Family Services
ability to meet court-ordered requirements, according to CFSA officials, 

caseworkers, and the court monitor. CFSA’s cases are complex, in part 

because of the high proportion of hard-to-place teenagers and children 

with medical or mental health needs in the District’s child welfare system. 

Caseworkers reported that they do not have enough specialized training or 

adequate support from supervisors to help them develop the skills they 

need to address the complexities of their caseloads, particularly when 

cases involve children who have behavioral problems or have experienced

domestic violence. Furthermore, CFSA’s effort to meet time frames is 

complicated in a small number of cases by difficulty in coordinating with 

the District’s Metropolitan Police Department. At the same time, CFSA 

officials told us there is a shortage of medical, dental, and mental health 

care providers. Officials told us this is partly because District 

reimbursement rates for Medicaid—the joint federal-state health care 

financing program that covers low-income children, including certain 

children in foster care and adoptive placements—are lower than the 

average fees providers charge. Furthermore, a shortage of qualified foster

and adoptive homes in the District hinders CFSA’s ability to meet some 

requirements, such as giving children the most appropriate foster care 

placements, placing siblings together, and ensuring timely adoptions. 

Several factors, such as the changing demographics of the District, 

contribute to this shortage, and a lack of border agreements with 

Maryland and Virginia makes it difficult for CFSA to look across District 

boundaries to place children with family members or in other homes in the 

surrounding suburbs. 

CFSA uses routine reports and qualitative studies to monitor its progress 

toward meeting unmet requirements, but current data may not accurately 

portray the agency’s progress. CFSA generates a number of daily and

monthly data reports that allow managers to track performance on the 

court-ordered requirements as well as develop strategies to improve 

performance. In addition, CFSA uses information from interviews, focus 

groups, and surveys of caseworkers, managers, and families to get a more 

complete picture of how the agency is performing. However, the data 

CFSA uses may not accurately portray progress toward meeting 

requirements, because of challenges in implementing a new Web-based 

case management system and caseworkers not always entering accurate

and complete data. The agency is working to resolve these issues by 

offering training and other support for caseworkers and others using the 

new system. The court monitor recently reported that data issues related 

to the implementation of the Web-based system should be resolved soon. 

Page 3 GAO-06-1093 D.C. Child and Family Services
Within the past few years, CFSA has implemented a number of initiatives

to address the challenges it faces and to help meet court-ordered 

requirements, but it may be too soon to know if they will yield long-term 

results. CFSA has hired new staff and reorganized existing staff to focus 

resources in key areas. For example, CFSA has hired additional 

caseworkers to improve its ability to conduct investigations in a timely 

manner, but is not yet meeting benchmarks in this area. CFSA has also 

implemented new practices, including a standardized process to screen 

calls to its telephone hotline reporting child abuse or neglect. Caseworkers 

use established risk factors, such as the number of children involved in a 

case or the parent’s criminal history, to screen calls and prioritize 

investigations. This approach allows CFSA to better focus its resources on 

its most urgent cases and refer others to community agencies to provide 

appropriate services to assist the family. In addition, CFSA is beginning to

hold its management staff as well as private contractors accountable for 

helping the agency meet specific performance requirements. For example, 

CFSA found that private contractors who manage the cases of about 40 

percent of CFSA’s children and families were performing at a lower level 

than CFSA caseworkers on certain requirements, such as making frequent

home visits to children and their families. The agency reported that it has 

taken a number of steps to improve contractors’ performance, including

holding monthly meetings to review expectations and resolve problems. 

Agency officials told us they will link contractors’ pay to achieving specific 

outcomes in 2007. Many of these initiatives seem reasonable, but it is too 

soon to tell whether these efforts will help CFSA meet court-ordered 

requirements. 

We are recommending that the Mayor of the District of Columbia direct 

CFSA to provide caseworkers with specialized training to help them 

address the complexities of their caseloads, and explore options for 

increasing the number of providers for mental health, medical, and dental

services. In its written comments, CFSA agreed with our findings and 

recommendations. Additionally, CFSA suggested several changes to help

clarify the report, which we incorporated as appropriate. The comments 

are shown in appendix II. 

CFSA is responsible for ensuring the safety and well-being of children at 

risk for abuse and neglect in the District, but many children in CFSA’s care 

languished for long periods of time due to managerial shortcomings and 

long-standing organizational divisiveness in the District. In 1989, the 

American Civil Liberties Union sued the District on behalf of children who 

were in foster care and other abused and neglected children over the 

Background 

Page 4 GAO-06-1093 D.C. Child and Family Services
quality of services the city was providing to them. In 1991 the U.S. District 

Court for the District of Columbia heard the case, found the District’s child 

welfare agency liable and issued a remedial order in 1991 to improve 

performance. 1

 When that remedial order and other orders did not result in 

sufficient improvement, the court placed the agency under full

receivership in 1995.2

 After 6 years under receivership, CFSA was 

reorganized as a District cabinet-level agency, a change that gave the 

agency more control over its staff and budget. 

The court appointed CSSP to monitor the agency’s compliance with the 

court’s orders, including the performance requirements set forth in the 

court order releasing CFSA from receivership and the related plan for 

implementing the order. In 2003, a final implementation plan was 

approved by the District Court and included court-ordered requirements 

that cover the full range of CFSA’s work. Some of the requirements are 

related to managing child welfare cases, such as initiating and conducting

timely and quality investigations of child abuse and neglect allegations, 

providing a range of services to children and their families, and placing 

children in appropriate foster or adoptive homes. There also are 

requirements related to the administration and management of the agency, 

such as CFSA’s information systems and financial management. The 

implementation plan also established court-ordered benchmarks—or 

expected performance levels—for CFSA to meet on each requirement and, 

for most of the requirements, set interim benchmarks that gradually 

increased over time until reaching full compliance. For example, the court 

mandated that investigations of abuse or neglect must be completed 

within 30 days. By June 30, 2003, 60 percent of cases had to meet that time 

frame. This benchmark gradually increases at 6-month intervals until 

reaching the benchmark of full compliance by December 30, 2006. 

However, the court has not yet established a precise performance level 

that defines full compliance; the court monitor expects these negotiations

to begin this fall. 

Generally, families become involved with the child welfare system after 

someone—a neighbor, teacher, or other individual—reports to CFSA 

through its telephone hotline that the child has been abused or neglected. 

CFSA then investigates to determine whether the report can be

substantiated. If agency investigators determine that it is safe for the child

 1 LaShawn v. Dixon, 762 F. Supp. 959 (D.D.C. 1991). 

2 LaShawn v. Kelly, 887 F. Supp. 297 (D.D.C. 1995). 

Page 5 GAO-06-1093 D.C. Child and Family Services
to remain at home with his or her parents or guardians, CFSA relies on 

community agencies, such as the Healthy Families/Thriving Communities 

Collaboratives,3

 to provide services to help the family, including parenting 

skills classes, if needed. If required, the child may be removed from the 

home, necessitating court proceedings. 

CFSA caseworkers are responsible for managing foster care cases by 

developing case plans; visiting the children; participating in administrative

review hearings involving CFSA officials, children, parents, attorneys, and 

other officials; attending court hearings; and working with other District 

government agencies. CFSA caseworkers are also responsible for 

documenting in the agency’s case management system the steps taken and

decisions made related to a child’s safety, well-being, and foster care 

placements, as well as those related to developing the most appropriate 

goal for permanency. Depending on their circumstances, children leave

foster care and achieve permanency by being (1) reunified with their birth 

or legal parents, (2) adopted, (3) placed in the legal guardianship of a 

relative, or (4) declared independent at the age of 18. Caseworkers are 

assigned to various units responsible for providing services to children 

and families. CFSA program managers and supervisors within those units 

are responsible for providing the necessary guidance and support needed 

by caseworkers to manage their cases. 

CFSA relies on other District agencies and private organizations to help 

achieve its mission. For example, CFSA has a contract with Children’s 

National Medical Center, known as DC Kids, to provide medical 

evaluations for children when they enter CFSA’s care and for as long as 

they remain in the system. In addition, CFSA relies on private dental and

mental health care providers to give children dental care and 

psychological or psychiatric evaluations. Some private organizations, such 

as Catholic Charities, manage about 40 percent of CFSA’s cases, including 

preparing case plans for children placed in foster care and those that 

remain in the home, making home visits, or providing for visitations 

between siblings or parent and child. CFSA also works with agencies in 

Maryland, Virginia, and other states to arrange for placements for District 

children. CFSA is responsible for licensing and monitoring organizations 

 3

 Collaboratives are independent nonprofit organizations operating in areas of the District 

of Columbia with at-risk children, adults, and families. Collaboratives partner with CFSA to 

provide services and support, such as housing and training, working toward a goal of

reducing or eliminating the possibility of children being removed from their families or 

communities, or reunifying children with their families when removal does occur.

Page 6 GAO-06-1093 D.C. Child and Family Services
in the District with which it contracts, including group homes that house 

foster care children. Also, CFSA oversees the licensing and monitoring for 

organizations outside of the District where children are placed. 

CFSA has met some court-ordered requirements, but the agency is not 

likely to meet all of its requirements by December 2006, according to the 

recent court-monitor’s report and our work. From December 2005 to April 

2006, CFSA showed progress, meeting court-required benchmarks in areas 

such as limiting to five the number of caseworkers assigned to each 

supervisor, ensuring that children age 12 and under are not routinely 

placed in group settings, and ensuring that children do not stay in 

emergency placements for more than 30 days. In addition, the data show 

an improvement in some requirements, even though CFSA has yet to meet 

the court-required benchmarks. For example, 61 percent of children who 

are in out-of-home placements were placed with some or all of their 

siblings as of April, an improvement of 5 percentage points from 

December. In other areas, CFSA’s performance was stagnant. For 

example, CFSA is required to initiate all investigations within 48 hours 

after receiving a report of abuse or neglect. CFSA did so in 70 percent of 

cases in December, and as of April its performance was still at 70 percent.4

CFSA Has Met Some 

Court-Ordered 

Requirements, but Is 

Not Likely to Meet All 

Requirements by 

December 2006 

However, performance on the majority of requirements still did not meet 

the court-required benchmarks, and in some cases fell seriously below 

benchmarks.5

 For example, despite a benchmark set at 90 percent,6 only 29

percent of children in foster care had received medical evaluations as of 

April 2006, and data were not available for the percentage of children who 

received dental evaluations. This raises questions about the agency’s 

ability to meet the court-required benchmarks by December and to sustain 

 4

 District law sets a stricter time frame for initiating investigations. District law requires 

CFSA to initiate an investigation within 24 hours of receiving a report of child abuse or

neglect not involving immediate danger to the child. However, for the purpose of the courtordered requirements, CFSA must meet the 48-hour time frame for initiating investigations 

for the proportion of cases established in the benchmark. 

5

 CFSA’s Web-based case management data system, FACES.net, is the primary, and in some

cases the only, source for data to measure the agency’s progress in meeting court-ordered 

requirements. However, FACES.net data have some limitations that we discuss in the third 

section of this report. See also appendix I for GAO’s review of FACES.net data quality. 

6

 This is the last numeric benchmark set before full compliance, established for the period

beginning June 30, 2005. 

Page 7 GAO-06-1093 D.C. Child and Family Services
the improvements it has made.7

 Table 1 shows CFSA’s performance on key 

unmet requirements as of April 2006.

Table 1: Performance on Key Unmet Court-Ordered Requirements, April 2006 

April 2006 

Key unmet requirements 

Numeric benchmark Performance level 

achieved

Whether met 

benchmark 

Timeliness of investigations

• Investigations initiated within 48 hours. 

• Investigations completed within 30 days. 

90 percenta

90 percenta

70 percent 

39 percent 

Not met 

Not met 

Comprehensive investigations of abuse and

neglect reports in foster homes and institutions

95 percent 62 percent initiated within 

48 hours 

76 percent closed within

30 days 

Not met 

Appropriate and timely physical and 

psychological evaluations

• Children receive appropriate medical, 

psychological, or psychiatric evaluations when

necessary as part of an investigation of abuse or 

neglect. 

• Children in foster care receive a full medical and 

dental evaluation within 30 days of placement. 

80 percent 

90 percent 

53 percent (medical) 

40 percent 

(psychological/psychiatric) 

29 percent (medical)c

Not met 

Not met 

Appropriate caseloads for case workers and

supervisors 

• Workers conducting investigations have no more 

than 12 investigations at a time. 

• Supervisors are responsible for no more than five 

caseworkers. 

• Supervisors do not manage cases unless a 

caseworker leaves without providing notice, and 

in such circumstances, only for a 5-day period. 

0 percent of workers 

have more than 12 cases

95 percent of supervisors

90 percent of 

supervisorsa

40 percent have more 

than 12 cases 

92 percent 

55 percent 

Not met 

Benchmark met

b

Not met 

 7

 At the end of our review, CFSA provided us with updated performance data as of July 31,

2006. CFSA officials told us that the data show an improvement from April. We did not 

analyze the data or assess its reliability. The court monitor is currently assessing these data 

and will be incorporating the data in its final report of CFSA’s progress. 

Page 8 GAO-06-1093 D.C. Child and Family Services
April 2006 

Key unmet requirements 

Numeric benchmark Performance level 

achieved

Whether met 

benchmark 

Increased visitations for children and families 

• Caseworkers visit homes in which there has been 

abuse and neglect to ensure children can live with 

birth parents safely with services. 

• Children placed apart from their siblings visit 

some or all of their siblings at least two times per 

month. 

• Children in foster care and their birth parents visit 

weekly, if CFSA has a goal to reunify them. 

90 percent (once/month)

40 percent (twice/month)

70 percent 

85 percenta

61 percent (once/month) 

20 percent (twice/month) 

26 percent 

13 percent 

Not met 

Not met 

Not met 

Appropriate referrals to community agencies 

• Families who are the subject of a report of 

neglect/abuse that is determined to be 

unsubstantiated are referred to an appropriate 

community agency for services. 

70 percent 8 percent Not met 

Children are given the most appropriate out-ofhome placements 

• Children in out-of-home placement are placed

with some or all of their siblings. 

• Children under 12 are not routinely placed in 

congregate care settings. 

• Children under age 6 are not placed in a group 

setting unless they have exceptional needs. 

• Foster homes, group homes, and independent 

living facilities have a current and valid license. 

• Children will not stay in emergency facilities for 

more than 30 days. 

75 percent 

No more than 20 children

No more than 5 childrena

95 percenta

No more than 25 children

61 percent 

21 children

10 children

80 percent (foster homes) 

97 percent (group homes) 

69 percent (independent 

living) 

22 children

Not met 

Benchmark 

substantially met

b

Not met 

Not met 

Benchmark met 

Reduce multiple placements of children in foster 

care 

• Fewer children in foster care have three or more 

placements in a 12-month period. 

No more than 5 percent 18 percent Not met 

Timely adoptions

• Children are in approved adoptive placement 

within 9 months after CFSA sets a goal of 

adoption. 

85 percent 50 percent Not met 

Source: Center for the Study of Social Policy. “An Assessment of The District of Columbia’s Progress as of April 30, 2006, in Meeting

the Implementation and Outcome Benchmarks for Child Welfare Reform.” (Washington, D.C: July 19, 2006). 

a

Last numeric benchmark before full compliance. 

b

As determined by the court monitor. 

c

No data available on dental care.

Page 9 GAO-06-1093 D.C. Child and Family Services
Complex cases and shortages of health care providers and qualified foster 

and adoptive homes hinder CFSA’s ability to meet court-ordered 

requirements, according to CFSA officials, caseworkers, and the court 

monitor. While caseworkers’ caseloads have been reduced because of 

CFSA’s efforts to recruit and retain caseworkers, cases are complex, in 

part because of the high proportion of teenagers and children with medical 

or mental health needs. CFSA’s efforts to meet court-ordered time frames 

is further complicated in a small number of cases by difficulty in 

coordinating with the District’s Metropolitan Police Department. At the 

same time, CFSA officials told us that there is a shortage of health care 

providers to serve these children with health care needs, and the limited 

number of qualified foster and adoptive homes hinders CFSA’s ability to 

give children the most appropriate and timely placements. 

The complexity of the caseload is hindering CFSA’s efforts to meet court 

ordered requirements, according to CFSA officials. While caseworkers’ 

caseloads have been reduced as a result of CFSA’s efforts to recruit and 

retain caseworkers, cases are complex for a number of reasons. First, 

there is a high proportion of older children in the District’s child welfare 

system who are harder to place and may have different needs than 

younger children. This high proportion is due to the fact that the District 

serves children in its care until age 21 and, historically, CFSA had not been 

successful finding permanent homes for these children when they were 

younger. As a result, there are almost 800 youths aged 16 to 21—almost 

one-third of the city’s current foster child population—many of whom 

have grown up in foster care. Second, a large proportion of children within 

the system have complex needs, such as the need for mental health 

services or for foster parents that are licensed to support children with 

severe medical conditions. 

Several Factors 

Hinder CFSA’s

Progress in Meeting 

Performance 

Requirements 

CFSA Managers and 

Caseworkers Cited 

Complex Cases and a 

Shortage of Health Care 

Providers as Hindrances 

Caseworkers reported not having enough specialized training or adequate

support from supervisors to help them develop the skills they need to

address the complexities of their caseloads, including cases involving 

children with behavioral problems or who have experienced domestic 

violence. While CFSA has a comprehensive training curriculum, much of 

the curriculum is focused on developing a base of knowledge, such as 

understanding how children in foster care develop attachment disorders—

which make it difficult for them to develop healthy relationships with 

primary caregivers—or understanding other separation issues. The court 

monitor recently recommended that in addition to focusing on what the 

caseworker should know and understand, the CFSA curriculum needs to 

Page 10 GAO-06-1093 D.C. Child and Family Services
identify what the caseworker should do and help the caseworkers develop

a set of applicable skills. 

CFSA officials told us there is a shortage of health care providers to give 

necessary medical, dental, or mental health services to children in the 

agency’s care. These shortages are not unique to the District’s child 

welfare system, but they hinder CFSA’s ability to meet a number of courtordered requirements. For example, caseworkers told us that not having 

enough doctors and dentists to conduct screenings and examinations 

made it difficult to complete investigations or provide routine 

examinations within required time frames. Specifically, they told us that 

there is not a sufficient number of dentists in the District who provide 

services to CFSA’s children. Furthermore, CFSA told us that in February

2006, the agency did a competitive request for proposals from all District

medical providers for a comprehensive medical system of care, but 

received only one bid. While there may be a number of reasons for the lack 

of providers, CFSA officials told us that low Medicaid reimbursement rates 

for children who are residents of the District was a major factor. 8

In a Small Number of 

Cases, Coordinating with 

the Police Department Has 

Complicated CFSA’s

Ability to Meet Time 

Frames 

CFSA’s ability to meet court-ordered time frames for conducting 

investigations may be complicated in a small number of cases by difficulty 

in coordinating with the District’s Metropolitan Police Department, which 

sometimes operates under different time frames and priorities. For 

example, caseworkers told us that they cannot close out investigations 

involving severe physical or sexual abuse without a report from the police 

department. However, the court monitor noted that caseworkers and 

police officials were not consistently collaborating in a timely manner as 

required by a memorandum of understanding developed between the two 

agencies or were not documenting their efforts properly in CFSA’s data 

system. While CFSA and the police department are required to coordinate 

on these cases, the court monitor reported in February 2006 that, 

according to CFSA’s data, joint investigations were held in only 31 percent

of such cases. To assist with coordination, the monitor recommended that 

CFSA enlist the assistance of the Deputy Mayor for Children, Youth, 

Families and Elders to ensure joint investigations are performed in a 

timely manner. CFSA officials told us that they are taking steps to improve 

 8

 Most children in foster care or adoptive placements are eligible for Medicaid—the joint

federal-state health care financing program that covers certain categories of low-income 

children. Like each state, the District sets reimbursement rates for its Medicaid providers. 

Page 11 GAO-06-1093 D.C. Child and Family Services
this coordination. Officials of the two agencies have begun holding weekly 

meetings to discuss and resolve emerging issues, and CFSA has started 

colocating staff at the police department. However, at this time it is too 

soon to know whether these steps will be effective in helping CFSA meet 

investigation time frames. 

Shortage of Qualified 

Foster and Adoptive 

Homes Limits CSFA’s

Ability to Place Children 

A shortage of qualified foster and adoptive homes is also hindering CFSA’s 

ability to meet some requirements, such as giving children the most 

appropriate foster care placements, placing siblings together, and ensuring

timely adoptions. Several factors are contributing to this shortage. The 

demographics of the District are changing and there are fewer qualified 

homes, according to CFSA and other officials we interviewed. They cited 

an influx of young professionals who are less likely to serve as foster 

parents or adopt children from the child welfare system. Officials also 

reported that the average size of houses in the District has decreased over

time, with new condominium developments that have fewer rooms, and 

these homes will not readily meet accommodation guidelines, particularly 

when trying to keep siblings together. They noted that older houses that 

are large enough to meet standards may require significant investment of 

resources to remove lead paint, which would be a danger for young 

children. 

In addition, there is a shortage of facilities within the District to care for 

children with special medical or mental health needs. The court monitor’s 

recent progress report notes that in April 2006, CFSA had placed 82 

children in residential settings more than 100 miles away from the city for 

medical or mental health treatment.9 The court monitor reported that for 

29 children in these facilities, CFSA had no plans to bring the children 

back to the District because of the lack of homes and limited availability of 

specialized services, including medical and mental health care services. 

The court monitor recommended that CFSA explore the possibility of 

developing additional resources in the District to serve children with 

special needs. 

Many children in the District’s child welfare system have family members 

living in neighboring states willing to take them in, but challenges exist 

 9

 As of June 2005, CFSA was required to have no more than 35 children living in foster care

more than 100 miles from the District. In June 2006, the requirement is no more than 25

children. 

Page 12 GAO-06-1093 D.C. Child and Family Services
with placing children across state lines. Because of the District’s proximity 

to Maryland and Virginia, many of the children in CFSA’s care have 

relatives in these other states. However, even when children are placed 

with relatives, the homes must be licensed for foster care if the relatives 

are to be compensated by the District, and CFSA does not have 

agreements with Maryland and Virginia that would remove barriers to 

licensing homes and placing these children. For example, the state in 

which the child would be placed would be required to expend its 

resources to oversee the placement and manage the case, including 

conducting timely home visits and providing services. Because the District 

lacks a border agreement with Maryland and Virginia that would speed 

placements for children with family members across state lines, these 

children may experience multiple placements while waiting for the 

necessary paperwork, including background checks, to be completed. 

CFSA reported that they have recently presented new proposals to 

facilitate interstate placements in Maryland and Virginia, and is awaiting a 

response. 

Recent legislation, signed into law July 3, 2006, and intended to expedite

the placement of children across state lines, may provide some needed 

assistance to the District. The Safe and Timely Interstate Placement of 

Foster Children Act of 2006 requires both the receiving state and the 

requesting state to act within specified time frames (generally 60 days for 

the receiving state to conduct a study of the potential adoption or foster 

care home and 14 days for the requesting state to determine whether 

making a decision relying on the report would be contrary to the welfare 

of the child).

 10 Also, the act would provide a $1,500 incentive payment to a 

state for every interstate study of an adoption and foster care home 

completed within 30 days. 

 10 Pub. L. No. 109-239 (2006). 

Page 13 GAO-06-1093 D.C. Child and Family Services
CFSA is generating a number of daily and monthly reports to show its 

progress in meeting court-ordered requirements. In addition, CFSA is 

using qualitative information from interviews, focus groups, and surveys of

caseworkers, managers, and families to get a more complete picture of 

how the agency is performing and to address ongoing challenges. 

However, the data CFSA uses may not accurately portray progress toward 

meeting performance requirements, in part because caseworkers do not 

always enter information completely and accurately in the case 

management data system. CFSA provides training and other support for 

using the new Web-based version of the data system and has begun to take

steps to address early implementation issues with the new system. 

CFSA generates a number of daily and monthly reports to track cases and 

monitor progress toward meeting court-ordered requirements using 

information from FACES, the agency’s automated child welfare 

information system. Daily reports allow managers to review the agency’s 

performance on cases on a daily basis and contain information such as the 

number of cases in the backlog awaiting investigation, as well as the 

number of children that caseworkers were able to place and the nature of

those placements. In addition, CFSA produces monthly trend reports as 

required by the court monitor to track progress toward meeting courtordered benchmarks detailed in the Implementation Plan. CFSA uses data 

from the monthly trend reports to develop performance scorecards, which 

use graphics to provide a snapshot of the performance of contract 

agencies and departments within the agency. Each year, CFSA compiles 

these reports and other information into an annual report addressing 

CFSA’s progress and some of the challenges faced in implementing the 

court-ordered requirements. As CFSA develops new data reports, top 

CFSA managers told us they have begun to focus less on simply complying 

with the court-ordered requirements and more on using the data to 

develop strategies for program improvement. This approach is consistent 

with that of many high-performing organizations, which, as we have

reported, continuously assess performance against benchmarks and use 

this information to improve performance.11

CFSA Uses Routine 

Reports and 

Qualitative Studies to 

Monitor Its Progress 

toward Meeting 

Court-Ordered 

Requirements, but 

Current Data May Not 

Provide an Accurate 

Picture 

CFSA Generates Daily and 

Monthly Reports to Track 

Progress toward Meeting 

Requirements 

 11 GAO, Managing for Results: Enhancing Agency Use of Performance Information for 

Management Decision Making, GAO-05-927 (Washington, D.C.: Sept. 9, 2005). 

Page 14 GAO-06-1093 D.C. Child and Family Services
CFSA also collects qualitative data through interviews, focus groups, and

surveys of caseworkers, supervisors, managers, and families that are 

designed to provide insight as to why some court-ordered requirements 

remain unmet. For example, data show that CFSA has been unable to meet

the requirement that children placed apart from their siblings visit some or 

all of their siblings at least two times per month. CFSA examined the issue 

further in a sibling placement report that used information from interviews 

and focus groups of placement staff and siblings’ families to augment data 

on the number of children placed with siblings and how many times they 

visited each other. The report helped CFSA learn some of the underlying 

reasons that such visits may not be taking place—for example, siblings 

were not placed in proximity to each other to easily facilitate a visit. CFSA

used the report to create strategies to address these issues, such as placing 

children in the same or nearby neighborhoods, and assigning one 

caseworker for all siblings whenever possible. In addition, CFSA issues a 

Needs Assessment Report every 2 years that uses interviews with foster 

parents and CFSA caseworkers to identify and provide strategies for 

addressing the most urgent needs of CFSA clients. 

Similarly, CFSA conducts Quality Service Reviews (QSR) twice a year, 

which involve examining a sample of case files and interviewing as many 

people involved in the cases as possible, including parents, children, 

caseworkers, teachers, and others. The fall 2005 QSR, which examined 39

cases and included nearly 300 interviews, revealed that overall, the 

children in the cases reviewed were safe, healthy, and living in appropriate

placements. However, the QSR report identified a number of areas in need 

of improvement, many of which were related to court-ordered 

requirements that CFSA has had difficulty meeting. For example, 

reviewers found that sibling and parental visits were not consistently 

documented in FACES. In response, CFSA developed a number of 

strategies to address these areas, such as creating a caseworker peer 

review system in which caseworkers review each other’s work for overall

quality. 

The data that CFSA uses to monitor its progress in meeting the court’s 

requirements may not provide an accurate picture of the agency’s current

performance. CFSA released a new, Web-based version of FACES in 

February 2006—FACES.net—to update its older case management system, 

and there have been some challenges with the transition. Caseworkers 

told us that they had found it frustrating to enter information in the system 

and that it could take up to 4 hours to enter the data for a single case. 

Caseworkers, as well as supervisors and CFSA’s chief information officer, 

Qualitative Studies Help 

CFSA Identify and Address 

Ongoing Challenges 

Data Used to Report 

Agency Performance May 

Not Accurately Portray 

Actual Progress Made 

toward Meeting CourtOrdered Requirements 

Page 15 GAO-06-1093 D.C. Child and Family Services
told us that when the FACES.net system was initially implemented, it 

would often crash, resulting in a loss of data or in delays in entering the 

data. Caseworkers commented that because of these issues, they often 

entered less than fully detailed case data into the system. These 

implementation issues may have implications for the accuracy and 

completeness of data that have been recorded in the system to date. 

In addition to experiencing problems with the implementation of the new

system, caseworkers have not always entered some information into the 

correct fields in the database, preventing data from being captured in 

CFSA’s progress reports. For example, the court monitor’s most recent 

report indicated that of the 444 children in foster care as of April 2006 with 

a goal of reunification with their families, more than half did not have any 

documented visits with their parents. However, based on the Quality 

Service Reviews, CFSA concluded that the visits were occurring, but the 

caseworkers were not entering the information into FACES.net. In 

addition, CFSA officials told us that some caseworkers have been entering

information into narrative case notes rather than the appropriate discrete 

fields in the FACES.net screens. For example, a caseworker may visit a 

child in the family’s home and then take him or her to visit the doctor. 

When entering this information in the database, the caseworker may 

record only the family visit in the required screen and write up the medical 

visit in the case notes, which cannot be captured in the progress reports. 

As a result, reports would not indicate that the medical visit had occurred.

CFSA is working to resolve issues with inaccurate or incomplete data in

FACES.net, and administrators meet monthly to discuss challenges and 

potential resolutions. In addition, the chief information officer told us 

there are several training measures in place for caseworkers and contract

agencies to receive assistance and training in recording data and using the

new FACES.net system. For example, CFSA created four teams to assist 

caseworkers with recording case data, and to ensure that data are 

recorded accurately and used appropriately in reports. The Child 

Information Systems Administration also conducts FACES.net workdays 

for CFSA and contract agency employees. These are regularly scheduled 

opportunities for caseworkers to enter data into the FACES.net system 

with the assistance of an information systems employee, who can ensure 

that caseworkers are entering data in the correct fields. The Child 

Information Systems Administration has also posted tip sheets for using 

FACES.net and distributed training manuals to caseworkers.

In addition to training, CFSA is taking additional steps to improve 

FACES.net that may help address some of the earlier implementation 

Page 16 GAO-06-1093 D.C. Child and Family Services
issues. CFSA issues system upgrades to address identified problems every 

2 to 3 weeks, and is developing a process to fully test these upgrades 

before implementing them. In addition, CFSA has identified individuals 

from each department within CFSA to act as liaisons between the system 

users and the technical staff so that the system can be tested, and 

problems can be identified early and quickly resolved. Officials now report 

that the volume of help desk calls is below previous levels. Based on this 

progress, the court monitor’s most recent report anticipates that data 

issues related to early system implementation should be resolved soon.

In the last 2 years CFSA has implemented a number of initiatives to help 

address hindrances in meeting court-ordered requirements. CFSA has 

hired new staff and reorganized existing staff to focus resources in key 

areas. For example, CFSA has hired additional caseworkers to ease 

caseloads, reduce backlogs, and improve the timeliness of investigations 

of child abuse or neglect. CFSA also has implemented new practices to 

better serve children and families, such as holding family team meetings 

that bring all parties together to make decisions about a child’s care. In 

addition, CFSA is beginning to take steps to hold its management staff as 

well as private contractors accountable for helping the agency meet 

specific performance requirements. Because many of these initiatives have

been implemented only recently, it is too soon to know whether the efforts 

will yield success over time. Figure 1 shows the initiatives CFSA 

implemented or plans to implement between January 2005 and summer 

2007. 

CFSA Has 

Implemented Several 

Initiatives to Help 

Achieve Unmet 

Requirements, but It 

May Be Too Soon to 

Know if They Will 

Yield Long-term

Results 

Page 17 GAO-06-1093 D.C. Child and Family Services
Figure 1: Timeline of CFSA’s Key Initiatives 

Implemented Structured Decision Making (SDM) risk assessment 

tool for screening hotline calls

Reorganized the Office of Clinical Practice

Implementation of family team meetings

Performance Based Contracting for Private Providers

Increased qualification requirements for hotline staff

Organized Centralized Placement Unit

Developed separate specialized in-home units

February 2006

January 2006

January 2005

Summer 2007 (projected)

May 2005

March 2006

Implementation date Initiative

Source: CFSA documents and Interviews with CFSA officials.

CFSA Has Increased Staff 

and Reorganized to Help 

Improve Performance in 

Key Areas 

CFSA has hired additional caseworkers to improve its ability to conduct 

investigations in a timely manner. Historically, CFSA has not been able to

conduct prompt investigations because it did not have enough

caseworkers to manage all of its cases. According to a CFSA report, in 

September 2002 there was a backlog of 807 cases awaiting investigation. 

As we previously reported, CFSA began a number of recruitment activities

in fiscal year 2003 and has recently focused on recruiting staff to conduct 

investigations.12 As of July 2006, CFSA officials reported only 1 vacancy in

the unit that is responsible for conducting investigations, down from 15 in 

January 2006, and 84 cases in the backlog, down from 318 cases in January

2006. CFSA officials told us that having fewer cases has allowed 

caseworkers to focus more attention on improving the quality of 

investigations. 

 12 GAO, D.C. Child and Family Services Agency: More Focus Needed on Human Capital 

Management Issues for Caseworkers and Foster Parent Recruitment and Retention, 

GAO-04-1017 (Washington, D.C.: Sept. 24, 2004). 

Page 18 GAO-06-1093 D.C. Child and Family Services
While these efforts may have a positive impact on the way investigations 

are conducted, CFSA still struggles to meet many of its court-ordered 

requirements related to investigations. A review of CFSA investigation 

case files conducted by the court monitor in June 2005 revealed that 

investigations were not meeting quality standards, such as workers 

routinely ensuring that families receive the services they need. Another 

report in July 2006 showed little progress in this area. Moreover, in this 

report the court monitor noted that leadership within the investigation 

units has changed frequently as CFSA has tried to implement 

comprehensive improvements in this area, and the agency has not been 

successful in either fully implementing recommendations made by 

consultants to improve operations or in sustaining advancements made. 

In addition to hiring new staff, CFSA has reorganized existing staff to 

focus resources and attention on key unmet requirements. Caseworkers 

have told us that they did not always have support from their supervisors 

to help them make decisions, such as those related to obtaining the 

appropriate placement for children in their care. To address this, in 2005 

CFSA created a centralized unit of employees to make decisions on the 

placement of children. These staff members are on call around the clock

to help caseworkers match children with the placements that best meet 

their needs. Staff in this unit are knowledgeable about various placement 

options, such as placing children across state lines, finding foster care 

placements for children needing medical attention, and arranging for 

independent living services for older children. In 2006, the new placement 

unit recruited six licensed District emergency foster homes with seasoned 

foster parents, referred to as Stabilization and Replacement (STAR) 

homes. These homes will be available at any time of the day to provide 

emergency foster care for children for up to 5 days regardless of age,

gender, or behavioral difficulty. STAR foster parents will provide basic 

services for children while caseworkers determine the child’s needs, and 

placement specialists will match the child with an appropriate, stable 

placement. Although CFSA has made some progress in improving the 

placement process for children, it is too soon to determine whether these 

efforts will yield long-term success. According to the monitor’s progress 

report, as of April 2006, placement issues remain in a crisis mode at 

CFSA—placements are still too often based on bed space availability, 

rather than child need, and too many children experience multiple 

placements during their time in foster care. 

CFSA has dedicated a number of caseworkers to specialize in making 

home visits to ensure the safety of children living at home with their birth 

parents. Previously, caseworkers could be assigned to provide services to

Page 19 GAO-06-1093 D.C. Child and Family Services
children who remained in-home along with those who were placed outside

of the home, such as with a foster family. However, in May 2006, after a 

study found that children placed at home were not being visited frequently 

by caseworkers, CFSA created a separate unit of caseworkers to focus on 

these children. CFSA officials expect this unit to improve the frequency

and quality of caseworker’s visits to children at home, and allow 

caseworkers to thoroughly assess family situations, engage parents, and 

diligently monitor and influence a family’s stability and progress so that 

the child can remain safely in the home. Although it is too soon to assess 

the impact of this arrangement, the court monitor reported that as of April 

2006, CFSA had not met requirements for making in-home visits, but the 

data show an improvement. 

CFSA also reorganized the office that assists caseworkers with arranging 

medical and mental health services for children and their families. CFSA 

hired additional nurses and psychologists in its Office of Clinical Practice 

to provide advice and counsel to caseworkers with cases requiring 

medical expertise. CFSA officials expect that this will help the agency 

meet requirements to provide appropriate physical and psychological 

evaluations, since caseworkers are now able to seek professional guidance 

on their cases and the services children might need. 

CFSA Has Implemented 

New Practices Designed to 

Improve Services to 

Children and Families 

CFSA has implemented several new practices to improve services. It 

changed how telephone hotline staff prioritize calls reporting child abuse 

or neglect to improve the overall quality and timeliness of investigations 

and to help them make appropriate referrals to community agencies. In

February 2006, CFSA implemented a standardized risk assessment tool for 

screening hotline calls in order to better focus their resources by helping 

caseworkers quickly assess the urgency of the case and whether or not a 

referral to a community agency would meet the family’s needs. The tool 

prompts caseworkers to ask each caller a series of structured questions to 

identify the level of risk to the child’s safety and the appropriate 

intervention based on certain risk factors, such as number of prior 

investigations, number of children involved, and whether or not the parent 

has a criminal history or a history of drug use. Cases are ranked based on 

these factors and designated as either high, moderate, or low risk. All highrisk cases are to be retained by CFSA and assigned to a CFSA investigator. 

For those cases assessed to be of low or moderate risk, children and their 

families are to be referred to one of CFSA’s community partners for 

intervention and support services, including housing and employment 

information, parenting workshops, and referrals to other services. CFSA 

has not yet met the court-ordered requirement to refer more families to 

Page 20 GAO-06-1093 D.C. Child and Family Services
community agencies, and it is too soon to know whether the initiative will

improve its performance in this area. 

CFSA also recently began using family team meetings, which bring 

together immediate and extended family members and other support for 

the family to discuss the child’s needs and strategies for overcoming 

family problems and to develop a plan for the child’s safety. These 

meetings are held in cases where children have been removed or are at 

risk of being removed from their homes because of abuse or neglect. 

According to a June 2005 CFSA report,13 family team meetings may play a

role over time in reducing the number of children who are removed from 

their homes, placed in nonfamily foster care, or placed in multiple foster

homes. The court monitor’s April 2006 report indicates that CFSA is still 

not meeting the requirement to reduce the number of children in foster 

care who have been in three or more homes within a 12-month period, but 

the data show improvement. However, the court monitor also cautioned

that strategies such as the family team meetings have not always been 

implemented at the level of intensity needed to achieve the desired 

outcomes, saying relatively few of the cases that might benefit from the 

approach have actually used it. 

CFSA Is Holding 

Management, Foster Care 

Providers, and Contractors 

Accountable for Meeting 

Performance 

Requirements 

CFSA is holding all unit managers and supervisors accountable for helping 

caseworkers meet court-ordered requirements. The quality of supervision 

has been a long-standing issue for CFSA. As we previously reported, many 

CFSA caseworkers told us that supervisors had not fulfilled their 

responsibilities to provide the guidance and support needed to help them 

better perform their jobs, and agency officials told us that CFSA 

supervisors were not held accountable for performing their supervisory 

duties.14 To address this issue, CFSA requires supervisors to document in 

FACES.net each time they interact with a social worker on a particular 

case. In addition, CFSA has contracted with the Child Welfare Institute to 

help provide management training for managers and supervisors. 

CFSA is also holding external partners, such as foster care providers, 

accountable for helping it meet court-ordered requirements. Although it is 

the agency’s policy not to place children in unlicensed homes, we 

 13 CFSA Quality Assurance Report, CFSA Quality Improvement Administration.

(Washington, D.C.: June 2005)

14 GAO-04-1017. 

Page 21 GAO-06-1093 D.C. Child and Family Services
previously reported that about 22 percent of foster children in CFSA’s care 

were residing in unlicensed homes as of May 2004. To address this issue, 

CFSA officials reported that they recently reviewed all unlicensed foster 

homes to check for their compliance with basic health and safety 

standards and are no longer placing children in unlicensed homes. As a 

result of this review, CFSA licensed most homes and reduced the number 

of unlicensed foster homes to 17, or 5 percent, by July 2006. While the 

most recent court monitor’s report found that CFSA had not met the 

requirement that all foster homes, group homes, and independent living 

facilities have a current and valid license, the data showed an 

improvement. 

CFSA has also begun to take steps to hold private contractors—who 

manage the cases of approximately 40 percent of CFSA’s children and 

families—-accountable for their performance. In June 2006, CFSA 

reported that contractors managing cases were performing at a lower level 

than CFSA caseworkers on certain requirements, such as making frequent

in-home visits. CFSA has taken a number of actions designed to improve 

the care provided by contractors. CFSA officials told us that its contract 

monitors meet with private agency staff on a monthly basis to review 

expectations and resolve issues. And in March 2006, CFSA began to post 

monthly scorecards on the Internet for the public to view that detail each 

contracted agency’s performance on the court-ordered requirements. 

CFSA also reported that it sends each month’s report directly to the 

executive leadership of each contracted agency and secures corrective 

action plans from private agencies that are not in compliance with the 

contract and other performance requirements. 

In addition, after lengthy delays, CFSA will soon begin to hold private 

contractors accountable for meeting performance requirements by linking

contractor payments to specific outcomes for children and families 

through performance-based contracting. Under the new performancebased contracting agreements, contractors will be expected to attain 

specific outcomes for children and families and will be financially 

rewarded for meeting the outcomes and penalized for falling short. Moving 

toward performance-based contracting has been difficult, and it has taken 

several years. While CFSA began this process in 2003, it now anticipates 

awarding the first performance-based contracts by spring 2007, and

services under these contracts are expected to begin by summer 2007. 

See table 2 for a summary of CFSA’s key unmet performance requirements 

as of April 2006 and the initiatives developed to address them. 

Page 22 GAO-06-1093 D.C. Child and Family Services
Table 2: CFSA Initiatives Addressing Key Unmet Court-Ordered Requirements 

Key unmet requirements Initiatives to address unmet requirements

Timeliness of investigations • Hire more caseworkers to lower caseloads 

• Improve coordination with police department and other investigative stakeholders 

• Implement standardized tool for assessing risk and prioritizing hotline calls

Quality of investigations • Increase qualification requirements for hotline staff 

• Hold supervisors accountable for helping caseworkers with challenging cases 

• Use Family Team Meetings to bring all relevant parties to the table 

Comprehensive investigations of reports of 

abuse and neglect in foster homes and 

institutions 

• Reduce caseloads to seven investigations per worker in the unit handling 

institutional cases 

• Develop the capacity to initiate investigations during the weekend hours as

necessary 

Appropriate and timely physical and 

psychological evaluations 

• Reorganize Office of Clinical Practice to coordinate resources and services

• Seek additional health care providers to provide services 

Increased visitations for children and families • Dedicated social worker staff to focus on visiting children living with birth parents 

Appropriate referrals to community agencies • Uses hotline screening tool to refer low and moderate-risk cases to appropriate 

community agencies 

Children are given the most appropriate outof-home placements 

• Create Placement Services Administration to centralize placement decision making 

• Develop new licensing and monitoring standards for contract providers and foster 

parents and expedited the licensing process for homes located in D.C. 

• Retained short-term emergency foster homes where families agree to take children

at any time while CFSA identifies permanent placement 

Reduce multiple placements in foster care • Require family team meeting before moving a child 

• Uses mobile crisis support and stabilization service to help child and foster family 

Timely adoptions • Reconfigure case management teams to include a permanency specialist early in 

the case when children have adoption as a goal 

• Developing new recruitment strategies to increase their pool of available adoptive 

parents 

Source: GAO analysis based on reviews of CFSA documents and interviews with officials. 

The District of Columbia’s Child and Family Services Agency has had a 

troubled history in its efforts to care for the city’s abused and neglected 

children—one that led the U.S. District court to step in and take control of

the agency. In the 5 years since CFSA left court-ordered receivership, it 

has made considerable progress toward meeting the court’s requirements. 

But it has sometimes lost ground, too, perhaps because its focus shifted 

away from sustaining the achievements, toward meeting other pressing 

requirements. Current leadership, however, seems to be focused on 

addressing the problems head on, with innovative approaches and 

strategic use of data to resolve ongoing areas of concern. We are 

encouraged by the progress made and the initiatives implemented in the 

last 2 years. Of particular note are the efforts to build a collaborative 

Conclusions 

Page 23 GAO-06-1093 D.C. Child and Family Services
relationship with the police department and to use performance data to 

focus on program improvement, not just on meeting the requirements 

imposed by the court. However, continued success will require an 

unrelenting focus, not just on requirements that remain unmet, but on 

sustaining the achievements already in place. It will also require that 

efforts now in the pipeline, such as family team meetings and 

performance-based contracting, are implemented swiftly and sufficiently 

to ensure the maximum results. 

There remain two issues of critical concern regarding CFSA’s ability to 

meet ongoing requirements and to provide needed services. First, 

caseworkers may not have the specialized training they need to meet the 

complex needs of the children they work with, particularly teenagers and 

children with special medical or mental health needs. Without such 

training, caseworkers may not have the skills and the tools they need to 

make the best possible decisions for those in their care within established 

time frames.

Second, adequately serving the children under the agency’s care—and 

meeting certain court-ordered requirements—necessitates sufficient 

medical, dental, and mental health care. However, increasing the number 

of providers willing to serve children in the District’s child welfare system 

will require help. In the absence of new solutions to the health care 

problem, CFSA will be unable to achieve the court-mandated 

requirements. Worse yet, the children who depend on CFSA’s help will be 

unable to get the care they need. 

To improve CFSA’s ability to serve the District’s children and to help meet 

court-ordered requirements, we recommend that the Mayor of the District 

of Columbia: 

• direct CFSA to provide caseworkers with specialized training to help 

them develop the skills needed to address the complexities of their 

caseloads and 

• explore options for increasing the pool of providers for mental health, 

medical, and dental services. 

We provided a draft of this report to CFSA for its review and comment. In 

its comments, CFSA agreed with our findings and recommendations, 

noting that the agency has made even greater progress since April 2006,

the time frame used for this report. At the same time, CFSA 

Recommendations for 

Executive Action 

Agency Comments 

Page 24 GAO-06-1093 D.C. Child and Family Services
acknowledged that some performance gaps remain that must be closed. 

CFSA also provided technical comments, which were incorporated as 

appropriate. A copy of CFSA’s formal response is in appendix II. 

As arranged with your offices, unless you publicly announce the contents 

of this report earlier, we plan no further distribution of this report until 30 

days from the date of this report. At that time, we will send copies of this 

report to the Honorable Anthony A. Williams, Mayor of the District of 

Columbia, and other District officials, relevant congressional committees, 

and others who are interested. Copies will also be made available to 

others upon request. The report is also available at no charge on GAO’s 

Web site at http://www.gao.gov. 

Please contact me at (202) 512-7215 if you or your staff have any questions 

about this report. Key contributors to this report are listed in appendix III.

Cornelia M. Ashby, Director 

Education, Workforce, and 

 Income Security Issues 

Page 25 GAO-06-1093 D.C. Child and Family Services
Appendix I: Scope and Methodology Appendix I: Scope and Methodology 

To conduct our review, we focused on court-ordered requirements that 

remained unmet as of December 2005. We limited our scope to

requirements related to managing child welfare cases such as initiating 

and conducting timely and quality investigations of child abuse and 

neglect allegations, providing a range of services to children and their 

families, and placing children in appropriate foster or adoptive homes. We 

did not review requirements related to administration and management of

the agency, nor did we review requirements that were not tracked using 

FACES.net. 

To assess whether the Child and Family Services (CFSA) is likely to meet 

court-ordered requirements by December 2006, we reviewed the court 

monitor’s July 2006 progress report. To understand the hindrances that 

may prevent CFSA from meeting its court-ordered requirements, we 

conducted interviews with CFSA managers, supervisors, and caseworkers. 

To gain an understanding of staff views on the hindrances in meeting 

performance requirements, we conducted separate group interviews with 

caseworkers and supervisors randomly selected to represent a cross 

section of CFSA divisions and employment tenures. We also interviewed 

CFSA officials responsible for recruiting and retaining foster and adoptive 

parents to learn about the hindrances that CFSA faces with recruiting an

adequate number of foster and adoptive homes. Finally, we interviewed 

the court-appointed monitor and other D.C. child welfare experts to get 

their perspectives on what they believe to be CFSA’s hindrances to 

meeting the performance requirements. 

Our sampling strategy for the group interviews included randomly 

selecting participants to help ensure that they represented cross sections 

of the organization. Attendance on the part of the invited participants was 

voluntary. For our four discussion groups, we interviewed supervisors and 

caseworkers whose work involved initiating and completing investigations 

of child abuse and neglect, placing children through the use of adoptions 

or foster care, and monitoring children at home or in out-of-home care 

with a goal of returning to their family. The supervisors and caseworkers 

from each group were randomly selected and included those who had 

been at CFSA for 0-2 years, 2-6 years, and 6 or more years. A trained 

discussion group moderator led the discussions while our analysts took 

notes. We developed a discussion group guide to assist the moderator in 

leading the discussions. 

To learn how CFSA monitors its progress in meeting the court-ordered 

requirements, we reviewed CFSA data and reports that CFSA managers 

use to assess the agency’s performance in meeting its requirements. We 

Page 26 GAO-06-1093 D.C. Child and Family Services
Appendix I: Scope and Methodology 

also interviewed (1) CFSA managers to learn about the strategies the 

agency has used to help guide its decisions on what data to gather and 

how to use these data; (2) CFSA’s Chief Information Officer to learn about 

CFSA’s automated child welfare information system, FACES, and its 

capacity for informing CFSA managers on the agency’s progress in 

meeting its performance requirements; and (3) the court-appointed 

monitor, the Center for the Study of Social Policy (CSSP), to gain its 

perspective on what CFSA has done and where it might improve in its 

efforts to develop data needed to assess its performance. 

To gather information on the extent to which CFSA has implemented 

initiatives or developed plans to achieve unmet requirements, we reviewed 

the court monitor’s reports and identified key requirements related to 

managing child welfare cases that had not been met as of December 2005.

We reviewed CFSA documents, handbooks, and guidance to document any 

new or planned initiatives designed to satisfy unmet requirements. We also 

interviewed CFSA managers, the court-appointed monitor, and other D.C. 

child welfare experts to determine what initiatives CFSA plans to take or 

has taken to meet these requirements. 

Page 27 GAO-06-1093 D.C. Child and Family Services
Appendix II: Comments from D.C. Child and Appendix II: Comments from D.C. Child and Family Services Agency

Family Services Agency 

Page 28 GAO-06-1093 D.C. Child and Family Services
Appendix II: Comments from D.C. Child and

Family Services Agency

Page 29 GAO-06-1093 D.C. Child and Family Services
Appendix II: Comments from D.C. Child and

Family Services Agency

Page 30 GAO-06-1093 D.C. Child and Family Services
Appendix II: Comments from D.C. Child and

Family Services Agency

Page 31 GAO-06-1093 D.C. Child and Family Services
Appendix II: Comments from D.C. Child and

Family Services Agency

Page 32 GAO-06-1093 D.C. Child and Family Services
Appendix II: Comments from D.C. Child and

Family Services Agency

Page 33 GAO-06-1093 D.C. Child and Family Services
Appendix III: GAO

A

 Contact and 

cknowledgments 

Page 34 GAO-06-1093

Appendix III: GAO Contact and 

Acknowledgments 

Cornelia M. Ashby; (202) 512-7215 or ashbyc@gao.gov

Dianne Blank, Assistant Director 

GAO Contact 

Acknowledgments 

Anjali Tekchandani, Analyst-in-Charge 

In addition, the following staff made major contributions to this report: 

Vernette Shaw, Jacqueline Harpp, and Lisa McMillen served as team 

members; Walter Vance advised on design and methodology issues and 

conducted group interviews; Rachael Valliere advised on report 

preparation; James Rebbe advised on legal issues; Kevin Kumanga, Lise 

Levie, and Katharine Leavitt verified our findings. 

D.C. Child and Family Services
Related GAO Products Related GAO Products 

District of Columbia: Federal Funds for Foster Care Improvements Used 

to Implement New Programs, but Challenges Remain. GAO-05-787. 

Washington, D.C.: July 22, 2005. 

D.C. Child and Family Services Agency: More Focus Needed on Human 

Capital Management Issues for Caseworkers and Foster Parent 

Recruitment and Retention. GAO-04-1017. Washington, D.C.: 

September 24, 2004. 

D.C. Child and Family Services: Better Policy Implementation and 

Documentation of Related Activities Would Help Improve Performance. 

GAO-03-646. Washington, D.C.: May 27, 2003. 

D.C. Child and Family Services: Key Issues Affecting the Management of 

Its Foster Care Cases. GAO-03-758T. Washington, D.C.: May 16, 2003. 

District of Columbia: Issues Associated with the Child and Family 

Services Agency’s Performance and Polices. GAO-03-611T. 

Washington, D.C.: April 2, 2003. 

Foster Care: Recent Legislation Helps States Focus on Finding 

Permanent Homes for Children, but Long-Standing Barriers Remain. 

GAO-02-585. Washington, D.C.: June 28, 2002. 

District of Columbia Child Welfare: Long-Term Challenges to Ensuring 

Children’s Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000. 

(130572) Page 35 GAO-06-1093 D.C. Child and Family Services
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