ACCREDITATION OF PUBLIC CHILD WELFARE AGENCIES 

Prepared by 

Office of Inspector General


Office of Evaluation and Inspections


U.S. Department of Health and Human Services


March 1994


OEI-O4-94-OOO1O

PURPOSE 

To describe the accreditation process and possible implications of accreditation for 

public sector child welfare agencies. 

BACKGROUND 

This is a companion memo report to an OIG report on oversight of State Child 

Welfare Programs (OEI-01-92-O0770). That report suggested that the Administration 

for Children and Families (ACF) find new ways to work with States to make program 

improvements and solve problems. One option we suggested was to require State 

child welfare agencies to be accredited, using accreditation bodies overseen by the 

ACF. This memo report is intended to supplement that report and provide more 

detailed information on the accreditation of child welfare agencies in general. 

TheAccraiiiwionProcess 

Accreditation is a voluntary review process in which outside observers - peer reviewers 

who are trained, experienced professionals - survey and assess an agency’s total 

operation using recognized criteria in the field. 

Accreditation differs from licensing. Licensing is mandatory for private organizations, 

and is not a peer-review process. Accreditation goes beyond the requirements of State 

licensing, which normally establishes service “minimums.” According to the Council on 

Accreditation of Sewices for Families and Children (Council), accreditation establishes 

a provider as a deliverer of “quality” service. While a licensing process generally 

occurs annually, accreditation reviews occur less frequently, e.g., every four years. 

Government-run child welfare agencies are not required to be licensed or accredited. 

Accreditation of child welfare agencies, both public and private, has been performed 

since 1977 by the Council. The Council was created to establish an independent, 

objective process of agency review in the field of mental health and human services. 

The Council establishes requirements for accreditation that include standards which 

address all aspects of any agency’s administration, organization, and program. The 

~ requirements are established through a process of consensus building in the field. 

As of November 1993, the Council had accredited 26 public agencies, of which 25 

were American and 1 was Canadian. Two of the accredited public agencies are State 

child welfare agencies, the South Carolina Department of Social Services, Office of 

Children, Family and Adult Semites, and the Oklahoma Department of Human 

Services, Children’s Services Unit. 

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The Councilon Accruihtion 

A grant from the U. S. Department of Health, Education and Welfare for $330,000 

helped finance the founding of the Council. Since then, however, the Council has 

been essentially a private sector organization and is now supported by seven national, 

private sponsors. Thesponsoring organizations are: 

o Association of Jewish Family and Children’s Agencies 

o Catholic Charities USA 

o Child Welfare League of America 

o Family Service America 

o Lutheran Social Ministry System 

o National Committee for Adoption 

o National Association of Homes and Services for Children 

METHODOLOGY 

The information presented in this memo report was obtained through a literature 

review and interviews with recognized experts in the field of child welfare. Experts 

interviewed represented the following organizations: 

o Administration for Children and Families, HHS


0 Council on Accreditation


0 University of Iowa


0 Child Welfare League of America


0 American Humane Association


0 National Governors Association


0 American Bar Association


0 Annie E. Casey Foundation


0 Child Welfare Institute


0 Youth Law Center, San Francisco


0 Edna McConnel Clark Foundation


0 American Public Welfare Association (APWA)


0 Child Protective Services, State of Georgia


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


0 Families First, a private child welfare agency


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


County, GA 

0 Prevention of Unnecessa~ Placements Program, State of Georgia 

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Interviews with these experts addressed the process of accreditation per se, its effects, 

and/or the impact of accreditation on outcomes of child welfare cases. 

FINDINGS 

l%e Council On Accre.dikztionh Btwntly 1%.eOn/yAccreditingBody For Child Weljare 

& encies 

Any child welfare agency seeking accreditation must meet the Council’s standards and 

pay their established fee for an accreditation review. 

AccreditationIs A DemandingAnd D@ded Rmxss 

An agency must apply to the Council for an accreditation review. After the 

application has been approved, the Council determines the time necessa~ for and the 

scope of the review. The accreditation process perfornied by the Council is comprised 

of the seven steps listed below. 

1.	 The agency seeking accreditation conducts a self study, using guidelines 

supplied by the Council. 

2.	 A team of Council peer reviewers conducts an on-site review lasting at least 

tsvo days, resulting in a report of compliance with the standards. 

3. The agency prepares a response to the report. 

4.	 A specialized Council committee considers the agency’s response and makes a 

recommendation to the Council’s trustees. 

5.	 The trustees act upon the recommendation by approving or denying 

accreditation or deferring a decision pending remedial action. 

6.	 Upon approval, the Council publishes the agency’s name and notifies relevant 

individuals and organizations in the community of the approval. 

7.	 The agency conducts a yearly review, based on the same standards used in the 

original re~ew, and transmits the review material to the Council. 

The entire review process must be repeated every four years. 

Public sector agencies and private agencies holding all applicable State and local 

licenses that have been in operation for at least one year, delivering services in one or 

more of the areas included in the Council’s standards, are eligible to apply for 

accreditation. The “Standards for Agency Management and Service Delive~” are 

divided into three broad categories: 

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o Generic Organizational Standards 

o Generic Service Delivery Standards 

o Specialized Service Standards 

~eNocategoties ofgenetic standards apply to all organizations. The specialized 

service standards set forth additional requirements for each specific service area. 

In each of the three broad categories of standards there are three levels. At the 

primary level is a general statement summarizing the requirement of the standard. At 

the secondary and tertiary levels, the standards detail in increasing specificity how that 

requirement is to be met. A list of the titles of the primary level standards and some 

examples of secondary and tertiary standards are provided in Appendix A. 

At the primary level there are 38 standards in all three-categories combined. At the 

tertiary level there are more than 1,000 standards in all three categories combined. 

However, an organization would not have to meet all 1,000 tertiary standards to be 

accredited. An organization would have to meet all of the standards in the two 

generic categories, and the specialized standards for just its particular service area. 

For example, an agency providing day care services for the aging would have to meet 

all generic standards and 14 service-specific standards. An agency providing adoption 

semices would have to meet all generic standards and 51 sefice-specific standards. 

OpinionsVa~ On The Effecfi OfAccreditationFor R.dlic ChildWe~areAgencks 

The vast majority of accredited agencies are in the private sector. Approximately 604 

agencies are currently accredited by the Council. As of November 1993, only 25 of 

those (4 percent) were in the public sector in the United States. One additional 

public sector agency was accredited in Canada. 

The Council’s literature states certain benefits derived from accreditation. Those 

benefits are as follows. 

o	 Assurance to clients, the public, funding bodies, governmental agencies, other 

professionals and agency volunteers that an agency meets rigorous standards. 

Further, accreditation demonstrates that an agency 

has effective management,


is fiscally sound,


designs programs to meet community needs,


continually monitors and evaluates service quality,


has qualified personnel, and


has safe, accessible facilities.


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o	 A declaration that an agency cares deeply about its reputation as a provider of 

quality services and wants others to know of that achievement. 

Of the experts we interviewed, one believed that accreditation per se had an effect on 

quality of semices. That individual stated that accreditation has a positive effect on 

quality, but said that the effect was hard to measure. 

On the other hand, most of the other experts we interviewed regarding the effects of 

accreditation raised questions about the benefits of accreditation for public agencies or 

expressed concern that the effect of accreditation on case outcomes could not be 

determined. They contended that accreditation makes no difference in how an agency 

performs. Some claimed that accreditation is sought primarily by organizations which 

have been successful and are performing well. Further, most of these experts agreed 

that accreditation does not guarantee positive outcomes in any child welfare case. 

Accreditation is more appealing to the private sector, they said, because it improves 

their chances of obtaining funding from organizations such as United Way. 

CwTentAccreditationStandkrakMightBe More Stringentl%an i%ose Used@ Pidilc 

Child We@re Agencies 

The Council’s accreditation standards are possibly more stringent than those of some 

State merit systems, particularly those that govern public child welfare agencies’ 

personnel policies and procedures. The Director of the Council stated that he 

believes there is a reluctance on the part of public agencies to seek accreditation 

because of a general fear that they cannot meet the standards, especially those 

regarding qualifications of their staff. To illustrate, the Council’s personnel standards 

require that the head of each program have an advanced degree in a field such as 

social work education, another mental health discipline, medicine, nursing, family life, 

early childhood education, geriatrics, or another human service field. However, some 

State merit systems may allow a person to head up a program based on a combination 

of their education and experience. Where there are significant differences between 

State and Council education requirements, an agency might not be able to obtain 

accreditation without restructuring the State merit system. 

Likewise, the Council’s standards for quality assurance might be difficult for most 

public child welfare agencies to meet. To illustrate, the Council’s standards require a 

quarterly internal review to assure, among other factors, the quality of case outcomes. 

The standards do not, however, specify how to measure outcomes. 

Experts we intetiewed stated that there is presently no consensus in the child welfare 

field regarding how to measure outcomes. They said that measuring outcomes is 

currently more art than science, and that there is no single common core of outcome 

measures in the field. Requiring accreditation would necessitate all public child 

welfare agencies to devise methods for measuring outcomes to meet the Council’s 

standards, or the Department to develop and mandate standardized measures. 

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An Accrdikztion Revkw Generdy Cash Atnind $5,(XM 

The fee for accreditation is calculated from a fee schedule. According to a Council


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


review must be conducted every four years.


The Council’s policy on what is a distinct organizational unit is not precise, however.


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


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


having “significant influence” over the establishment of policy, independent


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


geographic identity.


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


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


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


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


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


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


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


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


nationwide.


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CONCLUSION 

At this time, no one has sufficient information to ascertain fully the benefits of and 

barriers to accreditation for public child welfare agencies. Accreditation might be a 

valuable mechanism for improving the performance of State child welfare agencies; 

however, the barriers to accreditation for public child welfare agencies should be 

weighed against the benefits. 

PoNJibi2?Ben@is 

Mandato~ accreditation for public child welfare agencies could possibly accomplish 

the following. 

o	 Require public child welfare agencies which are presently operating below 

accreditation standards to make changes to meet those standards. 

o	 Provide public child welfare agencies with an explicit set of resource 

requirements. Such information would enable State legislatures to better 

determine costs and decide on an appropriate level of support. 

o	 Necessitate development of outcome measures in all public child welfare 

agencies which do not currently have them. 

PassibkBanim 

Requiring State child welfare agencies to become accredited could potentially meet 

with some barriers, such as the following. 

o	 Create conflicts or discrepancies between personnel standards and State merit 

systems, requiring modifications in State merit systems. 

o	 Require State agencies to develop outcome measures to meet all quality 

assurance standards for accreditation, or require the Department to develop 

standardized measures which all public child welfare agencies would have to 

use. 

o	 Cause States or the Department to incur a considerable expense for 

accreditation reviews of all child welfare agencies nationwide, based on current 

fees. 

o	 Failure to support public child welfare agencies might cause loss of 

accreditation. A loss of accreditation and failure to pass an accreditation 

review might increase vulnerability to lawsuits. 
Iswes Re@ikg Fmher Study 

Prior to making a commitment to accreditation, more information, both pro and con, 

is needed. Areas of concern which need to be addressed follow. 

o	 Does accreditation as presently performed by the Council lend itself to public 

sector child welfare agencies. 

o	 What benefits or barriers have been experienced by the 25 public sector 

agencies in the United States which already have obtained accreditation. 

o	 Would it be desirable for each State to develop its own outcome measures, if 

accreditation were mandatory. 

o	 How would accreditation relate to reviews of public child welfare agencies 

currently conducted by States or the Department. 

o	 Would it be worthwhile or preferable to encourage another organization 

besides the Council to perform accreditation of child welfare agencies. 

o	 To what extent would State child welfare agencies require accreditation of 

private agencies with which they contract for child welfare services. 

ACF can obtain needed information and begin to resolve these issues by 

o	 analyzing the benefits of accreditation for those public sector child welfare 

agencies which already have obtained it, 

o evaluating possible barriers to accreditation, and 

o	 developing a consensus on appropriate outcome measures for child welfare 

cases which would satisfy both public and private advocacy organizations. The 

Council has expressed an interest in collaborating with the Department in 

developing outcome measures in any of the areas of service they accredit, 

including child welfare. 

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APPENDIX A


Titlesfor PrimaryLevel Standards 

and Examplesof Secondaryand TertiaryStandards 

This list contains the headings for the 38 primary level standards. Some examples of 

secondary and tertiary level standards follow the prima~ headings, and a complete list 

may be found in the Council’s publication, “Standards for Agency Management and 

Service Delivery.” 

GENERIC 0RGANlZA770N& ST~ARDS 

o The Agency in the Community 

o Agency Governance and Administration 

o Personnel 

o Quality Assurance 

o Fiscal Management 

o Facilities and Equipment 

GENER?C SERVICE DELIVERY ST~b4.RDS 

o Intake and Assessment 

o Service Planning 

o Implementation of the Service Plan, Termination and Aftercare 

o Client Information and Confidentiality 

SPECL4LIZED SERl?lCE ST~ARDS 

o Community Organization Service/Social Advocacy Service 

o	 Information and Referral Service; Crisis Intervention Service; Emergency 

Telephone Response System 

o	 Emergency Shelter Service for Abused and Neglected Children; Emergency 

Shelter Service for Homeless Individuals and Families 

A-1

o Foster or Group Care for Unaccompanied Minor Entrants or Refugees 

o Group Home Service; Residential Center Service for Children and Youth 

o Residential Treatment 

o Pregnancy Counseling and Supportive Sexvice 

o Adoption Service 

o Independent Living Service for Youth 

EXAMPLES OF SECONDARY LEVEL STANDARDS 

Each of the 38 primary standards have a set of secondary level standards. To


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


standards for quality assurance are .


Management


Information


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


evaluate its programs effectively. 

Planning and 

Evaluation:	 The agency determines whether the agency’s services are needed 

and evaluates the effectiveness and efficiency of the agency in 

achieving its purposes and/or mission. 

Quality


Assurance


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


individual client semices meet the agency’s expectations as to 

sem-ice quality and outcomes. 

Remediation:	 Action is taken to eliminate or ameliorate problems identified in 

program evaluation and in review of the quality of individual 

client services, including, as appropriate: 

o Revision of policies and/or operational procedures; 

o	 Changes in personnel assignments, personnel supemision, 

or in-service training and 

o Modification, addition or deletion of a program or service. 

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. 

Client


Protections


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


exhibits due regard for client privacy and the right of the client to 

participate on a voluntary basis. 

EXAMPLES OF TERTIARY LEVEL STANDARDS 

Each seconda~ level standard has a set of tertiary level standards. For example, the 

following tertiary level standards are established for the secondary standard “Quality 

Assurance Program.”, 

Written Plan or 

Outline: The overall scope of the quality assurance program is described in 

a written plan or outline which sets forth: 

o	 mechanisms, committees, or other means of assigning 

responsibility for carrying out and coordinating quality 

assurance activities; 

o objectives and scope of the activity; 

o methods of monitoring used; 

o reporting of results; and 

o follow-up mechanisms. 

Quarterly Internal 

Review:	 On a quarterly basis, agency management, designated supervisory 

personnel, or a peer team conducts an internal review of 

randomly selected open cases for the quality of the client 

assessments, case or service planning, services provided or 

obtained, outcomes, and aftercare planning. 

Written Criteria:	 The agency has established written criteria, such as thresholds, 

benchmarks, or timeliness, which trigger further review or 

evaluation of problem areas by management when a case or cases 

are not in compliance with those criteria. 

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