United States General Accounting Office

GAO Report to the Honorable

Nydia Velazquez, House of

Representatives

July 1997 CHILD PROTECTIVE

SERVICES

Complex Challenges

Require New Strategies

GAO/HEHS-97-115

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-271267 

July 21, 1997

The Honorable Nydia Velazquez

House of Representatives

Dear Ms. Velazquez:

Each year, nearly 1 million American children are the victims of abuse and

neglect by their parents or other caregivers. For almost 20 years, the

country has seen a steady rise in reports of child abuse and neglect,

including a 14-percent increase, from 1990 to 1994 alone, in the number of

children who were the subject of maltreatment reports.1

 These

children—many from homes with multiple problems, such as parents with

serious substance abuse problems—are among our nation’s most

vulnerable citizens. Tragically, an estimated 2,000 children die each year

from maltreatment.

The responsibility for receiving and investigating reports of child

maltreatment falls primarily on a system of child protective services (CPS)

units within state and local child welfare agencies, which are responsible

for the day-to-day operation of these units. The rising number of child

maltreatment reports, the difficulties presented by substance-abusing

parents, and diminished resources have placed these units and agencies

under increasing stress. The federal government has an important role in

the nation’s response to these problems. Through the Child Abuse

Prevention and Treatment Act (CAPTA), enacted in 1974, and recent

amendments, the federal government has underscored its commitment to

provide funding and technical assistance for CPS to state and local

governments, which are striving to find the most effective ways to protect

children.

Because of your concern over the increase in child maltreatment cases

and the barriers CPS units face when protecting children, you asked us to

identify (1) problems confronting CPS units that affect the system’s

capacity to protect children from abuse and neglect, (2) state and local

responses to these problems, and (3) opportunities for the federal

government to assist in improving the system’s capacity to respond to the

needs of abused and neglected children. In conducting this work, we

reviewed the literature on child maltreatment and interviewed state and

federal officials and other experts. To obtain first-hand information on CPS

1

The term maltreatment refers to children who are the victims of child abuse and neglect. Many types

of abuse—such as physical, sexual, or emotional—and neglect—such as educational or medical—can

occur.

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practices, we visited four states—California, Florida, Missouri, and New

York—in different stages of reforming their CPS systems. In addition, we

convened a panel of experts in the areas of child maltreatment and CPS to

examine what role the federal government can play in assisting states and

localities in improving their CPS activities. We conducted our work

between February 1996 and April 1997, in accordance with generally

accepted government auditing standards. A complete discussion of our

scope and methodology appears in appendix I.

Results in Brief The CPS system is in crisis, plagued by difficult problems, such as growing

caseloads, increasingly complex social problems underlying child

maltreatment, and ongoing systemic weaknesses in day-to-day operations.

The states we visited have experienced large increases in maltreatment

reports in recent years, thus increasing the CPS caseload to an

overwhelming level. In addition, states report that families are entering the

system with multiple problems, among the most common of which is an

increase in substance abuse. Experts consider this increase to be a

significant factor in maltreatment, which has caught all parts of the CPS

system unprepared. Moreover, CPS units have been plagued by

long-standing systemic weaknesses in day-to-day operations, including

difficulty in maintaining a skilled workforce; consistently following key

policies and procedures designed to protect children; developing useful

case data and recordkeeping systems, such as automated case

management; and establishing good working relationships with the courts.

Highly qualified staff who have the necessary resources and support to

carry out the complex tasks involved in protecting children are essential to

ensure that maltreated children find safety in the CPS system. Therefore,

without these critical elements, the effectiveness of CPS is undermined.

In response to this crisis, states and localities are testing new strategies for

service delivery. Given the increased volume and severity of the cases, CPS

units find that using traditional approaches, they can no longer handle all

reports alleging abuse or neglect. As a result, states and localities are

developing new strategies, depending on the severity of the maltreatment,

to respond to CPS reports. States and localities are also focusing on

forming partnerships with families, friends, churches, and community

organizations to help keep children safe from maltreatment. These

partnerships enable CPS units to share responsibility for intervening in

various types of maltreatment cases. For example, in Missouri, CPS

caseworkers teamed with community partners to develop and deliver

services to families in which they consider the imminent risk of harm to

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the child to be low, such as in child neglect. These new strategies,

however, are not without certain challenges. They include such challenges

as (1) adapting to new caseworker roles, required by new responsibilities,

and (2) the underlying systemic weaknesses that diminish day-to-day

operational effectiveness. For example, without a highly trained and stable

workforce to mobilize and build trust among the diverse group of partners,

realizing reform goals may be difficult. More importantly, there is little or

no research to assess whether these new strategies effectively solve the

problems of abused and neglected children and their families.

As state and local CPS units experiment with new strategies aimed at better

coping with rising and complex caseloads, units will need more focused

support and improved technical assistance from the federal government.

Previous federal research has concentrated on the causes of maltreatment

and on ways to treat abused and neglected children and their families,

rather than on topics that support the states’ community-based response

to the CPS crisis. Similarly, federally provided technical assistance has also

been limited in helping the states develop new strategies to address this

crisis. In addition, dissemination of federal research findings and practical

information for improving daily CPS operations is lacking. By focusing its

efforts on the new strategies within states, the federal government could

provide states with much needed information on what other CPS units have

tried and the outcomes of these experiments.

Background CPS units within local child welfare agencies serve as a community’s first

line of defense for children whose families are having difficulty caring for

them or are no longer able to care for them. CPS units represent the

front-end of the child welfare system since the majority of children

receiving child welfare services (such as foster care) first come to the

attention of the system through CPS. CPS caseworkers investigate reports of

child abuse and neglect to verify the alleged maltreatment, conduct

assessments to determine what services may help stabilize a family and

reduce the risk of further maltreatment, and coordinate the delivery of

treatment services by a variety of public and private providers. These

activities are often conducted under adverse and sometimes dangerous

circumstances. In addition, caseworkers must balance the often

conflicting roles of investigator and social worker. As investigators, CPS

caseworkers collect evidence and work with law enforcement officials; as

social workers, they work with families to identify services needed to

improve conditions in the home and provide a safe environment for the

child.

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States generally follow a common set of procedures when investigating a

report that a family is either neglecting or abusing a child under its care.

Most reports of maltreatment are by telephone and are received by staff

trained to collect information concerning the alleged incident. These staff

then assess whether the circumstances described in the telephone call

match the state definition for maltreatment and whether there is sufficient

cause to believe that the child is in danger of further harm.2

 If the report

meets these conditions, the staff refers the report to the CPS unit for

investigation.3

CPS Activities Referred reports are generally categorized into two groups. In the first

group, CPS caseworkers are dispatched immediately for children believed

to be in imminent risk of harm. In the second group, investigations are

usually initiated within 24 to 72 hours, depending on state statute.

Caseworkers usually check if the child’s family has had a prior validated

report of abuse or neglect. Caseworkers then visit and interview the

family, including initiating face-to-face contact with the child, and begin

collecting information about the alleged maltreatment incident. This

information includes physical evidence, such as the results of a physical

examination of the child showing any marks or bruises, and statements

from family members and other individuals who may have information

relevant to the case. Law enforcement officials may be asked to

accompany a caseworker on this visit if the caseworker believes the child

may need to be immediately removed from the home or that the situation

may become dangerous or violent. Finally, caseworkers determine the

report’s validity and record and summarize the information. These

determinations are based on the agency’s criteria for an acceptable level of

risk to the child and caseworkers’ training, prior experience, and

judgment. Since a faulty evaluation can endanger a child’s life, CPS

protocols usually recommend specialized training for caseworkers and

regular and close supervisory review of these difficult decisions.

If a CPS caseworker, during the initial investigation, believes that a child

has been maltreated and needs the court to protect the child’s safety, the

caseworker must initiate judicial oversight of the case, which can be

2

State definitions of the various types of maltreatment are generally based on definitions found in

CAPTA, which defines abuse and neglect as “at a minimum, any recent act or failure to act on the part

of a parent or caregiver, which results in death, serious physical or emotional harm, sexual abuse or

exploitation, or an act or failure to act which presents an imminent risk of serious harm.”

3

Reports that do not meet state definitions for abuse or neglect and are not referred to local CPS units

can be referred to other state or local information telephone numbers, local law enforcement agencies,

or other state social service agencies.

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time-consuming and complicated. The caseworker begins by filing a

petition with the court, detailing the alleged maltreatment and how it

meets the legal definition in that state. Then, depending on the course of

the CPS investigation and state requirements, a series of court hearings may

follow. First, the court decides whether the risk to the child is great

enough to warrant removing the child from the home on a temporary

basis. Next, the court decides whether the alleged maltreatment occurred.

This determination is made based on evidence gathered by the caseworker

during the investigation, which usually must be completed within 30 days.

Finally, the court decides who will have control over the child and what

steps must be taken by the family and the child welfare agency to improve

the family situation. The court can allow the child to remain in, or return

to, the home or place the child with a foster family, in a group home, or

with a relative.

While the caseworker is following the procedures involved in investigating

the alleged maltreatment, he or she is also developing a tentative plan to

address those conditions in the home that CPS believes contributed to the

maltreatment of the child. This plan ultimately becomes the case plan that

outlines treatment services for the child and the family. The plan describes

what actions are required of all the parties involved to correct the

conditions that caused the maltreatment and, in some cases, the

placement outside the home, as well as the time frames for accomplishing

them. In addition, the plan must address a child’s health and education

needs, including arrangements for any specialized treatment by health care

providers. The causes of child abuse and neglect are complex, and a case

plan can involve referrals to an array of individuals, including caseworkers

from other units in the child welfare agency, such as adoption or foster

care specialists; private service providers, such as mental health and

counseling professionals on contract with CPS to provide treatment

services; other public agencies that can assist with nonhealth services,

such as housing; and organizations providing transportation or other

support services. Maintaining the services outlined in the case plan is key

to avoiding further exacerbation of the family’s problems and a return to

the crisis mode that often precipitated the initial report.

Federal Involvement in

CPS Activities

Federal activities directed specifically at child maltreatment prevention

and treatment began in 1974, with the passage of CAPTA. This legislation

and subsequent amendments have influenced CPS in important areas. For

example, CAPTA provides (1) federal guidelines for states to use in their

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definitions of child abuse and neglect and (2) for states to have in effect

laws for the reporting of suspected maltreatment.

The CPS activities of investigating and verifying suspected maltreatment

are almost entirely funded by state governments; however, the federal

government provides some funding for support activities, such as research

and technical assistance. CAPTA authorizes and funds three key entities that

support state CPS units: (1) the Office on Child Abuse and Neglect (OCAN),

within the Department of Health and Human Services (HHS), which

oversees federal research on child abuse and neglect, demonstration

projects, and other activities; (2) The National Resource Center on Child

Maltreatment, under a contract with HHS, which provides technical

assistance to states on child welfare issues; and (3) The National

Clearinghouse on Child Abuse and Neglect, also under an HHS contract,

which gathers and disseminates information on child maltreatment. In

addition, CAPTA charges HHS with providing state and local agencies with

support and technical assistance, as well as ensuring that CPS activities are

executed and coordinated among all agencies involved with CPS-related

activities. For fiscal year 1996, CAPTA provided over $50 million for federal

research and demonstration grants, program grants, and training and

technical assistance. Other sources of federal funding provide states with

(1) support while a child is in foster care or (2) the ability to make services

available to help prevent the removal of a child from the home.4

CPS System Plagued

by Difficult Problems

Increases in the number of maltreatment cases, the changing nature of

family problems, and long-standing systemic weaknesses have placed the

CPS system in a state of crisis and undermined its ability to fully carry out

the responsibilities for abused and neglected children. First, child

maltreatment reports have risen steadily across the country. The caseloads

of CPS units have grown correspondingly, and CPS units often cannot keep

pace with this workload.5

 Second, these caseloads are increasingly

composed of families whose problems have grown more troubling and

complicated, with substance abuse a common and pervasive condition.

Finally, systemic weaknesses—such as difficulty maintaining a

4

The Social Security Act, Title IV-B, subpart 1 (Child Welfare Services), provides funds for support

services, to prevent abuse and neglect, and for foster care services, to reunite families, arrange

adoptions, and ensure adequate foster care placements; Title IV-B, subpart 2 (Family Preservation and

Support), provides funds to support families and prevent the need for foster care; Title IV-E provides

funds for food and shelter for children in foster care; and Title XX (Social Services Block Grant)

provides funds for support services to families at risk of child abuse and neglect.

5

The Continuing Child Protection Emergency: A Challenge to the Nation, U.S. Advisory Board on Child

Abuse and Neglect, U.S. Department of Health and Human Services, Administration for Children and

Families (Washington, D.C.: U.S. Government Printing Office [GPO], Apr. 1993).

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professional and skilled workforce, inconsistently implementing policies

and procedures, a lack of automated case management in recordkeeping

systems, and poor working relationships between CPS and the

courts—have further weakened CPS units. The combined effect of difficult

caseloads and systemic weaknesses (1) overburdens caseworkers and

dilutes the quality of their response to families and (2) may further

endanger the lives of children coming to the attention of CPS.

CPS Caseloads Are

Growing

In 1990, the U.S Advisory Board on Child Abuse and Neglect concluded

that child abuse and neglect was a national emergency.6

 According to the

study, reports of child maltreatment steadily increased over the years,

from about 60,000 cases reported in 1974 to 1.1 million in 1980. Reports

then doubled to about 2.4 million during the 1980s. More recently, HHS

reported that between 1990 and 1994, the number of children that were the

subject of reports of abuse and neglect rose approximately 14 percent, to

over 2.9 million.7

 Although reasons for the high number of reports are

complex, research indicates that the number has risen, in part, due to

(1) increased child maltreatment by drug-dependent caretakers, as a result

of the cocaine epidemic during the 1980s, (2) the mandate for certain

groups of professionals to report suspected maltreatment, and (3) the

stresses of poverty among families. Since HHS began collecting data in

1990, neglect has been the predominant type of maltreatment. For

example, in 1995, approximately 52 percent of the maltreated children

were neglected, while approximately 25 percent were physically abused.

Sexually abused children accounted for about 13 percent. HHS recently

reported that for the first time, a leveling off—in both the annual number

of reports nationwide and the annual number of confirmed cases—is

occurring. However, some state and local officials told us they are

concerned about the effect welfare reform will have on the number of CPS

reports.

The U.S. Advisory Board on Child Abuse and Neglect reported in 1995 that

state and local CPS caseworkers are often overextended and cannot

6

Child Abuse and Neglect: Critical First Steps in Response to a National Emergency, U.S. Advisory

Board on Child Abuse and Neglect, U.S. Department of Health and Human Services (Washington, D.C.:

GPO, Aug. 1990).

7

Child Maltreatment 1994: Reports from the States to the National Center on Child Abuse and Neglect,

U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect

(Washington, D.C.: GPO, 1996). Data in this report are collected by the National Child Abuse and

Neglect Data System, a voluntary reporting system, funded by HHS. Differing state CPS policies,

programs, designs of information systems, and resources influence the capacity of states to provide

child abuse and neglect data to the system and, thus, affect the collection and interpretation of data at

the national level.

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adequately function under their current caseloads. As a result,

breakdowns occur in their ability to protect children. The report also

stated that in many jurisdictions, caseloads are so high that CPS response is

limited to taking the complaint call, making a single visit to the home, and

deciding whether or not the complaint is valid, often without any

subsequent monitoring of the family.

Of the four states we visited, three—Missouri, California, and New

York—also experienced a rise in maltreatment reports, which is consistent

with the national trend. In Missouri, child abuse and neglect reports have

increased over 18 percent since 1991. In California, the total number of

reports received by county CPS units have increased approximately

25 percent since 1988. In New York, reports to the state’s child abuse and

neglect central register have increased almost 330 percent since 1974. Only

in 1990 and 1994 did the state see a slight drop in reports.

Likewise, all four sites we visited indicated that increased caseloads affect

the amount of time and resources that can be invested in individual cases,

which can result in insufficient services for families and children. For

example, in Florida, CPS staff in the counties we visited stated that high

caseloads delay their initial response to new cases, hinder the quality of

the work they perform, and limit the ability of supervisors to review cases.

Service providers who work with CPS staff also noted that caseworkers are

unable to sufficiently monitor families and that they respond only to

crises. Similarly, a 1996 report8

 on Sacramento County, California—where

calls to the CPS hotline have tripled from 1980 to 1993, to over 3,000 calls

per month—stated that (1) the demand for CPS exceeds current capacity,

(2) caseloads exceed recommended levels,9

 and (3) caseworkers’

decisions are strongly influenced by the pressure to limit the number of

active cases. High caseloads require caseworkers either to accept greater

levels of risk to the child while with the family or to decide to remove the

child inappropriately, county staff said. In addition, county service

providers indicated that high caseloads can result in procedural failures,

such as an inadequate review of prior case history or incomplete

documentation of casework conducted.

8

Critical Case Investigation Committee Final Report, Office of the County Executive, County of

Sacramento (May 1996).

9

The Child Welfare League of America, a professional organization for child welfare officials, has

developed guidelines for optimal caseload size.

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Substance Abuse in

Families Becoming

Common

CPS caseworkers must increasingly deal with families that suffer from

multiple problems, including substance abuse. The escalating cocaine

epidemic during the 1980s exacerbated the already challenging work of CPS

caseworkers. According to OCAN, the number of women who abuse drugs

has increased, resulting in a growing number of infants who are exposed

to illegal substances before birth. In addition, intoxication is a

precipitating factor for every kind of abuse; many children experience

neglect as a result of their parents’ physical or psychological absence

while seeking alcohol and other harmful drugs or being under the

influence. The recognition of this link between child maltreatment and

substance abuse was identified in 1990 in the first report of the U.S.

Advisory Board on Child Abuse and Neglect.10 The board reported that the

vast increase in child maltreatment associated with substance abuse and

the extent of the problem caught CPS units unprepared. On the basis of a

national survey, HHS reported that the number of CPS cases involving

substance abuse can range from 20 to 90 percent, depending on the area of

the country. As a result, CPS units must not only develop more effective

ways to work with parents who use drugs, but must also address the

problems of substance-exposed infants and increasing concerns for

caseworker safety in the field.

Officials in the states we visited echoed the findings of research and

identified substance abuse of caregivers as one of the most difficult

problems CPS units address when responding to child abuse and neglect

cases. In New York City, for example, approximately three-quarters of the

confirmed cases involve drug addiction of at least one caregiver.

According to the Manhattan Field Office staff, a majority of cases involve

substance-abusing parents, many of whom live in drug-infested and poor

neighborhoods, intensifying family problems. CPS caseworkers visiting

these families do so at considerable risk to their own safety. In

Sacramento County, where substance abuse affects an estimated 75 to

80 percent of the CPS cases, a county official identified poverty and

substance abuse as the two biggest problems the CPS unit faces. Moreover,

the presence of these problems can delay case progress and limit clients’

ability to change their lives, the official noted. According to St. Louis City

and County supervisors, developing service plans for drug-abusing

mothers poses one of their greatest challenges.

Although substance abuse has increased among CPS cases, many

communities lack treatment services. Across the country, the demand for

drug treatment slots exceeds the supply. According to state and local

10Child Abuse and Neglect: Critical First Steps in Response to a National Emergency, p. 55.

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officials in the sites we visited, clients cannot obtain needed services

because of the shortage of appropriate treatment programs and the

waiting lists for many programs in their communities. In addition, the

more commonly available services are short-term rather than long-term,

and are less likely to have a lasting effect, according to a 1993 HHS study of

high-risk child abuse and neglect groups. Finally, even when substance

abusers do receive treatment, the relapse rate is high. Both the lack of

treatment services and the likelihood of relapse may necessitate more

involvement by CPS.

Systemic Weaknesses

Hampering CPS

Effectiveness

Long-standing systemic weaknesses within CPS units further hamper their

capacity to protect children. These weaknesses have plagued CPS units for

a number of years, and we observed these problems to varying degrees

across all four sites we visited. These problems include (1) difficulty

maintaining a professional and skilled workforce, (2) inconsistently

implementing policies and procedures, (3) a lack of case data and

automated case management, and (4) poor working relationships between

CPS and the courts. Taken together, these weaknesses can undermine the

effectiveness of CPS’s response to child maltreatment. In particular,

without a quality staff who have the necessary resources and support to

carry out the complex tasks involved in protecting children, the CPS system

will continue to lag behind in dealing with the growing problem of child

abuse and neglect.

Skilled Workforce Difficult to

Maintain

Hiring, training, and retaining a skilled workforce is essential to

maintaining a professional and competent staff; however, CPS units were

often unable to attract and retain qualified staff and to provide relevant

training. CPS staff in sites we visited reported that some new hires were not

qualified for their positions, either due to inadequate hiring policies or low

entry-level salaries. For example, in New York City, until recently, new

hires were required to have only a college degree, rather than a degree in

social work or a related field. In Sacramento County, some staff were

hired without the qualities needed to fulfill their job responsibilities,

resulting in poor performance, according to county staff. In addition,

training programs were often inadequate in terms of content and

frequency. In Missouri, for example, funding has limited the amount of

inservice training the state can provide, and some staff report that training

manuals are out-of-date and that trainers are not up-to-date on the

environment in which caseworkers operate today. In New York City,

experienced staff reported that new caseworkers did not need to obtain

passing grades in their entry-level training classes. New York City,

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however, began taking steps to reform its CPS system in 1996. Hiring and

training requirements have been improved, and the city is developing a

system for providing all personnel with needed inservice training.

Finally, in all the sites we visited, retaining an experienced workforce was

often cited as a problem. In Florida, Missouri, and New York, low salaries

contributed to staff leaving for better paying positions. Likewise, in

Florida, a 1995 panel appointed by the governor found that Florida’s

salaries were too low to attract and retain qualified CPS caseworkers.

These conditions affect caseworkers’ ability to consistently serve clients

and result in a lack of experience among supervisory staff.

Policies Inconsistently

Implemented

In CPS, where staff are sometimes dealing with life-and-death issues, the

knowledge of and consistent application of appropriate policies and

procedures are critical. CPS policies and procedures—such as those that

define acceptable levels of risk to the child and those that outline the time

frames, methods, and protocols for sharing information with local service

providers, as well as documentation requirements for collecting evidence

during the investigation—are important safeguards for children. These

policies and procedures provide structure in the stressful environment in

which caseworkers function and reduce the probability of making serious

mistakes. Clear policies and procedures can also provide important

guidance when staff receive inadequate or inconsistent supervision.

In some of the sites we visited, however, CPS staff were unable to

consistently apply existing policies. For example, a 1995 state review of

New York City’s CPS operations found numerous problems in

implementing policies, such as inadequate safety assessments for all

children within the home in over 20 percent of the cases, inadequate

investigations in over 50 percent of the cases, excessive time frames for

conducting investigations in 50 percent of the cases, and missing service

plans in 18 percent of open cases for which abuse was validated.

Moreover, the review identified a lack of supervisory involvement in

determining the validity of alleged maltreatment in 21 percent of the cases.

Bronx and Manhattan Field Office managers, supervisors, and

caseworkers reported that they lack knowledge on policies and

procedures, in part, because policies change frequently, no procedures

manual exists, and information is inconsistently distributed to all staff. In

addition, a 1996 report on Sacramento County operations identified a need

for clearer procedures and found that consultation with supervisors

appears to take place on an informal, ad hoc basis. The report also stated

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that written policies and procedures are not always consistent with verbal

communications and directions to staff.

Lack of Automated Case

Management Leads to

Inefficiencies

Lack of automated case management in recordkeeping systems can result

in inefficiencies, such as reliance on burdensome paper files and lost or

inaccessible client files. Although some CPS data are automated for state

and federal reporting purposes, these data are not useful in the day-to-day

management of cases, according to staff we met with in Florida’s District

12 and in Sacramento County. As a result, CPS workers in all four sites we

visited still work primarily in a paper environment. They and their

supervisors generally do not have access to automated information

systems for individual case planning and monitoring, and must rely on

paper files to conduct their day-to-day activities. For example, New York

City caseworkers and supervisors relied on hand-written case information

on 5”-by-8” cards for the current status of cases and their history.

Retrieving case records from agency archives or transferring the files from

one field office to another can take weeks and files can become lost,

according to New York City caseworkers. Agencywide computerization,

which is being partially funded through federal grants, was not fully

operational at the time of our visits. In developing these systems, CPS units

will have the opportunity to add automated features that could assist CPS

staff in managing workload, identifying available resources, and preparing

and tracking court documents. If properly implemented, these systems

could provide caseworkers with essential information for intervening in

maltreatment situations, as well as reduce paperwork and manual

recordkeeping.

Working Relationship With

Courts Poor

By necessity, CPS units should work efficiently and effectively with the

courts to protect children. However, the court system, like CPS, also faces

problems associated with the large volume of increasingly complex cases.

For example, according to the American Bar Association, overcrowded

dockets, inefficient case scheduling, unprepared or overburdened

attorneys, and frequent rotation of judges who may or may not have

expertise in child welfare law all contribute to significant delays in making

decisions about children. Linked, in part, to these problems, all sites we

visited noted poor working relationships between CPS staff and the courts.

CPS staff reported a lack of respect for the caseworkers’ experience,

insufficient preparation time with attorneys assigned to help them, and

minimal assistance in preparing court records in a professional manner. In

some cases, staff resorted to turning in court documents in handwritten

form. Because the courts do not schedule specific court times for

individual cases, a caseworker must often spend many hours waiting for

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his or her case to be called on the day it appears on the docket.

Unnecessary time spent in court diverts the caseworker from performing

investigative activities on other open cases. Federally funded initiatives,

designed to address these problems, are just beginning; thus far, they have

focused on states’ self-assessment of problems.

States and Localities

Focus on New

Strategies to Cope

With Rising and

Complex Caseloads

Different types of maltreatment require dramatically different prevention

and treatment strategies. Each of the four states we visited has been

moving towards new strategies—in different stages of development—in its

CPS system. Missouri and Florida, for example, have been developing

responses to match the severity of various types of maltreatment; they

have been forming partnerships between CPS and community service

providers. These early partnerships have been generally characterized by

sharing physical space with community agencies and including these

organizations in case planning.

Experts, state agency officials, and caseworkers believe that these new

strategies show promise, but their ultimate success will depend, in part, on

the CPS staff’s ability to overcome certain challenges, such as developing a

willingness within the community to become more active in protecting

children from maltreatment and to adapt to new roles and responsibilities.

In addition, states reported that regardless of reforms in place, systemic

problems continue to affect day-to-day operations and the quality of

assistance provided to families; these problems may threaten the success

of any new strategies.

States Experiment With

New Service Delivery

Models

In two of the states we visited, Missouri and Florida, state child welfare

agencies have implemented new service delivery models. These agencies

and local CPS units have turned to the broader community of churches,

schools, mental health providers, and others to expand their reach. By

developing partnerships with these community groups, CPS units are able

to quickly increase the number of people available to serve children and

their families, without increasing CPS staffing levels. The models in these

two states are also based on the premise that all CPS cases do not require

the same traditional approach. Instead, the models incorporate a flexible

response, whereby CPS cases can be grouped according to the nature of the

allegation, recognizing that different types of allegations require different

responses. For example, the level of investigation needed to clearly

Page 13 GAO/HEHS-97-115 Child Protective Services
B-271267 

establish facts and gather evidence in a sexual abuse case may be

unnecessary for a report of educational neglect.11

In 1994, Missouri developed a new strategy to handle the overwhelming

number of reports coming into its CPS system. Missouri recognized that

state government, acting alone, had neither the resources nor the local

community, neighborhood, or family base to effectively alter the cycle of

abuse and neglect. In response, Missouri began a demonstration initiative

designed to divide incoming reports into two categories. Cases in the first

category, called investigations, require law enforcement be contacted;

these cases focus on reports of serious physical or emotional abuse and all

reports of sexual abuse. CPS caseworkers conduct investigations jointly

with law enforcement officials and then refer the cases to other

caseworkers, as necessary, for foster care or services to preserve the

family. All other cases, such as reports of neglect and mild physical

abuse,12 are in the second category and handled differently, without a

traditional protective investigation. For these cases, for which the risk of

imminent harm is less, a caseworker conducts a thorough assessment,

called a family assessment, according to state guidelines. The caseworker

determines the degree of risk to the child’s safety and the family’s need for

assistance from the CPS unit or the community. Family assessment staff are

expected to collaborate with their community partners.

Parts of St. Louis City and St. Louis County, Missouri, are participating in

this demonstration. In cases screened using the family assessment model,

caseworkers make the initial visit and then work with the family, generally

providing services for up to 90 days. The majority of the incoming reports

are placed in this category, and family assessment caseworkers work

closely with their community partners. For example, some caseworkers

are located with their partners in a community education center, which

provides on-site services and linkages to a variety of community supports,

such as family counseling, housing assistance, and drug abuse prevention

programs. This arrangement allows for better communication and

collaboration among the caseworkers and service providers. At the time of

our review, Missouri was also considering developing a process in which

community partners could conduct family assessments themselves,

although the CPS units would still be ultimately responsible and approve

11Educational neglect includes permitting chronic truancy, failing to enroll a child of mandatory school

age, and not attending to a special educational need.

12Child neglect is characterized by failure to provide for a child’s basic needs and can be physical,

educational, or emotional. Research has shown that neglect tends to be chronic and long-term, and can

result in long-term developmental consequences. Research also shows that intervention does not

always result in improvements or fewer subsequent reports to CPS.

Page 14 GAO/HEHS-97-115 Child Protective Services
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the final assessment. Evaluation of the impact of Missouri’s flexible

response strategy is required by the Missouri State Legislature, and a final

report is due in January 1998.

Like Missouri, Florida has been reworking its approach to child

protection. In 1992, Florida’s legislature and governor mandated that the

State Department of Health and Rehabilitative Services develop a strategic

plan to more clearly delineate how Florida would protect its children. The

resulting plan addressed a fundamental lack of community involvement in

CPS operations. For example, historically, Florida’s human services

programs, such as CPS, were designed and administered at the state level

and thus were removed from local community problems. Under the new

plan, Florida decentralized the management of CPS from the state to the

district level.

To further strengthen the link between child welfare services and local

communities, the governor signed legislation in 1993, directing local child

welfare officials to jointly develop a CPS program with community

agencies. Under this program, similar to Missouri’s strategy, incoming

child abuse and neglect reports are separated into two categories: (1) for

the more serious cases, such as sexual abuse and severe physical abuse,

caseworkers use the traditional approach, an investigation by CPS and law

enforcement, and (2) for the remaining cases, rather than using the

traditional approach, caseworkers assess the child’s safety, as well as

family strengths and resources that could help to reduce risk.

Florida’s District 12, where we focused our review, developed a

community-based strategy to enhance its handling of sexual and serious

physical abuse cases. The resulting Child Advocacy Center is a

collaborative effort between a not-for-profit agency that provides

treatment for child victims of abuse, CPS, law enforcement, the Young

Women’s Christian Association, and the state attorney. The center’s goal is

to provide a warm, nonthreatening environment for joint CPS and law

enforcement investigations, case reviews, medical examinations and

evaluation, mental health treatment, victim advocate support services,

training, and community education. Since all team members are generally

located together, the lag time between case initiation and service provision

is decreased.

Other States Make Early

Efforts at New Models

Sacramento County, California, and New York City are making early

efforts to reorganize the delivery of CPS services. In both cases, state and

Page 15 GAO/HEHS-97-115 Child Protective Services
B-271267 

local officials have recognized the critical role communities will play in the

future effectiveness of CPS. At the time of our visit, however, these sites

had not fully developed their new strategy to implement reforms.

Sacramento County is beginning by using a team approach. Team

members include clinical experts from CPS and other county

departments—such as mental health, alcohol and other drug treatment,

and public health—as well as representatives from the community and the

state’s Department of Social Services. The goals of the team are to

(1) protect children, by bringing together county functions—such as

mental health treatment, alcohol and other drug treatment, public health

services, and public assistance—to provide a unified approach to planning

interventions and (2) ensure the community is involved in improving the

county’s CPS system.

To overcome its history of ineffective approaches to protecting children,

New York City is undergoing major structural reforms, designed to

streamline and clarify its processes to ensure that all efforts are directed

to the safety and well-being of children. As part of this reform, the city

recently acknowledged that it must galvanize its residents, neighborhoods,

churches, and community-based organizations to become partners in the

drive to make certain that every child is safe. One of New York City’s first

planned actions is consistent with reforms observed in the other states we

visited. New York City plans to (1) realign the boundaries of its CPS offices

to coincide with community-district boundaries and (2) assign managers

and caseworkers to specific communities. This realignment will allow staff

to have greater access to individuals and institutions that are familiar to

the child and family, as well as to local services.

Child Fatality Panels Help

Build Community

Partnerships

State and local officials are using the tragic circumstances of child deaths

to mobilize community resources. These officials realize the value of

reviewing the circumstances surrounding the death of a child to determine

not only whether the death was the result of abuse, but also what can be

learned to further improve how CPS cases are handled and families are

served. In all sites, either state or local officials have established child

fatality review teams, generally composed of physicians, law enforcement

officials, social workers, and other child welfare experts; each member of

the team brings his or her own expertise and skills to each review. These

child fatality review teams are often the first step in recognizing the value

of building relationships between community partners.

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In Missouri, representatives on county-based panels include the

prosecuting attorney or circuit attorney, the coroner or medical examiner,

law enforcement personnel, child welfare staff, public health care service

providers, juvenile court staff, and emergency medical services staff.

Conclusions drawn from fatality reviews are used for targeting prevention

strategies, identifying specific community needs, and developing trend

information, as well as improving the services provided by each team

member’s discipline. The multidisciplinary nature of the panels increases

the likelihood that the correct cause of death is identified. In St. Louis

County, for example, panel members reported that some deaths are

initially classified as Sudden Infant Death Syndrome (SIDS). However,

when these cases are reviewed by the fatality panel, information shared by

individual members may lead the panel to conclude that the death was

caused by abuse rather than SIDS.

Two fatality panels, also composed of team members from various

disciplines, operate in New York City. A few members are common to both

panels. One panel reviews deaths in cases known to the CPS units,

examining case practice and policies and making recommendations when

necessary. This panel is operated by the child welfare agency and is

composed of representatives from other local government agencies, as

well as external health and social work experts. The other panel is

independently operated by the Office of the Chief Medical Examiner of

New York City and has a broader mission. This panel investigates all child

deaths in New York City that meet the panel’s critieria to, among other

things, (1) identify broader social issues of child abuse and neglect, as well

as public health concerns relating to the safety of children, and (2) devise

policies and procedures that will decrease the likelihood of a child’s death.

In addition, the state of New York reviews cases involving the death of a

child if the child was in the custody of an authorized agency or if the

child’s death was reported to the state central register.

New Strategies Show

Promise but Many

Challenges Remain

While new strategies hold the promise of helping CPS units better respond

to increases in child abuse and neglect, with responsibility for intervention

shared with the community, little research has been done to determine

whether these new strategies result in improvements in families and

children or a reduction in the number of subsequent referrals. A

December 1996 evaluation of the Florida program, for example, found

improvements in service delivery, but noted some differences based on a

district’s level of implementation of the new strategies. For example, the

study found that in those districts that had more fully implemented the

Page 17 GAO/HEHS-97-115 Child Protective Services
B-271267 

new strategy, early decisions to place children were more consistent with

later decisions on the safest option for the child. On other measures of

success, all districts improved. These measures included the extent to

which caseworkers were able to resolve family issues without involving

the court.

However, this evaluation also confirms what officials during our site visits

said: Creating successful community partnerships is difficult, and many

challenges exist that can hinder progress. Some of these challenges reflect

the long-standing problems that CPS units recognize as barriers to their

overall effectiveness; others stem from the new strategies being tested.

One of the long-standing problems CPS units will continue to struggle with

is finding appropriate treatment slots for substance-abusing parents. In

addition, states we visited have found that forging new community

partnerships represents a significant change in operations for both CPS

caseworkers and their new allies. These caseworkers traditionally have

operated independently and represent agencies with their own sets of

policies and priorities. The evaluation found that some districts were

successful in establishing partnerships across both policy and practice

levels; others had difficulty in clearly delineating their relationships and

roles with local partners. Representatives of community organizations in

St. Louis report that these partnerships can be slow to form, as funding,

teambuilding, issues of developing trust among members, and agreement

on sharing information about children and families are gradually worked

out. St. Louis County staff reported that one community claimed child

abuse and neglect did not exist among its families and was reluctant to

become involved with the pilot program. In addition, some community

groups initially came to meetings seeking funding for services they

provide. Over time, however, their involvement has reflected an increased

level of commitment.

The Florida evaluation found that employees’ attitudes and ownership of

the new philosophy, as well as the level of support received from

supervisors and administrators, affect the success of the program. The

transition can be difficult for CPS caseworkers since most caseworkers

were previously traditional CPS investigators. They must adapt to their new

roles, learning how to conduct family assessments. Such new roles

represent a fundamental change, requiring a new perspective and a new

set of skills. In addition, caseworkers must sometimes manage their

existing caseloads while transitioning to the new method of delivering

services. Caseworkers in St. Louis City and St. Louis County, for example,

report that they are responsible for managing their ongoing cases using the

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traditional approach, while at the same time managing new cases using the

new strategy, the family assessment model.

While new strategies to serve families may help CPS units reduce the

burden of addressing child abuse and neglect, these strategies should not

be expected to resolve the underlying systemic problems many CPS units

face. These problems remain and may jeopardize the future success of

these promising strategies. For example, regardless of the new strategies

taken to handle abuse and neglect reports, state officials recognize that

without skilled and trained caseworkers, these strategies could flounder.

In addition, these officials reported that keeping new and existing staff

abreast of changing procedures and policies is difficult, given that training

resources are already stretched to capacity. In Florida, staff reported that

inconsistencies in practice still occur because of inadequate supervision. A

recent Florida Governor’s Panel on Child Protection Issues found that high

staff turnover, unmanageable caseloads, poorly trained staff, and

inconsistent procedures continue to plague the CPS system. Poorly trained

staff or inconsistent policy implementation can undermine the credibility

of CPS caseworkers among their community partners and hamper

cooperation.

Changed Federal

Response Would

Better Assist the

States

The new strategies of states and localities call for a new partnership

between state child welfare agencies and the federal government.

Although the federal government has played an important role over the

last two decades, opportunities exist to enhance and refocus its assistance

to states and localities. Important legislation, such as CAPTA, generated

federal mandates that are responsible for many of the reforms of the past

20 years, including mandatory reporting systems for child abuse and

neglect, as well as judicial review of decisions to remove children from

their homes. This legislation has enhanced state and local CPS systems. But

HHS’s research agenda has not focused on new strategies of direct service

to families, and HHS’s provision of technical assistance to CPS units has

been limited.

Federal Research Agenda

Too Broad

Members of our expert panel believe the federal research agenda is too

broad and is not developed in conjunction with the needs of the states. For

example, they believe that the major research questions that are relevant

to CPS units today are inadequately addressed because the total amount of

funds authorized for research is low and is spread among too many other

projects. Such research can result in findings that may apply only to

Page 19 GAO/HEHS-97-115 Child Protective Services
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limited locations and may not be generalizable to the larger CPS

community. CAPTA outlines topics for research, such as the causes of

maltreatment and its prevention and the national incidence of child abuse

and neglect. CAPTA also recognizes emerging collaborative CPS and

community partnerships as a relevant field of inquiry. However, the final

research agenda is left in large part to the discretion of HHS, although

legislation and input from other organizations are considered. In our

analysis, we found that approximately two-thirds of the research and

demonstration grants, funded by HHS between fiscal year 1992 and the first

quarter of fiscal year 1997, focused on the various causes and effects of

sexual abuse, maltreatment prevention strategies, and the relationship

between substance abuse and maltreatment. The remainder cover a broad

spectrum of projects, ranging from funding a national data archive to using

children as witnesses in court cases. While developing a research agenda

is difficult in the face of limited resources and competing needs, HHS has

not funded projects that reflect the emerging direction of CPS units, such as

how to build collaborative relationships with multiple community and

local government partners or the advantages, for some CPS cases, of using

family assessments over a traditional approach. An HHS research official

acknowledged that HHS has given many researchers a small part of the

available funding, thus attempting to keep a number of researchers

interested in the child abuse and neglect area and to attract new

researchers to the field.

Dissemination of Research

Results Critical

Disseminating the results of research on child abuse and neglect to

practitioners in the field is critical. The National Clearinghouse for Child

Abuse and Neglect is charged with maintaining and disseminating

information on programs that show promise of success in preventing,

identifying, and treating child abuse and neglect. However, members of

our expert panel and state officials reported that dissemination efforts are

often not timely or do not meet state needs. Although state officials were

aware that the clearinghouse disseminated information on maltreatment,

they were unable to see a connection between their work in developing

new strategies in their local communities and the information being

offered. HHS agrees that dissemination of information has been a problem,

and an HHS official attributes this situation to a lack of publishing and

distribution funds, as well as the lack, sometimes, of a requirement for the

researcher to produce a final report. Researchers funded under CAPTA,

however, must submit reports that include implications for policy and

practice.

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Technical Assistance

Could Be Expanded

The federal government provides technical assistance to states, through

means such as The National Resource Center on Child Maltreatment and

HHS regional offices.13 HHS defines the workplan for the Resource Center,

which includes developing a training and technical assistance plan for

each of HHS’s regions, conducting on-site training or technical assistance

activities, sponsoring symposia on relevant topics and, in cooperation with

the clearinghouse, compiling CPS assessment tools. However, center

documents state that the small amount of funding for each year severely

limits the amount of services that can be provided to each state. For

example, the center estimates that each state would be entitled to only

$17,000 of services, including administrative costs, conference costs, and

tribes and territories costs.

HHS regional offices also play a role in providing technical assistance to the

states. Under ordinary circumstances, these offices do not work with

county or local agencies. They are, rather, charged with overseeing the

programmatic and financial management of child welfare programs,

including ensuring compliance with applicable laws and regulations and

issuing grant awards. These offices are also charged with assisting in the

management of cross-cutting initiatives and activities among the regions.

Since regional office personnel can have regular contact with local

programs, these offices are uniquely positioned to monitor the progress of

various strategies and share their insights with other state and local

officials. These offices, however, have not played a leadership role in

providing assistance to states on topics that are relevant to the changing

strategies in the states. Such topics include knowledge of the reform

efforts of other states and whether these programs have achieved positive

outcomes in child welfare. Because this type of information is not readily

available, states report that they independently call other states for

information when attempting to design new programs.

Getting comprehensive information to CPS units on different state

initiatives, as well as on ways states are addressing systemic problems,

could greatly assist the child welfare community in areas that are integral

to developing new CPS strategies. CPS units could benefit from information

on such issues as the appropriate levels of risk and child safety, ways to

build and sustain community partnerships, and appropriate outcomes by

which to measure these reform programs. The regional offices vary in how

proactively they assist their states, according to experts, HHS officials, and

state officials. HHS agrees that some regions perform better than others and

13HHS has 10 regional offices across the country that represent HHS—to state, county, city or town, and

tribal governments, as well as to grantees and public and private local organizations—in the

administration of programs that assist vulnerable and dependent children and families.

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that they tend to act independently in developing ways of interacting with

their assigned states. But these offices, HHS believes, provide considerable

technical assistance to states. One HHS official stated, however, that

becoming more proactive in CPS reform could be difficult for some

regional offices. Existing communication technologies offer enhanced

opportunities to be more proactive and widely share this information with

a variety of audiences. HHS told us it is beginning to take advantage of its

ability to communicate electronically.

Conclusions Public agencies responsible for protecting children have faced increased

reports of child abuse and neglect, as well as a disturbing increase in the

number of families with severe and multiple problems. The high incidence

of substance abuse found in these families places CPS caseworkers on the

front line of one of our nation’s biggest social problems. While the

commitment of these workers to protect abused children is strong, the

obstacles facing CPS units are daunting. A decade of calls for reform by

national advisory boards and commissions has produced few

improvements in many of the fundamental problems found in CPS units.

The burden to improve the ways CPS units respond to children at risk of

abuse and neglect falls on state and local governments. However, the

responsibility for the safety and well-being of a community’s children

cannot rest solely on an overwhelmed CPS system. CPS units have

recognized that the traditional approaches to child protection cannot keep

pace with the demand for services. CPS units are now reaching out to

communities to establish partnerships among service agencies, attempting

to share the responsibility for the safety of a neighborhood’s children

among a community’s service providers, as well as its citizens, and

increasing the attention given to support services. However, state child

welfare officials responsible for CPS operations must not lose sight of the

potential effect that long-standing systemic problems may have on these

reform efforts. These officials must seek ways to correct deficiencies and

to build and maintain the personnel and information systems that will

support the new strategies. Without addressing these problems, reform

goals may not be fully realized. In addition, state officials must be cautious

about implementing new strategies for handling maltreatment reports,

given the limited information available on their effectiveness.

A new era of federal partnership is needed to help CPS units respond to the

rising rates of child maltreatment. While the federal government has

funded research efforts on abuse and neglect, HHS needs to better support

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the emerging needs of state and local CPS units. Local governments can ill

afford to independently develop, test, and implement new strategies to

protect our nation’s children. New federal strategies are needed to provide

focused assistance to CPS units and to evaluate and disseminate

information about local efforts. Without federal assistance, states and

localities will continue to find their own solutions to combat the problems

of abuse and neglect, not benefitting from the collective experience of the

entire nation.

Recommendations We recommend that the Secretary for Health and Human Services

• use the current research agenda, allowed under CAPTA, to facilitate better

targeting of future funding for those areas that support local efforts to

explore collaborative partnerships with other community agencies;

• develop new cost-effective strategies to disseminate and deliver the results

of these local efforts and other related work through the National

Clearinghouse and the National Resource Center; and

• develop specific techniques, such as regional seminars, white papers, and

on-site technical assistance, to promote community-based approaches to

CPS.

Agency Comments

and Our Evaluation

In commenting on a draft of this report, HHS noted that the CPS system

operates in the broader context of child welfare services and is thus

integrally related to other federal programs beyond those authorized by

CAPTA. HHS further stated that strategies taken from these programs, such

as a demonstration of the use of multidisciplinary teams to provide

intensive services to families whose children might otherwise have to be

placed or remain in foster care, directly influence and benefit CPS. We

agree that these programs, whose primary purposes do not emphasize CPS,

can also assist states and localities find ways to become partners with

community and other governmental groups to help children. In our work,

however, we focus on the initial stages of report intake and investigation,

for abuse and neglect cases, and the associated problems. We did not

review community services available to prevent or treat victims of child

abuse and neglect.

HHS also commented that we did not address the issue of conflicting

confidentiality provisions among agencies that handle and treat families

that are brought to CPS’s attention. HHS noted that these conflicting

policies, for example, can prohibit local CPS agencies from obtaining

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B-271267 

information on a client’s participation in substance abuse treatment

programs. We recognize the importance of developing confidentiality

policies that help, rather than hinder, social worker access to important

client information that may affect decisions concerning a child’s safety; we

discussed this topic with state and local CPS personnel, as well as with CPS

experts. While they agreed that confidentiality barriers exist, we focused

on the systemic issues that surfaced as the most pressing. In addition,

social work practices can be developed to help alleviate the magnitude of

the confidentiality problem, some experts said. For example, if a client is

not willing to sign a waiver to allow information on treatment to be

obtained, the client’s participation in the drug program may not be

considered in CPS decisions affecting the child’s safety.

As to our recommendation that the Secretary use the current research

agenda to better target funding for topics that support local efforts to

explore collaborative partnerships, HHS acknowledged the importance of

developing these partnerships and making system improvements. HHS

stated that current CAPTA legislation places emphasis on CPS system

functions and that HHS demonstration priorities address the development

of community networks and CPS operations. At the time of this report,

however, HHS had not published its final research priorities. HHS concurred

with our remaining two recommendations and noted several strategies it is

implementing to enhance dissemination and communication and to

expand technical assistance.

HHS also made a number of technical comments, which we have

incorporated where appropriate. A copy of all HHS’s comments, both

general and technical, is included in appendix II.

We are sending copies of this report to the Secretary of Health and Human

Services, state child welfare agencies, and other interested parties. Copies

will also be made available to others on request. If you or your staff have

any questions about this report, please call me at (202) 512-7215. Other

major contributors to this report are listed in appendix III.

Sincerely yours,

Jane L. Ross

Director, Income Security Issues

Page 24 GAO/HEHS-97-115 Child Protective Services
Page 25 GAO/HEHS-97-115 Child Protective Services
Contents

Letter 1

Appendix I 

Scope and

Methodology

28

Appendix II 

Comments From the

Department of Health

and Human Services

30

Appendix III 

GAO Contacts and

Staff

Acknowledgments

40

Related GAO Products 44

Abbreviations

CAPTA Child Abuse Prevention and Treatment Act

CPS Child Protective Services

GPO Government Printing Office

HHS Department of Health and Human Services

OCAN Office on Child Abuse and Neglect

SIDS Sudden Infant Death Syndrome

Page 26 GAO/HEHS-97-115 Child Protective Services
Page 27 GAO/HEHS-97-115 Child Protective Services
Appendix I 

Scope and Methodology

We reviewed the relevant literature on child maltreatment, as well as

national and state statistical data on child maltreatment, and analyzed

various reports and evaluations that examined CPS policies, programs, and

activities. In addition, we interviewed various experts in the area of child

maltreatment and CPS, representatives from professional associations, and

state and local officials. We also interviewed officials at HHS’s

Administration for Children and Families, including officials from the

Childrens’ Bureau and the Office on Child Abuse and Neglect (OCAN).

We conducted field visits in New York City’s boroughs of the Bronx and

Manhattan; Sacramento County, California; Florida’s District 12 (Volusia

and Flagler Counties); and the City and County of St. Louis, Missouri. In

addition, we visited the state child welfare offices in each state capital.

These sites were selected, in part, to review states in different stages of

changing their traditional approaches to CPS. The CPS unit in New York City

is making early efforts at organizational change. The CPS unit in

Sacramento County, California, is making early efforts to reexamine its

processes and its links to the community. The CPS units in New York and

California were also selected because the two states represent a

significant portion of the population of children under 18 years old and the

population in the child welfare system. Florida and Missouri were

identified by experts as examples of states in which CPS units were furthest

along in efforts to change from traditional approaches to new strategies

based on community and family services. The CPS unit in Florida’s District

12 was selected to illustrate efforts to improve the investigation and

validation of abuse cases by integrating CPS, medical, judicial, and law

enforcement professionals under a community-based nonprofit

organization. The CPS unit in Missouri had implemented a pilot program to

test new ways of responding to reports of abuse and neglect in five areas

of the state.

At each site, we interviewed officials responsible in the areas of CPS policy,

program activities, training and professional development, quality

assurance, budget, and information management. In addition, we collected

relevant evaluations, reports, and analyses of CPS policies, operations, and

practices. To develop a complete understanding of CPS units’ operations

and the barriers that exist, we interviewed groups of managers,

supervisors, and caseworkers at each site. We also interviewed private

organizations that provide child protection and child welfare services to

these units. Lastly, we interviewed local officials from community child

advocacy groups and child fatality review panels.

Page 28 GAO/HEHS-97-115 Child Protective Services
Appendix I 

Scope and Methodology

Finally, we convened a panel of six experts for a 1-day discussion to solicit

their perspectives on what role(s) the federal government can play in

assisting states and localities in improving their CPS activities. The

panelists were asked to identify areas in which the federal government can

provide leadership and strategies or specific activities that can support

state efforts to manage CPS systems. This expert panel was held on

December 3, 1996, and included Diana English, Office Chief, Office of

Children’s Administration Research, Department of Social and Health

Services, Washington; Mark Hardin, Director, Foster Care and Family

Preservation, Center on Children and the Law, American Bar Association,

Washington, D.C.; Robert Lindecamp, State Liaison Officer, Division of

Family Services, Department of Services for Children, Youth and Their

Families, Delaware; Robert McKeagney, Director, National Center for

Excellence in Child Welfare, Child Welfare League of America,

Washington, D.C.; Susan Notkin, Director, Program for Children, The Edna

McConnell Clark Foundation, New York, New York; and Michael Weber,

Associate Director, National Committee to Prevent Child Abuse, Chicago,

Illinois.

We conducted our work between February 1996 and April 1997, in

accordance with generally accepted government auditing standards.

Page 29 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Page 30 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Page 31 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Page 32 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Page 33 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Page 34 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Page 35 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Page 36 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Now on p. 4.

Now on p. 4, para. 2.

Now on p. 8.

Page 37 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Now on p. 7.

Now on p. 8.

Now on p. 20.

Now on pp. 21 and 22.

Page 38 GAO/HEHS-97-115 Child Protective Services
Appendix II 

Comments From the Department of Health

and Human Services

Now on pp. 6, 9, and 28.

Page 39 GAO/HEHS-97-115 Child Protective Services
Appendix III 

GAO Contacts and Staff Acknowledgments

GAO Contacts Kay E. Brown, Assistant Director, (202) 512-3674

Diana M. Pietrowiak, Evaluator-in-Charge, (202) 512-6239

Staff

Acknowledgments

In addition to those named above, David D. Bellis and John Vocino

contributed significantly to the writing of the report and all data-gathering

and analysis efforts.

Page 40 GAO/HEHS-97-115 Child Protective Services
Page 41 GAO/HEHS-97-115 Child Protective Services
Page 42 GAO/HEHS-97-115 Child Protective Services
Page 43 GAO/HEHS-97-115 Child Protective Services
Related GAO Products

Child Welfare: Complex Needs Strain Capacity to Provide Services

(GAO/HEHS-95-208, Sept. 26, 1995).

Child Welfare: Opportunities to Further Enhance Family Preservation and

Support Activities (GAO/HEHS-95-112, June 15, 1995).

Foster Care: Health Needs of Many Young Children Unknown and Unmet

(GAO/HEHS-95-114, May 26, 1995).

Foster Care: Parental Drug Abuse Has Alarming Impact on Young Children

(GAO/HEHS-94-89, Apr. 4, 1994).

Residential Care: Some High-Risk Youth Benefit, but More Study Needed

(GAO/HEHS-94-56, Jan. 28, 1994).

Foster Care: Services to Prevent Out-of-Home Placements Are Limited by

Funding Barriers (GAO/HRD-93-76, June 29, 1993).

Foster Care: State Agencies Other Than Child Welfare Can Access Title

IV-E Funds (GAO/HRD-93-6, Feb. 9, 1993).

Child Abuse: Prevention Programs Need Greater Emphasis (GAO/HRD-92-99,

Aug. 3, 1992).

Child Abuse and Neglect: Progress of the National Center Since May 1991

(GAO/T-HRD-92-14, Mar. 6, 1992).

Child Abuse and Neglect: NCCAN’s Implementation of CAPTA of 1988

(GAO/T-HRD-91-29, May 9, 1991).

Child Abuse Prevention: Status of the Challenge Grant Program

(GAO/HRD-91-95, May 9, 1991).

Foster Care: Children’s Experiences Linked to Various Factors; Better

Data Needed (GAO/HRD-91-64, Sept. 11, 1991).

Child Welfare: Monitoring Out-of-State Placements (GAO/HRD-91-107BR, Sept.

3, 1991).

(106711) Page 44 GAO/HEHS-97-115 Child Protective Services
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