D.C. Child And Family Services Agency: More Focus Needed on Human Capital Management Issues for Caseworkers and Foster Parent Recruitment and Retention
Published: 2004-09-24T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The District of Columbia's Child and Family Services Agency (CFSA) is responsible for ensuring the safety and well being of about 3,000 children in its care and ensuring that services are provided to them and their families. In fiscal year 2003, CFSA's total budget was about $200 million. Concerns have been raised about CFSA's supply of caseworkers, the foster care and adoptive homes, and the quality and timeliness of mental health services for foster care children. To help address these issues, the Congress appropriated $14 million in fiscal year 2004 to CFSA, the Department of Mental Health (DMH), and the Metropolitan Washington Council of Governments (COG) specifically for foster care improvement. GAO examined CFSA's (1) strategies for recruiting, retaining, and managing its caseworkers; (2) efforts to license an adequate supply of safe foster and adoptive homes; and (3) efforts to collaborate with DMH and the Family Court to provide timely mental health services to foster care children. GAO also reviewed plans for and use of the federal foster care improvement funds.
section_title: What GAO Found
paragraphs: CFSA actively recruited caseworkers and implemented retention strategies; however, caseworkers cited several management practices they said lowered their morale and adversely affected their ability to perform their duties. CFSA employed several recruitment approaches recommended by a number of child welfare organizations and exceeded most of its staffing goals for fiscal year 2003. Caseworkers cited high salaries and the training for new caseworkers as factors that encouraged them to remain at CFSA. However, GAO found a general consensus among the caseworkers with which GAO met that some management practices--poor communication, a lack of resources, poor supervision, and no rewards and recognition program--adversely affected their performance and morale. Agency officials said they had made some changes and were planning to take other actions to address these issues. CFSA has developed goals and strategies for recruiting new foster and adoptive homes and improved licensing requirements. CFSA has made progress licensing new families, although more families have stopped serving than expected. Further, CFSA does not have processes for identifying the reasons foster parents stop serving or for determining the effectiveness of its recruitment strategies. CFSA has standardized and raised licensing requirements for all foster and adoptive homes, but as of May 2004, 308 foster homes were unlicensed, with about 22 percent of CFSA's foster children residing in them. CFSA has begun collaborating with DMH and the Family Court to centralize and track mental health services for foster care children, but challenges remain to ensuring timely delivery. CFSA and DMH designed a standard process for referring foster care children to DMH for assessment and treatment and for tracking service delivery. DMH has also started expanding its service capacity for foster care children. For example, it has begun recruiting additional evaluators to perform assessments. While CFSA began using a database to track service delivery in August 2004, it has not analyzed the service delivery data collected on paper prior to August 2004 to determine whether foster care children were receiving timely services. Additionally, CFSA and DMH still face certain challenges, such as integrating caseworkers and Family Court judges into the new referral process. CFSA, DMH, and COG have spending plans that are consistent with the statutory language providing the federal funds, but only a small portion of the foster care improvement funds had been obligated or spent as of June 2004, in part because funding was not received until March 2004. Further, it is unclear how the District and COG plan to support some of these programs in the long-term because future funding is uncertain.

section_title: Letter
paragraphs: The District of Columbia’s Child and Family Services Agency (CFSA) is the  agency with primary responsibility for the child welfare system in the  District of Columbia (the District). In fiscal year 2003, CFSA was  responsible for about 3,000 children, and its operating budget, which was  comprised of funds from the District of Columbia government, the federal  government, and private sources, was about $200 million. Many parties are  involved in the District’s child welfare system, and several agencies  provide essential services. For example, the Department of Mental Health  (DMH) is responsible for arranging, among other things, evaluations to  determine the mental health status and treatment needs of children in  foster care. The D.C. Family Court was created as a court solely dedicated  to matters concerning the District’s children and families and, as such, it  has jurisdiction over cases involving child abuse and neglect. In addition,  CFSA works with agencies in Maryland, Virginia, and other states to  arrange for placements of District children and also works with private  agencies to place children in foster and adoptive homes.
Because CFSA was plagued with mismanagement and had failed to protect  some of the children under its care, the U.S. District Court has been and  remains involved with the agency’s management and operations. In   1995, the U.S. District Court placed CFSA in receivership. In 2001, the  receivership ended, and CFSA then served a 1-year probationary period.  The U.S. District Court appointed the Center for the Study of Social Policy  (CSSP) to monitor and assess CFSA’s performance. CSSP worked with  CFSA and developed an implementation plan to help the agency achieve  reforms ordered by the court and meet professional standards of care for  the children it serves. This plan, which the court approved on May 15,  2003, covers outcomes and activities for CFSA through December 31, 2006,  and sets performance benchmarks at 6-month intervals.
The court-appointed monitor and we have reported that the management  and operations of CFSA have improved since the receivership. Yet, there  are still concerns that the agency may not have an adequate supply of  skilled caseworkers or safe homes for foster care and adoptions and that  mental health services needed for some children in foster care have not  been provided in a timely manner. To help address these and other  concerns about the District’s foster care program, the Congress  appropriated $14 million in fiscal year 2004 to CFSA, DMH, and the  Metropolitan Washington Council of Governments (COG)—an  organization of government officials from the greater Washington, D.C.,  metropolitan area that works cross jurisdictionally to address issues  facing the area. CFSA received funds to upgrade its technology, expand  services to foster children, and implement a student loan repayment  program for caseworkers. DMH received funds to help it provide mental  health assessments and treatment to foster children in a timely fashion.  Finally, COG was appropriated funds to develop a plan for recruiting new  foster parents and a respite care program—a support network of  individuals to care for foster children when the foster family needs to take  a break or attend to other matters.
Congress is interested in knowing whether CFSA’s strategies, processes,  and operations will help it to sustain the improvements previously  reported and further improve the District’s foster care system as well as  what steps are planned or have been taken to use the appropriated funds.  Specifically, we were asked to assess (1) CFSA’s strategies for recruiting,  retaining, and managing its caseworkers; (2) CFSA’s efforts to license an  adequate supply of safe foster and adoptive homes; (3) CFSA’s efforts to  collaborate with DMH and the Family Court to provide timely mental  health services to foster care children; and (4) CFSA’s, DMH’s, and COG’s  plans for and use of the federal foster care improvement funds.
To make these assessments, we reviewed and analyzed key documents  and discussed these issues with knowledgeable and affected parties. Our  steps included reviewing best practices and standards for child welfare  agencies developed by various child welfare organizations, CFSA’s  recruitment and retention plans for caseworkers and for foster and  adoptive parents, licensing requirements for all foster and adoptive homes,  as well as relevant reports and data. We conducted discussion groups with  CFSA’s caseworkers and supervisors; we also held a group interview with  foster and adoptive parents. For the discussion groups with caseworkers  and supervisors, we selected participants on a random basis, with  participation being voluntary. We also reviewed key DMH and COG  documents, and we analyzed the spending plans and budget data for  CFSA, DMH, and COG. Additionally, we interviewed CFSA, DMH, Family  Court, and COG officials, as well as national experts.
We conducted our work between October 2003 and September 2004 in  accordance with U.S. generally accepted government auditing standards.  See appendix I for more details on our scope and methodology.
subsections: section_title: Background
paragraphs: The child welfare system is designed to promote the well being of children  by ensuring their safety and permanency and by strengthening families to  enable them to successfully care for their children. Families become  involved with the child welfare system after a report of abuse or neglect  has been made and confirmed. When agency officials determine that a  child may be further harmed or mistreated if left in the home, the child  may be placed in foster care. The federal government has allocated about  $7 billion each year to investigate abuse and neglect of children in this  country, provide placements to children outside their homes, and deliver  services to help keep families together. The federal Department of Health  and Human Services (HHS) is responsible for the administration and  oversight of federal funding to states to support the child welfare system.  Title IV-E of the Social Security Act, as amended, is a major source of  federal funding and is primarily used to pay for the room and board of  children in foster care.
While HHS is responsible for setting standards and monitoring the nation’s  child welfare system, state child welfare agencies are responsible for  administering the programs and monitoring the children and their families.  Child welfare caseworkers, assisted by their supervisors, are at the core of  the child welfare system. They are responsible for the management of  individual cases and for performing many critical tasks. For example, child  welfare caseworkers investigate reports of abuse and neglect; arrange  placements when children must be removed from their homes; develop  plans for the care of individual children; conduct visits with the children  and foster families; attend court hearings; maintain records on each case;  and coordinate with other agencies to obtain services for the children,  including mental health care. The primary role of supervisors is to help  caseworkers perform these functions, thereby meeting the needs of  families and carrying out the agency’s mission.
Child welfare agencies face a number of challenges in recruiting and  retaining caseworkers and supervisors. We previously reported that low  salaries hindered agencies’ abilities to attract and retain child welfare  workers and their supervisors. Furthermore, we found that high  caseloads, administrative burdens, a lack of supervisory support, and  insufficient time to take training were issues that impacted caseworkers’  abilities to work effectively and their decisions about staying in the child  welfare profession.
CFSA manages the child welfare system for the District. CFSA receives  Title IV-E funding as well as other funds to support its programs. In fiscal  year 2003, CFSA’s budget included $65 million primarily from two federal  sources—Medicaid and Title IV-E. The Medicaid funds are used to cover  various expenses related to services for children in foster care, such as  specific therapeutic and medically necessary care. Other sources of  funding for CFSA include the District government and private grants. In  fiscal year 2003, CFSA’s operating budget was $208 million. CFSA’s  strategic goals for 2002-2004 are to (1) recruit and retain caseworkers,   (2) investigate abuse and neglect reports, (3) expedite permanency for  children, (4) recruit and retain foster homes, (5) promote agency and  neighborhood-based resources, (6) enhance agency information system,  and (7) complete court requirements.
Like CFSA, the District’s mental health service agency was placed in  receivership in the 1990s. When DMH was established in 2001, the mental  health system lacked the infrastructure to meet the needs of children,  youth, and their families. Among other problems, DMH lacked a sufficient  number of providers to accommodate the needs of the District’s foster  care children. To better link foster care children to mental health services,  CFSA began to contract directly with mental health providers for services.  Consequently, the mental health service delivery system for foster care  children was fragmented with no single system of providers or service  standards and no centralized information system to track the provision of  services to foster care children. Further, the courts had no aggregate  information on court-ordered mental health services for foster care  children.
Mental health services are considered critical for children who have  suffered abuse or neglect. For children in the District, assessment and  treatment are among the mental health services available through DMH.  Assessments are evaluations conducted by mental health professionals to  determine the mental health status and treatment needs of an individual.  For children in foster care, assessments are generally requested or ordered  on a case-by-case basis. Treatment, such as individual or family counseling  and group therapy, can be initiated when the result of an assessment  indicates that it is needed.
Over the years, the Congress has enacted laws and provided funds to help  improve the District’s child welfare system. The D.C. Family Court Act of  2001 established the D.C. Family Court and, among other things,  established procedures intended to improve interactions between the  court and social service agencies in the District. Also, the Congress  authorized funds to the District in fiscal year 2002 for the completion of a  plan to integrate the District’s computer systems with those of the Family  Court and for CFSA’s caseworks to help implement family court reform.  On January 23, 2004, the Congress passed the District of Columbia  Appropriations Act, 2004, (the act), which included an appropriation of  $14 million for foster care improvements in the District. Funds were  appropriated for fiscal year 2004 only, to CFSA, DMH, and COG for  specific programs.
The act appropriated the funds as follows    $9 million for CFSA, of which $2 million would be to establish an early  intervention program to provide intensive and immediate services to  foster children; $1 million would be to establish an emergency support  fund to purchase necessary items to allow children to remain in the  care of a licensed, approved family member; $3 million would be to  establish a student loan repayment program for caseworkers; and   $3 million would be to upgrade CFSA’s automated case management  system, known as FACES, to a Web-based system and to provide  computer technology to caseworkers;    $3.9 million for DMH to provide all court-ordered or agency-required  mental health screenings, assessments, and treatment to children in the  care of CFSA; and    $1.1 million for COG to develop a program in conjunction with the  Foster and Adoptive Parents Advocacy Center to provide respite care  for and recruitment of foster parents.
The act also stipulates a timeframe for DMH to provide mental health  services to foster care children. The law requires the DMH Director to   (1) initiate court–ordered or agency-required mental health services within  3 days of notification, (2) complete court–ordered or agency–required  assessments within 15 days of the request, and (3) provide the court with  all assessments within 5 days of completion.
section_title: CFSA Has Actively Recruited Caseworkers and Implemented Retention Strategies; however, Caseworkers Cited Management Practices That Adversely Affected Their Performance and Morale
paragraphs: CFSA has implemented various caseworker recruitment and retention  strategies; however, caseworkers told us about several management  practices that adversely affected their ability to perform their duties and  lowered their morale. The recruitment strategies included posting  announcements on the Internet, visiting schools of social work across the  country, developing relationships with local schools of social work, and  offering monetary incentives. CFSA successfully hired 147 new  caseworkers, which enabled the agency to exceed most of its staffing  goals and lower caseworkers’ caseloads. Additionally, CFSA has held  discussions with staff, established partnerships to allow caseworkers to  pursue graduate degrees, and offered monetary incentives to help recruit  and retain caseworkers. However, caseworkers and supervisors reported  some human capital management issues that were not contributing to a  positive work environment. CFSA caseworkers and their supervisors told  us about a lack of resources and poor communication and supervision,  and that the agency did not have a program to reward good performance.  We heard these concerns consistently from caseworkers with varying  lengths of service and found these same concerns in agency records of exit  interviews.
subsections: section_title: CFSA Conducted Several Recruitment Activities and Exceeded or Met Its Staffing Goals
paragraphs: In fiscal year 2003, CFSA conducted several recruitment activities, some of  which were new. These recruitment activities followed the  recommendations of the court monitor and included several of the  strategies endorsed by public and private child welfare organizations. The  recruitment activities CFSA used include the following:    Recruiting on the Internet. CFSA posted job announcements on the  agency’s Web site, and used Internet job sites such as “monster.com”,  “ihiresocialworkers.com”, and the Web site for the National  Association of Social Workers to recruit caseworkers.
Recruiting at schools of social work across the country. CFSA  targeted a number of schools across the country by sending  recruitment teams, mailing announcements to the schools, and using  schools’ internal Web sites to generate employment interest. According  to agency officials, targeted schools were located in Delaware,  Maryland, New Jersey, New York, North Carolina, Pennsylvania,   South Carolina, and Virginia.
Advertising in media publications. CFSA advertised in media  publications such as the Washington Post, Social Work Today—a  national magazine for social workers seeking jobs and wanting to  connect with others in the social work profession—and the  Employment Guide—a national weekly employment magazine.
Developing ongoing relationships with local schools of social  work. CFSA developed relationships with Howard University, the  Catholic University of America, the University of the District of  Columbia, George Mason University, Virginia Commonwealth  University, and Bowie State University—universities located in the  Washington, D.C., metropolitan area.
Attending regional and local career fairs. CFSA attended career  fairs in New Orleans, New York, and Pennsylvania, and local job fairs  in Washington, D.C., and Maryland.
Targeting universities and colleges for bilingual and/or  bicultural staff. CFSA conducted outreach activities directed to  students at colleges focused on producing licensed caseworkers that  speak Spanish and are well acquainted with the Latino/Hispanic  culture. CFSA recruited at San Diego State University and New Mexico  State University—universities with large Hispanic populations.
Using monetary incentives. CFSA introduced a number of monetary  incentives to attract new caseworkers. CFSA awarded bonuses to  newly recruited caseworkers that had achieved a high academic grade  point average, needed to relocate, or had bilingual skills. CFSA also  established an employee referral program. CFSA employees can  receive a $1,000 or 2 days off, if they refer a licensed caseworker to  CFSA who joins the agency and completes 6 months of continuous  service. Table 1 lists the monetary recruitment incentives CFSA offered  and paid in fiscal year 2003.
CFSA’s recruitment activities and the resulting new hires enabled the  agency to meet or exceed its staffing goals. CFSA hired 147 caseworkers in  fiscal year 2003 and by doing so was able to exceed its staffing goals of   300 caseworkers and 60 supervisors. At the end of fiscal year 2003, the  agency employed 309 caseworkers of which 285 had masters of social  work degrees (MSWs) and 24 had bachelors of social work degrees  (BSWs). Additionally, CFSA met its goal to double the agency’s bilingual  staff by hiring 5 caseworkers that can communicate in English and other  languages such as Spanish and sign language. CFSA’s staffing goals and  achievements are summarized in figure 1.
Furthermore, according to CFSA managers, the new hires have facilitated  reduction of each caseworker’s caseload, as required by the court monitor.  As of December 26, 2003, CFSA reported that the average caseload was   17 cases, down from the average of 27 in 2002. However, the court monitor  reported that some caseworkers had caseloads that exceeded the  September 30, 2003, benchmark for caseload standards set forth in CFSA’s  implementation plan. For example, while caseworkers responsible for  investigations should carry no more than 16 cases, the caseload ranged  from 1 to 39 cases, and 15 workers had caseloads higher than the  benchmark.
CFSA analyzed its caseworker recruitment effort and identified areas for  improvement. CFSA’s June 2004 recruitment and retention plan identified  several fruitful recruitment efforts such as its efforts to advance  relationships with local schools of social work and its use of the Internet  to identify candidates. Also, the plan states that the agency will revise its  recruitment efforts based on further analysis of the results.
section_title: CFSA Has Begun to Implement Strategies to Help Retain Caseworkers
paragraphs: Retaining caseworkers is a challenge that CFSA as well as other child  welfare agencies face. In fiscal year 2003, CFSA’s attrition rate for  caseworkers was about 15 percent. We could not determine if this was an  improvement because CFSA did not have data for 2002. As of June   2004, about 45 caseworkers had left CFSA in fiscal year 2004—just over   15 percent of the staff. Our previous work on child welfare caseworker  retention identified several causes of caseworker turnover and identified  practices to help improve retention, such as university training  partnerships and bonuses.
In 2003, CFSA developed a work plan that included strategies to help  retain well-qualified caseworkers by improving the agency’s work  environment. Experts in the child welfare community endorsed several of  these strategies. The plan’s goals are to create a supportive and  professionally stimulating environment and promote continuing education  for its supervisors. To help meet these goals, the agency has done the  following:    Sought employee feedback to identify good practices as well as  areas in need of improvement. CFSA officials conducted surveys,  held discussions with staff, and reviewed data from exit interviews to  identify good practices as well as areas for improvement. CFSA began  conducting exit interviews and issued an exit interview analysis report  in fiscal year 2003. The report contained data on the employee’s  position, program division, and the reasons given for leaving the  agency. Agency officials told us they used this information to improve  recruitment and retention efforts.
Required supervisory training. Supervisors of caseworkers are  required to attend training classes for 12 days, over a 5-month period.  The classes cover topics such as leadership effectiveness, case  consultation, and other topics designed to improve supervisors’ skills.
Established partnerships to allow caseworkers to pursue  graduate degrees. CFSA has agreements with Howard University and  the Catholic University of America, two universities in the District of  Columbia, to allow its caseworkers to pursue master’s level degrees in  social work. CFSA, in partnership with these universities, will provide  scholarships, stipends, and other sources of financial support.  Employees who receive this benefit must agree to remain with the  agency for a period of time or repay any financial support provided. A  pilot program is scheduled to begin in September 2004.
Developed financial incentives. To encourage workers to remain at  the agency, CFSA offered service agreement bonuses, reimbursement  for first-time licensure fees, and additional income allowances. Table 2  describes the financial retention incentives and the number awarded in  fiscal year 2003.
In addition to these retention strategies, caseworkers told us that CFSA’s  training program for new caseworkers and the higher than average salary  paid by CFSA were important factors that contributed to their decisions to  remain with the agency. CFSA’s pre-service training for new caseworkers  was cited as a positive experience by several caseworkers that  participated in our discussion groups and several who completed exit  surveys. This training lasts 8-½ weeks and greatly exceeds the average  training time of about 3-½ weeks offered by most child welfare agencies.  CFSA’s training program involves both classroom study and on-the-job  training, and gradual assumption of case responsibilities under close  supervision. Caseworkers also cited CFSA’s high salaries as a key  incentive for continuing to work with the agency. CFSA’s current average  salary for a master’s level caseworker is $41,440 compared with the  national average of $37,097 at other public agencies.
The student loan repayment program funded by the Congress in fiscal year  2004 may further help CFSA’s retention and recruitment efforts, once the  program has been implemented. Caseworkers who have worked or will  work full-time for CFSA in a nonsupervisory capacity are eligible to apply  for CFSA’s loan repayment program. In addition, CFSA states that it  determined caseworkers in a private agency under contract to CFSA will  also be eligible for the loan repayment program. According to agency  officials, the program offers up to $18,000 to caseworkers with MSWs and  $10,000 for those with BSWs toward repayment of student loans. The  exact amount will depend on the size of the loan and the number of  qualified program applicants. Caseworkers must complete 2 years of  service before any loan payments are made. CFSA pays one-half the total  payment at the end of the caseworkers third year and the remaining half at  the end of the fourth year. Initially, applications for the program were due  August 16, 2004, and candidates had to sign a continuing service  agreement to work for CFSA by September 3, 2004.  According to agency  officials, CFSA extended its application deadline to September 16, 2004.
section_title: Many Caseworkers Cited Management Practices That Affected Their Ability to Perform Their Duties and Their Morale
paragraphs: During discussion sessions and in exit interviews, caseworkers said that  they did not have adequate support in terms of resources to do their jobs.  The caseworkers said that they did not have cell phones needed to  maintain contact with foster families or with the office, and they did not  have enough cars to make needed visits to monitor children under their  care. Also, they reported not having adequate office space to hold  confidential discussions with families and others involved with their cases.  Supervisors also cited the lack of resources as a problem that hindered  caseworkers’ abilities to perform their duties. According to CFSA  managers, in May the agency bought a fleet of new cars, and in June of  2004, the agency bought new cell phones for every caseworker.  Additionally, CFSA is planning on adding shuttles to drop and pick up  caseworkers from regularly traveled destinations to help reduce the need  for cars.
CFSA caseworkers also told us that management did not consistently  communicate with them about issues affecting the agency and its  operations. We also reported on this concern in our December 2000  report. During our recent meetings with caseworkers and supervisors,  they said, for example, that changes in policy and procedures were not  always communicated effectively or consistently throughout the agency.  Many caseworkers said that they were not aware of such changes until  they were in the process of completing an essential task, such as  requesting a clothing voucher for a foster care family, and that  caseworkers often heard of policy changes from each other. In exit  interviews from January 2003 through May 2004, some employees  suggested that communication be improved between all levels of  management and staff, especially related to policy changes. For example,  one employee filling out the exit interview form said that, “What is policy  on Monday may not be policy on Friday…. CFSA must improve the way it  communicates policy to its caseworkers. E-mails do not appear to be  effective. The trickle down method of providing information to  supervisors is also ineffective.” National child welfare organizations and  other human capital experts suggest that management should maintain  clear lines of communication and involve employees in the decision  making process of changing policies. CFSA managers explained that while  they have a formal procedure for communicating policy changes and  routinely include caseworkers in the decision making process, changes to  practice standards that affect day-to-day operational matters are  communicated through less formal methods. According to agency officials,  these changes are communicated during staff meetings, via e-mail  messages, and newsletters.
In addition, caseworkers said that many supervisors had not fulfilled their  responsibilities. They cited examples of supervisors not being available to  help them during a crisis to provide guidance and support and not  providing answers to questions affecting their work. One caseworker said  in an exit interview, “My supervisor seldom kept our supervisory  conferences or team meetings scheduled. She pushed tasks down that  were managerial duties and failed to state priorities when assigning  multiple tasks.” Several caseworkers said that their supervisors had not  provided them feedback about their performance. We reviewed a random  sample of caseworkers’ personnel files and analyzed those for   31 caseworkers who were hired on or before December 31, 2000.  According to a CFSA official, these caseworkers should have had  performance appraisals in their files for 2001, 2002, and 2003. While nearly  all of the performance appraisals for 2003 were in the files, only 1 of the   31 files included an appraisal for all 3 years. The primary role of child  welfare supervisors is to help caseworkers perform their duties. In  addition to assigning cases, supervisors should monitor caseworkers’  progress in achieving desired outcomes, provide feedback to caseworkers  in order to develop their skills, support the emotional needs of  caseworkers, and help make decisions about cases. The quality of  supervision of caseworkers at CFSA is not a new issue. We also reported  that social workers cited the quality of supervision as a reason for their  decisions to resign in December 2000. Subsequently, to help improve the  quality of supervision, CFSA required its supervisors to complete several  training courses. However, as of August 2004, 12 of CFSA’s 59 case- carrying supervisors have completed the training, as required.  Furthermore, according to agency officials, CFSA’s supervisors were not  held accountable for performing their supervisory duties. CFSA officials  indicated in 2000 that they planned to take steps to help enhance  accountability for management and supervisory employees, including  developing a new agency performance appraisal system. CFSA’s managers  acknowledged in 2004 that the performance of some of its supervisors still  needed to improve. The agency’s 2004-2005 recruitment and retention plan  includes a new goal that focuses on providing supervisors and managers  with more training and support to help increase the quality of supervision.  Also, agency officials said that CFSA is developing new performance  measures to better hold caseworkers and supervisors accountable for  performing their duties.
Furthermore, caseworkers said and CFSA managers confirmed that the  agency does not have a program to reward or recognize individuals who  perform well, make outstanding contributions, or achieve exceptional  results. The agency honors all of its caseworkers annually during the  month of May for Social Worker Appreciation Month with a Social Worker  Appreciation Day celebration. Human capital experts have said that an  individual recognition program is an important element and that workers  who are recognized and rewarded for hard work are more likely to achieve  maximum performance. Some caseworkers said in discussion groups with  us and during exit interviews that a formal rewards and recognition  program would enhance their morale, help create a positive work  environment, and improve staff retention. Agency officials said that they  are planning to develop policies and procedures for a formal rewards and  recognition program.
section_title: CFSA Has Developed a Recruitment Plan and Established New Licensing Standards for Foster and Adoptive Homes, but More Foster Families than Expected Have Stopped Serving
paragraphs: CFSA has taken several steps to recruit and license an adequate supply of  safe foster and adoptive homes. The agency developed a recruitment plan  and intends to establish a second recruitment unit devoted to recruiting  new foster families and finding homes for children who are difficult to  place, including teens and children with special needs. Also, CFSA has  established new licensing requirements for congregate care and kinship  homes. While CFSA has placed new emphasis on recruitment of foster  and adoptive families, as of May 30, 2004, more foster families stopped  serving than expected. Further, CFSA does not have a process for  evaluating its recruitment strategies or the attrition of families from the  foster care program. In addition, according to CFSA data, about 22 percent  of foster children in CFSA’s care were residing in unlicensed homes as of  May 2004. Agency officials said that they were attempting to license these  homes on a case-by-case basis.
subsections: section_title: CFSA Has Developed Strategies and Goals for Recruiting New Homes, but Does Not Have a Process to Evaluate Its Strategies
paragraphs: In January 2004, the CFSA created a recruitment plan that includes  strategies and goals for recruiting foster and adoptive homes. According to  agency officials, this is the first such plan. The recruitment plan identifies  specific strategies for recruiting new families. For example, the agency  plans to invite current foster parents to hold social gatherings to interest  others in becoming foster families and to continue the “Wednesday’s  Child” program which uses television commercials to feature individual  District children who are available for adoption. In addition, the plan calls  for increasing the roster of licensed foster families by 50 at the close of  fiscal year 2004. For 2005, the agency plans to increase its supply of foster  families by another 100 homes. In order to have an additional 50 families  licensed, CFSA estimated that it must bring approximately 1,000 interested  families to its orientation sessions since about one-tenth of the families  who have attended past sessions became licensed, and an average of   50 families have left the program each year. Figure 2 summarizes the  foster family recruitment and attrition patterns.
In addition to CFSA’s own recruitment plan, COG prepared a report for  CFSA in 2003 that identifies specific, targeted recruitment strategies. This  report identifies strategies designed to attract potential foster and  adoptive parents with certain demographic characteristics from different  neighborhoods in the District. For example, the COG report suggests that  CFSA should partner with a local women’s professional sports team to  host a “Foster Care Day” and conduct a presentation on foster parenting  during halftime. The report states that this recruitment strategy would  reach families from various District neighborhoods who would work well  with children who have special needs. In commenting on a draft of this  report, agency officials said that they have incorporated some of the  suggestions in the COG report, such as involving coaches and others  working with children in sports by partnering with the District’s  Department of Parks and Recreation.
CFSA also plans to establish a second unit dedicated to recruiting new  foster and adoptive parents. The agency currently has one recruitment unit  that includes a seven-person team—a supervisor, a social services  assistant, and five recruiters, each of whom carries a caseload of   20-30 hard-to-place children targeted for adoption. The team plans to  recruit new foster and adoptive parents through community outreach  activities and child-specific recruiting, a strategy used to find permanent  homes for children who are traditionally the most difficult to place. CFSA  plans to launch a second recruitment unit in October 2004. The new unit  will also have seven staff members and will focus on community outreach  activities and child-specific recruiting.
Although CFSA’s plan calls for the evaluation of its foster parent  recruitment efforts, we found that CFSA had not developed a process to  measure the effectiveness of its recruitment strategies and to learn why  prospective families do not complete the licensing process. CFSA’s  recruitment plan alludes to the agency’s FACES database as a potential  tool for collecting such data, but agency officials told us that the system  does not capture the information. Such evaluation is commonly  considered good practice.
section_title: CFSA Established and Enforced Its Licensing Standards, Broadened Its Oversight of Homes, and Has Taken Steps to Strengthen Contracts
paragraphs: In April 2004, CFSA established a process for issuing temporary licenses  for kinship foster homes in the District. Kinship homes house about   30 percent of the children in CFSA’s care. Requirements for the temporary  license include a home study, criminal background check via the National  Crime Information Center (NCIC), and a health history of primary  caregivers.  Once a child is placed, the family must apply for a  nontemporary foster family license. Temporary licenses are good for   120 days and may be renewed once for 90 days as long as the family has  made a good faith effort to comply with the nontemporary licensing  process. According to agency officials, CFSA’s goal is to be able to issue a  temporary license in 3 days. As of May 2004, two temporary licenses had  been issued and both took 2 weeks to process. Agency officials reported  that they are currently working with Maryland officials to develop a  temporary license for Maryland kinship placements—a step designed to  further expand safety checks and decrease the length of time some  children spend in emergency placements.
In August 2001, CFSA instituted new licensing standards for congregate  care homes, and in 2003 CFSA closed those that did not meet these  standards. Prior to these new standards, congregate care facilities  received a facility inspection but were not licensed. The standards cover  the physical safety of the facility, staff credentials, staffing ratios, and  required background checks for staff. In 2002, just after the publication of  the new licensing standards, most of these facilities—25 of the 28  facilities—were issued provisional licenses in order to allow them time to  make physical upgrades required in the new standards. However, as of  June 2003, 4 of the 25 congregate care homes had been closed because  they could not meet these licensing requirements. Like traditional foster  homes, congregate homes are monitored regularly and licenses must be  renewed each year. Agency officials reported that although some  challenges remain—for example, facilities have had difficulty finding staff  with the credentials needed to meet CFSA’s requirements—the new  licensing requirements have greatly improved the quality of congregate  care.
CFSA broadened its oversight of out-of-state and private agency  placements in order to help ensure a consistent level of safety. In 2003, the  agency added staff to a unit that reviews the licenses of out-of-state  homes and manages contracts with private agencies that help place  CFSA’s children in neighboring states. This oversight process gives CFSA  the opportunity to remove a child from a home if it finds a serious problem  with a family’s license and, in the case of a less significant licensing issue,  the agency can work with the private agency to help correct the problem.  Because of previous problems, CFSA began requiring out-of-state private  agencies to provide foster families with support workers—caseworkers  who make monthly visits and act as a liaison between the agency and the  foster parent. Foster parents who live in Maryland and participated in our  discussion groups told us that in the past they experienced many problems  obtaining a support worker but for the most part these problems had been  resolved.
Additionally, CFSA has taken steps to establish performance-based  contracts with congregate care providers and private agencies. Agency  officials expect performance-based contracting to further improve the  quality of foster care homes by requiring contractors to achieve specific,  measurable outcomes on the level of safety and quality of care they  provide to foster children. As a first major step in moving toward  performance-based contracting, CFSA issued two requests for proposals  (RFPs). The first RFP, which closed in September 2003, sought contracts  for congregate care facilities that provide emergency care, group homes,  homes for teen parents and their children, and/or independent living  services. CFSA received 30 viable proposals for congregate care providers,  and agency officials planned to make awards for congregate care in  August 2004. The second RFP closed in February 2004 and sought  contracts to help place children in traditional foster homes. As of August  2004, CFSA was in the process of evaluating the proposals it received. The  implementation plan requires all CFSA contracts to be performance-based  by September 2005, and officials said that CFSA plans to meet this  requirement.
section_title: CFSA Has Made Progress in Licensing New Families; however, More Families Stopped Serving than Expected, and CFSA Has Not Determined Reasons Why
paragraphs: While fewer families than expected have participated in CFSA’s  orientation programs, more families than expected have been licensed but  more stopped serving. As of June 30, 2004, the agency reported having  processed 448 families through orientation, just under 50 percent of its  goal to have 1,000 interested families participate in an orientation session.  CFSA also reported that about 170 new families were licensed—exceeding  its goal of 100 new families. However, agency officials also reported that  as of May 30, 2004, 77 families stopped serving—significantly more than  the agency’s projected loss of 50 families for fiscal year 2004. Nonetheless,  as of June 30, 2004, there was a net gain of about 90 families. If in the last  quarter of fiscal year 2004, the number of newly licensed families  continues to exceed or at least equals the number of families who stop  serving, CFSA should be able to exceed its goal to have a net increase of   50 newly licensed families. With respect to adoption, CFSA finalized 288  adoptions as of June 30, 2004, a number that exceeds the 208 adoptions  finalized as of June 2003. If CFSA continues to find adoptive homes for  children at its current rate, the agency should exceed the 315 adoptions it  finalized at the close of 2003.
However, CFSA has not determined why foster families stop serving each  year. Child welfare experts recommend that agencies conduct exit  interviews with foster families and use these data to help improve the  program. Agency officials said that they believe the main reasons families  stop serving as foster parents are that they become adoptive families, have  served for many years, and are “retiring” from service, or cannot meet  licensing requirements because of issues such as a change in employment  status. However, agency officials could not provide documented support  for these statements and, therefore, cannot be certain that foster parents  do not stop serving for other reasons. In addition to systematically  identifying the reasons families leave the foster program, agency officials  can learn about ways to improve the program from exit interviews. Foster  parents we met with identified several ways that CFSA could improve the  program. For example, foster parents suggested that CFSA change some of  its training requirements and that CFSA improve the way information  about a foster child is maintained because information has been lost when  a  child’s caseworker changed. We previously reported that CFSA’s  automated case management system, FACES, lacked data on many foster  care cases and noted that information missing from the automated  systems can be lost and that such missing information requires  caseworkers to spend more time to become familiar with children’s cases  that are transferred.
By increasing the net supply of foster homes available, the agency reports  that it expects to achieve other important benefits. If there are more  traditional foster homes, CFSA can reduce the number of children placed  in congregate homes as required by the implementation plan. Further, with  more traditional foster homes, CFSA reports that it will likely be able to  facilitate more adoptions, given that foster parents often decide to adopt  once they live with a child. For example, as of March 2004, 614 foster  children (about 62 percent of children under CFSA’s care with a goal of  adoption) were living with a family who intended to adopt them.
Furthermore, the respite care program being developed by COG with the  foster care improvement funds may also help increase the net supply of  homes. Foster parents said during congressional hearings and group  interviews that a respite program would, in the long run, reduce attrition  because it would reduce stress and burn-out. COG has designed a respite  program that will recruit families from the District and other surrounding  jurisdictions who will voluntarily provide respite care. COG’s goal is to  make 700 respite care placements by March 2005; however, the  organization does not yet know how many respite families will be required  to provide this number of placements. As of August 9, 2004, COG officials  reported that 6 families already licensed as foster care providers had  verbally committed to serving as respite families. In addition, 10 families  had completed training but were not yet licensed. COG officials also  reported that on August 6, 2004, they began soliciting respite requests from  foster families and that they plan to begin offering respite services on  August 30, 2004.  In commenting on a draft of this report, COG officials  said that they were assessing the number of foster families that need  respite and will use that information to gauge the number of respite  families required to meet the need.
section_title: Some Foster Children Remain in Unlicensed Homes
paragraphs: CFSA has taken a number of steps to ensure that children are placed in  licensed foster care homes, yet as of May 2004, 495 children—about   22 percent of children in CFSA’s care—were in unlicensed homes. It is the  agency’s policy not to place children in unlicensed homes, and measures  such as the temporary license for kinship homes and greater oversight of  out-of-state placements have been taken to prevent children from being  placed in unlicensed homes. CFSA officials told us that the majority of the  308 unlicensed homes that remained as of May 2004 entered the foster  care program before the new licensing standards were issued and that  many are kinship homes and homes located in Maryland. CFSA is working  to correct this situation by examining these homes on a case-by-case basis  to identify the specific barrier each home faces in becoming licensed and,  if possible, to resolve that issue. The emergency support fund made  possible by Congress’s 2004 appropriation may help by providing money to  help families make improvements—such as, installing a ramp for a  disabled child or splitting a larger bedroom into two for greater privacy for  siblings—that will help them become licensed.
section_title: CFSA Has Begun Collaborating to Centralize and Track Mental Health Services for Foster Care Children, but Challenges Remain to Ensuring Timely Delivery
paragraphs: CFSA has begun implementing a centralized mental health referral process  in collaboration with DMH and the Family Court and has developed a  database to track service delivery; however, challenges remain in meeting  the statutory timeframes for initiating services and for completing and  reporting on assessments. To increase the continuity of care between the  foster care and mental health systems, CFSA and DMH designed a  standard process for referring foster care children to DMH for mental  health assessment and treatment and for tracking service delivery. In  addition, officials from each agency have met routinely with Family Court  judges to discuss the referral process and other issues that may affect  efforts to link foster care children to mental health services. CFSA and  DMH began using the referral process in March 2004, and CFSA began  using its newly developed database for tracking service delivery in August  2004. In conjunction with CFSA’s efforts to centralize and track mental  health services, DMH has started expanding its capacity to provide  services to foster care children. Efforts include recruiting additional  evaluators to perform assessments, certifying additional mental health  providers to deliver treatment, and contracting with providers for new  types of treatment. While progress has been made to better link foster care  children to mental health services, several challenges remain for CFSA and  DMH in order to meet the statutory timeframes, such as completing  complex and time-intensive assessments and integrating caseworkers and  judges into the new referral process.
subsections: section_title: CFSA Has Created a Referral Process and Designed a Database for Tracking Service Delivery
paragraphs: In March 2004, CFSA—in concert with DMH—began implementing a  standard process for referring foster care children to mental health  services. CFSA and DMH staff developed the new referral process to  increase continuity of care between systems and to ultimately improve the  effectiveness of mental health services for foster care children. In an effort  to collaborate on the new referral process, CFSA and DMH officials have  held regular meetings and workgroups to plan, make decisions, and share  information regarding mental health services for foster care children. For  example, the agencies have made hiring and contracting decisions  together and have begun efforts to co-locate staff. These strategies are  consistent with those cited by a national expert as indicators of a state’s  commitment to coordinate care for children across multiple public  systems. In addition to working together, both CFSA and DMH have been  meeting with Family Court judges to present information on the new  referral process and to discuss ways to ensure that judges are ordering the  most appropriate services and that services are delivered on a timely basis.
Under the new referral process, CFSA’s newly established Behavioral  Services Unit (BSU) coordinates referrals for mental health assessments  or treatment, which are then delivered primarily by DMH through its  network of evaluators and providers. A child’s case is forwarded to BSU  when a Family Court judge issues an order for mental health services or  when a caseworker makes a request for services. In the case of  assessments, a BSU specialist determines whether the type of assessment  requested or ordered is clinically appropriate for the child. When the  assessment request or order is deemed appropriate, the caseworker  submits a referral package to BSU. After reviewing the package for quality  and completeness, BSU forwards it to DMH’s Assessment Center, which is  responsible for coordinating assessments of foster care children for the  Family Court and CFSA. Unless an evaluator is specified in a court order,  the Assessment Center assigns the child to the first available evaluator to  conduct the assessment. Upon completion of the assessment, DMH sends  the report to BSU and to the Family Court. When a child is referred for  treatment, BSU contacts DMH’s Access Helpline—a telephone hotline  providing crisis emergency services, enrollment assistance and  information, and referral 24 hours a day and 7 days a week—to enroll the  child in the mental health system. Enrollment, which the Access Helpline  is to complete within 24 hours of referral, includes assigning the child to a  core services agency. The core services agency is notified of the  enrollment and is required to contact the child’s caseworker within 7 days  of enrollment to set the first appointment for treatment. Figure 3  summarizes the referral process.
To electronically track mental health service delivery, CFSA created a  database to capture data on new referrals for services for foster care  children and, began entering service delivery information in August 2004.  Prior to the implementation of the database, BSU was using paper referral  forms to manually collect information on foster care children being  referred for mental health services. According to CFSA officials,  preliminary data showed that as of July 2004, BSU was receiving between  80 and 100 referrals for mental health services a week, 40 percent of which  were for assessments and 60 percent for treatment. CFSA and DMH also  reported that, from mid-March 2004 through May 2004, CFSA completed  141 assessments and DMH’s Assessment Center completed   111 assessments. With regard to treatment, from mid-March 2004 through  May 2004, DMH enrolled 286 foster care children to begin treatment in a  certified core services agency, of which there are 13. According to CFSA  officials, DMH’s core services agencies were able to accept 95 percent of  the referrals of foster care children for treatment. CFSA treatment  providers accepted the remaining 5 percent, which were for specialized  services that a DMH provider did not offer, such as attachment therapy.  While officials were able to report some of the data collected manually,  CFSA had not analyzed the information to determine whether foster care  children were receiving mental health services within the statutory  timeframes.  However, Family Court judges and a CFSA report noted that  completed assessments could take from 30 to 60 days.
BSU officials indicated that once CFSA’s database is fully operational,  every child’s electronic file would include information from caseworkers,  court orders, and DMH. For example, the file will capture demographic  data, the assigned caseworker, the child’s mental health diagnosis, and,  where applicable, the judge assigned to the case. Additionally, the  database will allow BSU to establish an electronic record for each service  referral. According to CFSA officials, these electronic records would  reflect when the service was requested or court-ordered, the mental health  evaluator or treatment provider that accepted the referral, and the date the  service was delivered. To collect data on the first treatment appointment,  BSU staff plan to call the child’s core services agency to ensure that  treatment was delivered. This approach may be burdensome for BSU,  since approximately 50 to 60 children are being referred to the core  services agencies on a weekly basis. CFSA officials anticipate that the  database will capture information on all referrals made after the initial  date of implementation. CFSA officials also said that temporary staff were  hired to enter the data for the referrals made since March 17, 2004. It was  also noted that the agency intends to link this database to FACES, the  District’s automated case management system. As of September 2004,  CFSA officials said that revisions to FACES to allow the linkage was being  planned.
section_title: DMH Has Started Expanding Its Capacity to Serve Foster Care Children
paragraphs: Timely delivery of mental health services will largely depend on DMH’s  ability to expand and sustain its existing capacity to provide services.  DMH plans to increase the number of evaluators available to conduct  assessments, certify and train additional providers to deliver treatment,  and contract for new types of treatment. The new types of treatment for  foster care children will add to the variety of services previously available  to foster care children in DMH’s system. Table 3 identifies examples of key  existing and planned services for foster care children. According to DMH  officials, expanding its capacity to provide services to foster care children  is a formidable task. For example, recruiting qualified evaluators is  difficult due to the level of education needed to perform assessments, as  well as competition with neighboring jurisdictions for qualified staff.
DMH has made some progress in expanding its capacity to meet the  assessment and treatment needs of foster care children. DMH officials  noted that efforts are underway to recruit additional evaluators and  transition CFSA evaluators to DMH’s Assessment Center. For example,  CFSA officials meet with their evaluators to encourage them to contract   with DMH. Regarding treatment providers, as of June 2004, 10  organizations specializing in serving children and families had applied for  DMH certification to be a core services agency, specialty provider, or  subprovider. In addition to new evaluators and treatment providers, DMH  has begun a competitive grant process to make several new types of  treatment available to foster care children. As of August 2004, DMH had  approved grants for providers to deliver multisystemic therapy, intensive  home and community-based services, and mobile crisis services and was  awaiting proposals to deliver trauma treatment. DMH estimated that   300 to 500 foster care children would be served under these grant  programs within 1 year of the grant contracts being signed. DMH officials  noted that providers would not be able to begin delivering services before  the end of fiscal year 2004.
Initially funded by the $3.9 million in federal foster care improvement  funds, DMH has strategies in place aimed at sustaining the additional  assessment and treatment capacity. In terms of financing the increased  capacity for assessments, DMH's director said that the department would  continue to fund evaluators to provide assessments, which represents  approximately $1.1 million of the federal funds; however, the volume of  assessments presents a challenge to meeting the statutory timeframes  after fiscal year 2005. As for treatment, which represents approximately  $2.5 million of the federal funds, DMH expects that Medicaid will largely  cover the cost of the new types of treatment under the mental health  rehabilitation services option.
section_title: Challenges Remain to Ensuring the Timely Delivery of Mental Health Services
paragraphs: While significant steps have been taken to better link foster care children  to mental health services, CFSA and DMH face challenges to ensuring the  timely delivery of these services due to the complex working environment  in which they operate. For example, before assessments can be  conducted, caseworkers must prepare referral packages, which include  extensive amounts of information on a child. The caseworkers’ ability to  prepare and submit referral packages to BSU quickly can depend in part  on how well they know the child or can obtain access to information about  the child’s demographics; previous school, police or health reports; and  developmental history. A CFSA official estimated that it could take  caseworkers from 2 days to several weeks to prepare a referral package.  Further, the need for more intensive, complex assessments for some foster  care children can affect the extent to which services are provided on a  timely basis. In particular, DMH officials noted that meeting the statutory  timeframes for completing and reporting on assessments could be  problematic, because some complex assessments such as bonding studies,  which determine the extent to which a child has bonded with his or her  caregiver, require multiple appointments, and may take longer to complete  than other assessments. (See table 4 for a list of the types and purposes of  assessments for children in foster care.) Additionally, some types of  assessments have prerequisites that can lengthen the time needed for  completion. For example, to complete a neuropsychological assessment,  the child must first undergo a psychological assessment. To the extent that  some foster care children may require more complex, time-consuming  assessments than others, it may be difficult for DMH to meet the statutory  timeframes of completing the assessment within 15 days of the request or  court order and providing the results to the Family Court within 5 days of  its completion. According to one national expert in mental health system  reform, other jurisdictions generally have not legislated timeframes for  mental health systems to provide services, in part because different  assessments vary in the length of time required for completion.
In addition to operating in a working environment that has extensive  information requirements and variations regarding individual need, CFSA  and DMH are working to better integrate caseworkers and judges into the  new referral system. While BSU is in place to provide clinical expertise in  making mental health service referrals, caseworkers and judges may not  be aware of or understand how to use the office. For example, one Family  Court official said that some judges have ordered that a specific DMH  evaluator perform an assessment, which may delay its completion due to  the evaluator’s availability. A CFSA official working as a liaison to the  Family Court also indicated that caseworkers continue to contact DMH  directly to link children to mental health services, which may delay the  court order going through BSU for processing. To help educate  caseworkers about the new referral process, officials from BSU created a  fact sheet providing caseworkers guidance on how to link children to  mental health services. In addition, in May 2004, a BSU official began  meeting with caseworkers to formally present the new process and answer  questions. As mentioned previously, CFSA has also presented the referral  process to Family Court judges, and DMH is exploring ways to have its  staff available during Family Court hearings to answer questions related to  mental health services.
section_title: Uncertainties Exist in the Long-Term and Short-Term Funding Status for Some of the Projects Included in the Plan
paragraphs: In February 2004, CFSA, DMH, and COG submitted spending plans to the  Congress outlining how they intended to use the foster care improvement  funds, and in March 2004, they received the funds. As of June 30, 2004,  they reported obligations of about $1.5 million of their appropriated funds,  with about $419,000 of that total having been expended. Most of the  planned expenditures outlined in the spending plans are for operating  costs that would continue in the future once the programs are established.  How the District and COG plan to fund some of these initiatives in the long  term is uncertain.
subsections: section_title: CFSA, DMH, and COG Have Planned Expenditures for Purposes Identified in the Act
paragraphs: Following the passage of the act on January 23, 2004, the organizations  could not receive funding until 30 days after they submitted a plan. The  District submitted a spending plan for CFSA and DMH on February 9,  2004, and COG submitted its spending plan on February 13, 2004. The  expenditures included in the plans are consistent with the stated purposes  in the legislation. Table 5 summarizes the purposes for the funds as  designated in the law and the planned expenditures listed in the spending  plans.
CFSA’s spending plan outlined a strategy for accomplishing the objectives  of each of its programs as established under the act. According to the plan,  CFSA would    establish an early intervention program through the implementation of  Facilitated Family Team Meetings that would focus on permanency  options for foster children;    create an emergency support fund for kinship caregivers to pay for  necessary expenses such as lead abatement, home repairs and  renovation, and child care, in order to help these caregivers become or  remain licensed foster homes;    establish a student loan repayment program for caseworkers; and   enhance CFSA’s ability to share information within and outside the  agency by upgrading the agency’s child welfare tracking database,  FACES, to a Web-enabled system, providing laptop computers for  caseworkers and enhancing CFSA’s networking capabilities to enable  this Web-based initiative.
The budgets from the three organizations provided details about the  planned expenses. The major expenses detailed in CFSA’s budget are  related to the hiring of new personnel for Facilitated Family Team  Meetings, student loan repayments to caseworkers, equipment and labor  for technology upgrades, and direct support services to children and  families. DMH’s spending plan identified funding for expanded psychiatrist  and psychologist hours for assessment and mental health treatment, such  as that provided by mobile crisis intervention teams and specialized  therapy. DMH’s budget confirmed these as the major portions of the  federal funds. COG’s spending plan outlined programs for providing  respite care for and the recruitment of foster parents, but it did not  provide a monetary breakdown of how the funds would be spent.  However, COG’s budget identified the expenditures for the respite care  and recruitment programs, and the major expenses budgeted were for  personnel costs and funds that would be passed through to contractors  and community organizations to provide respite, recruitment, and related  training services. Furthermore, COG officials indicated that they have until  March 2005 to expend all of its funds.
section_title: Future Funding for Some of the Long-Term Projects in the Plan Is Uncertain
paragraphs: While the expenditures proposed in the District and COG spending plans  appear to be in line with the intentions of the act, it is unclear how the  District and COG plan to support all of the programs and initiatives  outlined in the spending plan in the long-term. Although the District’s  fiscal year 2005 proposed budget for CFSA reflects realignment of agency  funds as a means to continue the early intervention program that was  funded in fiscal year 2004 with federal funds, it does not address funding  for continuing the other CFSA programs. Also, CFSA has reported that the  student loan repayment program would be made available only to staff  currently on board due to the expiration of the funds on September 30,  2004, although these funds are intended to support a multiyear strategy  that would allow CFSA to retain highly qualified caseworkers over time.  The District’s proposed budget for fiscal year 2005 for DMH includes a  realignment of funds to support some mental health treatment services.  For fiscal year 2005, the budget includes funds to support programs  designed to help foster care children, such as Multi-Systemic Therapy  services. Also, DMH officials said that they are working to include the new  types of treatment in the services reimbursed under the District’s Medicaid  program as a longer-term mechanism to fund additional services. With  regard to assessment, it is unclear how the District plans to sustain the  funding necessary for the additional evaluators.  According to the DMH  director, DMH would continue to fund evaluators to provide assessments.  In addition, COG officials told us that they would likely need an additional  $500,000 from the federal government to continue their respite care  initiative through the end of fiscal year 2005 and hope that private sources  would support the respite program in the future. In commenting on a draft  of this report, COG officials said that they had received a partnership  commitment from a private source and would seek further funding as  needed.
section_title: As of June 30, 2004, Only a Small Portion of the $14 Million Had Been Obligated or Spent
paragraphs: The District and COG did not receive authority over their funding until   6 months into fiscal year 2004. Following passage of the act on January 23,  2004, the District and COG could not receive funding until 30 days after  they submitted a spending plan. On March 17, 2004, the District received  the $14 million payment, less a 0.59 percent rescission, for a total of  $13,917,400. The District’s Office of Budget and Planning granted CFSA  budget authority for its share of funds, $8,946,900 on March 22, 2004, and  granted DMH budget authority for its funds totaling $3,876,990 on March  17, 2004. The District sent COG its payment of $1,093,510 on March 25,  2004.
As of June 30, 2004, CFSA, DMH, and COG reported a small portion of the  funds appropriated for foster care improvements were obligated or spent.  CFSA reported that it had outstanding contractual obligations of   $183,105 and had expended $31,998, resulting in 2.4 percent of its funding  under the act being expended or obligated. DMH reported that it had  $704,527 in outstanding contractual obligations of the funds and had  expended $190,538, totaling 23.1 percent of its funding under the act. COG  reported that it had expended $196,307 of its funds, and that it had  incurred $145,043 in outstanding contractual obligations, representing   31.2 percent of its funding under the act. In all, over $12.4 million of the  foster care improvement funds, appropriated for fiscal year 2004 only,  remained available 9 months into fiscal year 2004. Table 6 provides details  on the organizations’ expenditures and obligations as of June 30, 2004.
section_title: Conclusions
paragraphs: Many steps have been taken to help improve the District’s foster care  system, but most of the programs and initiatives will need sustained  attention and ongoing support. CFSA has implemented effective  recruitment strategies and established retention incentives to help recruit  and retain skilled caseworkers. CFSA has also developed a plan to recruit  foster and adoptive families and instituted practices to better ensure the  safety of foster and adoptive homes. While these efforts are promising,  CFSA will need to continue to support these initiatives and monitor their  effectiveness. Several other initiatives have just begun and will need  sustained attention to ensure they are fully implemented. COG has not yet  licensed families to provide respite or offered respite placements and is  not certain about the number of families that will be needed to support the  program. CFSA’s and DMH’s process for providing mental health services  for foster care children was recently initiated, and it is uncertain whether  these services are being provided in a timely fashion. In addition, there are  several challenges remaining to ensuring the timely delivery of mental  health services, including DMH’s ability to expand its capacity to provide  services. Furthermore, while the expenditures proposed in the District and  COG spending plans appear to be in line with the intentions of the act, it is  unclear how the District and COG plan to support some of the programs  and initiatives outlined in the spending plan in the long-term.
However, some of CFSA’s management practices have not created a  positive work environment for its caseworkers. Caseworkers play a  critical role in the District’s child welfare system, and CFSA needs its  caseworkers to be productive, motivated, and committed in order to make  further improvements to the District’s child welfare system. Without  making further changes in its management practices, CFSA may  experience decreases in productivity and increases in attrition of its  caseworkers. Further, low morale may affect caseworkers efforts to fulfill  their duties and provide adequate care to the children they manage.  Without consistent and effective communication strategies, caseworkers  may not be aware of what services they can provide to foster care children  and their families or the processes for obtaining such services. Without  supervisors fulfilling their responsibilities, CFSA caseworkers are left  without guidance and direction on how to improve on their performance  and fulfill their case management duties. Additionally, caseworkers may  not be making the best decisions about their cases, which in turn can  affect the care and services provided to children and their families.
In addition to having a cadre of highly skilled and motivated caseworkers,  an adequate number of safe, foster, and adoptive homes is a critical factor  to improving foster care in the District. Despite CFSA’s new efforts and  attention to recruiting foster and adoptive families, the agency does not  have a process for assessing the effectiveness of its recruitment efforts.  Therefore, the agency does not know which efforts are most productive  and which strategies should be continued or abandoned. Additionally,  CFSA does not have sufficient information about the reasons foster  families stop serving and leave the foster care system because it does not  have a process to solicit feedback from them. Such information could help  the agency improve its program and help reduce the attrition of foster  families.
section_title: Recommendations
paragraphs: To build upon the improvements underway, we recommend that the  director of CFSA take the following three actions:    Address human capital management issues that affect caseworkers by  establishing processes to consistently and effectively communicate  information about agency operations and developing strategies to help  ensure that supervisors fulfill their responsibilities.
Develop a systematic method to evaluate its foster parent recruitment  efforts to help identify the most effective strategies.
Conduct exit interviews with foster parents who stop serving to  identify the factors affecting their decisions and develop an action plan  to address those factors that relate to systematic issues.
section_title: Agency Comments and Our Evaluation
paragraphs: We received written comments from CFSA on a draft of this report. These  comments are reprinted in appendix II. CFSA agreed with each of our  recommendations and said that it plans to implement them. CFSA  provided additional information to clarify the issues in the report, and we  made changes to the report to reflect several of these comments.  Specifically, we (1) revised the maximum student loan repayment amounts  and the application deadline, (2) updated the number of finalized  adoptions, (3) changed the new recruitment unit operational date from  August to October, (4) noted that CFSA has implemented some  suggestions from the COG report, (5) corrected the information on  licensing for kinship homes, and (6) noted that CFSA has begun entering  data on mental health referrals made since March 2004. CFSA provided  other information and data that we did not incorporate because the data  could not be corroborated in time for this report.
We also received written comments on a draft of this report from DMH.  These comments are reprinted in appendix III. DMH provided information  to clarify and provide context for three areas in the report: sustainability,  building provider capacity, and improving the timeliness of evaluations  and assessments. We made changes to recognize DMH’s plan to sustain the  programs begun with federal funding. Specifically, we note a realignment  of funds to support various mental health services that could help the  District’s foster care children. Also, we added information on DMH’s plans  to include new types of treatment in the services reimbursed under the  District’s Medicaid program. With regard to DMH’s efforts to meet the  timeliness requirements for completing evaluations and assessments, we  did not change the report to reflect the new information provided. DMH  did not include supporting documentation for the timeframes reported,  and we could not verify the data on the timelines for completing  assessments.
Additionally, we received written comments on a draft of this report from  COG. These comments are reprinted in appendix IV. COG provided us  with information on its plans to obtain long-term funding for its program  and to assess the number of respite providers it will need. We modified the  report to reflect these comments.
We will send copies of this report to the Acting Director of CFSA, the  Director of DMH, the Executive Director of COG, appropriate  congressional committees, and other interested parties. We will also make  copies of this report available to others on request. In addition, the report  will be available at no charge on GAO’s Web site at http://www.gao.gov  If you have any questions about this report, please contact me on   (202) 512-8403. Other contacts and staff acknowledgments are listed in  appendix V.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: To identify Child and Family Services Agency’s (CFSA) strategies for  recruiting, retaining, and managing its caseworkers, we reviewed key  CFSA documents, analyzed data, and interviewed several experts and  agency officials. Specifically, we reviewed CFSA’s strategic and annual  plans for fiscal years 2003 and 2004 and CFSA’s recruiting and retention  plans for fiscal years 2003, 2004, and 2005. We reviewed CFSA data, such  as worker caseload counts, attrition data, and exit interviews. To check  the frequency with which performance appraisals were being held, we  reviewed personnel folders for a random sample of 80 caseworkers, of  which we excluded 49 caseworker files to include only those hired on or  before December 31, 2000. We reviewed national standards for child  welfare agencies set by the Child Welfare League of America and the  Council on Accreditation. Additionally, we met with several CFSA  program officials and the court-appointed monitor, the Center for the  Study of Social Policy (CSSP). We also interviewed national child welfare  experts from the Child Welfare League of America, Council on  Accreditation, the Department of Health and Human Services (HHS)  Children’s Bureau, Institute for Social Welfare Research, Council on Social  Work Education, National Association of Social Workers, and Casey  Family Services.
We also used discussion groups to obtain the opinions and insights of  CFSA supervisors and caseworkers regarding their opinions of CFSA’s  recruiting, retention, and management support of caseworkers. Discussion  groups are a form of qualitative research in which a specially trained  leader, the moderator, meets with a small group of people who have  similar characteristics and are knowledgeable about the specific issue. The  results from the discussion groups are descriptive, showing the range of  opinions and ideas among participants. However, the results cannot serve  as a basis for statistical inference because discussion groups are not  designed to (1) demonstrate the extent of a problem or to generalize  results to a larger population, (2) develop a consensus for an agreed-upon  plan of action, or (3) provide statistically representative samples with  reliable quantitative estimates. The opinions of many group participants  showed a great deal of consensus, and the recurring themes provide some  amount of validation.
After an initial group interview with supervisors selected by CFSA  officials, we conducted four discussion groups—one with supervisors and  three with caseworkers. We randomly selected participants to help ensure  that they represented a cross section of the organization. Attendance on  the part of invited participants was voluntary. For the three discussion  groups that were held with caseworkers, we had one with employees who  had been at CFSA for 1 year or less, one discussion group with employees  who had been at CFSA 1-6 years, and one with employees who had been at  CFSA more than 6 years. A trained discussion group moderator led the  discussions while our analysts took notes. We developed a discussion  group guide to assist the moderator in leading the discussions.
To assess CFSA’s efforts to license an adequate number of safe homes for  foster care placements and adoptions, we reviewed CFSA documents,  analyzed related data, interviewed agency officials, and held group  interviews with foster and adoptive parents. Specifically, we examined  CFSA’s plan for foster and adoptive parent recruitment and retention and  its resource development plan. We also reviewed CFSA’s licensing policies  for traditional foster, kinship, and congregate care placements. We  analyzed CFSA data on the number of children in unlicensed foster homes,  people attending orientation sessions, foster homes issued a license from  October 2003 through June 2004, and the attrition rates for foster families  from October 2003 to May 2004. We also evaluated the number of foster  families with the intent to adopt their foster children as of March 2004, and  the number of children in CFSA’s care waiting to be adopted as of March  2004. We reviewed HHS’ Child and Family Services Review (CFSR) on  CFSA, the Implementation Plan issued by CFSA’s court-appointed  monitor, and other national studies on recruiting foster parents. We met  with CFSA program officials and the court-appointed monitor to discuss  CFSA’s processes and goals for licensing foster parents. We coordinated  with D.C.-based organizations, the Foster Parent Advocacy Center  (FAPAC) and the Foster Parent Association, to hold group interviews with  foster parents. Additionally, we interviewed officials from the Adoption  Resource Center in Washington, D.C. and the Metropolitan Washington  Council of Governments (COG).
To determine how CFSA has collaborated with the Department of Mental  Health (DMH) and the D.C. Family Court to provide mental health services  to foster care children and what challenges remain, we analyzed CFSA and  DMH planning documents, notices of available funding, provider  contracts, and documentation of internal procedures for referring foster  care children to mental health services. Prior to its implementation, we  previewed CFSA’s database for tracking mental health referrals and  reviewed the documents used to collect and log the data. We also  reviewed preliminary data on the number of assessments completed and  the number of children enrolled with DMH treatment providers from mid- March 2004 through May 2004. We interviewed CFSA and DMH program  officials and D.C. Family Court judges. In addition, we interviewed  national experts in coordinating care for children across public systems,  including the court monitors for the District’s child welfare and mental  health systems, respectively.
To report on CFSA’s, DMH’s, and COG’s plans and use of their fiscal year  2004 federal funds for foster care improvements, we reviewed the  agencies’ spending plans, budget data, and unaudited reports of  obligations and expenditures. We interviewed financial and program  personnel from all three organizations and from within the District’s  central Chief Financial Officer’s office.
section_title: Appendix II: Comments from the District of Columbia’s Child and Family Services Agency
section_title: Appendix III: Comments from the District of Columbia’s Department of Mental Health
section_title: Appendix IV: Comments from the Metropolitan Washington Council of Governments
section_title: Appendix V: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Staff Acknowledgments
paragraphs: The following individuals also made important contributions to this report:  Susan Barnidge, Joah Iannotta, JoAnn Martinez, Deborah Peay, James  Rebbe, Lori Ryza, Norma Samuel, Vernette Shaw, Zakia Simpson, Walter  Vance, and Carolyn Yocom.