D.C. Child and Family Services Agency: Performance Has Improved, but Exploring Health Care Options and Providing Specialized Training May Further Enhance Performance
Published: 2006-09-28T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The District of Columbia's Child and Family Services Agency (CFSA) has a history of serious performance problems. A court case in 1989 set in motion sweeping efforts to improve the District's child welfare system. Since then, CFSA has worked to meet performance requirements ordered by the U.S. District Court. However, recent reports by the court monitor show that CFSA is not meeting performance requirements on many measures. To update Congress, we assessed (1) whether CFSA is likely to meet requirements by December 2006; (2) what factors, if any, hinder the agency from meeting requirements; (3) how CFSA is monitoring its progress; and (4) the extent to which CFSA has implemented initiatives to achieve unmet requirements. To conduct this work, we reviewed reports by CFSA and the court monitor and interviewed stakeholders, including the court monitor and CFSA managers, supervisors, and caseworkers.
section_title: What GAO Found
paragraphs: CFSA has made progress, but the agency is not likely to meet all of the court-ordered requirements by December 2006, based on the recent court monitor's report and our work. From December 2005 to April 2006, CFSA improved its performance and met some benchmarks. However, CFSA's performance on other requirements remains well below benchmarks, raising questions about the agency's ability to meet all of the court-ordered requirements by December and sustain the improvements it has made. For example, only 29 percent of children in foster care received medical evaluations within 30 days of placement in April 2006, despite a benchmark of at least 90 percent. Several factors--complex caseloads and shortages of health care providers and qualified foster and adoptive homes--hinder CFSA's ability to meet court-ordered requirements. CFSA's cases are complex, in part because of the high proportion of hard-to-place teenagers and children with medical or mental health needs in the District's child welfare system. Caseworkers reported that they do not have enough specialized training to help them develop the skills they need to address these caseload complexities. CFSA's effort to meet court-ordered time frames is complicated in a small number of cases--those involving severe physical or sexual abuse--by the difficulty of coordinating with the District's Metropolitan Police Department. At the same time, CFSA officials told us there is a shortage of health care providers to serve these children, and the limited number of qualified foster and adoptive homes hinders CFSA's ability to give children the most appropriate and timely placements. CFSA uses routine reports and qualitative studies to determine whether it is meeting requirements, but current data may not provide an accurate picture of the agency's progress. Implementing the agency's new Web-based case management system has been challenging and caseworkers reported that because of these implementation difficulties, they have not always entered complete and accurate data on their cases into the system. However, CFSA has recently taken a number of steps to resolve these issues, including, for example, issuing frequent system upgrades to address identified problems and developing enhanced system training for caseworkers. Within the past few years, CFSA has implemented several initiatives to address the challenges it faces and achieve remaining requirements, but it may be too soon to know if they will yield long-term results. CFSA has hired new staff and reorganized existing staff to focus on key areas. In addition, CFSA has implemented new practices, such as a tool to prioritize investigations based on risk. CFSA is also beginning to hold its management staff and private contractors accountable for helping the agency meet specific performance requirements. Many of these initiatives seem reasonable, but it is too soon to tell whether these efforts will help CFSA meet the remaining court-ordered requirements.

section_title: Letter
paragraphs: Over the years, the District of Columbia’s (the District) Child and Family  Services Agency (CFSA)—the city’s agency responsible for protecting  children from abuse or neglect and, when necessary, placing them in  appropriate foster or adoptive homes—has had serious management and  performance problems that have hindered its ability to protect some of the  children in its care. In June 1989, a lawsuit was filed in the U.S. District  Court for the District of Columbia on behalf of children in the District’s  foster care system and the thousands of children who had been abused or  neglected in the District. The court found that the District failed to (1)  investigate reports of abuse or neglect in a timely manner, (2) make  appropriate foster care placements, (3) monitor the care children received,  and (4) adequately ensure children had permanent homes. This court case  set in motion efforts to reform the District’s child welfare system,  beginning with a federal takeover of the agency. In 1995 the court placed  the agency in full receivership, an arrangement in which the court  appoints a person with broad authority to temporarily manage the agency.  The agency has since been removed from receivership but continues to be  monitored by the Center for the Study of Social Policy (CSSP), which has  been acting in the capacity of court-appointed monitor since 1991. The  monitor is responsible for assessing CFSA’s progress in meeting  performance requirements that cover the full range of CFSA’s work. CFSA  is scheduled to exit from the court monitor’s supervision in December of  this year if it is performing at an acceptable level on these court-ordered  requirements. The parties will attempt to agree on an acceptable level of  performance in negotiations this fall.
Prior GAO work and recent assessments by the court monitor indicate that  while CFSA has made progress in some areas, there remain concerns  about whether the agency will be able to meet all court-ordered  requirements by December 2006. The monitor reported that as of April  2006, CFSA had not met most of the requirements, and the agency’s  performance had declined in some areas. Additionally, the monitor was  not able to determine whether CFSA had made progress in several areas  because no data were available. In order to provide Congress with an  update on CFSA’s performance, we assessed (1) whether CFSA is likely to  meet court-ordered requirements by December 2006; (2) what factors, if  any, hinder the agency from meeting requirements; (3) how CFSA is  monitoring its progress toward meeting unmet requirements; and (4) the  extent to which CFSA has implemented initiatives or developed plans to  achieve unmet requirements.
In conducting this work, we held group interviews with a random sample  of CFSA caseworkers and supervisors, and we interviewed CFSA  managers, the court-appointed monitor, and other District child welfare  experts, including officials from the Consortium for Child Welfare—a  coalition of nonprofit service agencies established to improve child  welfare services in the District. We also reviewed the court-appointed  monitor’s progress reports and various CFSA documents, such as  handbooks, guidance, and policies. Our review focused on key  requirements related to managing child welfare cases that remained unmet  as of December 2005. We conducted our work between May and  September 2006 in accordance with generally accepted government  auditing standards. A complete description of our scope and methodology  is in appendix I.
subsections: section_title: Background
paragraphs: CFSA is responsible for ensuring the safety and well-being of children at  risk for abuse and neglect in the District, but many children in CFSA’s care  languished for long periods of time due to managerial shortcomings and  long-standing organizational divisiveness in the District. In 1989, the  American Civil Liberties Union sued the District on behalf of children who  were in foster care and other abused and neglected children over the  quality of services the city was providing to them. In 1991 the U.S. District  Court for the District of Columbia heard the case, found the District’s child  welfare agency liable and issued a remedial order in 1991 to improve  performance.  When that remedial order and other orders did not result in  sufficient improvement, the court placed the agency under full  receivership in 1995. After 6 years under receivership, CFSA was  reorganized as a District cabinet-level agency, a change that gave the  agency more control over its staff and budget.
The court appointed CSSP to monitor the agency’s compliance with the  court’s orders, including the performance requirements set forth in the  court order releasing CFSA from receivership and the related plan for  implementing the order. In 2003, a final implementation plan was  approved by the District Court and included court-ordered requirements  that cover the full range of CFSA’s work. Some of the requirements are  related to managing child welfare cases, such as initiating and conducting  timely and quality investigations of child abuse and neglect allegations,  providing a range of services to children and their families, and placing  children in appropriate foster or adoptive homes. There also are  requirements related to the administration and management of the agency,  such as CFSA’s information systems and financial management. The  implementation plan also established court-ordered benchmarks—or  expected performance levels—for CFSA to meet on each requirement and,  for most of the requirements, set interim benchmarks that gradually  increased over time until reaching full compliance. For example, the court  mandated that investigations of abuse or neglect must be completed  within 30 days. By June 30, 2003, 60 percent of cases had to meet that time  frame. This benchmark gradually increases at 6-month intervals until  reaching the benchmark of full compliance by December 30, 2006.  However, the court has not yet established a precise performance level  that defines full compliance; the court monitor expects these negotiations  to begin this fall.
Generally, families become involved with the child welfare system after  someone—a neighbor, teacher, or other individual—reports to CFSA  through its telephone hotline that the child has been abused or neglected.  CFSA then investigates to determine whether the report can be  substantiated. If agency investigators determine that it is safe for the child  to remain at home with his or her parents or guardians, CFSA relies on  community agencies, such as the Healthy Families/Thriving Communities  Collaboratives, to provide services to help the family, including parenting  skills classes, if needed. If required, the child may be removed from the  home, necessitating court proceedings.
CFSA caseworkers are responsible for managing foster care cases by  developing case plans; visiting the children; participating in administrative  review hearings involving CFSA officials, children, parents, attorneys, and  other officials; attending court hearings; and working with other District  government agencies. CFSA caseworkers are also responsible for  documenting in the agency’s case management system the steps taken and  decisions made related to a child’s safety, well-being, and foster care  placements, as well as those related to developing the most appropriate  goal for permanency. Depending on their circumstances, children leave  foster care and achieve permanency by being (1) reunified with their birth  or legal parents, (2) adopted, (3) placed in the legal guardianship of a  relative, or (4) declared independent at the age of 18. Caseworkers are  assigned to various units responsible for providing services to children  and families. CFSA program managers and supervisors within those units  are responsible for providing the necessary guidance and support needed  by caseworkers to manage their cases.
CFSA relies on other District agencies and private organizations to help  achieve its mission. For example, CFSA has a contract with Children’s  National Medical Center, known as DC Kids, to provide medical  evaluations for children when they enter CFSA’s care and for as long as  they remain in the system. In addition, CFSA relies on private dental and  mental health care providers to give children dental care and  psychological or psychiatric evaluations. Some private organizations, such  as Catholic Charities, manage about 40 percent of CFSA’s cases, including  preparing case plans for children placed in foster care and those that  remain in the home, making home visits, or providing for visitations  between siblings or parent and child. CFSA also works with agencies in  Maryland, Virginia, and other states to arrange for placements for District  children. CFSA is responsible for licensing and monitoring organizations  in the District with which it contracts, including group homes that house  foster care children.  Also, CFSA oversees the licensing and monitoring for  organizations outside of the District where children are placed.
section_title: CFSA Has Met Some Court-Ordered Requirements, but Is Not Likely to Meet All Requirements by December 2006
paragraphs: CFSA has met some court-ordered requirements, but the agency is not  likely to meet all of its requirements by December 2006, according to the  recent court-monitor’s report and our work. From December 2005 to April  2006, CFSA showed progress, meeting court-required benchmarks in areas  such as limiting to five the number of caseworkers assigned to each  supervisor, ensuring that children age 12 and under are not routinely  placed in group settings, and ensuring that children do not stay in  emergency placements for more than 30 days. In addition, the data show  an improvement in some requirements, even though CFSA has yet to meet  the court-required benchmarks. For example, 61 percent of children who  are in out-of-home placements were placed with some or all of their  siblings as of April, an improvement of 5 percentage points from  December. In other areas, CFSA’s performance was stagnant. For  example, CFSA is required to initiate all investigations within 48 hours  after receiving a report of abuse or neglect. CFSA did so in 70 percent of  cases in December, and as of April its performance was still at 70 percent.
However, performance on the majority of requirements still did not meet  the court-required benchmarks, and in some cases fell seriously below  benchmarks. For example, despite a benchmark set at 90 percent, only 29  percent of children in foster care had received medical evaluations as of  April 2006, and data were not available for the percentage of children who  received dental evaluations. This raises questions about the agency’s  ability to meet the court-required benchmarks by December and to sustain  the improvements it has made. Table 1 shows CFSA’s performance on key  unmet requirements as of April 2006.
section_title: Several Factors Hinder CFSA’s Progress in Meeting Performance Requirements
paragraphs: Complex cases and shortages of health care providers and qualified foster  and adoptive homes hinder CFSA’s ability to meet court-ordered  requirements, according to CFSA officials, caseworkers, and the court  monitor. While caseworkers’ caseloads have been reduced because of  CFSA’s efforts to recruit and retain caseworkers, cases are complex, in  part because of the high proportion of teenagers and children with medical  or mental health needs. CFSA’s efforts to meet court-ordered time frames  is further complicated in a small number of cases by difficulty in  coordinating with the District’s Metropolitan Police Department. At the  same time, CFSA officials told us that there is a shortage of health care  providers to serve these children with health care needs, and the limited  number of qualified foster and adoptive homes hinders CFSA’s ability to  give children the most appropriate and timely placements.
subsections: section_title: CFSA Managers and Caseworkers Cited Complex Cases and a Shortage of Health Care Providers as Hindrances
paragraphs: The complexity of the caseload is hindering CFSA’s efforts to meet court  ordered requirements, according to CFSA officials. While caseworkers’  caseloads have been reduced as a result of CFSA’s efforts to recruit and  retain caseworkers, cases are complex for a number of reasons. First,  there is a high proportion of older children in the District’s child welfare  system who are harder to place and may have different needs than  younger children. This high proportion is due to the fact that the District  serves children in its care until age 21 and, historically, CFSA had not been  successful finding permanent homes for these children when they were  younger. As a result, there are almost 800 youths aged 16 to 21—almost  one-third of the city’s current foster child population—many of whom  have grown up in foster care. Second, a large proportion of children within  the system have complex needs, such as the need for mental health  services or for foster parents that are licensed to support children with  severe medical conditions.
Caseworkers reported not having enough specialized training or adequate  support from supervisors to help them develop the skills they need to  address the complexities of their caseloads, including cases involving  children with behavioral problems or who have experienced domestic  violence. While CFSA has a comprehensive training curriculum, much of  the curriculum is focused on developing a base of knowledge, such as  understanding how children in foster care develop attachment disorders— which make it difficult for them to develop healthy relationships with  primary caregivers—or understanding other separation issues. The court  monitor recently recommended that in addition to focusing on what the  caseworker should know and understand, the CFSA curriculum needs to  identify what the caseworker should do and help the caseworkers develop  a set of applicable skills.
CFSA officials told us there is a shortage of health care providers to give  necessary medical, dental, or mental health services to children in the  agency’s care. These shortages are not unique to the District’s child  welfare system, but they hinder CFSA’s ability to meet a number of court- ordered requirements. For example, caseworkers told us that not having  enough doctors and dentists to conduct screenings and examinations  made it difficult to complete investigations or provide routine  examinations within required time frames. Specifically, they told us that  there is not a sufficient number of dentists in the District who provide  services to CFSA’s children. Furthermore, CFSA told us that in February  2006, the agency did a competitive request for proposals from all District  medical providers for a comprehensive medical system of care, but  received only one bid. While there may be a number of reasons for the lack  of providers, CFSA officials told us that low Medicaid reimbursement rates  for children who are residents of the District was a major factor.
section_title: In a Small Number of Cases, Coordinating with the Police Department Has Complicated CFSA’s Ability to Meet Time Frames
paragraphs: CFSA’s ability to meet court-ordered time frames for conducting  investigations may be complicated in a small number of cases by difficulty  in coordinating with the District’s Metropolitan Police Department, which  sometimes operates under different time frames and priorities. For  example, caseworkers told us that they cannot close out investigations  involving severe physical or sexual abuse without a report from the police  department. However, the court monitor noted that caseworkers and  police officials were not consistently collaborating in a timely manner as  required by a memorandum of understanding developed between the two  agencies or were not documenting their efforts properly in CFSA’s data  system. While CFSA and the police department are required to coordinate  on these cases, the court monitor reported in February 2006 that,  according to CFSA’s data, joint investigations were held in only 31 percent  of such cases. To assist with coordination, the monitor recommended that  CFSA enlist the assistance of the Deputy Mayor for Children, Youth,  Families and Elders to ensure joint investigations are performed in a  timely manner. CFSA officials told us that they are taking steps to improve  this coordination. Officials of the two agencies have begun holding weekly  meetings to discuss and resolve emerging issues, and CFSA has started  colocating staff at the police department. However, at this time it is too  soon to know whether these steps will be effective in helping CFSA meet  investigation time frames.
section_title: Shortage of Qualified Foster and Adoptive Homes Limits CSFA’s Ability to Place Children
paragraphs: A shortage of qualified foster and adoptive homes is also hindering CFSA’s  ability to meet some requirements, such as giving children the most  appropriate foster care placements, placing siblings together, and ensuring  timely adoptions. Several factors are contributing to this shortage. The  demographics of the District are changing and there are fewer qualified  homes, according to CFSA and other officials we interviewed. They cited  an influx of young professionals who are less likely to serve as foster  parents or adopt children from the child welfare system. Officials also  reported that the average size of houses in the District has decreased over  time, with new condominium developments that have fewer rooms, and  these homes will not readily meet accommodation guidelines, particularly  when trying to keep siblings together. They noted that older houses that  are large enough to meet standards may require significant investment of  resources to remove lead paint, which would be a danger for young  children.
In addition, there is a shortage of facilities within the District to care for  children with special medical or mental health needs. The court monitor’s  recent progress report notes that in April 2006, CFSA had placed 82  children in residential settings more than 100 miles away from the city for  medical or mental health treatment. The court monitor reported that for  29 children in these facilities, CFSA had no plans to bring the children  back to the District because of the lack of homes and limited availability of  specialized services, including medical and mental health care services.  The court monitor recommended that CFSA explore the possibility of  developing additional resources in the District to serve children with  special needs.
Many children in the District’s child welfare system have family members  living in neighboring states willing to take them in, but challenges exist  with placing children across state lines. Because of the District’s proximity  to Maryland and Virginia, many of the children in CFSA’s care have  relatives in these other states. However, even when children are placed  with relatives, the homes must be licensed for foster care if the relatives  are to be compensated by the District, and CFSA does not have  agreements with Maryland and Virginia that would remove barriers to  licensing homes and placing these children. For example, the state in  which the child would be placed would be required to expend its  resources to oversee the placement and manage the case, including  conducting timely home visits and providing services. Because the District  lacks a border agreement with Maryland and Virginia that would speed  placements for children with family members across state lines, these  children may experience multiple placements while waiting for the  necessary paperwork, including background checks, to be completed.   CFSA reported that they have recently presented new proposals to  facilitate interstate placements in Maryland and Virginia, and is awaiting a  response.
Recent legislation, signed into law July 3, 2006, and intended to expedite  the placement of children across state lines, may provide some needed  assistance to the District. The Safe and Timely Interstate Placement of  Foster Children Act of 2006 requires both the receiving state and the  requesting state to act within specified time frames (generally 60 days for  the receiving state to conduct a study of the potential adoption or foster  care home and 14 days for the requesting state to determine whether  making a decision relying on the report would be contrary to the welfare  of the child).  Also, the act would provide a $1,500 incentive payment to a  state for every interstate study of an adoption and foster care home  completed within 30 days.
section_title: CFSA Uses Routine Reports and Qualitative Studies to Monitor Its Progress toward Meeting Court-Ordered Requirements, but Current Data May Not Provide an Accurate Picture
paragraphs: CFSA is generating a number of daily and monthly reports to show its  progress in meeting court-ordered requirements. In addition, CFSA is  using qualitative information from interviews, focus groups, and surveys of  caseworkers, managers, and families to get a more complete picture of  how the agency is performing and to address ongoing challenges.  However, the data CFSA uses may not accurately portray progress toward  meeting performance requirements, in part because caseworkers do not  always enter information completely and accurately in the case  management data system. CFSA provides training and other support for  using the new Web-based version of the data system and has begun to take  steps to address early implementation issues with the new system.
subsections: section_title: CFSA Generates Daily and Monthly Reports to Track Progress toward Meeting Requirements
paragraphs: CFSA generates a number of daily and monthly reports to track cases and  monitor progress toward meeting court-ordered requirements using  information from FACES, the agency’s automated child welfare  information system. Daily reports allow managers to review the agency’s  performance on cases on a daily basis and contain information such as the  number of cases in the backlog awaiting investigation, as well as the  number of children that caseworkers were able to place and the nature of  those placements. In addition, CFSA produces monthly trend reports as  required by the court monitor to track progress toward meeting court- ordered benchmarks detailed in the Implementation Plan. CFSA uses data  from the monthly trend reports to develop performance scorecards, which  use graphics to provide a snapshot of the performance of contract  agencies and departments within the agency. Each year, CFSA compiles  these reports and other information into an annual report addressing  CFSA’s progress and some of the challenges faced in implementing the  court-ordered requirements. As CFSA develops new data reports, top  CFSA managers told us they have begun to focus less on simply complying  with the court-ordered requirements and more on using the data to  develop strategies for program improvement. This approach is consistent  with that of many high-performing organizations, which, as we have  reported, continuously assess performance against benchmarks and use  this information to improve performance.
section_title: Qualitative Studies Help CFSA Identify and Address Ongoing Challenges
paragraphs: CFSA also collects qualitative data through interviews, focus groups, and  surveys of caseworkers, supervisors, managers, and families that are  designed to provide insight as to why some court-ordered requirements  remain unmet. For example, data show that CFSA has been unable to meet  the requirement that children placed apart from their siblings visit some or  all of their siblings at least two times per month. CFSA examined the issue  further in a sibling placement report that used information from interviews  and focus groups of placement staff and siblings’ families to augment data  on the number of children placed with siblings and how many times they  visited each other. The report helped CFSA learn some of the underlying  reasons that such visits may not be taking place—for example, siblings  were not placed in proximity to each other to easily facilitate a visit. CFSA  used the report to create strategies to address these issues, such as placing  children in the same or nearby neighborhoods, and assigning one  caseworker for all siblings whenever possible. In addition, CFSA issues a  Needs Assessment Report every 2 years that uses interviews with foster  parents and CFSA caseworkers to identify and provide strategies for  addressing the most urgent needs of CFSA clients.
Similarly, CFSA conducts Quality Service Reviews (QSR) twice a year,  which involve examining a sample of case files and interviewing as many  people involved in the cases as possible, including parents, children,  caseworkers, teachers, and others. The fall 2005 QSR, which examined 39  cases and included nearly 300 interviews, revealed that overall, the  children in the cases reviewed were safe, healthy, and living in appropriate  placements. However, the QSR report identified a number of areas in need  of improvement, many of which were related to court-ordered  requirements that CFSA has had difficulty meeting. For example,  reviewers found that sibling and parental visits were not consistently  documented in FACES. In response, CFSA developed a number of  strategies to address these areas, such as creating a caseworker peer  review system in which caseworkers review each other’s work for overall  quality.
section_title: Data Used to Report Agency Performance May Not Accurately Portray Actual Progress Made toward Meeting Court- Ordered Requirements
paragraphs: The data that CFSA uses to monitor its progress in meeting the court’s  requirements may not provide an accurate picture of the agency’s current  performance. CFSA released a new, Web-based version of FACES in  February 2006—FACES.net—to update its older case management system,  and there have been some challenges with the transition. Caseworkers  told us that they had found it frustrating to enter information in the system  and that it could take up to 4 hours to enter the data for a single case.  Caseworkers, as well as supervisors and CFSA’s chief information officer,  told us that when the FACES.net system was initially implemented, it  would often crash, resulting in a loss of data or in delays in entering the  data. Caseworkers commented that because of these issues, they often  entered less than fully detailed case data into the system. These  implementation issues may have implications for the accuracy and  completeness of data that have been recorded in the system to date.
In addition to experiencing problems with the implementation of the new  system, caseworkers have not always entered some information into the  correct fields in the database, preventing data from being captured in  CFSA’s progress reports. For example, the court monitor’s most recent  report indicated that of the 444 children in foster care as of April 2006 with  a goal of reunification with their families, more than half did not have any  documented visits with their parents. However, based on the Quality  Service Reviews, CFSA concluded that the visits were occurring, but the  caseworkers were not entering the information into FACES.net. In  addition, CFSA officials told us that some caseworkers have been entering  information into narrative case notes rather than the appropriate discrete  fields in the FACES.net screens. For example, a caseworker may visit a  child in the family’s home and then take him or her to visit the doctor.  When entering this information in the database, the caseworker may  record only the family visit in the required screen and write up the medical  visit in the case notes, which cannot be captured in the progress reports.  As a result, reports would not indicate that the medical visit had occurred.
CFSA is working to resolve issues with inaccurate or incomplete data in  FACES.net, and administrators meet monthly to discuss challenges and  potential resolutions. In addition, the chief information officer told us  there are several training measures in place for caseworkers and contract  agencies to receive assistance and training in recording data and using the  new FACES.net system. For example, CFSA created four teams to assist  caseworkers with recording case data, and to ensure that data are  recorded accurately and used appropriately in reports. The Child  Information Systems Administration also conducts FACES.net workdays  for CFSA and contract agency employees. These are regularly scheduled  opportunities for caseworkers to enter data into the FACES.net system  with the assistance of an information systems employee, who can ensure  that caseworkers are entering data in the correct fields. The Child  Information Systems Administration has also posted tip sheets for using  FACES.net and distributed training manuals to caseworkers.
In addition to training, CFSA is taking additional steps to improve  FACES.net that may help address some of the earlier implementation  issues. CFSA issues system upgrades to address identified problems every  2 to 3 weeks, and is developing a process to fully test these upgrades  before implementing them. In addition, CFSA has identified individuals  from each department within CFSA to act as liaisons between the system  users and the technical staff so that the system can be tested, and  problems can be identified early and quickly resolved. Officials now report  that the volume of help desk calls is below previous levels. Based on this  progress, the court monitor’s most recent report anticipates that data  issues related to early system implementation should be resolved soon.
section_title: CFSA Has Implemented Several Initiatives to Help Achieve Unmet Requirements, but It May Be Too Soon to Know if They Will Yield Long-term Results
paragraphs: In the last 2 years CFSA has implemented a number of initiatives to help  address hindrances in meeting court-ordered requirements. CFSA has  hired new staff and reorganized existing staff to focus resources in key  areas. For example, CFSA has hired additional caseworkers to ease  caseloads, reduce backlogs, and improve the timeliness of investigations  of child abuse or neglect. CFSA also has implemented new practices to  better serve children and families, such as holding family team meetings  that bring all parties together to make decisions about a child’s care. In  addition, CFSA is beginning to take steps to hold its management staff as  well as private contractors accountable for helping the agency meet  specific performance requirements. Because many of these initiatives have  been implemented only recently, it is too soon to know whether the efforts  will yield success over time. Figure 1 shows the initiatives CFSA  implemented or plans to implement between January 2005 and summer  2007.
subsections: section_title: CFSA Has Increased Staff and Reorganized to Help Improve Performance in Key Areas
paragraphs: CFSA has hired additional caseworkers to improve its ability to conduct  investigations in a timely manner. Historically, CFSA has not been able to  conduct prompt investigations because it did not have enough  caseworkers to manage all of its cases. According to a CFSA report, in  September 2002 there was a backlog of 807 cases awaiting investigation.  As we previously reported, CFSA began a number of recruitment activities  in fiscal year 2003 and has recently focused on recruiting staff to conduct  investigations. As of July 2006, CFSA officials reported only 1 vacancy in  the unit that is responsible for conducting investigations, down from 15 in  January 2006, and 84 cases in the backlog, down from 318 cases in January  2006. CFSA officials told us that having fewer cases has allowed  caseworkers to focus more attention on improving the quality of  investigations.
While these efforts may have a positive impact on the way investigations  are conducted, CFSA still struggles to meet many of its court-ordered  requirements related to investigations. A review of CFSA investigation  case files conducted by the court monitor in June 2005 revealed that  investigations were not meeting quality standards, such as workers  routinely ensuring that families receive the services they need. Another  report in July 2006 showed little progress in this area. Moreover, in this  report the court monitor noted that leadership within the investigation  units has changed frequently as CFSA has tried to implement  comprehensive improvements in this area, and the agency has not been  successful in either fully implementing recommendations made by  consultants to improve operations or in sustaining advancements made.
In addition to hiring new staff, CFSA has reorganized existing staff to  focus resources and attention on key unmet requirements. Caseworkers  have told us that they did not always have support from their supervisors  to help them make decisions, such as those related to obtaining the  appropriate placement for children in their care. To address this, in 2005  CFSA created a centralized unit of employees to make decisions on the  placement of children. These staff members are on call around the clock  to help caseworkers match children with the placements that best meet  their needs. Staff in this unit are knowledgeable about various placement  options, such as placing children across state lines, finding foster care  placements for children needing medical attention, and arranging for  independent living services for older children. In 2006, the new placement  unit recruited six licensed District emergency foster homes with seasoned  foster parents, referred to as Stabilization and Replacement (STAR)  homes. These homes will be available at any time of the day to provide  emergency foster care for children for up to 5 days regardless of age,  gender, or behavioral difficulty. STAR foster parents will provide basic  services for children while caseworkers determine the child’s needs, and  placement specialists will match the child with an appropriate, stable  placement. Although CFSA has made some progress in improving the  placement process for children, it is too soon to determine whether these  efforts will yield long-term success. According to the monitor’s progress  report, as of April 2006, placement issues remain in a crisis mode at  CFSA—placements are still too often based on bed space availability,  rather than child need, and too many children experience multiple  placements during their time in foster care.
CFSA has dedicated a number of caseworkers to specialize in making  home visits to ensure the safety of children living at home with their birth  parents. Previously, caseworkers could be assigned to provide services to  children who remained in-home along with those who were placed outside  of the home, such as with a foster family. However, in May 2006, after a  study found that children placed at home were not being visited frequently  by caseworkers, CFSA created a separate unit of caseworkers to focus on  these children. CFSA officials expect this unit to improve the frequency  and quality of caseworker’s visits to children at home, and allow  caseworkers to thoroughly assess family situations, engage parents, and  diligently monitor and influence a family’s stability and progress so that  the child can remain safely in the home. Although it is too soon to assess  the impact of this arrangement, the court monitor reported that as of April  2006, CFSA had not met requirements for making in-home visits, but the  data show an improvement.
CFSA also reorganized the office that assists caseworkers with arranging  medical and mental health services for children and their families. CFSA  hired additional nurses and psychologists in its Office of Clinical Practice  to provide advice and counsel to caseworkers with cases requiring  medical expertise. CFSA officials expect that this will help the agency  meet requirements to provide appropriate physical and psychological  evaluations, since caseworkers are now able to seek professional guidance  on their cases and the services children might need.
section_title: CFSA Has Implemented New Practices Designed to Improve Services to Children and Families
paragraphs: CFSA has implemented several new practices to improve services. It  changed how telephone hotline staff prioritize calls reporting child abuse  or neglect to improve the overall quality and timeliness of investigations  and to help them make appropriate referrals to community agencies. In  February 2006, CFSA implemented a standardized risk assessment tool for  screening hotline calls in order to better focus their resources by helping  caseworkers quickly assess the urgency of the case and whether or not a  referral to a community agency would meet the family’s needs. The tool  prompts caseworkers to ask each caller a series of structured questions to  identify the level of risk to the child’s safety and the appropriate  intervention based on certain risk factors, such as number of prior  investigations, number of children involved, and whether or not the parent  has a criminal history or a history of drug use. Cases are ranked based on  these factors and designated as either high, moderate, or low risk. All high- risk cases are to be retained by CFSA and assigned to a CFSA investigator.  For those cases assessed to be of low or moderate risk, children and their  families are to be referred to one of CFSA’s community partners for  intervention and support services, including housing and employment  information, parenting workshops, and referrals to other services. CFSA  has not yet met the court-ordered requirement to refer more families to  community agencies, and it is too soon to know whether the initiative will  improve its performance in this area.
CFSA also recently began using family team meetings, which bring  together immediate and extended family members and other support for  the family to discuss the child’s needs and strategies for overcoming  family problems and to develop a plan for the child’s safety. These  meetings are held in cases where children have been removed or are at  risk of being removed from their homes because of abuse or neglect.  According to a June 2005 CFSA report, family team meetings may play a  role over time in reducing the number of children who are removed from  their homes, placed in nonfamily foster care, or placed in multiple foster  homes. The court monitor’s April 2006 report indicates that CFSA is still  not meeting the requirement to reduce the number of children in foster  care who have been in three or more homes within a 12-month period, but  the data show improvement. However, the court monitor also cautioned  that strategies such as the family team meetings have not always been  implemented at the level of intensity needed to achieve the desired  outcomes, saying relatively few of the cases that might benefit from the  approach have actually used it.
section_title: CFSA Is Holding Management, Foster Care Providers, and Contractors Accountable for Meeting Performance Requirements
paragraphs: CFSA is holding all unit managers and supervisors accountable for helping  caseworkers meet court-ordered requirements. The quality of supervision  has been a long-standing issue for CFSA. As we previously reported, many  CFSA caseworkers told us that supervisors had not fulfilled their  responsibilities to provide the guidance and support needed to help them  better perform their jobs, and agency officials told us that CFSA  supervisors were not held accountable for performing their supervisory  duties. To address this issue, CFSA requires supervisors to document in  FACES.net each time they interact with a social worker on a particular  case. In addition, CFSA has contracted with the Child Welfare Institute to  help provide management training for managers and supervisors.
CFSA is also holding external partners, such as foster care providers,  accountable for helping it meet court-ordered requirements. Although it is  the agency’s policy not to place children in unlicensed homes, we  previously reported that about 22 percent of foster children in CFSA’s care  were residing in unlicensed homes as of May 2004. To address this issue,  CFSA officials reported that they recently reviewed all unlicensed foster  homes to check for their compliance with basic health and safety  standards and are no longer placing children in unlicensed homes. As a  result of this review, CFSA licensed most homes and reduced the number  of unlicensed foster homes to 17, or 5 percent, by July 2006. While the  most recent court monitor’s report found that CFSA had not met the  requirement that all foster homes, group homes, and independent living  facilities have a current and valid license, the data showed an  improvement.
CFSA has also begun to take steps to hold private contractors—who  manage the cases of approximately 40 percent of CFSA’s children and  families—-accountable for their performance. In June 2006, CFSA  reported that contractors managing cases were performing at a lower level  than CFSA caseworkers on certain requirements, such as making frequent  in-home visits. CFSA has taken a number of actions designed to improve  the care provided by contractors. CFSA officials told us that its contract  monitors meet with private agency staff on a monthly basis to review  expectations and resolve issues. And in March 2006, CFSA began to post  monthly scorecards on the Internet for the public to view that detail each  contracted agency’s performance on the court-ordered requirements.  CFSA also reported that it sends each month’s report directly to the  executive leadership of each contracted agency and secures corrective  action plans from private agencies that are not in compliance with the  contract and other performance requirements.
In addition, after lengthy delays, CFSA will soon begin to hold private  contractors accountable for meeting performance requirements by linking  contractor payments to specific outcomes for children and families  through performance-based contracting. Under the new performance- based contracting agreements, contractors will be expected to attain  specific outcomes for children and families and will be financially  rewarded for meeting the outcomes and penalized for falling short. Moving  toward performance-based contracting has been difficult, and it has taken  several years. While CFSA began this process in 2003, it now anticipates  awarding the first performance-based contracts by spring 2007, and  services under these contracts are expected to begin by summer 2007.
See table 2 for a summary of CFSA’s key unmet performance requirements  as of April 2006 and the initiatives developed to address them.
section_title: Conclusions
paragraphs: The District of Columbia’s Child and Family Services Agency has had a  troubled history in its efforts to care for the city’s abused and neglected  children—one that led the U.S. District court to step in and take control of  the agency. In the 5 years since CFSA left court-ordered receivership, it  has made considerable progress toward meeting the court’s requirements.  But it has sometimes lost ground, too, perhaps because its focus shifted  away from sustaining the achievements, toward meeting other pressing  requirements. Current leadership, however, seems to be focused on  addressing the problems head on, with innovative approaches and  strategic use of data to resolve ongoing areas of concern. We are  encouraged by the progress made and the initiatives implemented in the  last 2 years. Of particular note are the efforts to build a collaborative  relationship with the police department and to use performance data to  focus on program improvement, not just on meeting the requirements  imposed by the court. However, continued success will require an  unrelenting focus, not just on requirements that remain unmet, but on  sustaining the achievements already in place. It will also require that  efforts now in the pipeline, such as family team meetings and  performance-based contracting, are implemented swiftly and sufficiently  to ensure the maximum results.
There remain two issues of critical concern regarding CFSA’s ability to  meet ongoing requirements and to provide needed services. First,  caseworkers may not have the specialized training they need to meet the  complex needs of the children they work with, particularly teenagers and  children with special medical or mental health needs. Without such  training, caseworkers may not have the skills and the tools they need to  make the best possible decisions for those in their care within established  time frames.
Second, adequately serving the children under the agency’s care—and  meeting certain court-ordered requirements—necessitates sufficient  medical, dental, and mental health care. However, increasing the number  of providers willing to serve children in the District’s child welfare system  will require help. In the absence of new solutions to the health care  problem, CFSA will be unable to achieve the court-mandated  requirements. Worse yet, the children who depend on CFSA’s help will be  unable to get the care they need.
section_title: Recommendations for Executive Action
paragraphs: To improve CFSA’s ability to serve the District’s children and to help meet  court-ordered requirements, we recommend that the Mayor of the District  of Columbia:    direct CFSA to provide caseworkers with specialized training to help  them develop the skills needed to address the complexities of their  caseloads and    explore options for increasing the pool of providers for mental health,  medical, and dental services.
section_title: Agency Comments
paragraphs: We provided a draft of this report to CFSA for its review and comment. In  its comments, CFSA agreed with our findings and recommendations,  noting that the agency has made even greater progress since April 2006,  the time frame used for this report.  At the same time, CFSA  acknowledged that some performance gaps remain that must be closed.  CFSA also provided technical comments, which were incorporated as  appropriate. A copy of CFSA’s formal response is in appendix II.
As arranged with your offices, unless you publicly announce the contents  of this report earlier, we plan no further distribution of this report until 30  days from the date of this report.  At that time, we will send copies of this  report to the Honorable Anthony A. Williams, Mayor of the District of  Columbia, and other District officials, relevant congressional committees,  and others who are interested.  Copies will also be made available to  others upon request.  The report is also available at no charge on GAO’s  Web site at http://www.gao.gov.
Please contact me at (202) 512-7215 if you or your staff have any questions  about this report.  Key contributors to this report are listed in appendix III.
section_title: Appendix I: Scope and Methodology
paragraphs: To conduct our review, we focused on court-ordered requirements that  remained unmet as of December 2005. We limited our scope to  requirements related to managing child welfare cases such as initiating  and conducting timely and quality investigations of child abuse and  neglect allegations, providing a range of services to children and their  families, and placing children in appropriate foster or adoptive homes. We  did not review requirements related to administration and management of  the agency, nor did we review requirements that were not tracked using  FACES.net.
To assess whether the Child and Family Services (CFSA) is likely to meet  court-ordered requirements by December 2006, we reviewed the court  monitor’s July 2006 progress report. To understand the hindrances that  may prevent CFSA from meeting its court-ordered requirements, we  conducted interviews with CFSA managers, supervisors, and caseworkers.  To gain an understanding of staff views on the hindrances in meeting  performance requirements, we conducted separate group interviews with  caseworkers and supervisors randomly selected to represent a cross  section of CFSA divisions and employment tenures. We also interviewed  CFSA officials responsible for recruiting and retaining foster and adoptive  parents to learn about the hindrances that CFSA faces with recruiting an  adequate number of foster and adoptive homes. Finally, we interviewed  the court-appointed monitor and other D.C. child welfare experts to get  their perspectives on what they believe to be CFSA’s hindrances to  meeting the performance requirements.
Our sampling strategy for the group interviews included randomly  selecting participants to help ensure that they represented cross sections  of the organization. Attendance on the part of the invited participants was  voluntary. For our four discussion groups, we interviewed supervisors and  caseworkers whose work involved initiating and completing investigations  of child abuse and neglect, placing children through the use of adoptions  or foster care, and monitoring children at home or in out-of-home care  with a goal of returning to their family. The supervisors and caseworkers  from each group were randomly selected and included those who had  been at CFSA for 0-2 years, 2-6 years, and 6 or more years. A trained  discussion group moderator led the discussions while our analysts took  notes. We developed a discussion group guide to assist the moderator in  leading the discussions.
To learn how CFSA monitors its progress in meeting the court-ordered  requirements, we reviewed CFSA data and reports that CFSA managers  use to assess the agency’s performance in meeting its requirements. We  also interviewed (1) CFSA managers to learn about the strategies the  agency has used to help guide its decisions on what data to gather and  how to use these data; (2) CFSA’s Chief Information Officer to learn about  CFSA’s automated child welfare information system, FACES, and its  capacity for informing CFSA managers on the agency’s progress in  meeting its performance requirements; and (3) the court-appointed  monitor, the Center for the Study of Social Policy (CSSP), to gain its  perspective on what CFSA has done and where it might improve in its  efforts to develop data needed to assess its performance.
To gather information on the extent to which CFSA has implemented  initiatives or developed plans to achieve unmet requirements, we reviewed  the court monitor’s reports and identified key requirements related to  managing child welfare cases that had not been met as of December 2005.  We reviewed CFSA documents, handbooks, and guidance to document any  new or planned initiatives designed to satisfy unmet requirements. We also  interviewed CFSA managers, the court-appointed monitor, and other D.C.  child welfare experts to determine what initiatives CFSA plans to take or  has taken to meet these requirements.
section_title: Appendix II: Comments from D.C. Child and Family Services Agency
section_title: Appendix III: GAO Contact and Acknowledgments
subsections: section_title: GAO Contact
section_title: Acknowledgments
paragraphs: Dianne Blank, Assistant Director  In addition, the following staff made major contributions to this report:  Vernette Shaw, Jacqueline Harpp, and Lisa McMillen served as team  members; Walter Vance advised on design and methodology issues and  conducted group interviews; Rachael Valliere advised on report  preparation; James Rebbe advised on legal issues; Kevin Kumanga, Lise  Levie, and Katharine Leavitt verified our findings.
section_title: Related GAO Products
paragraphs: District of Columbia: Federal Funds for Foster Care Improvements Used  to Implement New Programs, but Challenges Remain. GAO-05-787.  Washington, D.C.: July 22, 2005.
D.C. Child and Family Services Agency: More Focus Needed on Human  Capital Management Issues for Caseworkers and Foster Parent  Recruitment and Retention. GAO-04-1017. Washington, D.C.:   September 24, 2004.
D.C. Child and Family Services: Better Policy Implementation and  Documentation of Related Activities Would Help Improve Performance.  GAO-03-646. Washington, D.C.: May 27, 2003.
D.C. Child and Family Services: Key Issues Affecting the Management of  Its Foster Care Cases. GAO-03-758T. Washington, D.C.: May 16, 2003.
District of Columbia: Issues Associated with the Child and Family  Services Agency’s Performance and Polices. GAO-03-611T.   Washington, D.C.: April 2, 2003.
Foster Care: Recent Legislation Helps States Focus on Finding  Permanent Homes for Children, but Long-Standing Barriers Remain.  GAO-02-585. Washington, D.C.: June 28, 2002.
District of Columbia Child Welfare: Long-Term Challenges to Ensuring  Children’s Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000.