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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.

Summary: 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. 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.