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. 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. 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. 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.