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NCSL State Legislative Report
Analysis of State Actions on Important Issues
Child and Family Service Reviews:
Implications for State Oversight of Local Child Welfare Agencies
By Steve Christian
Until recently, state and federal oversight of child welfare systems has focused heavily on compliance with rules rather than on improving results. Accountability in child welfare often meant imposing penalties instead of encouraging better outcomes for children and families.
In January 2000, the U.S. Department of Health and Human Services (DHHS) issued regulations establishing a new system of child welfare oversight, the Child and Family Service Reviews (CFSRs). The new system differs from the old one in three major respects: it involves a collaboration between states and the federal government, it focuses on improving outcomes for children and families, and it allows states to improve their performance before penalties are imposed.
The new federal reviews are a catalyst for states to rethink how they hold their own local child welfare agencies accountable for good performance. Although states, not localities, will be required to enter into program improvement plans and will be subject to financial penalties in the event of continued nonconformity, many of the programmatic and practice improvements that will be required by the CFSRs will have to be made at the local level. The Children's Bureau, the arm of DHHS responsible for administering the reviews, has stated it has " ... no authority to hold individual counties accountable for compliance ... It is the State that is accountable, and responsible for assuring that counties administering their own programs operate in compliance with applicable requirements."
The Child and Family Service Reviews
The CFSRs are the federal government's mechanism to determine if states are in substantial conformity with requirements in titles IV-B and IV-E of the Social Security Act. These statutes govern states' use of federal funds for child welfare services, including child protection, adoption, foster care, family preservation and independent living services for youths in foster care. The CFSRs will determine two things.
First, they will examine the extent to which states are achieving seven outcomes in the broad domains of child safety, permanency, and child and family well-being. State performance will be measured against national standards established by DHHS.
Second, they will assess states' capacity to achieve the outcomes by examining seven "systemic factors" that are key components of state child welfare systems required by federal law.
The review process consists of two phases. In the first phase, the statewide assessment, the state examines data relating to its programs and evaluates the effectiveness of its system in meeting the needs of children and families. The second phase is an "on-site review" in which a team of state, federal and other participants reviews a sample of cases and interviews key stakeholders to determine whether the outcomes are being achieved and whether the systemic factors substantially conform to federal requirements (see figure 1 for a tentative CFSR schedule).
If one or more of the outcomes and systemic factors are found not to be in substantial conformity, the state will be required to develop a program improvement plan (PIP) to address the areas of nonconformity. If a state fails to develop a PIP or fails to improve performance as agreed to in a PIP, the federal government will penalize the state by withholding a portion of child welfare funds. Financial penalties are commensurate with the level of nonconformity and increase over time if the issues identified in a review remain uncorrected.
State and Local Roles in the Administration of
Child Welfare Systems
Although the majority of states administer their child welfare systems at the state level, a few have delegated administrative responsibility to the counties. Some of the states with the largest child welfare populations-including California, New York, Ohio and Pennsylvania-are county-administered. A few states have hybrid systems. In Alabama, for example, county child welfare directors are state employees but are appointed by a local board and exercise a measure of independence. Whether a state's system is centrally or locally administered, wide variations usually exist in performance from county to county or from region to region. Thus, local accountability for the achievement of positive outcomes in child welfare is an issue for all states, but particularly for states where the systems are county-administered.
Typically, county-administered systems are characterized by substantial local control, wide variations in practice, and limited oversight resources and authority at the state level. Local administration of child welfare services has its advantages but can pose many challenges for both state and county governments. Counties often complain that states are more interested in enforcing rules than in helping to build capacity at the local level. They also resent what they see as confusing and ever-changing state agency structures and policies, inadequate state funding of county operations, lack of county involvement in state-level decision making, unrealistic state expectations, and a general lack of state support and technical assistance. State agencies, in turn, complain about lack of resources, limited oversight authority, the difficulty of framing policy that is relevant to all counties and lack of county understanding of the state role and function. State agencies often find that their leverage over counties is particularly limited when the counties pay the major portion of the non-federal share of child welfare funding. Both states and counties see the need for improvements in communication, coordination and decision making.
Improving Local Accountability
Although the challenges associated with state oversight of county child welfare agencies are not new, the federal reviews will require that states and counties renew their efforts to work together as partners to make lasting systemic improvements. State child welfare agencies will need to consider how they can enhance local accountability in a positive way without further straining state/county relations. Ideally, this enhanced accountability will emphasize the achievement of outcomes, instead of focusing exclusively on compliance with regulations. For example, states can remove barriers to improvement and promote capacity building at the local level by eliminating unnecessary restrictions on innovation and by providing better training, technical assistance and information.
Some states are experimenting with new methods of monitoring outcomes at the county level. In general, these initiatives are not attempts to fix blame and punish counties for poor performance but, rather, are intended to encourage systemic improvements.
The CFSRs were modeled in part on Alabama's quality assurance review system that was implemented in 1996. The state and a community quality assurance committee review each county department at regular intervals by examining a sample of cases and interviewing stakeholders. The reviews determine whether the counties are operating in conformity with the state's child welfare consent decree.
Ohio's Child Protection Oversight and Evaluation (CPOE) System, also part of a consent decree, partially replicates the CFSRs on a state and county basis. The state has defined six core and 10 optional outcome indicators and regularly evaluates data from the counties. Each county must undergo an on-site review every 18 months, which involves stakeholder interviews and case reviews. Counties are required to develop and implement quality improvement plans. Unlike the federal reviews, there are no penalties for noncompliance.
Iowa, which has a state-administered child welfare system, is piloting quality service reviews (QSRs) that are similar to the case review portion of the CFSRs. The QSRs involve review of a representative sample of cases in particular locations and interviews with key people involved in the lives of the children and their families. The purpose of the reviews is to identify practice patterns, to learn more about what works and to stimulate systemic improvements.
Legislation is pending in California that would direct the state Department of Social Services to establish a California Child and Family Service Review System based on measurable outcome standards to be developed by July 1, 2002.(1)
Other states are moving toward results-based accountability by providing counties with flexible funding and other financial incentives. Colorado now provides child welfare funds in the form of a capped allocation that the counties may spend without categorical restriction.(2) Counties have been given the authority to negotiate rates, services and outcomes with private providers of child welfare services. Six counties are participating in a pilot program, in which the counties enter into performance agreements with the state. If the county achieves the outcomes defined in the agreement, it may retain any savings from its capped allocation, not to exceed 5 percent. The agreements also provide for a waiver of certain state child welfare regulations. The Colorado initiative has not yet been fully evaluated, but the early results are encouraging. The pilot counties are achieving the desired outcomes, but these outcomes are not significantly better than those in non-pilot counties. Pilot counties are placing greater emphasis on utilization management, coordination of care, and prevention and early intervention services to reduce the need for out-of-home placements.
Ohio has obtained a Title IV-E waiver that authorizes flexible use of federal foster care funds. The 14 counties that are participating in the waiver receive a capped allocation of Title IV-E funds and may negotiate managed care agreements with child welfare service providers. Counties are responsible for achieving defined safety, permanency and well-being outcomes. Counties receive ongoing support, training and technical assistance from the state. Early evaluation results indicate that the demonstration counties have reduced the use of out-of-home placement, resulting in savings that are being reinvested in other child welfare services. Compared to other counties, the demonstration counties are developing a more comprehensive service array, are more likely to develop managed care strategies and focus on outcomes, and are using funding flexibility to redirect money to prevention and early intervention.
The Role of State Legislators
State legislators are very interested in the outcome of the CFSRs in their states and can play an important role in improving state oversight of local child welfare systems. In many states, moving toward a results-based accountability system may require legislation. At the very least, state legislators may want to keep abreast of how their state agencies are preparing for the federal reviews, including how these agencies are involving counties in the planning process. They also may want to consider holding hearings at crucial stages of the review process to monitor the state's performance and to ensure that counties are aware of the systemic changes that may be required by program improvement plans.
1. AB 636, introduced Feb. 22, 2001.
2. Colo. Rev. Stat. §§26-5-101 to 26-5-105.5.
The author wishes to thank Jerry Milner, Administration for Children and Families; Mary Nelson, Iowa Department of Human Services; and Susan Robison, NCSL consultant, for reviewing and commenting on this report.
Illustration for "Figure 1. Tentative Schedule of State Child and Family Services Reviews is not available online. Please view the Adobe Acrobat version or contact the author for a copy.
Volume 26, Number 5