Testimony Submitted to the Subcommittee on Human Resources of the Committee on Ways and Means U.S. House of Representatives for the Hearing on State Efforts to Comply with Federal Child Welfare Reviews
May 13, 2004
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The Child Welfare League of America (CWLA) welcomes this opportunity to offer testimony on behalf of our 1,000 public and private nonprofit child-serving member agencies nationwide for this hearing to examine the Child and Family Services Review (CFSR) process and the accompanying Program Improvement Plan (PIP) component of these reviews. We appreciate this Subcommittee's on-going commitment to examine our nation's child welfare system and the important opportunity this offers to explore ways to ensure that all children in this country are protected from abuse and neglect.
CWLA urges Congress to take a close look at what we are learning about the needs of state child welfare systems and to work with states and local child welfare partners to find ways to address these needs. The CFSR process is an important opportunity to address the reforms of the child welfare system that are needed to ensure safety and permanency for our most vulnerable children.
The Need For An Effective Federal Oversight Mechanism
The assortment of mechanisms currently in place that provide oversight for state child welfare systems were reviewed by this Subcommittee in a hearing earlier this year. That hearing began the focus on the Child and Family Services Reviews that are the main tool that the federal government uses to measure the performance of state child welfare agencies and to hold states accountable for services to children though a results-oriented approach.
During CFSRs, the federal government determines: (1) if a state child welfare agency's practice is in conformity with Title IV-B (Promoting Safe and Stable Families and Child Welfare Services) and Title IV-E (Foster Care and Adoption Assistance) requirements; (2) if children and families are achieving desirable outcomes; and (3) if a state needs assistance with its efforts to help children and families achieve positive outcomes.
The Child and Family Services Review process was the result of a 1994 congressional mandate that was included as amendments to the Social Security Act (P.L. 103-432). That law required the U.S. Department of Health and Human Services (HHS) to review state child welfare programs to ensure "substantial conformity" with state plan requirements in Titles IV-B and IV-E of the Social Security Act. That law requires that state child welfare programs be measured or judged in certain areas or standards. Over the next several years, HHS and the states worked to develop this review process according the dictates of the law. The planning for CFSRs was completed in 2000. The initial round of state reviews began in 2001 and was completed a few weeks ago.
The decision by Congress to create a comprehensive review process was an important step for this nation's child welfare system. Some states have used this process as a way to engage other critical partners in an examination of their child welfare systems. Partners, such as the state's legislative body, the news media, and the community, are critical to creating and maintaining a system that, nationally, must protect the one million who are victims of abuse and neglect, the more than 500,000 children in foster care and other out-of-home placements, the 50,000 children adopted each year from the child welfare system, and the thousands of other families receiving prevention and support programs.
What the Child and Family Service Reviews Tell Us
The results of the CFSR process have been mixed and the bottom line is that no state has been found to be in conformance with all fourteen outcome measure and systemic factors. States were slightly stronger in the safety outcomes than in the permanency and well-being outcomes. States were weakest in helping children achieve their permanency goals in a timely manner and in helping families with services they need to care for their children. The U.S. Children's Bureau has been very careful not to compare states in any area, but rather encourages a state to compare itself over a period of time, measuring progress and improvement.
These Results Cannot Simply be Viewed as Pass or Fail
The Children's Bureau does not use the term "fail" or "pass," but considers the outcomes in terms of "in substantial conformity" or "not in substantial conformity." The CFSR process is intended to reflect both the areas in which the state is doing well and the areas in which the state needs to make improvement. While it is appropriate to focus on the areas that need improvement, the entire child welfare system must be considered when evaluating state performance and making subsequent changes based on that evaluation. For most states, the CFSRs have held few new surprises, but now states are being held accountable in two areas: (1) outcomes for children and families in terms of safety, permanency, and child and family well-being; and (2) the administration of state programs that directly affect the capacity to deliver services leading to improved outcomes. This accountability had not been a focus in the past. The CFSR is also just the first step. States will also be evaluated in their ability to implement the changes outlined in their Program Improvement Plan.
How the Measurements Used in the Child and Family Service Reviews Can Be Improved
CWLA recognizes that there are serious flaws in the measurements used in the Child and Family Services Reviews. The scope and reliability of measurable outcomes need to be refined to improve comparability among states and to also produce measures that reflect good practice in the field. The current measures fall short in these areas and CWLA believes that the measures need to be reexamined.
CWLA has participated in work with all of the states through a National Working Group to Improve Child Welfare Data. Through that process, CWLA has documented the reliability deficiencies in the placement stability federal outcome measure, as well as reliability and accuracy problems with the measure on child maltreatment in foster care. Recommendations from this National Working Group were presented to the U.S. Children's Bureau and have resulted in improved guidance from HHS to the states.
The establishment of common definitions for widely used terms such as 'placement,' would also go a long way to produce comparable information that informs Congress of the efficacy of the child welfare system. CWLA has started a process working with states to determine definitional standards. That work will result in more clearly established common standards for the federal measures, using the existing federal guidelines.
CWLA also has recommended to HHS that the methodology to produce outcome measures be modified to include measures derived from longitudinal analysis, to complement the present point in time and exit cohort data. Longitudinal data is based on entry cohorts of children and this approach mitigates inherent biases associated with point in time and exit group data. This approach also is preferable for showing the effects of agency programs and policies.
State child welfare systems vary widely in terms of the populations they serve (juvenile justice, mental health, domestic violence, etc.), their administrative structures (county- or state-based), and their regional locations (rural, urban, north, south, etc.). CWLA recommends that states be allowed to use alternate measures to assess how their child welfare system is improving the safety, permanency, and well-being of children. These measures may vary according to the particular idiosyncratic elements of particular state systems.
The current measures do not necessarily reflect good practice. They are an artifact of aggregate data reported by the states through the Adoption Foster Care Analysis Review System (AFCARS) and the National Child Abuse and Neglect Data System (NCANDS). CWLA believes that the next generation of outcomes should be shepherded by an interdisciplinary group of state and federal participants, advocacy and consumer organizations, the research and academic communities, and the general public. Through this type of collaboration, evidence-based measurements can be identified and pursued as meaningful outcomes for children.
Building on the Program Improvement Plans
As a result of performance on the Child and Family Services Reviews, states are required to draft and submit to HHS a Program Improvement Plan. These plans are varied in format and design. A recent report for the U.S. General Accounting Office 1 found that the instruction and response from HHS regarding the Program Improvement Plans has not always been timely or consistent for all states.
While oversight and enforcement are critical to making the child welfare system better, an enforcement mechanism that relies on penalties is misguided. The result of the imposition of penalties for states that are not able to fully implement their Program Improvement Plan would only result in reduced funding for child welfare services in the state at time when more is needed. Penalties would hamper a state's ability to make the needed improvements.
A review of the Program Improvement Plans offers some valuable insight into some of the key issues facing state child welfare systems. The GAO report 2 found that the most common challenges affecting states' Program Improvement Plan implementation was insufficient funding, insufficient staff, insufficient time, and high caseloads.
Seventeen of the initial 18 states 3 to have finalized Program Improvement Plans referenced the need for more training. Worker and supervisory training should address the need for increased skill and competency in conducting safety assessments, in working with families experiencing substance abuse and domestic violence, in assisting youth transitioning from foster care, in assisting children and families in need of specialized services, and in providing effective supervision. There is also a need for comprehensive training and mentoring of new workers.
At least 12 of the initial 18 Program Improvement Plans reviewed cited the need for more or better access to mental health services. Twelve of the 18 state plans reviewed planned to step up their recruitment efforts in finding both adoptive and foster parents. More than one-third discussed the need for increased collaborations with the courts. Eleven of the 18 states included in their plans greater access to services for families and children, including services such as aftercare, family intervention, therapeutic services; strategies for filling the gaps, including those found in rural areas; and access to important supports such as housing or income support.
States are not required to include information or details on what it will cost the state to fully implement the PIP. Each state makes a determination based on resources as how to fund the requirements described in the PIP. The decisions to fund the improvements outlined in each states Program Improvement Plan now relies on each state's ability to dedicate scarce additional state resources.
Without new, dedicated federal resources to assist states implement the needed improvements, states will continue to struggle to comply with federal expectations and may be penalized as a consequence. CWLA supports legislation pending before this Subcommittee, the Child Protection Improvement Act (H.R. 1534), sponsored by Representative Benjamin Cardin (MD), that begins to address this need. That legislation would give states new federal resources to assist states in the implementation of their Program Improvement Plans. H.R. 1534 would provide grants to states to help implement program improvements and would provide an additional bonus for the most successful states.
Imposition of Penalties Are Misguided and May Have Unintended Consequences
Once a state has received federal approval of the Program Improvement Plan, quarterly reports of progress, with supporting data, are required. At the end of the two-year PIP, a final report is prepared and HHS determines if a state had achieved compliance. Failure to achieve compliance may result in financial penalties.
Although penalties are deferred while the state implements its Program Improvement Plan, the state is held accountable for meeting the milestones detailed in the plan and ultimately completing the plan successfully. If the state does not meet the milestones, or does not complete the plan, HHS will assess penalties commensurate with the extent of the non-compliance. In successive reviews, the amount of the penalty increases for continued non-compliance. The GAO report 4 estimated financial penalties could range from a total of $91,492 for North Dakota to $18,244,430 for California. If a state is sanctioned for not achieving substantial conformity, private providers may also be affected. The decisions to pass on sanctions will be made at the local level.
Need For National Standards
Unlike other systems that provide critical services to children and families, such as schools and hospitals, there are no comprehensive, nationally mandated standards for child welfare services. For many years, CWLA has been the principal national organization responsible for developing child welfare standards. CWLA's twelve volumes of standards provide best practice guidance on many aspects of child welfare, including the quantification of caseload ratios. Unfortunately, there remains a wide gap between the best practices recommended in these standards and what actually occurs in practice in many jurisdictions.
The absence of a core set of nationally agreed-upon standards by which agency services can be measured seriously compromises quality and consistency across child welfare services. The lack of clear agency policy and accountability with regard to best practice all too frequently permits "freelance" and unstructured casework practice. It fosters decision-making that, by default, may be driven by individual workers who are often inexperienced and inadequately trained. The lack of national standards by which agencies are held accountable has played out nationally in recent reports of the disappearance, serious injury, and death of children. In addition to these most tragic examples, without complying with such standards, many agencies are ill-equipped to provide the basic care and protection of children and support to families that we expect of an effective child welfare system.
CWLA proposes the federal government establish national standards for child welfare practice that would be linked to the federal Child and Family Service Reviews. Once established, nationally adopted child welfare standards would provide guidance to state efforts to achieve the child welfare outcomes and meet the requirements of state Program Improvement Plans. Establishing national standards of practice for child welfare services, and creating and implementing a process for states to use to "gear up" to the standards, would result in more consistent, quality practice across jurisdictions and nationally. It would provide clear guidance to states in their efforts to achieve the child welfare outcomes and make improvements as laid out in their Program Improvement Plans. It would provide a needed practice framework, enabling child welfare service systems to achieve good outcomes for children and families and to be accountable for the important work that they do.
CWLA's Call for Comprehensive Child Welfare Reform
Based on the findings of the CFSR process and the documented needs expressed in the PIPs, CWLA continues to urge Congress to take action on what is truly needed to build the system of care so that children are protected. CWLA recognizes that the child welfare system, as currently constructed, cannot protect all children adequately. Failures occur. They are not limited to any single state. These failures will continue to occur until we put into place a comprehensive child welfare system. There is a compelling national interest in providing consistent levels of safety, protection, and care for America's children across each state.
The national child welfare system continues to be in need of:
Without all of these elements in place the well-being of many of our country's children will continue to be threatened.
- A reliable, responsive, and predictable method of guaranteed funding, for a full range of essential services, as well as placement and treatment services.
- A means of maintaining consistent focus on safety, permanency, and well-being as outcomes for children.
- Rigorous standards combined with strong federal and state accountability mechanisms.
- Recruitment and support of an adequately trained child welfare workforce, foster and adoptive parents, mentors, and community volunteers.
- Resources that enable parents to provide adequate protection and care for their children.
- Direct tribal access to Title IV-E funding. Allowing Native American tribes and tribal consortia to apply to the U.S. Department of Health and Human Services to directly administer the Title IV-E foster care and adoption assistance program would increase opportunities for Native American children to find permanent families and receive the supports they need.
New Investments Needed
The findings of the CFSRs and the PIPs have made it clear that states need help in order to successfully care and protect our children. The federal government must recognize its unique role in better supporting state efforts.
Implement Program Improvement Plans
All states have now undergone their federally mandated Child and Family Services Reviews. States are now putting together Program Improvement Plans that outline what improvements are needed to better ensure that children are protected. Many states will struggle to implement these plans unless resources are provided.
Legislation pending before the Subcommittee sponsored by Representative Benjamin Cardin (H.R. 1534) offers an innovative approach that would target funds to assist states in the implementation of their Program Improvement Plans. H.R. 1534 would provide grants to states to help implement program improvements and would provide an additional bonus for the most successful states.
Increase Support for Prevention and Early Intervention Services
Resources are needed for primary prevention services that can prevent many families from ever reaching the point where a child is removed from the home. Prevention and early intervention services play a vital role for children and families in communities. Family support, home visiting, and in-home services enable many parents to gain competence and confidence in their parenting while addressing other family concerns. Child care, housing, and job training/employment are services that enable families to stay together to the fullest extent possible. These and other preventive services need to be much more available to families early on, as well as when a crisis occurs.
Community-based child protection programs have demonstrated that many families can be helped before there is a need for protective intervention with the family. Often, the family can identify what is needed and be connected to resources-and contact with the formal child welfare system can be averted. Often, after a formal report has been made, a child can be maintained safely at home with sufficient supports, clear expectations, and monitoring. At all points in the continuum, however, ongoing, targeted assessment must be taking place. Both the initial child protective services investigation and placement prevention services require appropriate immediate assessments of the family, the child, and the community. CWLA supports the Act To Leave No Child Behind (H.R. 936) that would allow states to claim reimbursement under the Title IV-E foster care program to address these needs. In addition, we urge Congress to approve the Administration's requested increases under the Child Abuse Prevention and Treatment Act.
Increase Funding for Promoting Safe and Stable Families
CWLA, along with members of this Subcommittee, supports increased funding to $505 million for the Promoting Safe and Stable Families program (PSSF). States use these funds for family support, family preservation, adoption, and family reunification. Since 2001 when this program was last reauthorized, Congress has had the ability to add $200 million to the $305 million in mandatory funding. Despite the best efforts of members of this Subcommittee, Congress had never approved more than $405 million for PSSF.
Restore Funding for the Social Services Block Grant
CWLA again calls for the restoration of funding to $2.8 billion for the Social Services Block Grant (SSBG, Title XX of the Social Security Act). In 2000, SSBG represented 17% of all federal funding for child welfare services. While SSBG funds can be used for an array of social services, such as child care or services for the aging, states chose to spend these funds on child welfare services more than any other service area. In federal FY 2001, child protection and child foster care services each accounted for 22% of SSBG expenditures; 43 states used SSBG funds to address child protection services; and 35 states used SSBG to fund foster care.
Support the Adoption Incentives Fund
CWLA, along with members of this Subcommittee, supports full funding of $42 million for the Adoption Incentives Fund. This is an important fund that provides resources to the states to encourage the adoption of children. Increased funding is especially needed to help states reach the new target of facilitating the adoption of older children. Congress, led by the work of this Subcommittee, reauthorized the Adoption Incentives fund just last year. Despite that effort, the 2004 funding does not provide the full $42 million.
Adopt Strategies to Better Support the Child Welfare Workforce
A well-trained, reliable, and experienced workforce is a critical element to making children safer. Legislation pending in this Subcommittee introduced by Representative Pete Stark (CA), H.R. 2437, as well as H.R. 1534 mentioned earlier, encourages a number of workforce strategies, including expanded access to training for new and current child welfare workers. In the U.S. Senate, Senator Mike DeWine (OH) has sponsored legislation (S. 407) that expands college loan forgiveness to this part of our nation's workforce.
Change the Eligibility for Title IV-E Foster Care and Adoption Assistance
To ensure child safety, permanency, and well-being, federal funding should be provided for all children in out-of-home care. Congress has mandated legal and permanency protections for all foster and adopted children, however, federal funding is only available to pay for the costs of children who are eligible for Title IV-E of the Social Security Act. The current law links Title IV-E eligibility to archaic standards that each state had in place under their 1996 AFDC eligibility standards.
Since AFDC no longer exists, this continues to be an administrative burden on the states. Even more critical, however, is the fact that as time goes by, fewer and fewer children will be eligible for federal support. Data gathered by the Urban Institute indicates that as of 2000, approximately 57% of all children in out-of-home placement were eligible for Title IV-E funding. Some states may be able to serve less than one-third of their children in out-of-home placement through the use of Title IV-E foster care fund. If the current eligibility link remains, fewer and fewer children will be eligible for federal foster care and adoption assistance.
Expand Family Reunification Services
Reunification is the first permanency option states consider for children entering care. Yet, in many ways, it is the most challenging option to achieve in a plan-based, permanent way. Forty-three percent (239,552) of children in care on September 30, 2000, had a case plan goal of reunification with their parents or other principal caretaker while 57% (157,712) of the children who exited care during FY 2000 returned to their parent's or caretaker's home. Successful permanency through reunification requires many things, including skilled workers, readily available supportive and treatment resources, clear expectations and service plans, and excellent collaboration across involved agencies, at a minimum. The Act To Leave No Child Behind (H.R. 936) would allow states to claim reimbursement under the Title IV-E foster care program to address these needs.
Support Kinship Permanency and Guardianship
One area that can serve as an important tool in providing children with a safe and permanent setting is the use of guardian kinship care arrangements. Some states have used various resources to fund this permanency option. A few states have utilized federal Title IV-E funds to support guardianship through the use of Title IV-E waivers.
CWLA supports a federally funded guardianship permanency option available through Title IV-E to allow states to provide assistance payments on behalf of children to grandparents and other relatives who have assumed legal guardianship of the children for whom they have committed to care for on a permanent basis. Kinship guardianship assistance agreements and payments would be similar to the adoption assistance agreements in that they would take into consideration the circumstances and the needs of the child.
Kinship care, when properly assessed and supported, has been shown to provide safe and stable care for children who remain with or return to their families. Twenty-five percent of children in care are living with relatives, some of whom will not be able to return to their parents. States vary in their use of relative homes for foster care even though federal regulations state that there is a preference for relative placements. States are challenged to provide the financial, social, and legal supports that are needed to ensure safety and permanency in kinship placements. Generally there is a lack of case management and support services made available to relative and legal guardian providers.
The Child and Family Services Reviews offer a valuable opportunity to carry out a serious and ongoing examination of how well our nation's child welfare system is taking care of and protecting our children. The Program Improvement Plans also provide valuable information about what is truly needed to build the system of care so that children can be protected.
The improvements to the child welfare system can only be made through an improved system of shared financing responsibilities among federal, state, local, and tribal governments. Now is the time for the federal government to help support states in their efforts to implement needed changes by providing states with the needed resources. Without additional support, states cannot reach the goals of improved outcomes for the children and families that are touched by our nation's child welfare system.
- Child and Family Services Review: Better Use of Data and Improved Guidance Could Enhance HHS's Oversight of State Performance. U.S. General Accounting Office (GAO-04-333), April 2004.
- AL, AZ, AR, CA, DE, FL, GA, IN, KS, MA, MN, NM, NY, OK, OR, PA, TN.
- GAO-04-333, Child and Family Services Review: Better Use of Data and Improved Guidance Could Enhance HHS's Oversight of State Performance. U.S. General Accounting Office (), Washington, DC: April 2004.
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