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Purpose:
This technical bulletin (TB) provides guidance to States on system issues related to the collection and reporting of information on caseworker visits with children in foster care. This TB does not establish new Federal systems or reporting policy. It is intended to assist States with aligning their information system activities to support caseworker visit data requirements of the Child and Family Services Improvement Act of 2006 (P.L. 109-288) at section 424(e)(1) and (2) of the Social Security Act (the Act) and Program Instruction ACYF-CB-PI-08-03, issued April 18, 2008. It also provides a list of considerations should a State choose to expand their data collection activities beyond the Federal requirements into program analyses that may support monitoring activities such as the Child and Family Services Reviews (CFSR).
Background:
Case practice in the area of caseworker visitation with children in foster care has been a concern of the Administration for Children and Families (ACF) for some time. This issue was examined in the first round of the CFSRs that started in 2001 and evaluated child welfare practice in all 50 States, the District of Columbia, and Puerto Rico. In those reviews, among other things, ACF evaluates whether States maintain face-to-face visits with children in foster care commensurate with their needs. The reviews found that the quality and frequency of caseworker visits with children were strongly associated with 1) adequately assessing risk of harm to children; 2) identifying needs and provision of services for children, parents, and foster parents; and 3) effectively involving children and parents in their case planning. Conversely, cases in which caseworker visits were less frequent showed poor performance in the critical outcome areas noted above. A summary of findings from the 35 CFSRs1 conducted between 2002 and 2004 found that 27 States were cited for insufficient frequency of face-to-face contacts with children to address their safety and well-being.
In response to concerns raised by the CFSR findings, in 2004 the Department of Health and Human Services' Office of Inspector General (OIG) undertook a study to determine 1) the written standards States have implemented for frequency of caseworker visits with children in foster care, 2) the extent to which States could provide statewide automated reports reflecting the frequency of caseworker visits, and 3) the extent to which statewide reports indicate that children were visited. The results were published in a December 2005 report entitled State Standards and Capacity to Track Frequency of Caseworker Visits with Children in Foster Care (OEI-04-03-00350), available at http://www.oig.hhs.gov/oei/reports/oei-04-03-00350.pdf.
The findings from the December 2005 OIG report raised concerns about the ability of States to track and report caseworker visits with children. The findings may be summarized as follows: 1) 43 States had written standards calling for at least monthly caseworker visits with children; 2) 20 States demonstrated an ability to produce retroactive statewide reports on the frequency of visits for Federal Fiscal Year (FFY) 2003; and 3) seven of the 20 FFY 2003 statewide reports reviewed by the OIG indicated that on average fewer than half of children in foster care received monthly visits. Subsequent informal follow up by the Children's Bureau (CB) Division of State Systems (DSS) with the 28 States that had an operational Statewide Automated Child Welfare Information System (SACWIS) revealed that almost all of those States have such a report today or capture sufficient data to develop such a report when needed.
Prior to the enactment of the Child and Family Services Improvement Act of 2006 (P.L. 109-288) on September 28, 2006 there was no Federal requirement regarding how often children in foster care should be visited by caseworkers, other than a requirement for a minimum of one visit every six months2 to children in out-of-State placements. P.L. 109-288 included language related to visitation requirements, funding for caseworker visit activities, and a requirement to submit data on caseworker visits to the Federal government. Those provisions are found in the Act at:
In April 2008, the Children's Bureau issued Program Instruction ACYF-CB-PI-08-03, clarifying the State data submission requirements on caseworker visits to children in foster care in order to comply with the Child and Family Services Improvement Act of 2006 (P.L. 109-288) and section 424(e) of the Act.
Overview of the Technical Bulletin
The guidance in the remainder of this document is divided into five sections: 1) an overview of the Federal reporting requirements defined in ACYF-CB-PI-08-03; 2) suggestions for system design to meet those requirements; 3) discussion of the availability of Federal Financial Participation (FFP) to modify systems to meet new Federal reporting requirements; 4) suggestions for additional opportunities for program evaluation using the system functionality developed to meet mandatory data requirements; and 5) technical assistance resources.
Section I: Current Federal Reporting Requirements
Briefly, the new requirements3 call for States to collect and submit the following data:
The following data are required to compute the percentages:
States are required to use these data to report information for each year from FFY 2007 - FFY 2011 on 1) the percentage of children in foster care visited each and every calendar month, and 2) the percentage of those visits which occurred in the child's residence. Section 424(e)(2)(A) of the Act also requires States to establish, not later than June 30, 2008, an outline of the steps to be taken to ensure, by October 1, 2011, that at least 90 percent of the children in foster care under the responsibility of the State are visited by their caseworkers on a monthly basis, and that the majority of the visits occur in the residence of the child.
Unlike other Federal child welfare data sets, such as the Adoption and Foster Care Analysis and Reporting System (AFCARS), there is no automated submission requirement for reporting caseworker visit data. States were required to describe their data collection method to CB by June 30, 2007. Reporting may be based on full population counts or an approved representative sample. Data collection methods can range from manual hand counts based on reviews of paper records to management reports automatically generated from the State's SACWIS. Depending on whether they have an information system, the reliability of the data in that system, and even whether the system collects all the required data, States may face challenges in collecting and reporting these data to CB.
Section II: Suggestions on System Design for Collecting Data on Caseworker Visits
While initially a State may be unable to report caseworker visit data directly from their information system, States may propose a change in their reporting methodology to CB once they have developed that capacity. In evaluating any proposed changes to a State's data collection methodology, CB will primarily be concerned with whether the new method can be expected to improve the accuracy of the State's caseworker data submissions.
Among the challenges faced by States with child welfare information systems, whether SACWIS or non-SACWIS, is to determine whether the data they collect on caseworker visits includes sufficient discrete data elements to successfully generate the required information. By discrete data elements, ACF is referring to unique pieces of information captured in the system as opposed to information buried in a narrative field. A system that captures key data in unique fields greatly facilitates reporting. For example, if a system requires workers to select the participants in a visit from a drop-down list when entering information on the visit in the system, it will be easier later to determine who conducted the visit on behalf of the agency since the information can be pulled from a single place in the system. If the names, roles, and/or relationships of individuals visited are in a narrative field it will be difficult, if not impossible, to use an automated system to accurately generate reports on which children received a caseworker visit.
The following sections will address issues to consider when building or modifying an information system to comply with the caseworker visit reporting requirements. Successfully reporting these data requires the ability to answer five key questions about the activities of caseworkers: 1) Who participated in the visit? 2) What was the purpose of the visit? 3) What type of contact occurred? 4) Where did the visit occur? and 5) When did the visit occur?
1) Who Participated in the Visit?
A key element required to report on caseworker visits is an accurate understanding of who was present at the visit. The data should clearly identify whether visits were performed by the assigned caseworker, case aide, a contractor with case management responsibilities, or other party. This distinction is important because the reporting requirements allow the State Title IV-B/IV-E agency to define who qualifies as a caseworker with the caveat that the person be assigned or contracted to provide case management or visitation responsibilities. (See Child Welfare Policy Manual, 7.3 Title IV-B Programmatic Requirements - http://www.acf.hhs.gov/j2ee/programs/cb/laws_policies/laws/cwpm/policy_dsp.jsp?citID=178).
For CFSR purposes, CB evaluates how and when caseworkers with full case management responsibility are visiting children. On a case-by-case basis, other workers who do not have full case management responsibility may also be included in the CFSR evaluation of visitation, depending on such workers' roles in regard to ensuring the child's safety, permanency, and well-being and promoting achievement of case goals as described in State policy. Furthermore, the CFSR also examines caseworker visit patterns on both out-of-home and in-home services cases. To enhance its information base for management planning and quality monitoring, States may wish to consider developing reports that show performance based on the criteria developed in response to Section 424(e) of the Act, as well as those utilized by the CFSR. Again, such distinctions will only be possible if visit participant data are captured as discrete elements.
Capturing participant data as discrete elements also will be useful for determining whether the person conducting the visit also met with siblings in the same placement setting. In that case, the ability to record a single note that would populate to the records of more than one child will account for circumstances in which the visit may count as visitation for more than one child.
2) What Was the Purpose of the Visit?
Not every occasion during which contact is made with a child should be reported as a visit for purposes of meeting section 424(e) of the Act. While there is no formal standard defining which types of visits must be reported to CB, it would be beneficial to be able to validate the purpose of the visit. Section 422(b)(17) of the Social Security Act notes that at a minimum a visit should be "well-planned and focused on issues pertinent to case planning and service delivery to ensure the safety, permanency and well-being of the children." A method of noting, for example, whether the caseworker visit was conducted specifically to promote the monitoring and achievement of case goals as opposed to a child seen coincidentally with a visit related to another activity (e.g., provider licensing visit or an investigation of maltreatment in the home) would provide valuable information for subsequent analyses. In many cases this goal may be achieved by having data that captures the kind of worker who is conducting the visit. However, capturing discrete data related to the purpose of the visit would also help a State answer this question.
3) What Type of Contact Occurred?
The contact screen(s) in the information system will be the most likely source of information on caseworker visitation. Many systems use one place to capture all interactions (generally called contacts) with clients and others involved in the case. In those contact entry screens, there is generally the ability to note the type of contact (e.g., call, video conference, in-person, etc.). Often the application will enable the user to capture attempted contacts as well as successful contacts. It is incumbent upon those designing the functionality used to record contacts to support a level of detail that will facilitate reporting visits. The contact records should therefore clearly indicate whether the contact was face-to-face.
4) Where Did the Visit Occur?
Capturing the location of the visit is a key element in understanding visitation and in being able to report data on the percentage of monthly caseworker visits that occurred in the child's residence. Discrete data elements that allow the worker to indicate whether the meeting took place in his/her office, a school, a hospital, the child's residence, or another location are critical to capturing the information in a useful way. ACYF-CB-PI-08-03 defines the child's residence as the place where the child is residing, whether a foster family home, group home, or institution, regardless of whether the child was placed in-State or out-of-State. Please note that since children in out-of-State foster care placements are also part of the reporting population for section 424(e), States will need to work closely with their partner States to ensure that data on visits to children placed out-of-State are reported in a timely and accurate manner. Finally, if a State considers children who have gone home on a trial home visit to be in foster care, then the children should be included in the reporting population.
5) When Did the Visit Occur?
The date of the visit is the final mandatory element of the caseworker visit data reporting requirements. While many State information systems already capture this information, it is important to be aware that the system must be able to report the date that the contact occurred (and not the date the contact was entered into the system). States are reminded that visits are counted on a calendar month basis for each full month that the child was in foster care during a given FFY.
Summary
To recap, an information system that facilitates Federal reporting on caseworker visits pursuant to section 424(e) would ideally capture a number of discrete data elements, including, but not limited to:
We cannot emphasize enough that the design of screens built to capture these data, particularly their ease of use, can be just as important as whether the necessary elements are present. A lesson learned in many States is that the easier the data are to capture, the greater the likelihood that the data will be recorded in an accurate, consistent, and timely manner. We recommend that system staff work closely with program staff to identify appropriate agency nomenclature, any gaps or changes required, and to best determine worker preferences for any changes needed. To the extent possible, we strongly encourage the design concepts be field tested before development occurs.
Section III: Federal Financial Participation (FFP)
Some States have expressed concern over the potential cost to make enhancements to their child welfare information systems in order to produce caseworker visit data. Please note that FFP is available to modify systems to meet Federal reporting requirements or to produce reports that may support reviews such as the CFSR (including the range of activities from the development of the Statewide Assessment to the development of the Program Improvement Plan (PIP)). Here are some details:
Section IV: Additional Considerations Related to Reporting Caseworker Visits
Evaluation of State performance related to caseworker visits should not end with the annual submission of required Federal data. These data should be monitored on an ongoing basis at the State level through the use of tools such as management reports to evaluate compliance and identify gaps in the information (e.g., a report that lists every case that has not had a recorded visit within the last 30 days). States should also utilize tools such as administrative reviews and quality assurance audits to determine the timeliness and quality of visits.
This section discusses some additional considerations when collecting and reporting data related to caseworker visits. Besides knowing whether the visits occurred, policy makers and managers will certainly be interested in the quality of the visits, whether the visits yielded improved outcomes, and how the State can ensure every child is visited at least once a month. The additional analysis will help policy makers determine whether there are common elements in cases that are not meeting the standard and develop appropriate interventions to ensure timely caseworker visits are occurring. The data considerations noted in the previous section will support a State's effort to conduct further analysis of visitation practice. In addition to producing statewide aggregate data, States are encouraged to build systems capable of "drilling down" to individual records that are included in the reported aggregate.
The list of questions below is not meant to be exhaustive, but merely illustrative of the types of analyses of caseworker visit data that may be performed beyond those required to meet Federal reporting requirements. In some cases, we suggest additional data elements be collected to facilitate answering the questions. States must consider the amount of additional work it will be for caseworkers to collect the additional data and weigh the increased workload against the value of the information it would provide.
How timely and consistent is worker entry of the information needed to evaluate visit activity? The addition of a data element to capture the date the visit was entered into the system will allow for audit reports on timeliness of data entry. A review of exception reports that evaluate the completeness of each entry will support efforts to evaluate whether there are issues with workers' ability to provide complete and accurate information. Such analysis will allow for States to assess the quality of the data being submitted to the Federal government, including potential issues with training or system design that may be impeding effective and efficient collection of the data.
Does performance differ when the data are viewed by region/county/local office? Most systems already have the ability to identify case ownership based on the office to which it is assigned. By adding additional elements to reports on caseworker visits, administrators and managers will be able to "drill down" from State level data to evaluate performance by regions, counties, local offices, supervisor units, and even individual workers. Another view of the data would allow for evaluation of performance by factors such as judicial district or urban/rural breakdowns.
How can the data be used to evaluate the performance of contracted providers? Many States are using some mix of agency staff and contracted case management providers. Including such data on caseworker visit reports can provide one more valuable perspective on the implementation of performance-based contracting models.
In what ways does improved visitation correlate with improvement in outcomes for children? Many systems already provide for capturing data related to outcomes such as timely establishment of permanency, number of placement changes, or incidence of abuse/neglect while the child is in care. Once reliable data on visits are collected, evaluations may be conducted to determine outcomes for children with improved visitation.
Do length and/or frequency of visits correspond to better outcomes? If the system captures data that allows for measurement of length of visits, it is much easier to link descriptive statistics such as duration and frequency of visits to outcome information collected in the system.
Does the use of additional types of contacts to supplement face-to-face visits have a positive impact on outcomes? If the system has the capability to identify the specific types of contact in addition to face-to-face visits, such as phone or video conference, as a means of presenting the full range of caseworker interactions with clients, it will be easier to determine the impact of these activities on outcomes.
Are there certain types of cases that seem to require more frequent visits? These data would allow States to consider whether factors in cases that tend to require more intensive casework (e.g., presence of multiple physical or emotional disabilities, methamphetamine involvement, or imminent reunification) also require more frequent and/or intensive visitation to ensure child safety.
What issues were covered on a visit (e.g., did the worker address the child's needs, services, and case goals)? Implementing the changes necessary to meet the Federal reporting requirements will also allow States to consider capturing information, in addition to that in the narrative, which specifically addresses whether certain key activities took place. There are a number of possible ways to supplement the traditional narrative, collecting information on whether:
Certainly, capturing this type of information as discrete data elements leaves open the question of how useful and accurate the data are likely to be. Therefore, the accuracy of this information would have to be verified through ongoing reviews of case activities and the traditional narratives during supervisory or quality assurance reviews. Nonetheless, if a mechanism for ensuring data quality could be implemented, it will allow for the development of management reports that go beyond whether visits are occurring, and address aspects of the quality of the visits that are taking place. Indeed once the quality of the data is validated, further analysis could be conducted into the relationship between case outcomes and the content of the visits performed.
If the child's parent(s) or foster parent(s) were present at the location of the visit, did the caseworker spend one-on-one time with the child? Once the system supports recording of who was present for the visit and when the visit occurred, an additional consideration may be to capture whether the caseworker met privately, one-on-one with the child.
What is the average or mean time between visits? Tracking visit data that is based solely on calendar months may mean that up to 60 days elapse between visits (e.g., visit on first of the month with the next visit coming at the end of the next month). A look at visits based on days between visits will provide another supervisory oversight tool and a means of evaluating one aspect of caseworker visit patterns. This view of the data can be further refined if, for example, a State has a policy that specifies a maximum number of days between visits or requires more frequent visits for certain types of cases.
Examine the data based on out-of-home versus in-home services cases. Is performance consistent across both types of cases? States may already have performance measures in their PIP or may be considering their performance in advance of a CFSR. Examining outcomes for each type of case in the context of visitation performance would allow States to consider whether there are factors related to each type of case that may impact the frequency and quality of caseworker visits.
Examine the data based on placement setting. Are there significant differences in visitation patterns among children in various placement settings such as therapeutic homes, relative placements, residential facilities, etc.? Reliable data on caseworker visitation performance adds another variable to the analysis. Outcomes can be evaluated for various placement settings or populations and may facilitate reconsideration of policy such as requiring visits more frequently for more intensive service placements.
The discussion points listed above are not a prescriptive list of steps that must be followed in order to successfully analyze data related to caseworker visits. Rather, they are presented as a starting point for discussions among program, system, and data staff to determine whether there are ways to leverage the need to make changes to meet the reporting requirements of the Child and Family Services Improvement Act of 2006 into an opportunity to obtain a more holistic view of agency performance for achieving safety, permanency, and well-being.
V: Additional Technical Assistance
In addition to this document and ACYF-CB-PI-08-03, technical assistance is available through consultation with the Children's Bureau Division of State Systems and Regional Office staff.
The Children's Bureau also sponsors the National Resource Center for Child Welfare Data and Technology (NRC-CWDT). Requests for on-site technical assistance must be approved in advance by the appropriate ACF Regional Office; however, consultation with the NRC-CWDT is welcomed and encouraged. To make a request or find out more about technical assistance available from the NRC-CWDT, you may contact them using the information below.
National Resource Center for Child Welfare Data and Technology
2345 Crystal Drive
Suite 250
Arlington, VA 22202
Phone: 877- 672-4829 (toll free)
E-mail: nrccwdt@cwla.org
Web site: http://www.nrccwdt.org
1 See ACF web site at http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/index.htm for additional information on findings from the first round of CFSRs. Back
2 The Safe and Timely Interstate Placement of Foster Children Act of 2006 (P.L. 109-239), enacted August 11, 2006, increased the frequency of required caseworker visits with children placed in foster care out-of-State from every 12 months to every 6 months. Back
3 See section 424(e) of the Act and ACYF-CB-PI-08-03, available at http://www.acf.hhs.gov/programs/cb/laws_policies/policy/pi/pi00index.htm#2008, for additional details. Back
4 Per the guidance in ACFY-CB-PI-08-03, a visit month is counted for each and every full calendar month a child was in foster care during the period under review (e.g., one child in care for 5 months and another for 11 months = 16 visit months). Back
