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The 1994 Amendments to the Social Security Act (SSA) authorize the U.S. Department of Health and Human Services (HHS) to review State child and family service programs to ensure conformity with the requirements in titles IV-B and IV-E of the SSA. Traditionally, reviews focused primarily on assessing State agencies' compliance with procedural requirements, as evidenced by case file documentation. In addition, past reviews did not provide States with opportunities for making improvements before imposing penalties.
Now, however, the focus is on States' capacity to create positive outcomes for children and families and on the results achieved by the provision of appropriate services. On January 25, 2000, the HHS published a final rule in the Federal Register to establish a new approach to monitoring State child welfare programs. Under the rule, which became effective March 25, 2000, States are assessed for substantial conformity with certain Federal requirements for child protective, foster care, adoption, family preservation and family support, and independent living services.
The Children's Bureau, part of the HHS, administers the review system, known as the Child and Family Services Reviews (CFSRs).
The CFSRs enable the Children's Bureau to: (1) ensure conformity with Federal child welfare requirements; (2) determine what is actually happening to children and families as they are engaged in child welfare services; and (3) assist States to enhance their capacity to help children and families achieve positive outcomes.
Ultimately, the goal of the reviews is to help States improve child welfare services and achieve the following outcomes for families and children who receive services:
Children are, first and foremost, protected from abuse and neglect.
Children are safely maintained in their homes whenever possible and appropriate.
Children have permanency and stability in their living situations.
The continuity of family relationships and connections is preserved for families.
Families have enhanced capacity to provide for their children's needs.
Children receive appropriate services to meet their educational needs.
Children receive adequate services to meet their physical and mental health needs.
The Federal Government conducts the reviews in partnership with State child welfare agency staff; consultant reviewers supplement the Federal Review Team. The reviews are structured to help States identify strengths and areas needing improvement within their agencies and programs.
Each CFSR is a two-stage process consisting of a Statewide Assessment and an onsite review of child and family service outcomes and program systems. For the Statewide Assessment, the Children's Bureau prepares and transmits to the State the data profiles that contain aggregate data on the State's foster care and in-home service populations. The data profiles allow each State to compare certain safety and permanency data indicators with national standards determined by the Children's Bureau.
After the Statewide Assessment, an onsite review of the State child welfare program is conducted by a joint Federal-State team. The onsite portion of the review includes: (1) case record reviews; (2) interviews with children and families engaged in services; and (3) interviews with community stakeholders, such as the courts and community agencies, foster families, and caseworkers and service providers.
At the end of the onsite review, States determined not to have achieved substantial conformity in all the areas assessed are required to develop and implement Program Improvement Plans (PIPs) addressing the areas of nonconformity. The Children's Bureau supports the States with technical assistance and monitors implementation of their plans.
States that do not achieve their required improvements sustain penalties as prescribed in the Federal regulations. All 50 States, the District of Columbia, and Puerto Rico completed their first review by 2004. No State was found to be in substantial conformity in all of the seven outcome areas or seven systemic factors. Since that time, States have been implementing their PIPs to correct those outcome areas not found in substantial conformity. The second round of reviews began in the spring of 2007.
