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History and Purpose
The Child and Family Services Reviews (CFSRs) are conducted by the Children's Bureau, within the U.S. Department of Health and Human Services (HHS), to help States improve safety, permanency, and well-being outcomes for children and families who receive services through the child welfare system. The CFSRs monitor States' conformity with the requirements of title IV-B of the Social Security Act. The first round of reviews took place between 2000 and 2004 and all States were required to implement Program Improvement Plans (PIPs). The second round of reviews began in early spring of 2007. The CFSRs are an important tool that enables the Children's Bureau to: (1) ensure conformity with Federal child welfare requirements; (2) determine what is actually happening to children and families receiving child welfare services; and (3) assist States in enhancing their capacity to help children and families achieve positive outcomes. Significant financial penalties may be assessed for failure to make the improvements needed to achieve substantial conformity.
The onsite portion of the CFSR, conducted State-by-State, 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.
Mental Health and the CFSRs
States are required to work with a variety of systems, including mental health agencies, to ensure positive outcomes for children. In addition to using the CFSRs as a learning tool, mental health representatives may participate directly in the CFSR process in a variety of ways, such as participating as a consultant on a review team to help review cases and conduct interviews; serving on Statewide Assessment or PIP development teams; or being interviewed during stakeholder interviews conducted at each review site. Representatives may include persons from the State health program, Medicaid program, or State mental health agency, and mental health treatment providers. The CFSRs assess State efforts to address the mental/behavioral health needs of children through exploration of the following core questions:
Assessment: Did the agency conduct an assessment of the children's mental/behavioral health needs initially and on an ongoing basis to inform case planning decisions?
Services: Did the agency provide appropriate services to address the children's mental/behavioral health needs?
Findings From the First Round of CFSRs
The first round of CFSRs was conducted from October 2000 to March 2004. Four States received a strength rating for addressing the mental/behavior health needs of children. States noted challenges in meeting the mental health needs of children in care in the following areas:
Access to services. The reviews consistently noted a lack of available appropriate mental health services for children. Most notable were the lack of treatment for youth who had been sexually abused and the shortage of therapeutic foster care resources. The reviews also found a lack of substance abuse treatment (for parents and children) and domestic violence services in many States.
Rural areas. Many States lacked mental health service providers in rural areas.
Budget deficits. Many States had difficulty providing appropriate services because of budget constraints.
Collaboration. While most States engaged in collaboration, many described service coordination as problematic and difficult.
States proposed to address these challenges in a variety of ways:
Developing screening and assessment instruments
Building service arrays to address deficits in certain types of services
Training staff, clinicians, and foster parents on mental health issues
Monitoring services and child and family outcomes
Collaborating across agencies to achieve improved service delivery
Replicating systems of care
More Information
More information on the findings from the first round of reviews with regard to mental health services is available from the National Technical Assistance Center for Children's Mental Health at http://gucchd.georgetown.edu/programs/ta_center/ (see "An Analysis of Mental Health Issues in States' Child and Family Services Reviews and Program Improvement Plans"). See also "Most States Fail to Meet the Mental Health Needs of Foster Children," available from the National Center for Youth Law, http://www.youthlaw.org.
Mental health professionals can learn about the review process by becoming familiar with the outcomes of their State's first review. Final Reports, which include findings for mental health services for each State, are available on the Child Welfare Monitoring section of the Children's Bureau Web site at http://www.acf.hhs.gov/programs/cb/cwmonitoring/index.htm#cfsr.
