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CFSRs: Purpose and Process
The federally mandated 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 assess all areas of child welfare services, including foster care, child protection, family preservation, adoption, and youth development. Because substance use disorders are identified so often as a major factor in child welfare cases, opportunities for substance abuse treatment professionals to participate in the CFSRs are a crucial part of the process.
The CFSRs are conducted in all 50 States, the District of Columbia, and Puerto Rico in two phases: (1) the Statewide Assessment, which provides the State an opportunity to examine data indicators and other information, such as the input of a variety of stakeholders, regarding its programmatic goals and outcomes for children and families, and (2) an onsite review, which examines outcomes for a sample of children and families served by the State during a specific period at three sites. The State's largest metropolitan subdivision is a required site, and the other two sites are determined on the basis of information in the Statewide Assessment. During the onsite review phase, 65 cases are reviewed. The onsite 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.
If areas needing improvement are identified by the review, States are required to implement Program Improvement Plans (PIPs). A network of National Resource Centers provides technical assistance to help States develop and implement their PIPs. Significant financial penalties may be assessed for failure to make the improvements specified in the PIP. The first round of reviews took place between 2000 and 2004 and all States were required to implement PIPs. The second round of reviews began in early spring of 2007.
The CFSRs and Opportunities for Substance Abuse Treatment Professionals
The CFSRs evaluate the effectiveness of the entire child welfare delivery system, including other systems such as mental health agencies, the court system, and substance abuse treatment providers to ensure positive outcomes for children and their families. The CFSRs ask whether the State child welfare agency made concerted efforts to provide or arrange for appropriate services, such as those needed to ensure the child's safety and enhance the parents' ability to provide care and supervision. For example, if a parent's substance use disorder is associated with the neglect that brought the case to the attention of the agency, then substance abuse treatment would be an appropriate and required service.
The CFSRs assess State efforts to address the overall mental/behavioral health needs of children, which may include needs relating to substance abuse by the children and/or their parents, through exploration of questions such as:
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?
Did the agency provide appropriate services to address the children's and parents' mental/behavioral health needs?
How effective is the State's array of services in meeting the needs of the children and families it serves, including in-home and foster care cases?
How effective is the agency in providing services, when appropriate, to prevent removing children from their homes?
In addition to using the CFSRs as a learning tool by studying and applying the results from the first round of reviews, substance abuse treatment professionals and/or State substance abuse officers may participate directly in the CFSR process in a variety of ways. Possible opportunities for substance abuse professionals include participating in the development of the Statewide Assessment; serving on a review team to help review cases and conduct interviews; being interviewed as a treatment provider during stakeholder interviews conducted at each review site; or participating in the development of the PIP. Other participants in the process may include persons from the courts, State health program, Medicaid program, or State mental health agency, along with substance abuse treatment providers.
State substance abuse offices should participate in the development of PIP strategies and action steps that will improve outcomes for families with substance use disorders. Information on the number and outcomes of referrals from child welfare agencies or the dependency court system, where available, also would be useful to enhance the PIP development process.
Findings From the First Round of CFSRs
The CFSRs record the primary reason a child welfare case was opened during the period under review. These reasons may include substance abuse by the parents or the child. Information reported during the first round of reviews on the reasons for agency involvement validated the commonly held belief that parental substance use disorders were a major factor in opening child protective services cases 1. The reviews also found a lack of sufficient substance abuse treatment services for both parents and children in many States. In some States, collaborative work between the child welfare agency and substance abuse treatment agencies was identified as a strength, and family drug courts helped to ensure the provision of treatment services and closer monitoring of clients. With respect to PIP development, the need for training was emphasized, along with a need for new competency-based curricula on substance abuse issues in some States. Specialized teams working with families were noted as needing to include substance abuse workers.
More Information
Substance abuse 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.
An analysis of State-by-State details on substance abuse issues from the first round of reviews is provided in "A Review of Alcohol and Other Drug Issues in the States' Child and Family Services Reviews and Program Improvement Plans," available at http://www.ncsacw.samhsa.gov/files/SummaryofCFSRs.pdf (PDF - 463 KB).
Another resource for learning more about the CFSRs and substance abuse issues is the National Center on Substance Abuse and Child Welfare (NCSACW), a service of the Department of Health and Human Services' Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, and the Administration for Children and Families, Children's Bureau's Office on Child Abuse and Neglect. NCSACW maintains an extensive library of resources on the intersection of alcohol and other drug, child welfare, tribal child welfare, and family court systems. The NCSACW Web site, http://www.ncsacw.samhsa.gov, provides a wide range of online resources. In addition, NCSACW has developed online tutorials for substance abuse counselors and child welfare workers. For more information on NCSACW, see http://www.acf.hhs.gov/programs/cb/tta/nrc/ncsacw.htm.
1 A Review of Alcohol and Other Drug Issues in the States' Child and Family Services Reviews and Program Improvement Plans," available at http://www.ncsacw.samhsa.gov/files/SummaryofCFSRs.pdf. back