History of the CFSRs

Federal legislation established the authority for the Child and Family Services Reviews (CFSR) process. In 1994, Congress passed amendments to the Social Security Act authorizing the U.S. Department of Health and Human Services, through the Children’s Bureau, to review State child and family service programs to ensure State conformity with titles IV-B and IV-E. Subsequently, the Adoption and Safe Families Act of 1997 (ASFA) influenced the design of the reviews by emphasizing the child welfare goals of safety, permanency, and child and family well-being.

The CFSRs are administered by the Children's Bureau. A video (length: 13:30) by Will Hornsby of the CFSR Unit provides more information on the history, status, key operating principles, and structure of the review process. You can also read the script of the video.

Watch the Video

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Read the Script

This script contains the text of the video by Will Hornsby of the Children's Bureau.

Hello. My name is Will Hornsby, and I am a child welfare program specialist for the Children’s Bureau Child and Family Services Reviews Unit within the Administration for Children and Families. I’m going to provide a brief overview of the history of the Child and Family Services Reviews, or CFSRs; the key operating principles of the reviews; and the structure of the reviews.

Context for the Reviews

First, let me set the stage for you with a bit of history about the CFSRs.

Federal legislation established the authority for the review process. In 1994, Congress passed amendments to the Social Security Act authorizing the U.S. Department of Health and Human Services, through the Children’s Bureau, to review State child and family service programs to ensure State conformity with titles IV-B and IV-E. Subsequently, the Adoption and Safe Families Act of 1997, or ASFA, influenced the design of the reviews by emphasizing the child welfare goals of safety, permanency, and child and family well-being. ASFA established timeframes for achieving these goals and set forth the responsibility of child welfare agencies to improve outcomes by including families in case planning and by collaborating with community groups and institutions that have an impact on child welfare.

While the Children’s Bureau has the authority to assess compliance, it also is committed to the underlying philosophy of the legislation. That is, the evaluative component of the reviews is designed to be used to identify elements within child welfare systems that are working best to improve outcomes for children and families. That knowledge, in turn, is used to improve child welfare systems across the nation.

The Bureau spent a number of years designing and pilot-testing the reviews and incorporated hundreds of comments from the field into the Final Rule (published in the Federal Register in January 2000). The first round of CFSRs was launched in August 2000, when the first States began their required assessments.

We completed the first round of reviews in 2004. Between Federal fiscal years 2001 and 2004, child welfare programs in all States, the District of Columbia, and Puerto Rico were reviewed using the CFSR process. None of the States, the District of Columbia, or Puerto Rico achieved substantial conformity with respect to all seven child welfare outcomes and seven systemic factors. As a result, all were required to develop Program Improvement Plans, or PIPs, to address areas in which they were found to be out of conformity.

Since implementation of the reviews, the Children’s Bureau has taken many actions to improve the CFSR process:

  • We compiled lessons learned and recommendations from State child welfare agency administrators regarding the first round.
  • We assessed comments about the review process from various sources, including local, county, and State child welfare staff; Federal government child welfare staff; and national child welfare organizations.
  • We retained a consultant to convene a work group of State child welfare agency administrators and researchers to gather information on how the review process could be improved.
  • We established work groups consisting of National Review Team, or NRT, staff and consultants. (The NRT comprises staff from the Children’s Bureau and the Bureau’s Regional Offices who provide leadership to the review teams in planning and conducting the CFSRs.) These work groups then developed strategies for enhancing the review process in five areas: collaboration, helping States build on their prior CFSR and PIP, revising the format of the debriefing process and exit conferences, revising the case sampling strategy, and developing a process for ongoing NRT collaboration and communication.
  • We revised and improved measures for developing State data profiles.
  • We redesigned the Statewide Assessment Instrument, Onsite Review Instrument, and Stakeholder Interview Guide.
  • And finally, we automated the Onsite Review Instrument and the Stakeholder Interview Guide, which will allow for the instant compilation of preliminary review information for presentation at the exit conference and will provide a basis for the Final Reports.

Review Operating Principles

Now that we’ve covered the history of the reviews, let’s look at the key operating principles of the CFSR process. These principles were established for the first round of reviews and will be maintained as standards for the second round. The operating principles are as follows:

First, the reviews represent a partnership between the Federal and State governments. As such, the Children’s Bureau Central and Regional Office and the State child welfare agency work together to prepare for the review. During the 9 months before the onsite review, the Federal staff, via the Child Welfare Reviews Project, convenes at least five planning conference calls with the State, and the State completes a Statewide Assessment.

The second principle is that the reviews examine State programs from two perspectives: first, the outcomes for children and families of services provided and, second, the systemic factors that affect those outcomes.

We look at seven outcomes of services provided:

Two Safety Outcomes

  • Safety Outcome 1 is that children are protected from abuse and neglect.
  • Safety Outcome 2 is that children are safely maintained in their own homes.

Two Permanency Outcomes

  • Permanency Outcome 1 is that children have permanency and stability in their living arrangements.
  • Permanency Outcome 2 is that the continuity of family relationships and connections is preserved for children.

Three Child and Family Well-Being Outcomes

  • Well-Being Outcome 1 is that families have enhanced capacity to provide for their children’s needs.
  • Well-Being Outcome 2 is that children receive appropriate services to meet their educational needs.
  • Well-Being Outcome 3 is that children receive adequate services to meet their physical and mental health needs.

Outcomes are assessed primarily on case record reviews and case-related interviews conducted during the onsite review and on national data standards for safety and permanency measures.

When assessing outcomes, we are really talking about how the child welfare system in each State is serving the child or children and family whose case is being reviewed. For example, did the agency provide appropriate services to prevent a particular child’s entry into foster care?

However, for two of the outcomes, Safety Outcome 1 and Permanency Outcome 1, decisions about substantial conformity are based on both the onsite case review findings and on data indicators. For these outcomes, six national standards have been established for the data indicators. For the State to achieve substantial conformity on these outcomes, the State data must meet these standards. In addition, the case record review must indicate that the State is in substantial conformity.

As I mentioned previously, we also examine systemic factors that affect the agency’s ability to help children and families achieve those positive outcomes. The systemic factors are the statewide information system, the case review system, the quality assurance system, staff and provider training, the service array and resource development, agency responsiveness to the community, and foster and adoptive parent licensing, recruitment, and retention.

Information about the systemic factors is obtained through the Statewide Assessment and through interviews with State and local stakeholders conducted during the onsite review.

When referring to systemic factors, we are talking about how aspects of the State child welfare system as a whole are performing and how these are affecting outcomes for children and families involved with the child welfare system. For example, how effectively has the State implemented licensing or approval standards for foster family homes and child care institutions so that these standards ensure the safety and health of children in foster care?

In addition, the reviews provide a comprehensive look at services provided to children and families, covering child protective services, foster care, adoption, family preservation and family support, and independent living. The reviews focus on how all of the State’s child welfare programming affects outcomes for children and families.

Third, the reviews are designed to identify both the State agency’s strengths and areas needing improvement for each of the outcomes and systemic factors. The reviews include a program improvement process that States use to make improvements, where needed, and build on identified State strengths.

The fourth principle is that the reviews use multiple information sources to assess State performance. These sources of information include the Statewide Assessment; data indicators; case record reviews; interviews with children, parents, foster parents, social workers, and other professionals working with a child; and interviews with State and community stakeholders. Using multiple sources of information enables reviewers to gain a comprehensive picture of a system, which often is not achieved when looking only at case records.

The fifth key operating principle is that central to this review process is the promotion of sound practice principles believed to support improved outcomes for children and families. Those principles include family-centered practice, community-based services, strengthening parental capacity to protect and provide for children, and individualizing services that respond to the unique needs of children and families.

The sixth principle is that the reviews emphasize the accountability of States to the children, families, and communities that they serve. While the review process supports States in making program improvements before having Federal funds withheld due to nonconformity, there are significant penalties associated with failure to make improvements needed to attain substantial conformity. The Children’s Bureau makes no apologies for this approach. The Bureau’s goal is to ensure that children and families receive the best services possible.

This leads directly to the seventh principle. The reviews are designed to drive program improvements through focus on improving systems. Reviewers identify State program strengths that can be used to make improvements in other program areas where and when they are needed. The Children’s Bureau provides support to States during the Program Improvement Plan development and process.

And finally, the eighth principle is that the reviews focus on enhancing States’ capacity to become self-evaluating. By conducting the Statewide Assessment and participating in the onsite review, States engage in a process for examining outcomes for children and families and the systemic factors that affect those outcomes. States then can adapt, if desired, the process for use in their own quality assurance efforts to conduct ongoing evaluations of their systems and programs.

Review Structure

So what actually happens during a Child and Family Services Review? The CFSR is comprised of two phases: the Statewide Assessment, which the State completes in the 6 months before the onsite review, and the onsite review.

In the first phase, the Statewide Assessment Team completes a Statewide Assessment, using data indicators to evaluate the programs under review and examine the systemic factors subject to review.

In the second phase, the Onsite Review Team examines outcomes for a sample of children and families served by the State during a specific period (known as the Period Under Review) by doing two things:

  • First, conducting case record reviews and case-related interviews. These are designed to assess the quality of services provided in a range of areas.
  • Second, conducting State and local stakeholder interviews. The interviews are designed to provide information about the systemic factors that affect the quality of those services.

States determined not to be in substantial conformity with any of the outcomes or systemic factors must develop a PIP to address each area of nonconformity.

On behalf of the Child and Family Services Review Team and the Children’s Bureau, thank you for taking the time to watch this video. We hope that you’ve found it helpful and informative and that you will take advantage of the other training modules available on this training site. The resource section of this training module provides access to relevant CFSR documents that will provide you with more specific information in each of these areas we have reviewed. For more information on the CFSRs, visit the Children’s Bureau Web site at www.acf.hhs.gov/programs/cb/ or e-mail cw@jbsinternational.com. The Children’s Bureau appreciates your interest in the Child and Family Services Reviews and welcomes your questions and suggestions.