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Improved, but Exploring Health Care Options and Providing Specialized 
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United States Government Accountability Office: 

GAO: 

Report to the Chairman, Committee on Government Reform, House of 
Representatives: 

September 2006: 

D.C. Child And Family Services Agency: 

Performance Has Improved, but Exploring Health Care Options and 
Providing Specialized Training May Further Enhance Performance: 

D.C. Child and Family Services: 

GAO-06-1093: 

GAO Highlights: 

Highlights of GAO-06-1093, a report to the Chairman, Committee on 
Government Reform, House of Representatives 

Why GAO Did This Study: 

The District of Columbia’s Child and Family Services Agency (CFSA) has 
a history of serious performance problems. A court case in 1989 set in 
motion sweeping efforts to improve the District’s child welfare system. 
Since then, CFSA has worked to meet performance requirements ordered by 
the U.S. District Court. However, recent reports by the court monitor 
show that CFSA is not meeting performance requirements on many 
measures. To update Congress, we assessed (1) whether CFSA is likely to 
meet requirements by December 2006; (2) what factors, if any, hinder 
the agency from meeting requirements; (3) how CFSA is monitoring its 
progress; and (4) the extent to which CFSA has implemented initiatives 
to achieve unmet requirements. To conduct this work, we reviewed 
reports by CFSA and the court monitor and interviewed stakeholders, 
including the court monitor and CFSA managers, supervisors, and 
caseworkers. 

What GAO Found: 

CFSA has made progress, but the agency is not likely to meet all of the 
court-ordered requirements by December 2006, based on the recent court 
monitor’s report and our work. From December 2005 to April 2006, CFSA 
improved its performance and met some benchmarks. However, CFSA’s 
performance on other requirements remains well below benchmarks, 
raising questions about the agency’s ability to meet all of the court-
ordered requirements by December and sustain the improvements it has 
made. For example, only 29 percent of children in foster care received 
medical evaluations within 30 days of placement in April 2006, despite 
a benchmark of at least 90 percent. 

Several factors—complex caseloads and shortages of health care 
providers and qualified foster and adoptive homes—hinder CFSA’s ability 
to meet court-ordered requirements. CFSA’s cases are complex, in part 
because of the high proportion of hard-to-place teenagers and children 
with medical or mental health needs in the District’s child welfare 
system. Caseworkers reported that they do not have enough specialized 
training to help them develop the skills they need to address these 
caseload complexities. CFSA’s effort to meet court-ordered time frames 
is complicated in a small number of cases—those involving severe 
physical or sexual abuse—by the difficulty of coordinating with the 
District’s Metropolitan Police Department. At the same time, CFSA 
officials told us there is a shortage of health care providers to serve 
these children, and the limited number of qualified foster and adoptive 
homes hinders CFSA’s ability to give children the most appropriate and 
timely placements. 

CFSA uses routine reports and qualitative studies to determine whether 
it is meeting requirements, but current data may not provide an 
accurate picture of the agency’s progress. Implementing the agency’s 
new Web-based case management system has been challenging and 
caseworkers reported that because of these implementation difficulties, 
they have not always entered complete and accurate data on their cases 
into the system. However, CFSA has recently taken a number of steps to 
resolve these issues, including, for example, issuing frequent system 
upgrades to address identified problems and developing enhanced system 
training for caseworkers. 

Within the past few years, CFSA has implemented several initiatives to 
address the challenges it faces and achieve remaining requirements, but 
it may be too soon to know if they will yield long-term results. CFSA 
has hired new staff and reorganized existing staff to focus on key 
areas. In addition, CFSA has implemented new practices, such as a tool 
to prioritize investigations based on risk. CFSA is also beginning to 
hold its management staff and private contractors accountable for 
helping the agency meet specific performance requirements. Many of 
these initiatives seem reasonable, but it is too soon to tell whether 
these efforts will help CFSA meet the remaining court-ordered 
requirements. 

What GAO Recommends: 

GAO recommends that the Mayor of the District of Columbia (1) direct 
CFSA to provide caseworkers with specialized training that addresses 
caseload complexities, and (2) explore options for increasing the pool 
of health care providers. In its comments, CFSA agreed with our 
findings and recommendations, noting that the agency has made more 
progress since April 2006. 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-1093]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Cornelia Ashby at (202) 
512-7215 or ashbyc@gao.gov. 

[End of Section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

CFSA Has Met Some Court-Ordered Requirements, but Is Not Likely to Meet 
All Requirements by December 2006: 

Several Factors Hinder CFSA's Progress in Meeting Performance 
Requirements: 

CFSA Uses Routine Reports and Qualitative Studies to Monitor Its 
Progress toward Meeting Court-Ordered Requirements, but Current Data 
May Not Provide an Accurate Picture: 

CFSA Has Implemented Several Initiatives to Help Achieve Unmet 
Requirements, but It May Be Too Soon to Know if They Will Yield Long- 
term Results: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments: 

Appendix I: Scope and Methodology: 

Appendix II: Comments from D.C. Child and Family Services Agency: 

Appendix III: GAO Contact and Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Performance on Key Unmet Court-Ordered Requirements, April 
2006: 

Table 2: CFSA Initiatives Addressing Key Unmet Court-Ordered 
Requirements: 

Figure: 

Figure 1: Timeline of CFSA's Key Initiatives: 

Abbreviations: 

CFSA: Child and Family Services Agency: 

CSSP: Center for the Study of Social Policy: 

QSR: Quality Service Review: 

STAR: Stabilization and Replacement: 

United States Government Accountability Office: 
Washington, DC 20548: 

September 28, 2006: 

The Honorable Tom Davis: 
Chairman: 
Committee on Government Reform: 
House of Representatives: 

Dear Mr. Chairman: 

Over the years, the District of Columbia's (the District) Child and 
Family Services Agency (CFSA)--the city's agency responsible for 
protecting children from abuse or neglect and, when necessary, placing 
them in appropriate foster or adoptive homes--has had serious 
management and performance problems that have hindered its ability to 
protect some of the children in its care. In June 1989, a lawsuit was 
filed in the U.S. District Court for the District of Columbia on behalf 
of children in the District's foster care system and the thousands of 
children who had been abused or neglected in the District. The court 
found that the District failed to (1) investigate reports of abuse or 
neglect in a timely manner, (2) make appropriate foster care 
placements, (3) monitor the care children received, and (4) adequately 
ensure children had permanent homes. This court case set in motion 
efforts to reform the District's child welfare system, beginning with a 
federal takeover of the agency. In 1995 the court placed the agency in 
full receivership, an arrangement in which the court appoints a person 
with broad authority to temporarily manage the agency. The agency has 
since been removed from receivership but continues to be monitored by 
the Center for the Study of Social Policy (CSSP), which has been acting 
in the capacity of court-appointed monitor since 1991. The monitor is 
responsible for assessing CFSA's progress in meeting performance 
requirements that cover the full range of CFSA's work. CFSA is 
scheduled to exit from the court monitor's supervision in December of 
this year if it is performing at an acceptable level on these court- 
ordered requirements. The parties will attempt to agree on an 
acceptable level of performance in negotiations this fall. 

Prior GAO work and recent assessments by the court monitor indicate 
that while CFSA has made progress in some areas, there remain concerns 
about whether the agency will be able to meet all court-ordered 
requirements by December 2006. The monitor reported that as of April 
2006, CFSA had not met most of the requirements, and the agency's 
performance had declined in some areas. Additionally, the monitor was 
not able to determine whether CFSA had made progress in several areas 
because no data were available. In order to provide Congress with an 
update on CFSA's performance, we assessed (1) whether CFSA is likely to 
meet court-ordered requirements by December 2006; (2) what factors, if 
any, hinder the agency from meeting requirements; (3) how CFSA is 
monitoring its progress toward meeting unmet requirements; and (4) the 
extent to which CFSA has implemented initiatives or developed plans to 
achieve unmet requirements. 

In conducting this work, we held group interviews with a random sample 
of CFSA caseworkers and supervisors, and we interviewed CFSA managers, 
the court-appointed monitor, and other District child welfare experts, 
including officials from the Consortium for Child Welfare--a coalition 
of nonprofit service agencies established to improve child welfare 
services in the District. We also reviewed the court-appointed 
monitor's progress reports and various CFSA documents, such as 
handbooks, guidance, and policies. Our review focused on key 
requirements related to managing child welfare cases that remained 
unmet as of December 2005. We conducted our work between May and 
September 2006 in accordance with generally accepted government 
auditing standards. A complete description of our scope and methodology 
is in appendix I. 

Results in Brief: 

CFSA has made progress in meeting some of its court-ordered 
requirements, but the agency is not likely to meet all of its 
requirements by December 2006, based on the recent court monitor's 
report and our work. From December 2005 to April 2006, CFSA improved 
its performance and met benchmarks for a number of requirements, such 
as ensuring that children under age 12 are not routinely placed in 
group settings. In some areas, the data show an improvement in 
performance even though CFSA has yet to meet benchmarks. For example, 
61 percent of children who are in out-of-home placements were placed 
with some or all of their siblings as of April, an improvement of 5 
percentage points from December. However, CFSA's performance on several 
requirements is well below benchmarks. For example, as of April 2006 
only 29 percent of children in foster care had received medical 
evaluations within 30 days of placement despite a court-ordered 
benchmark of at least 90 percent. This raises questions about the 
agency's ability to meet all of the court-required benchmarks by 
December and to sustain the improvement it has made. 

Several factors--including complex caseloads, and shortages of health 
care providers, and qualified foster and adoptive homes--hinder CFSA's 
ability to meet court-ordered requirements, according to CFSA 
officials, caseworkers, and the court monitor. CFSA's cases are 
complex, in part because of the high proportion of hard-to-place 
teenagers and children with medical or mental health needs in the 
District's child welfare system. Caseworkers reported that they do not 
have enough specialized training or adequate support from supervisors 
to help them develop the skills they need to address the complexities 
of their caseloads, particularly when cases involve children who have 
behavioral problems or have experienced domestic violence. Furthermore, 
CFSA's effort to meet time frames is complicated in a small number of 
cases by difficulty in coordinating with the District's Metropolitan 
Police Department. At the same time, CFSA officials told us there is a 
shortage of medical, dental, and mental health care providers. 
Officials told us this is partly because District reimbursement rates 
for Medicaid--the joint federal-state health care financing program 
that covers low-income children, including certain children in foster 
care and adoptive placements--are lower than the average fees providers 
charge. Furthermore, a shortage of qualified foster and adoptive homes 
in the District hinders CFSA's ability to meet some requirements, such 
as giving children the most appropriate foster care placements, placing 
siblings together, and ensuring timely adoptions. Several factors, such 
as the changing demographics of the District, contribute to this 
shortage, and a lack of border agreements with Maryland and Virginia 
makes it difficult for CFSA to look across District boundaries to place 
children with family members or in other homes in the surrounding 
suburbs. 

CFSA uses routine reports and qualitative studies to monitor its 
progress toward meeting unmet requirements, but current data may not 
accurately portray the agency's progress. CFSA generates a number of 
daily and monthly data reports that allow managers to track performance 
on the court-ordered requirements as well as develop strategies to 
improve performance. In addition, CFSA uses information from 
interviews, focus groups, and surveys of caseworkers, managers, and 
families to get a more complete picture of how the agency is 
performing. However, the data CFSA uses may not accurately portray 
progress toward meeting requirements, because of challenges in 
implementing a new Web-based case management system and caseworkers not 
always entering accurate and complete data. The agency is working to 
resolve these issues by offering training and other support for 
caseworkers and others using the new system. The court monitor recently 
reported that data issues related to the implementation of the Web- 
based system should be resolved soon. 

Within the past few years, CFSA has implemented a number of initiatives 
to address the challenges it faces and to help meet court-ordered 
requirements, but it may be too soon to know if they will yield long- 
term results. CFSA has hired new staff and reorganized existing staff 
to focus resources in key areas. For example, CFSA has hired additional 
caseworkers to improve its ability to conduct investigations in a 
timely manner, but is not yet meeting benchmarks in this area. CFSA has 
also implemented new practices, including a standardized process to 
screen calls to its telephone hotline reporting child abuse or neglect. 
Caseworkers use established risk factors, such as the number of 
children involved in a case or the parent's criminal history, to screen 
calls and prioritize investigations. This approach allows CFSA to 
better focus its resources on its most urgent cases and refer others to 
community agencies to provide appropriate services to assist the 
family. In addition, CFSA is beginning to hold its management staff as 
well as private contractors accountable for helping the agency meet 
specific performance requirements. For example, CFSA found that private 
contractors who manage the cases of about 40 percent of CFSA's children 
and families were performing at a lower level than CFSA caseworkers on 
certain requirements, such as making frequent home visits to children 
and their families. The agency reported that it has taken a number of 
steps to improve contractors' performance, including holding monthly 
meetings to review expectations and resolve problems. Agency officials 
told us they will link contractors' pay to achieving specific outcomes 
in 2007. Many of these initiatives seem reasonable, but it is too soon 
to tell whether these efforts will help CFSA meet court-ordered 
requirements. 

We are recommending that the Mayor of the District of Columbia direct 
CFSA to provide caseworkers with specialized training to help them 
address the complexities of their caseloads, and explore options for 
increasing the number of providers for mental health, medical, and 
dental services. In its written comments, CFSA agreed with our findings 
and recommendations. Additionally, CFSA suggested several changes to 
help clarify the report, which we incorporated as appropriate. The 
comments are shown in appendix II. 

Background: 

CFSA is responsible for ensuring the safety and well-being of children 
at risk for abuse and neglect in the District, but many children in 
CFSA's care languished for long periods of time due to managerial 
shortcomings and long-standing organizational divisiveness in the 
District. In 1989, the American Civil Liberties Union sued the District 
on behalf of children who were in foster care and other abused and 
neglected children over the quality of services the city was providing 
to them. In 1991 the U.S. District Court for the District of Columbia 
heard the case, found the District's child welfare agency liable and 
issued a remedial order in 1991 to improve performance. [Footnote 1] 
When that remedial order and other orders did not result in sufficient 
improvement, the court placed the agency under full receivership in 
1995.[Footnote 2] After 6 years under receivership, CFSA was 
reorganized as a District cabinet-level agency, a change that gave the 
agency more control over its staff and budget. 

The court appointed CSSP to monitor the agency's compliance with the 
court's orders, including the performance requirements set forth in the 
court order releasing CFSA from receivership and the related plan for 
implementing the order. In 2003, a final implementation plan was 
approved by the District Court and included court-ordered requirements 
that cover the full range of CFSA's work. Some of the requirements are 
related to managing child welfare cases, such as initiating and 
conducting timely and quality investigations of child abuse and neglect 
allegations, providing a range of services to children and their 
families, and placing children in appropriate foster or adoptive homes. 
There also are requirements related to the administration and 
management of the agency, such as CFSA's information systems and 
financial management. The implementation plan also established court- 
ordered benchmarks--or expected performance levels--for CFSA to meet on 
each requirement and, for most of the requirements, set interim 
benchmarks that gradually increased over time until reaching full 
compliance. For example, the court mandated that investigations of 
abuse or neglect must be completed within 30 days. By June 30, 2003, 60 
percent of cases had to meet that time frame. This benchmark gradually 
increases at 6-month intervals until reaching the benchmark of full 
compliance by December 30, 2006. However, the court has not yet 
established a precise performance level that defines full compliance; 
the court monitor expects these negotiations to begin this fall. 

Generally, families become involved with the child welfare system after 
someone--a neighbor, teacher, or other individual--reports to CFSA 
through its telephone hotline that the child has been abused or 
neglected. CFSA then investigates to determine whether the report can 
be substantiated. If agency investigators determine that it is safe for 
the child to remain at home with his or her parents or guardians, CFSA 
relies on community agencies, such as the Healthy Families/Thriving 
Communities Collaboratives,[Footnote 3] to provide services to help the 
family, including parenting skills classes, if needed. If required, the 
child may be removed from the home, necessitating court proceedings. 

CFSA caseworkers are responsible for managing foster care cases by 
developing case plans; visiting the children; participating in 
administrative review hearings involving CFSA officials, children, 
parents, attorneys, and other officials; attending court hearings; and 
working with other District government agencies. CFSA caseworkers are 
also responsible for documenting in the agency's case management system 
the steps taken and decisions made related to a child's safety, well- 
being, and foster care placements, as well as those related to 
developing the most appropriate goal for permanency. Depending on their 
circumstances, children leave foster care and achieve permanency by 
being (1) reunified with their birth or legal parents, (2) adopted, (3) 
placed in the legal guardianship of a relative, or (4) declared 
independent at the age of 18. Caseworkers are assigned to various units 
responsible for providing services to children and families. CFSA 
program managers and supervisors within those units are responsible for 
providing the necessary guidance and support needed by caseworkers to 
manage their cases. 

CFSA relies on other District agencies and private organizations to 
help achieve its mission. For example, CFSA has a contract with 
Children's National Medical Center, known as DC Kids, to provide 
medical evaluations for children when they enter CFSA's care and for as 
long as they remain in the system. In addition, CFSA relies on private 
dental and mental health care providers to give children dental care 
and psychological or psychiatric evaluations. Some private 
organizations, such as Catholic Charities, manage about 40 percent of 
CFSA's cases, including preparing case plans for children placed in 
foster care and those that remain in the home, making home visits, or 
providing for visitations between siblings or parent and child. CFSA 
also works with agencies in Maryland, Virginia, and other states to 
arrange for placements for District children. CFSA is responsible for 
licensing and monitoring organizations in the District with which it 
contracts, including group homes that house foster care children. Also, 
CFSA oversees the licensing and monitoring for organizations outside of 
the District where children are placed. 

CFSA Has Met Some Court-Ordered Requirements, but Is Not Likely to Meet 
All Requirements by December 2006: 

CFSA has met some court-ordered requirements, but the agency is not 
likely to meet all of its requirements by December 2006, according to 
the recent court-monitor's report and our work. From December 2005 to 
April 2006, CFSA showed progress, meeting court-required benchmarks in 
areas such as limiting to five the number of caseworkers assigned to 
each supervisor, ensuring that children age 12 and under are not 
routinely placed in group settings, and ensuring that children do not 
stay in emergency placements for more than 30 days. In addition, the 
data show an improvement in some requirements, even though CFSA has yet 
to meet the court-required benchmarks. For example, 61 percent of 
children who are in out-of-home placements were placed with some or all 
of their siblings as of April, an improvement of 5 percentage points 
from December. In other areas, CFSA's performance was stagnant. For 
example, CFSA is required to initiate all investigations within 48 
hours after receiving a report of abuse or neglect. CFSA did so in 70 
percent of cases in December, and as of April its performance was still 
at 70 percent.[Footnote 4] 

However, performance on the majority of requirements still did not meet 
the court-required benchmarks, and in some cases fell seriously below 
benchmarks.[Footnote 5] For example, despite a benchmark set at 90 
percent,[Footnote 6] only 29 percent of children in foster care had 
received medical evaluations as of April 2006, and data were not 
available for the percentage of children who received dental 
evaluations. This raises questions about the agency's ability to meet 
the court-required benchmarks by December and to sustain the 
improvements it has made.[Footnote 7] Table 1 shows CFSA's performance 
on key unmet requirements as of April 2006. 

Table 1: Performance on Key Unmet Court-Ordered Requirements, April 
2006: 

Numeric benchmark: 
Performance level achieved: 
Whether met benchmark: 

Key unmet requirements: Timeliness of investigations; 
* Investigations initiated within 48 hours; 
April 2006: Numeric benchmark: 90 percent[A]; 
April 2006: Performance level achieved: 70 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Timeliness of investigations; 
* Investigations completed within 30 days; 
April 2006: Numeric benchmark: 90 percent[A]; 
April 2006: Performance level achieved: 39 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Comprehensive investigations of abuse and 
neglect reports in foster homes and institutions; 
April 2006: Numeric benchmark: 95 percent; 
April 2006: Performance level achieved: 62 percent initiated within 48 
hours; 76 percent closed within 30 days; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Appropriate and timely physical and 
psychological evaluations; 
* Children receive appropriate medical, psychological, or psychiatric 
evaluations when necessary as part of an investigation of abuse or 
neglect; 
April 2006: Numeric benchmark: 80 percent;  
April 2006: Performance level achieved: 53 percent (medical); 40 
percent (psychological/psychiatric); 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Appropriate and timely physical and 
psychological evaluations; 
* Children in foster care receive a full medical and dental evaluation 
within 30 days of placement; 
April 2006: Numeric benchmark: 90 percent; 
April 2006: Performance level achieved: 29 percent (medical)[C]; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Appropriate caseloads for case workers and 
supervisors; 
* Workers conducting investigations have no more than 12 investigations 
at a time; 
April 2006: Numeric benchmark: 0 percent of workers have more than 12 
cases; 
April 2006: Performance level achieved: 40 percent have more than 12 
cases; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Appropriate caseloads for case workers and 
supervisors; 
* Supervisors are responsible for no more than five caseworkers; 
April 2006: Numeric benchmark: 95 percent of supervisors; 
April 2006: Performance level achieved: 92 percent;  
April 2006: Whether met benchmark: Benchmark met[B]. 

Key unmet requirements: Appropriate caseloads for case workers and 
supervisors; 
* Supervisors do not manage cases unless a caseworker leaves without 
providing notice, and in such circumstances, only for a 5-day period; 
April 2006: Numeric benchmark: 90 percent of supervisors[A]; 
April 2006: Performance level achieved: 55 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Increased visitations for children and 
families; 
* Caseworkers visit homes in which there has been abuse and neglect to 
ensure children can live with birth parents safely with services; 
April 2006: Numeric benchmark: 90 percent (once/month) 40 percent 
(twice/ month); 
April 2006: Performance level achieved: 61 percent (once/ month) 20 
percent (twice/month); 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Increased visitations for children and 
families; 
* Children placed apart from their siblings visit some or all of their 
siblings at least two times per month; 
April 2006: Numeric benchmark: 70 percent; 
April 2006: Performance level achieved: 26 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Increased visitations for children and 
families; 
* Children in foster care and their birth parents visit weekly, if CFSA 
has a goal to reunify them; 
April 2006: Numeric benchmark: 85 percent[A]; 
April 2006: Performance level achieved: 13 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Appropriate referrals to community agencies; 
* Families who are the subject of a report of neglect/abuse that is 
determined to be unsubstantiated are referred to an appropriate 
community agency for services; 
April 2006: Numeric Benchmark: 70 percent; 
April 2006: Performance level achieved: 8 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Children are given the most appropriate out-of- 
home placements; 
* Children in out-of-home placement are placed with some or all of 
their siblings; 
April 2006: Numeric Benchmark: 75 percent; No more than 25 children; 
April 2006: Performance level achieved: 61 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Children are given the most appropriate out-of- 
home placements; 
* Children under 12 are not routinely placed in congregate care 
settings; 
April 2006: Numeric Benchmark: No more than 20 children; 
April 2006: Performance level achieved: 21 children; 
April 2006: Whether met benchmark: Benchmark substantially met[B]. 

Key unmet requirements: Children are given the most appropriate out-of- 
home placements; 
* Children under age 6 are not placed in a group setting unless they 
have exceptional needs; 
April 2006: Numeric Benchmark: No more than 5 children[A]; 
April 2006: Performance level achieved: 10 children; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Children are given the most appropriate out-of- 
home placements; 
* Foster homes, group homes, and independent living facilities have a 
current and valid license; 
April 2006: Numeric Benchmark: 95 Percent; No more than 25 children; 
April 2006: Performance level achieved: 80 percent (foster homes) 97 
percent (group homes) 69 percent (independent living); 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Children are given the most appropriate out-of- 
home placements; 
* Children will not stay in emergency facilities for more than 30 days; 
April 2006: Numeric Benchmark: No more than 25 children; 
April 2006: Performance level achieved: 22 children; 
April 2006: Whether met benchmark: Benchmark met. 

Key unmet requirements: Reduce multiple placements of children in 
foster care; 
* Fewer children in foster care have three or more placements in a 12-
month period; 
April 2006: Numeric Benchmark: No more than 5 percent; 
April 2006: Performance level achieved: 18 percent; 
April 2006: Whether met benchmark: Not met. 

Key unmet requirements: Timely adoptions; 
* Children are in approved adoptive placement within 9 months after 
CFSA sets a goal of adoption; 
April 2006: Numeric Benchmark: 85 percent; 
April 2006: Performance level achieved: 50 percent; 
April 2006: Whether met benchmark: Not met. 

Source: Center for the Study of Social Policy. "An Assessment of The 
District of Columbia's Progress as of April 30, 2006, in Meeting the 
Implementation and Outcome Benchmarks for Child Welfare Reform." 
(Washington, D.C: July 19, 2006). 

[A] Last numeric benchmark before full compliance. 

[B] As determined by the court monitor. 

[C] No data available on dental care. 

[End of table] 

Several Factors Hinder CFSA's Progress in Meeting Performance 
Requirements: 

Complex cases and shortages of health care providers and qualified 
foster and adoptive homes hinder CFSA's ability to meet court-ordered 
requirements, according to CFSA officials, caseworkers, and the court 
monitor. While caseworkers' caseloads have been reduced because of 
CFSA's efforts to recruit and retain caseworkers, cases are complex, in 
part because of the high proportion of teenagers and children with 
medical or mental health needs. CFSA's efforts to meet court-ordered 
time frames is further complicated in a small number of cases by 
difficulty in coordinating with the District's Metropolitan Police 
Department. At the same time, CFSA officials told us that there is a 
shortage of health care providers to serve these children with health 
care needs, and the limited number of qualified foster and adoptive 
homes hinders CFSA's ability to give children the most appropriate and 
timely placements. 

CFSA Managers and Caseworkers Cited Complex Cases and a Shortage of 
Health Care Providers as Hindrances: 

The complexity of the caseload is hindering CFSA's efforts to meet 
court ordered requirements, according to CFSA officials. While 
caseworkers' caseloads have been reduced as a result of CFSA's efforts 
to recruit and retain caseworkers, cases are complex for a number of 
reasons. First, there is a high proportion of older children in the 
District's child welfare system who are harder to place and may have 
different needs than younger children. This high proportion is due to 
the fact that the District serves children in its care until age 21 
and, historically, CFSA had not been successful finding permanent homes 
for these children when they were younger. As a result, there are 
almost 800 youths aged 16 to 21--almost one-third of the city's current 
foster child population--many of whom have grown up in foster care. 
Second, a large proportion of children within the system have complex 
needs, such as the need for mental health services or for foster 
parents that are licensed to support children with severe medical 
conditions. 

Caseworkers reported not having enough specialized training or adequate 
support from supervisors to help them develop the skills they need to 
address the complexities of their caseloads, including cases involving 
children with behavioral problems or who have experienced domestic 
violence. While CFSA has a comprehensive training curriculum, much of 
the curriculum is focused on developing a base of knowledge, such as 
understanding how children in foster care develop attachment disorders-
-which make it difficult for them to develop healthy relationships with 
primary caregivers--or understanding other separation issues. The court 
monitor recently recommended that in addition to focusing on what the 
caseworker should know and understand, the CFSA curriculum needs to 
identify what the caseworker should do and help the caseworkers develop 
a set of applicable skills. 

CFSA officials told us there is a shortage of health care providers to 
give necessary medical, dental, or mental health services to children 
in the agency's care. These shortages are not unique to the District's 
child welfare system, but they hinder CFSA's ability to meet a number 
of court-ordered requirements. For example, caseworkers told us that 
not having enough doctors and dentists to conduct screenings and 
examinations made it difficult to complete investigations or provide 
routine examinations within required time frames. Specifically, they 
told us that there is not a sufficient number of dentists in the 
District who provide services to CFSA's children. Furthermore, CFSA 
told us that in February 2006, the agency did a competitive request for 
proposals from all District medical providers for a comprehensive 
medical system of care, but received only one bid. While there may be a 
number of reasons for the lack of providers, CFSA officials told us 
that low Medicaid reimbursement rates for children who are residents of 
the District was a major factor.[Footnote 8] 

In a Small Number of Cases, Coordinating with the Police Department Has 
Complicated CFSA's Ability to Meet Time Frames: 

CFSA's ability to meet court-ordered time frames for conducting 
investigations may be complicated in a small number of cases by 
difficulty in coordinating with the District's Metropolitan Police 
Department, which sometimes operates under different time frames and 
priorities. For example, caseworkers told us that they cannot close out 
investigations involving severe physical or sexual abuse without a 
report from the police department. However, the court monitor noted 
that caseworkers and police officials were not consistently 
collaborating in a timely manner as required by a memorandum of 
understanding developed between the two agencies or were not 
documenting their efforts properly in CFSA's data system. While CFSA 
and the police department are required to coordinate on these cases, 
the court monitor reported in February 2006 that, according to CFSA's 
data, joint investigations were held in only 31 percent of such cases. 
To assist with coordination, the monitor recommended that CFSA enlist 
the assistance of the Deputy Mayor for Children, Youth, Families and 
Elders to ensure joint investigations are performed in a timely manner. 
CFSA officials told us that they are taking steps to improve this 
coordination. Officials of the two agencies have begun holding weekly 
meetings to discuss and resolve emerging issues, and CFSA has started 
colocating staff at the police department. However, at this time it is 
too soon to know whether these steps will be effective in helping CFSA 
meet investigation time frames. 

Shortage of Qualified Foster and Adoptive Homes Limits CSFA's Ability 
to Place Children: 

A shortage of qualified foster and adoptive homes is also hindering 
CFSA's ability to meet some requirements, such as giving children the 
most appropriate foster care placements, placing siblings together, and 
ensuring timely adoptions. Several factors are contributing to this 
shortage. The demographics of the District are changing and there are 
fewer qualified homes, according to CFSA and other officials we 
interviewed. They cited an influx of young professionals who are less 
likely to serve as foster parents or adopt children from the child 
welfare system. Officials also reported that the average size of houses 
in the District has decreased over time, with new condominium 
developments that have fewer rooms, and these homes will not readily 
meet accommodation guidelines, particularly when trying to keep 
siblings together. They noted that older houses that are large enough 
to meet standards may require significant investment of resources to 
remove lead paint, which would be a danger for young children. 

In addition, there is a shortage of facilities within the District to 
care for children with special medical or mental health needs. The 
court monitor's recent progress report notes that in April 2006, CFSA 
had placed 82 children in residential settings more than 100 miles away 
from the city for medical or mental health treatment.[Footnote 9] The 
court monitor reported that for 29 children in these facilities, CFSA 
had no plans to bring the children back to the District because of the 
lack of homes and limited availability of specialized services, 
including medical and mental health care services. The court monitor 
recommended that CFSA explore the possibility of developing additional 
resources in the District to serve children with special needs. 

Many children in the District's child welfare system have family 
members living in neighboring states willing to take them in, but 
challenges exist with placing children across state lines. Because of 
the District's proximity to Maryland and Virginia, many of the children 
in CFSA's care have relatives in these other states. However, even when 
children are placed with relatives, the homes must be licensed for 
foster care if the relatives are to be compensated by the District, and 
CFSA does not have agreements with Maryland and Virginia that would 
remove barriers to licensing homes and placing these children. For 
example, the state in which the child would be placed would be required 
to expend its resources to oversee the placement and manage the case, 
including conducting timely home visits and providing services. Because 
the District lacks a border agreement with Maryland and Virginia that 
would speed placements for children with family members across state 
lines, these children may experience multiple placements while waiting 
for the necessary paperwork, including background checks, to be 
completed. CFSA reported that they have recently presented new 
proposals to facilitate interstate placements in Maryland and Virginia, 
and is awaiting a response. 

Recent legislation, signed into law July 3, 2006, and intended to 
expedite the placement of children across state lines, may provide some 
needed assistance to the District. The Safe and Timely Interstate 
Placement of Foster Children Act of 2006 requires both the receiving 
state and the requesting state to act within specified time frames 
(generally 60 days for the receiving state to conduct a study of the 
potential adoption or foster care home and 14 days for the requesting 
state to determine whether making a decision relying on the report 
would be contrary to the welfare of the child).[Footnote 10] Also, the 
act would provide a $1,500 incentive payment to a state for every 
interstate study of an adoption and foster care home completed within 
30 days. 

CFSA Uses Routine Reports and Qualitative Studies to Monitor Its 
Progress toward Meeting Court-Ordered Requirements, but Current Data 
May Not Provide an Accurate Picture: 

CFSA is generating a number of daily and monthly reports to show its 
progress in meeting court-ordered requirements. In addition, CFSA is 
using qualitative information from interviews, focus groups, and 
surveys of caseworkers, managers, and families to get a more complete 
picture of how the agency is performing and to address ongoing 
challenges. However, the data CFSA uses may not accurately portray 
progress toward meeting performance requirements, in part because 
caseworkers do not always enter information completely and accurately 
in the case management data system. CFSA provides training and other 
support for using the new Web-based version of the data system and has 
begun to take steps to address early implementation issues with the new 
system. 

CFSA Generates Daily and Monthly Reports to Track Progress toward 
Meeting Requirements: 

CFSA generates a number of daily and monthly reports to track cases and 
monitor progress toward meeting court-ordered requirements using 
information from FACES, the agency's automated child welfare 
information system. Daily reports allow managers to review the agency's 
performance on cases on a daily basis and contain information such as 
the number of cases in the backlog awaiting investigation, as well as 
the number of children that caseworkers were able to place and the 
nature of those placements. In addition, CFSA produces monthly trend 
reports as required by the court monitor to track progress toward 
meeting court-ordered benchmarks detailed in the Implementation Plan. 
CFSA uses data from the monthly trend reports to develop performance 
scorecards, which use graphics to provide a snapshot of the performance 
of contract agencies and departments within the agency. Each year, CFSA 
compiles these reports and other information into an annual report 
addressing CFSA's progress and some of the challenges faced in 
implementing the court-ordered requirements. As CFSA develops new data 
reports, top CFSA managers told us they have begun to focus less on 
simply complying with the court-ordered requirements and more on using 
the data to develop strategies for program improvement. This approach 
is consistent with that of many high-performing organizations, which, 
as we have reported, continuously assess performance against benchmarks 
and use this information to improve performance.[Footnote 11] 

Qualitative Studies Help CFSA Identify and Address Ongoing Challenges: 

CFSA also collects qualitative data through interviews, focus groups, 
and surveys of caseworkers, supervisors, managers, and families that 
are designed to provide insight as to why some court-ordered 
requirements remain unmet. For example, data show that CFSA has been 
unable to meet the requirement that children placed apart from their 
siblings visit some or all of their siblings at least two times per 
month. CFSA examined the issue further in a sibling placement report 
that used information from interviews and focus groups of placement 
staff and siblings' families to augment data on the number of children 
placed with siblings and how many times they visited each other. The 
report helped CFSA learn some of the underlying reasons that such 
visits may not be taking place--for example, siblings were not placed 
in proximity to each other to easily facilitate a visit. CFSA used the 
report to create strategies to address these issues, such as placing 
children in the same or nearby neighborhoods, and assigning one 
caseworker for all siblings whenever possible. In addition, CFSA issues 
a Needs Assessment Report every 2 years that uses interviews with 
foster parents and CFSA caseworkers to identify and provide strategies 
for addressing the most urgent needs of CFSA clients. 

Similarly, CFSA conducts Quality Service Reviews (QSR) twice a year, 
which involve examining a sample of case files and interviewing as many 
people involved in the cases as possible, including parents, children, 
caseworkers, teachers, and others. The fall 2005 QSR, which examined 39 
cases and included nearly 300 interviews, revealed that overall, the 
children in the cases reviewed were safe, healthy, and living in 
appropriate placements. However, the QSR report identified a number of 
areas in need of improvement, many of which were related to court- 
ordered requirements that CFSA has had difficulty meeting. For example, 
reviewers found that sibling and parental visits were not consistently 
documented in FACES. In response, CFSA developed a number of strategies 
to address these areas, such as creating a caseworker peer review 
system in which caseworkers review each other's work for overall 
quality. 

Data Used to Report Agency Performance May Not Accurately Portray 
Actual Progress Made toward Meeting Court-Ordered Requirements: 

The data that CFSA uses to monitor its progress in meeting the court's 
requirements may not provide an accurate picture of the agency's 
current performance. CFSA released a new, Web-based version of FACES in 
February 2006--FACES.net--to update its older case management system, 
and there have been some challenges with the transition. Caseworkers 
told us that they had found it frustrating to enter information in the 
system and that it could take up to 4 hours to enter the data for a 
single case. Caseworkers, as well as supervisors and CFSA's chief 
information officer, told us that when the FACES.net system was 
initially implemented, it would often crash, resulting in a loss of 
data or in delays in entering the data. Caseworkers commented that 
because of these issues, they often entered less than fully detailed 
case data into the system. These implementation issues may have 
implications for the accuracy and completeness of data that have been 
recorded in the system to date. 

In addition to experiencing problems with the implementation of the new 
system, caseworkers have not always entered some information into the 
correct fields in the database, preventing data from being captured in 
CFSA's progress reports. For example, the court monitor's most recent 
report indicated that of the 444 children in foster care as of April 
2006 with a goal of reunification with their families, more than half 
did not have any documented visits with their parents. However, based 
on the Quality Service Reviews, CFSA concluded that the visits were 
occurring, but the caseworkers were not entering the information into 
FACES.net. In addition, CFSA officials told us that some caseworkers 
have been entering information into narrative case notes rather than 
the appropriate discrete fields in the FACES.net screens. For example, 
a caseworker may visit a child in the family's home and then take him 
or her to visit the doctor. When entering this information in the 
database, the caseworker may record only the family visit in the 
required screen and write up the medical visit in the case notes, which 
cannot be captured in the progress reports. As a result, reports would 
not indicate that the medical visit had occurred. 

CFSA is working to resolve issues with inaccurate or incomplete data in 
FACES.net, and administrators meet monthly to discuss challenges and 
potential resolutions. In addition, the chief information officer told 
us there are several training measures in place for caseworkers and 
contract agencies to receive assistance and training in recording data 
and using the new FACES.net system. For example, CFSA created four 
teams to assist caseworkers with recording case data, and to ensure 
that data are recorded accurately and used appropriately in reports. 
The Child Information Systems Administration also conducts FACES.net 
workdays for CFSA and contract agency employees. These are regularly 
scheduled opportunities for caseworkers to enter data into the 
FACES.net system with the assistance of an information systems 
employee, who can ensure that caseworkers are entering data in the 
correct fields. The Child Information Systems Administration has also 
posted tip sheets for using FACES.net and distributed training manuals 
to caseworkers. 

In addition to training, CFSA is taking additional steps to improve 
FACES.net that may help address some of the earlier implementation 
issues. CFSA issues system upgrades to address identified problems 
every 2 to 3 weeks, and is developing a process to fully test these 
upgrades before implementing them. In addition, CFSA has identified 
individuals from each department within CFSA to act as liaisons between 
the system users and the technical staff so that the system can be 
tested, and problems can be identified early and quickly resolved. 
Officials now report that the volume of help desk calls is below 
previous levels. Based on this progress, the court monitor's most 
recent report anticipates that data issues related to early system 
implementation should be resolved soon. 

CFSA Has Implemented Several Initiatives to Help Achieve Unmet 
Requirements, but It May Be Too Soon to Know if They Will Yield Long- 
term Results: 

In the last 2 years CFSA has implemented a number of initiatives to 
help address hindrances in meeting court-ordered requirements. CFSA has 
hired new staff and reorganized existing staff to focus resources in 
key areas. For example, CFSA has hired additional caseworkers to ease 
caseloads, reduce backlogs, and improve the timeliness of 
investigations of child abuse or neglect. CFSA also has implemented new 
practices to better serve children and families, such as holding family 
team meetings that bring all parties together to make decisions about a 
child's care. In addition, CFSA is beginning to take steps to hold its 
management staff as well as private contractors accountable for helping 
the agency meet specific performance requirements. Because many of 
these initiatives have been implemented only recently, it is too soon 
to know whether the efforts will yield success over time. Figure 1 
shows the initiatives CFSA implemented or plans to implement between 
January 2005 and summer 2007. 

Figure 1: Timeline of CFSA's Key Initiatives: 

[See PDF for image] 

Source: CFSA documents and interviews with CFSA officials. 

[End of figure] 

CFSA Has Increased Staff and Reorganized to Help Improve Performance in 
Key Areas: 

CFSA has hired additional caseworkers to improve its ability to conduct 
investigations in a timely manner. Historically, CFSA has not been able 
to conduct prompt investigations because it did not have enough 
caseworkers to manage all of its cases. According to a CFSA report, in 
September 2002 there was a backlog of 807 cases awaiting investigation. 
As we previously reported, CFSA began a number of recruitment 
activities in fiscal year 2003 and has recently focused on recruiting 
staff to conduct investigations.[Footnote 12] As of July 2006, CFSA 
officials reported only 1 vacancy in the unit that is responsible for 
conducting investigations, down from 15 in January 2006, and 84 cases 
in the backlog, down from 318 cases in January 2006. CFSA officials 
told us that having fewer cases has allowed caseworkers to focus more 
attention on improving the quality of investigations. 

While these efforts may have a positive impact on the way 
investigations are conducted, CFSA still struggles to meet many of its 
court-ordered requirements related to investigations. A review of CFSA 
investigation case files conducted by the court monitor in June 2005 
revealed that investigations were not meeting quality standards, such 
as workers routinely ensuring that families receive the services they 
need. Another report in July 2006 showed little progress in this area. 
Moreover, in this report the court monitor noted that leadership within 
the investigation units has changed frequently as CFSA has tried to 
implement comprehensive improvements in this area, and the agency has 
not been successful in either fully implementing recommendations made 
by consultants to improve operations or in sustaining advancements 
made. 

In addition to hiring new staff, CFSA has reorganized existing staff to 
focus resources and attention on key unmet requirements. Caseworkers 
have told us that they did not always have support from their 
supervisors to help them make decisions, such as those related to 
obtaining the appropriate placement for children in their care. To 
address this, in 2005 CFSA created a centralized unit of employees to 
make decisions on the placement of children. These staff members are on 
call around the clock to help caseworkers match children with the 
placements that best meet their needs. Staff in this unit are 
knowledgeable about various placement options, such as placing children 
across state lines, finding foster care placements for children needing 
medical attention, and arranging for independent living services for 
older children. In 2006, the new placement unit recruited six licensed 
District emergency foster homes with seasoned foster parents, referred 
to as Stabilization and Replacement (STAR) homes. These homes will be 
available at any time of the day to provide emergency foster care for 
children for up to 5 days regardless of age, gender, or behavioral 
difficulty. STAR foster parents will provide basic services for 
children while caseworkers determine the child's needs, and placement 
specialists will match the child with an appropriate, stable placement. 
Although CFSA has made some progress in improving the placement process 
for children, it is too soon to determine whether these efforts will 
yield long-term success. According to the monitor's progress report, as 
of April 2006, placement issues remain in a crisis mode at CFSA-- 
placements are still too often based on bed space availability, rather 
than child need, and too many children experience multiple placements 
during their time in foster care. 

CFSA has dedicated a number of caseworkers to specialize in making home 
visits to ensure the safety of children living at home with their birth 
parents. Previously, caseworkers could be assigned to provide services 
to children who remained in-home along with those who were placed 
outside of the home, such as with a foster family. However, in May 
2006, after a study found that children placed at home were not being 
visited frequently by caseworkers, CFSA created a separate unit of 
caseworkers to focus on these children. CFSA officials expect this unit 
to improve the frequency and quality of caseworker's visits to children 
at home, and allow caseworkers to thoroughly assess family situations, 
engage parents, and diligently monitor and influence a family's 
stability and progress so that the child can remain safely in the home. 
Although it is too soon to assess the impact of this arrangement, the 
court monitor reported that as of April 2006, CFSA had not met 
requirements for making in-home visits, but the data show an 
improvement. 

CFSA also reorganized the office that assists caseworkers with 
arranging medical and mental health services for children and their 
families. CFSA hired additional nurses and psychologists in its Office 
of Clinical Practice to provide advice and counsel to caseworkers with 
cases requiring medical expertise. CFSA officials expect that this will 
help the agency meet requirements to provide appropriate physical and 
psychological evaluations, since caseworkers are now able to seek 
professional guidance on their cases and the services children might 
need. 

CFSA Has Implemented New Practices Designed to Improve Services to 
Children and Families: 

CFSA has implemented several new practices to improve services. It 
changed how telephone hotline staff prioritize calls reporting child 
abuse or neglect to improve the overall quality and timeliness of 
investigations and to help them make appropriate referrals to community 
agencies. In February 2006, CFSA implemented a standardized risk 
assessment tool for screening hotline calls in order to better focus 
their resources by helping caseworkers quickly assess the urgency of 
the case and whether or not a referral to a community agency would meet 
the family's needs. The tool prompts caseworkers to ask each caller a 
series of structured questions to identify the level of risk to the 
child's safety and the appropriate intervention based on certain risk 
factors, such as number of prior investigations, number of children 
involved, and whether or not the parent has a criminal history or a 
history of drug use. Cases are ranked based on these factors and 
designated as either high, moderate, or low risk. All high-risk cases 
are to be retained by CFSA and assigned to a CFSA investigator. For 
those cases assessed to be of low or moderate risk, children and their 
families are to be referred to one of CFSA's community partners for 
intervention and support services, including housing and employment 
information, parenting workshops, and referrals to other services. CFSA 
has not yet met the court-ordered requirement to refer more families to 
community agencies, and it is too soon to know whether the initiative 
will improve its performance in this area. 

CFSA also recently began using family team meetings, which bring 
together immediate and extended family members and other support for 
the family to discuss the child's needs and strategies for overcoming 
family problems and to develop a plan for the child's safety. These 
meetings are held in cases where children have been removed or are at 
risk of being removed from their homes because of abuse or neglect. 
According to a June 2005 CFSA report,[Footnote 13] family team meetings 
may play a role over time in reducing the number of children who are 
removed from their homes, placed in nonfamily foster care, or placed in 
multiple foster homes. The court monitor's April 2006 report indicates 
that CFSA is still not meeting the requirement to reduce the number of 
children in foster care who have been in three or more homes within a 
12-month period, but the data show improvement. However, the court 
monitor also cautioned that strategies such as the family team meetings 
have not always been implemented at the level of intensity needed to 
achieve the desired outcomes, saying relatively few of the cases that 
might benefit from the approach have actually used it. 

CFSA Is Holding Management, Foster Care Providers, and Contractors 
Accountable for Meeting Performance Requirements: 

CFSA is holding all unit managers and supervisors accountable for 
helping caseworkers meet court-ordered requirements. The quality of 
supervision has been a long-standing issue for CFSA. As we previously 
reported, many CFSA caseworkers told us that supervisors had not 
fulfilled their responsibilities to provide the guidance and support 
needed to help them better perform their jobs, and agency officials 
told us that CFSA supervisors were not held accountable for performing 
their supervisory duties.[Footnote 14] To address this issue, CFSA 
requires supervisors to document in FACES.net each time they interact 
with a social worker on a particular case. In addition, CFSA has 
contracted with the Child Welfare Institute to help provide management 
training for managers and supervisors. 

CFSA is also holding external partners, such as foster care providers, 
accountable for helping it meet court-ordered requirements. Although it 
is the agency's policy not to place children in unlicensed homes, we 
previously reported that about 22 percent of foster children in CFSA's 
care were residing in unlicensed homes as of May 2004. To address this 
issue, CFSA officials reported that they recently reviewed all 
unlicensed foster homes to check for their compliance with basic health 
and safety standards and are no longer placing children in unlicensed 
homes. As a result of this review, CFSA licensed most homes and reduced 
the number of unlicensed foster homes to 17, or 5 percent, by July 
2006. While the most recent court monitor's report found that CFSA had 
not met the requirement that all foster homes, group homes, and 
independent living facilities have a current and valid license, the 
data showed an improvement. 

CFSA has also begun to take steps to hold private contractors--who 
manage the cases of approximately 40 percent of CFSA's children and 
families---accountable for their performance. In June 2006, CFSA 
reported that contractors managing cases were performing at a lower 
level than CFSA caseworkers on certain requirements, such as making 
frequent in-home visits. CFSA has taken a number of actions designed to 
improve the care provided by contractors. CFSA officials told us that 
its contract monitors meet with private agency staff on a monthly basis 
to review expectations and resolve issues. And in March 2006, CFSA 
began to post monthly scorecards on the Internet for the public to view 
that detail each contracted agency's performance on the court-ordered 
requirements. CFSA also reported that it sends each month's report 
directly to the executive leadership of each contracted agency and 
secures corrective action plans from private agencies that are not in 
compliance with the contract and other performance requirements. 

In addition, after lengthy delays, CFSA will soon begin to hold private 
contractors accountable for meeting performance requirements by linking 
contractor payments to specific outcomes for children and families 
through performance-based contracting. Under the new performance-based 
contracting agreements, contractors will be expected to attain specific 
outcomes for children and families and will be financially rewarded for 
meeting the outcomes and penalized for falling short. Moving toward 
performance-based contracting has been difficult, and it has taken 
several years. While CFSA began this process in 2003, it now 
anticipates awarding the first performance-based contracts by spring 
2007, and services under these contracts are expected to begin by 
summer 2007. 

See table 2 for a summary of CFSA's key unmet performance requirements 
as of April 2006 and the initiatives developed to address them. 

Table 2: CFSA Initiatives Addressing Key Unmet Court-Ordered 
Requirements: 

Key unmet requirements: Timeliness of investigations; 
Initiatives to address unmet requirements: 
* Hire more caseworkers to lower caseloads; 
* Improve coordination with police department and other investigative 
stakeholders; 
* Implement standardized tool for assessing risk and prioritizing 
hotline calls. 

Key unmet requirements: Quality of investigations; 
Initiatives to address unmet requirements: 
* Increase qualification requirements for hotline staff; 
* Hold supervisors accountable for helping caseworkers with challenging 
cases; 
* Use Family Team Meetings to bring all relevant parties to the table. 

Key unmet requirements: Comprehensive investigations of reports of 
abuse and neglect in foster homes and institutions; 
Initiatives to address unmet requirements: 
* Reduce caseloads to seven investigations per worker in the unit 
handling institutional cases; 
* Develop the capacity to initiate investigations during the weekend 
hours as necessary. 

Key unmet requirements: Appropriate and timely physical and 
psychological evaluations; 
Initiatives to address unmet requirements: 
* Reorganize Office of Clinical Practice to coordinate resources and 
services; 
* Seek additional health care providers to provide services. 

Key unmet requirements: Increased visitations for children and 
families; 
Initiatives to address unmet requirements: 
* Dedicated social worker staff to focus on visiting children living 
with birth parents. 

Key unmet requirements: Appropriate referrals to community agencies; 
Initiatives to address unmet requirements: 
* Uses hotline screening tool to refer low and moderate-risk cases to 
appropriate community agencies. 

Key unmet requirements: Children are given the most appropriate out-of- 
home placements; 
Initiatives to address unmet requirements: 
* Create Placement Services Administration to centralize placement 
decision making; 
* Develop new licensing and monitoring standards for contract providers 
and foster parents and expedited the licensing process for homes 
located in D.C; 
* Retained short-term emergency foster homes where families agree to 
take children at any time while CFSA identifies permanent placement. 

Key unmet requirements: Reduce multiple placements in foster care; 
Initiatives to address unmet requirements: 
* Require family team meeting before moving a child; 
* Uses mobile crisis support and stabilization service to help child 
and foster family. 

Key unmet requirements: Timely adoptions; 
Initiatives to address unmet requirements: 
* Reconfigure case management teams to include a permanency specialist 
early in the case when children have adoption as a goal; 
* Developing new recruitment strategies to increase their pool of 
available adoptive parents. 

Source: GAO analysis based on reviews of CFSA documents and interviews 
with officials. 

[End of table] 

Conclusions: 

The District of Columbia's Child and Family Services Agency has had a 
troubled history in its efforts to care for the city's abused and 
neglected children--one that led the U.S. District court to step in and 
take control of the agency. In the 5 years since CFSA left court- 
ordered receivership, it has made considerable progress toward meeting 
the court's requirements. But it has sometimes lost ground, too, 
perhaps because its focus shifted away from sustaining the 
achievements, toward meeting other pressing requirements. Current 
leadership, however, seems to be focused on addressing the problems 
head on, with innovative approaches and strategic use of data to 
resolve ongoing areas of concern. We are encouraged by the progress 
made and the initiatives implemented in the last 2 years. Of particular 
note are the efforts to build a collaborative relationship with the 
police department and to use performance data to focus on program 
improvement, not just on meeting the requirements imposed by the court. 
However, continued success will require an unrelenting focus, not just 
on requirements that remain unmet, but on sustaining the achievements 
already in place. It will also require that efforts now in the 
pipeline, such as family team meetings and performance-based 
contracting, are implemented swiftly and sufficiently to ensure the 
maximum results. 

There remain two issues of critical concern regarding CFSA's ability to 
meet ongoing requirements and to provide needed services. First, 
caseworkers may not have the specialized training they need to meet the 
complex needs of the children they work with, particularly teenagers 
and children with special medical or mental health needs. Without such 
training, caseworkers may not have the skills and the tools they need 
to make the best possible decisions for those in their care within 
established time frames. 

Second, adequately serving the children under the agency's care--and 
meeting certain court-ordered requirements--necessitates sufficient 
medical, dental, and mental health care. However, increasing the number 
of providers willing to serve children in the District's child welfare 
system will require help. In the absence of new solutions to the health 
care problem, CFSA will be unable to achieve the court-mandated 
requirements. Worse yet, the children who depend on CFSA's help will be 
unable to get the care they need. 

Recommendations for Executive Action: 

To improve CFSA's ability to serve the District's children and to help 
meet court-ordered requirements, we recommend that the Mayor of the 
District of Columbia: 

* direct CFSA to provide caseworkers with specialized training to help 
them develop the skills needed to address the complexities of their 
caseloads and: 

* explore options for increasing the pool of providers for mental 
health, medical, and dental services. 

Agency Comments: 

We provided a draft of this report to CFSA for its review and comment. 
In its comments, CFSA agreed with our findings and recommendations, 
noting that the agency has made even greater progress since April 2006, 
the time frame used for this report. At the same time, CFSA 
acknowledged that some performance gaps remain that must be closed. 
CFSA also provided technical comments, which were incorporated as 
appropriate. A copy of CFSA's formal response is in appendix II. 

As arranged with your offices, unless you publicly announce the 
contents of this report earlier, we plan no further distribution of 
this report until 30 days from the date of this report. At that time, 
we will send copies of this report to the Honorable Anthony A. 
Williams, Mayor of the District of Columbia, and other District 
officials, relevant congressional committees, and others who are 
interested. Copies will also be made available to others upon request. 
The report is also available at no charge on GAO's Web site at 
[Hyperlink, http://www.gao.gov]. 

Please contact me at (202) 512-7215 if you or your staff have any 
questions about this report. Key contributors to this report are listed 
in appendix III. 

Signed by: 

Cornelia M. Ashby, Director: 
Education, Workforce, and Income Security Issues: 

[End of section] 

Appendix I: Scope and Methodology: 

To conduct our review, we focused on court-ordered requirements that 
remained unmet as of December 2005. We limited our scope to 
requirements related to managing child welfare cases such as initiating 
and conducting timely and quality investigations of child abuse and 
neglect allegations, providing a range of services to children and 
their families, and placing children in appropriate foster or adoptive 
homes. We did not review requirements related to administration and 
management of the agency, nor did we review requirements that were not 
tracked using FACES.net. 

To assess whether the Child and Family Services (CFSA) is likely to 
meet court-ordered requirements by December 2006, we reviewed the court 
monitor's July 2006 progress report. To understand the hindrances that 
may prevent CFSA from meeting its court-ordered requirements, we 
conducted interviews with CFSA managers, supervisors, and caseworkers. 
To gain an understanding of staff views on the hindrances in meeting 
performance requirements, we conducted separate group interviews with 
caseworkers and supervisors randomly selected to represent a cross 
section of CFSA divisions and employment tenures. We also interviewed 
CFSA officials responsible for recruiting and retaining foster and 
adoptive parents to learn about the hindrances that CFSA faces with 
recruiting an adequate number of foster and adoptive homes. Finally, we 
interviewed the court-appointed monitor and other D.C. child welfare 
experts to get their perspectives on what they believe to be CFSA's 
hindrances to meeting the performance requirements. 

Our sampling strategy for the group interviews included randomly 
selecting participants to help ensure that they represented cross 
sections of the organization. Attendance on the part of the invited 
participants was voluntary. For our four discussion groups, we 
interviewed supervisors and caseworkers whose work involved initiating 
and completing investigations of child abuse and neglect, placing 
children through the use of adoptions or foster care, and monitoring 
children at home or in out-of-home care with a goal of returning to 
their family. The supervisors and caseworkers from each group were 
randomly selected and included those who had been at CFSA for 0-2 
years, 2-6 years, and 6 or more years. A trained discussion group 
moderator led the discussions while our analysts took notes. We 
developed a discussion group guide to assist the moderator in leading 
the discussions. 

To learn how CFSA monitors its progress in meeting the court-ordered 
requirements, we reviewed CFSA data and reports that CFSA managers use 
to assess the agency's performance in meeting its requirements. We also 
interviewed (1) CFSA managers to learn about the strategies the agency 
has used to help guide its decisions on what data to gather and how to 
use these data; (2) CFSA's Chief Information Officer to learn about 
CFSA's automated child welfare information system, FACES, and its 
capacity for informing CFSA managers on the agency's progress in 
meeting its performance requirements; and (3) the court-appointed 
monitor, the Center for the Study of Social Policy (CSSP), to gain its 
perspective on what CFSA has done and where it might improve in its 
efforts to develop data needed to assess its performance. 

To gather information on the extent to which CFSA has implemented 
initiatives or developed plans to achieve unmet requirements, we 
reviewed the court monitor's reports and identified key requirements 
related to managing child welfare cases that had not been met as of 
December 2005. We reviewed CFSA documents, handbooks, and guidance to 
document any new or planned initiatives designed to satisfy unmet 
requirements. We also interviewed CFSA managers, the court-appointed 
monitor, and other D.C. child welfare experts to determine what 
initiatives CFSA plans to take or has taken to meet these requirements. 

[End of section] 

Appendix II: Comments from D.C. Child and Family Services Agency: 

Government Of The District Of Columbia: 
Child and Family Services Agency: 
Office of the Director: 

September 25, 2006: 

Cornelia M. Ashby: 
Director: 
Education, Workforce and Income Security: 
United States Government Accountability Office: 
441 G Street, N.W., Room 5928: 
Washington, D.C. 20548: 

Re: Draft Report Number GAO 06-1093: 

Dear Ms. Ashby: 

Thank you for the opportunity to respond to the draft report GAO-06- 
1093, titled "D.C. Child and Family Services Agency: Performance Has 
Improved, but Exploring Health Care Options and Providing Specialized 
Training May Further Enhance Performance." Before providing our 
specific technical comments, we thought it would be helpful to provide 
some overall comments. 

We are pleased that the report recognizes the significant, measurable 
progress that we have made to date and that we have achieved or made 
significant progress on many of the benchmarks. But we too recognize 
that some gaps remain that must be closed. We are about to enter into 
negotiations with the LaShawn plaintiffs regarding an exit strategy - - 
in other words, exactly what the District must do to leave court 
oversight of child welfare. This discussion is possible only because 
improvement strategies we purposefully implemented are achieving 
tangible results. CFSA is steadily becoming a high-performing child 
welfare agency that consistently achieves positive outcomes for 
children and families. 

In reporting on CFSA's progress, we think it is important to emphasize 
how much we have progressed since the end of the receivership. In her 
most recent report, the LaShawn Court Monitor compared the functioning 
of the child welfare system at key points in time - -at the time of the 
LaShawn trial, at the time the LaShawn receivership ended, and as of 
April 30, 2006, which is the data that is reflected in this report. 
Yet, as of today, the April data no longer portrays an accurate picture 
of CFSA. For example, the report at page 8 states that 39% of 
investigations were completed within 30 days. We are proud to report 
that as of August 31, 2006, the percent of investigations closed within 
30 days is 70%. Similarly, unlike April, 2006 when 40% on investigators 
had caseloads exceeding 12, now no investigator is carrying more than 
12 investigations, and only 10 social workers throughout the Agency 
have caseloads exceeding court ordered limits. There has also been 
dramatic improvement in our visitation rates. Ninety percent of foster 
children had monthly visits in August, and 66 percent were visited 
twice in August. In home visitation rates are also improving, as 79% of 
children in home were visited monthly and 43% were visited twice in 
August. The Court Monitor once observed that the pace of change often 
made monitoring reports out of date even before they were issued. That 
has never been more true than today. We believe this to be the result 
of the new initiatives, focused strategies and management investments 
we have been making these past six months. 

We agree with GAO's recommendations relating to training. We appreciate 
the recognition that our cases are highly complex and that our high 
percentage of older youth pose particular challenges. Our semi-annual 
Quality Service Review in spring 2006 found that half the families in 
the sample of 40 in-home cases were struggling with severe, multiple 
issues that included lack of appropriate, affordable housing; untreated 
mental health problems; untreated substance abuse; and domestic 
violence. We are seeing more children with significant mental health 
and medical needs. Thus, we created an Office of Clinical Practice that 
includes nurses, a pediatrician, psychologists, domestic violence and 
substance abuse specialists and other support staff that are available 
to consult and go out on visits with staff. As you know, the vast 
majority of our social workers hold Masters of Social Work degrees, and 
thus have many of the tools needed to work with our children and 
families. Despite their high qualifications and the clinical support 
available in the Agency, we are aware that we must ensure our workers 
and foster parents have the kind of specialized training that equips 
them to make appropriate assessments and recommendations. Our Office of 
Training Services plans to include more specialized courses in upcoming 
months. 

We also agree that increasing and strengthening the provider network of 
mental health, medical, dental and vision care for foster children is 
critical. CFSA and our partners must continue to strengthen practice to 
meet these needs, and the District must rise to the challenge of 
developing and improving local resources to serve struggling residents. 
We are currently working with the Department of Mental Health as well 
as the Department of Health in an attempt to identify creative and 
appropriate solutions to these issues. 

Specific comments: 

* (page 6, 3rd paragraph, sentence 1-2) The report mistakenly states 
that the Department of Health does the medical evaluations for children 
in foster care. That is not correct. CFSA has a contract with 
Children's National Medical Center (CNMC), to do this service. Known as 
DC Kids, the contract provides that CNMC will conduct medical and 
behavioral health screening evaluations when a child enters foster care 
and between placements while in care, conduct comprehensive medical and 
behavioral health evaluations in the form of the Early Periodic 
Screening Diagnostic Treatment (EPSDT) evaluation within 30 days of a 
child's entry into care and subsequently coordinate care for prescribed 
subspecialty medical services, and routine well child care as 
determined by the EPSDT periodicity schedule. 

* (Page 10, 2nd paragraph and page 23): The report states that "This 
high proportion [of older children] is due to the fact that the 
District serves children. . . until age 21 and CFSA has not been 
successful in finding permanent homes for these children when they were 
younger. " We think it is important to note that this was truer in the 
past than today, as more children are reaching permanence that 
historically was the case. The past failures to get children to 
permanent homes is a factor in the age demographics of our system, but 
our success in getting children adopted (we had the third highest 
adoption incentive award nationwide in 2005) shows that we are 
addressing the issue. 

* (page 11, paragraph 1, sentence 6) The report states "CFSA told us 
that in February 2006, the agency requested proposals for medical 
services from additional providers, but received only one bid. " CFSA 
did a competitive Request for Proposals for a comprehensive medical 
system of care that was available to all District medical providers. It 
was not directed to "additional providers" but was available to all 
health care providers. 

* (page 11, paragraph 1, sentence 4) The report states: "Specifically, 
they told us that there is only one dentist in the District who 
provides services to CFSA's children." This is not wholly accurate - DC 
KIDS schedules dental appointments for CFSA children with several DC 
Medicaid dental providers of care. However, there are not a sufficient 
number of dental providers. 

* (Page 13): The report states: "CFSA does not have agreements with 
Maryland and Virginia that would remove barriers...This statement is 
accurate, but we have worked very hard to achieve this, but our 
neighboring states have no incentive to enter such an agreement with 
us. Recently we presented a new proposal to Maryland and Virginia, and 
are awaiting a response. 

* (Page 14. 2nd paragraph): The report states that "CFSA generates a 
number of daily and monthly reports . . . " CFSA actually produces 
hundreds of reports that reflect all aspects of our practice. We do a 
monthly report of key indicators for the court monitor, which is also 
provided to the Council's Human Services Committee, but that report is 
only a snapshot of our system's capacity. 

* Pp. 16 (first and third paragraphs) and page 17: The report 
identifies a number of implementation issues that resulted with FACES. 
Net implementation. As you may recall, CFSA recently upgraded its FACES 
system to enhance its capacity so that workers could access FACES from 
remote locations with internet access and review or enter data. Not 
surprisingly with a project this large, there were "bugs" that needed 
to be worked out once the system went live. We completed several 
upgrades to stabilize the system soon after it was implemented and the 
system downtime was reduced dramatically within 30 - 60 days of 
implementation - around March/April, 2006. In addition to fixing 
"bugs", during this same period our Information Systems staff also made 
minor enhancements which were requested from Program Operations. 
Finally, Program Operations staff at CFSA will identify qualified staff 
to act as liaisons to our FACES staff. 

* (Page 16, 2nd paragraph): The report states that visits are 
undercounted because "caseworkers were not entering the information 
into FACES.net". While that is true in some cases, in other cases, we 
are not entering visits that are occurring informally, such as when 
children in kinship care may attend family gatherings on weekends at 
which their parents or siblings are present. These visits can be 
appropriate when the court has permitted parental visits and the 
caregiver is supervising. But the caseworker doesn't always know about 
these arrangements. 

* (Page 17-19) - We appreciate the recognition that we have made great 
strides in filling critical social worker vacancies. It is important to 
note that now that we have caseloads at court ordered standards, we 
still must assess whether the caseloads will allow workers to complete 
their workloads. Both the plaintiffs and CFSA are currently evaluating 
whether the current workload (i.e., visitation requirements, assessment 
standards, case plans) as stated in the IP is manageable with the 
recommended caseloads. Given the past five years of implementation we 
believe that there might need some adjustments to achieve each of the 
benchmarks or the Implementation Plan. 

* (Page 21). The information about Family Team Meetings is a bit 
confusing. Our FTMs in cases at the initial removal stage began in 
January, 2005 and early evaluations are indicating it is effective in 
protecting children and in reducing lengths of stay. We recently 
expanding FTMs for cases at which a child is at risk of replacement, 
but we have not been as successful in enforcing the requirement of FTMs 
given the often emergent nature of some replacements. 

* (page 24. 2nd paragraph, sentence 1-2) As noted, CFSA employs a 
highly trained workforce of staff who graduated with a specialized 
skill set resulting from receiving a Masters in Social Work, but we 
recognize the unique needs of our children and families require 
specialized and targeted training. Currently, CFSA provides training 
geared toward new social workers and experienced social workers and 
management staff. The new social worker training program is a 
comprehensive 4 month training program where new social workers 
alternate between classroom and on-the-job training while in 
specialized units with training supervisors. The new social workers 
gradually receive cases and graduate from the program with a caseload 
of 12, having a variety of experiences and specialized child welfare 
skills. The new worker training program includes specialized training 
in positive youth development as well as a variety of other child 
welfare related topics including engaging families in the process of 
change, assessment, case planning, domestic violence, substance abuse 
and mental health issues. 

CFSA provided targeted training toward its staff who work with youth in 
FY06. These trainings included: "Effective Strategies with Today's 
Difficult Adolescents: Effective Interventions with Oppositional, 
Defiant and Challenging Behaviors". CFSA mandated this training to its 
staff and offered it to the group home provider staff who work directly 
with the youth on a day-to-day basis. This training provided skill- 
based sessions where social workers and group home providers learned 
assessment strategies and effective interventions on how to work with 
youth who have complex needs. We provided 30 hour training on positive 
youth development, where at the completion of the training, the social 
workers are certified in positive youth development from a local 
organization whose vision is that each child in the District of 
Columbia is given every opportunity to develop and grow into healthy, 
caring and productive adults. This training focused on Developmental 
Youth Outcomes, Cultural Assumptions, Best Practices and Youth 
Participation. CFSA also provided training on youth development and 
permanency for older youth through the University of Oklahoma. 

CFSA provides mandatory training for all social work staff and also 
offers specialized elective training. Mandatory training included 
training on Structured Decision Making. During FY07, CFSA will provide 
mandatory training on "Leading Effective Service Delivery Teams" and 
"Realizing Permanency for Children". CFSA offered 29 different elective 
training classes during FY06, these included: Suicidal Behavior in 
African-American Children and Adolescents, Clinical Interventions with 
African-American Men and Boys, Borderline Personality Disorder in Child 
Protection Cases, and Children and Adolescents in the Child Welfare 
System and the DSM-IV (see attachment for full course listings). 

To assess training needs, CFSA conducted a training needs assessment 
through a web-based survey system and found that social workers are 
requesting more training on mental health issues. This year CFSA plans 
to incorporate more specialized training in this area and also do more 
targeted on-the-job application since practice change most fully 
results from a classroom training followed by support of the while on 
the job. 

Once again, we thank you for your comments and thoughtful 
recommendations. Feel free to contact me at 442-6177 or Janet Maher, my 
Chief of Staff at 442-6160 if you have any questions. 

Sincerely, 

Signed by: 

Uma S. Ahluwalia: 
Interim Director, CFSA: 

Attachment (1): 

USA/jwy: 

Uma S. Ahluwalia, Interim Director: 
400 Sixth Street, S.W., Suite 5039 
Washington, DC 20024: 
Phone: (202) 442-4177: 
Fax: (202) 727-7700:E
E- mail: Uma.Ahluwalia@dc.gov: 
Web: www.cfsa.dc.gov:  

[End of section] 

Appendix III: GAO Contact and Acknowledgments: 

GAO Contact: 

Cornelia M. Ashby; (202) 512-7215 or ashbyc@gao.gov: 

Acknowledgments: 

Dianne Blank, Assistant Director: 

Anjali Tekchandani, Analyst-in-Charge: 

In addition, the following staff made major contributions to this 
report: Vernette Shaw, Jacqueline Harpp, and Lisa McMillen served as 
team members; Walter Vance advised on design and methodology issues and 
conducted group interviews; Rachael Valliere advised on report 
preparation; James Rebbe advised on legal issues; Kevin Kumanga, Lise 
Levie, and Katharine Leavitt verified our findings. 

[End of section] 

Related GAO Products: 

District of Columbia: Federal Funds for Foster Care Improvements Used 
to Implement New Programs, but Challenges Remain. GAO-05-787. 
Washington, D.C.: July 22, 2005. 

D.C. Child and Family Services Agency: More Focus Needed on Human 
Capital Management Issues for Caseworkers and Foster Parent Recruitment 
and Retention. GAO-04-1017. Washington, D.C.: September 24, 2004. 

D.C. Child and Family Services: Better Policy Implementation and 
Documentation of Related Activities Would Help Improve Performance. GAO-
03-646. Washington, D.C.: May 27, 2003. 

D.C. Child and Family Services: Key Issues Affecting the Management of 
Its Foster Care Cases. GAO-03-758T. Washington, D.C.: May 16, 2003. 

District of Columbia: Issues Associated with the Child and Family 
Services Agency's Performance and Polices. GAO-03-611T. Washington, 
D.C.: April 2, 2003. 

Foster Care: Recent Legislation Helps States Focus on Finding Permanent 
Homes for Children, but Long-Standing Barriers Remain. GAO-02-585. 
Washington, D.C.: June 28, 2002. 

District of Columbia Child Welfare: Long-Term Challenges to Ensuring 
Children's Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000. 

FOOTNOTES 

[1] LaShawn v. Dixon, 762 F. Supp. 959 (D.D.C. 1991). 

[2] LaShawn v. Kelly, 887 F. Supp. 297 (D.D.C. 1995). 

[3] Collaboratives are independent nonprofit organizations operating in 
areas of the District of Columbia with at-risk children, adults, and 
families. Collaboratives partner with CFSA to provide services and 
support, such as housing and training, working toward a goal of 
reducing or eliminating the possibility of children being removed from 
their families or communities, or reunifying children with their 
families when removal does occur. 

[4] District law sets a stricter time frame for initiating 
investigations. District law requires CFSA to initiate an investigation 
within 24 hours of receiving a report of child abuse or neglect not 
involving immediate danger to the child. However, for the purpose of 
the court-ordered requirements, CFSA must meet the 48-hour time frame 
for initiating investigations for the proportion of cases established 
in the benchmark. 

[5] CFSA's Web-based case management data system, FACES.net, is the 
primary, and in some cases the only, source for data to measure the 
agency's progress in meeting court-ordered requirements. However, 
FACES.net data have some limitations that we discuss in the third 
section of this report. See also appendix I for GAO's review of 
FACES.net data quality. 

[6] This is the last numeric benchmark set before full compliance, 
established for the period beginning June 30, 2005. 

[7] At the end of our review, CFSA provided us with updated performance 
data as of July 31, 2006. CFSA officials told us that the data show an 
improvement from April. We did not analyze the data or assess its 
reliability. The court monitor is currently assessing these data and 
will be incorporating the data in its final report of CFSA's progress. 

[8] Most children in foster care or adoptive placements are eligible 
for Medicaid--the joint federal-state health care financing program 
that covers certain categories of low-income children. Like each state, 
the District sets reimbursement rates for its Medicaid providers. 

[9] As of June 2005, CFSA was required to have no more than 35 children 
living in foster care more than 100 miles from the District. In June 
2006, the requirement is no more than 25 children. 

[10] Pub. L. No. 109-239 (2006). 

[11] GAO, Managing for Results: Enhancing Agency Use of Performance 
Information for Management Decision Making, GAO-05-927 (Washington, 
D.C.: Sept. 9, 2005). 

[12] GAO, D.C. Child and Family Services Agency: More Focus Needed on 
Human Capital Management Issues for Caseworkers and Foster Parent 
Recruitment and Retention, GAO-04-1017 (Washington, D.C.: Sept. 24, 
2004). 

[13] CFSA Quality Assurance Report, CFSA Quality Improvement 
Administration. (Washington, D.C.: June 2005) 

[14] GAO-04-1017. 

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