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In 2001, the Department of Health and Human Services' (HHS) Administration for Children and Families (ACF) implemented the Child and Family Services Reviews (CFSR) to increase states' accountability. The CFSR uses states' data profiles and statewide assessments, as well as interviews and an on-site case review, to measure state performance on 14 outcomes and systemic factors, including child well-being and the provision of caseworker training. The CFSR also requires progress on a program improvement plan (PIP); otherwise ACF may apply financial penalties. This report examines (1) ACF's and the states' experiences preparing for and conducting the statewide assessments and on-site reviews; (2) ACF's and the states' experiences developing, funding, and implementing items in PIPs; and (3) any additional efforts that ACF has taken beyond the CFSR to help ensure that all states meet federal goals related to children's safety, permanency, and well-being.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services 1. To ensure that ACF uses the best available data in measuring state performance, the Secretary of HHS should expand the use of additional data states may provide in their statewide assessments and consider alternative data sources when available, such as longitudinal data that track children's placements over time, before making final CFSR determinations.
Closed - Implemented
HHS has several steps underway to address necessary data improvements. With the agency's assistance, states have begun to submit more accurate information in their Adoption and Foster Care Analysis and Reporting System (AFCARS) and National Child Abuse and Neglect data profiles. In May 2005, HHS reported that revisions to AFCARS were being considered as part of an overall effort to evaluate that system. In 2006 and 2007, HHS reported that a notice of proposed rulemaking to update AFCARS was on the agency's unified agenda. On January 11, 2008, HHS posted a notice of proposed rulemaking (NPRM) proposing numerous improvements to AFCARS data, including changes to the reporting populations, data structure, elements, compliance determination and penalty provisions. In 2006, ACF announced new data measures, data composites, and national standards that will replace the six national data standards used during the first round of Child and Family Services Reviews (CFSRs) to assess the performance of State child welfare agencies (71 FR 32969, 6/7/2006). According to the notice, the goals of the data composites are to provide a more holistic view of State performance in a particular domain, account for both the strengths and weaknesses of a State, allow for the development of national standards that account for variations in State practices and policies, and provide a more effective assessment of State performance.
Department of Health and Human Services 2. In addition, to ensure that ACF regional offices and states fully understand the PIP development, approval, and monitoring processes, and that regional offices fully understand ACF's prioritization of the CFSR as the primary mechanism for child welfare oversight, the Secretary of HHS should take the following two actions: (1) issue clarifying guidance on the PIP process and evaluate states' and regional offices' adherence to this instruction and (2) provide guidance to regional offices explaining how to better integrate the many training and technical assistance activities for which they are responsible, such as participation in state planning meetings and the provision of counsel to states on various topics, with their new CFSR responsibilities.
Closed - Implemented
According to HHS officials, the agency has continued to provide technical assistance and training to states and regional offices when appropriate. It is committed to continually assessing and addressing training and technical assistance needs. In July 2004, the Administration for Children and Families (ACF) reported that the Children's Bureau planned to conduct training specifically related to the development, implementation, and monitoring of program improvement plans in each ACF regional office that will also include state staff. In addition, ACF reported in July 2005 that ten CFSR-related trainings have occurred over the course of this fiscal year, which benefit both regional and central office staff. In 2007, HHS reported that training with regional staff is ongoing and that ACF provided training in every region in FY 2006 related to implementing Round 2 of the FY 2007 CFSRs. ACF published a CFSR procedures manual in November 2006, which includes a chapter on the Program Improvement Plan (PIP) development and monitoring process and a PIP content checklist. In addition, the Children's Bureau posted PIP instructions and a matrix, last updated in October 2007, which are intended to provide guidance for States in developing a PIP following receipt of the Final Report on the child and family services review. This guidance document presents a suggested format for preparing a PIP and outlines the content or elements that must be included in the PIP regardless of the format used by the State, as described in the regulations.

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