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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.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Executive Office of the Mayor 1. To improve CFSA's ability to serve the District's children and to help meet court-ordered requirements, the Mayor of the District of Columbia should direct CFSA to provide caseworkers with specialized training to help them develop the skills needed to address the complexities of their caseloads.
Closed - Implemented
In 2009, CFSA redesigned their training curriculum for caseworkers new to the agency, as well as the ongoing training provided to their more experienced caseworkers. To develop these training courses, CFSA worked with child welfare experts, both internal to the agency as well as outside the agency. Some of the new courses that were developed include training on responding to trauma, mental health in child welfare, and best practices on dealing with fathers.
Executive Office of the Mayor 2. To improve CFSA's ability to serve the District's children and to help meet court-ordered requirements, the Mayor of the District of Columbia should direct CFSA to explore options for increasing the pool of providers for mental health, medical, and dental services.
Closed - Implemented
To address the mental health needs of children in CFSA's custody, in 2008 CFSA established contracts with seven mental health providers to address the needs of children in foster care. These providers offer specific services identified through the 2007 Mental Health Needs Assessment including evidence-based and non-traditional therapies. To help address the medical needs of children in CFSA's custody, CFSA opened the Healthy Horizons Assessment Center (an on-site Agency clinic) in December 2009. According to agency officials, the clinic is designed to address the medical pre-placement and replacement screening needs of all children/youth in the custody of CFSA, and provides comprehensive physicals for children entering care. This in-house screening process has the potential for providing more timely identification and initiation of medical and mental health services for the children CFSA serves. The Healthy Horizons Assessment Center staffing consists of five Certified Medical Assistants and five Advance Practice Registered Nurses (Nurse Practitioners). Nurse Practitioners practice independently and are authorized to write prescriptions. In July 2010, CFSA is launching a Nurse Care Management (NCM) Program, which is a mechanism for integrating health and social services planning. Registered nurses staff the NCM Program to ensure that children in foster care receive necessary health care services to address their comprehensive health needs. In this new role the Nurse Care Manager will provide administrative health expertise and will serve as the designated Agency (CFSA) skilled professional medical representative. The major functions of the NCM will include collecting and updating health information, accessing and coordinating health services, health education, discharge planning and facilitating communication between families and health care professionals. Experts believe that an increase in case managers and in-house nurse practitioners could help decrease the demand on area providers, but the number of staff dedicated to these programs may not be sufficient to address the needs of all CFSA foster children.

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