Child Neglect: A Guide for Prevention, Assessment and Intervention.

Author(s): Children's Bureau, Office on Child Abuse and Neglect. DePanfilis, Diane.

Year Published: 2006

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Appendix D
Neglect and the Child and Family Services Reviews

As a result of the Social Security Amendments of 1994, the U.S. Department of Health and Human Services developed and implemented the Child and Family Services Review (CFSR), a results-oriented, comprehensive monitoring system designed to assist States in improving outcomes for children and families who come into contact with the Nation's public child welfare systems. As of June 2005, all the States (and Puerto Rico and the District of Columbia) had completed the first two phases—statewide assessment and onsite review—and were engaged actively in the third, or Program Improvement Plan (PIP), phase. Several States have already completed their PIPs.¹ Because the CFSR process is designed to promote continuous quality improvement, all States that are not in substantial conformity in the initial review begin a full review 2 years after the approval of their PIPs.

The purpose of the CFSRs is to enhance the goals of children's safety, permanency, and well-being. Seven outcomes, measured by 23 indicators or "items," related to these three goals are assessed in the CFSR. The seven outcomes are:

Safety Outcome 1—Children are first and foremost protected from abuse and neglect.
Safety Outcome 2—Children are safely maintained in their homes when possible.
Permanency Outcome 1—Children have permanency and stability in their living situations.
Permanency Outcome 2—The continuity of family relationships and connections is preserved.
Well-being Outcome 1—Families have enhanced capacity to provide for children's needs.
Well-being Outcome 2—Children receive services to meet their educational needs.
Well-being Outcome 3—Children receive services to meet their physical and mental health needs.

As discussed throughout Child Neglect: A Guide for Prevention, Assessment, and Intervention, there are myriad challenges facing families experiencing neglect. Many States also experienced challenges in their efforts to ensure the safety, permanency, and well-being of children who encounter the child welfare system. To identify these challenges, a content analysis was conducted on the CFSR final reports for the 35 States participating in a CFSR from FY 2002 to FY 2004. (States participating in a CFSR in FY 2001 were not included in this analysis because the final reports for that year did not use the same format for content requirements as reports in subsequent years.) The content analysis focused on identifying challenges that were common across the 35 States for specific indicators. A challenge was considered a "common challenge" if it was relevant to approximately one-third of the 35 participating States (or 12 States).

With an emphasis on neglect, the following table examines some of the challenges to achieving several of the safety, permanency, and well-being outcomes associated with the issues discussed in this manual.

Common Challenges Identified with Respect to CFSR Safety, Permanency, and Well-being Indicators and Number of States for Which Concerns Were Relevant—FY 2002-2004²

Safety Indicators	Common Challenges	# (%) of States N = 35
Timeliness of investigations	Reports that are not designated "high priority" or "emergency" are not being routinely investigated in accordance with established timeframes.	12 (34)
Repeat maltreatment	Maltreatment allegations on families with open child welfare cases are not being reported as new allegations, and therefore there is no formal assessment of the validity of the allegation.	16 (46)
Services to families to protect children in their homes and prevent removal	Agency risk and safety assessments often are not sufficiently comprehensive to capture underlying family issues, such as substance abuse, mental illness, and domestic violence, that may contribute to maltreatment.	22 (63)
	The agency is not consistent in providing services to ensure children's safety while they remain in their own homes (either prior to or after reunification).	18 (51)
Risk of harm to child	The agency is not consistent in providing sufficient services to address risk of harm to children, particularly in the in-home services cases.	22 (63)
Risk of harm to child	The agency does not consistently monitor families to assess service participation and changes in risk factors.	20 (57)

Permanency Indicators	Common Challenges	# (%) of States N = 35
Re-entry	The agency does not have sufficient and/or adequate post-reunification services.	13 (37)
Stability of foster care placements	Emergency shelters frequently are used for initial placements and as "temporary" placements after a disruption occurs, even for young children.	18 (51)
	There is a scarcity of appropriate placement options for children with developmental disabilities or with severe behavior problems.	19 (54)
	The agency does not consistently provide services to foster parents to prevent placement disruptions.	21 (60)
	There is little matching of placements. Placements tend to be based on availability rather than on appropriateness.	21 (60)
Permanency goal for child	A case goal of long-term foster care often is established without thorough consideration of the options of adoption or guardianship.	15 (43)
	Concurrent planning efforts are not being implemented on a consistent basis when appropriate.	26 (74)
	The goal of reunification often is maintained for too long a period of time before reconsideration.	24 (69)
	The agency is not filing for termination of parental rights (TPR) in a timely manner and reasons for not filing are not provided in the case files.	12 (34)
Reunification, guardianship, and permanent placement with relatives	The agency is not consistent in its efforts to provide the services to parents or ensure parents' access to the services necessary for reunification.	18 (51)
Adoption	The agency is not consistent with regard to conducting adoption home studies or completing adoption-related paperwork in a timely manner.	17 (49)
Adoption	The appeals process for TPR decisions is extremely lengthy.	12 (34)
Visiting with parents and siblings	The agency is not consistent in its efforts to ensure sufficient visitation among siblings in foster care.	18 (51)
Preserving connections	The agency is not consistent in its efforts to ensure that children's connections to extended family are being preserved while children are in foster care.	19 (54)
Relative placement	The agency is not consistent with regard to seeking paternal relatives as potential placement resources for children entering foster care.

Well-being Indicators	Common Challenges	# (%) of States N = 35
Needs and services of child, parents, foster parents	The agency is not consistent in providing appropriate services to meet the identified needs of children and parents.	31 (89)
	The agency is not consistent in conducting adequate assessments to determine the needs of children, parents, and foster parents.	30 (86)
	The agency is not consistent in providing services to support foster parents or relative caretakers.	20 (57)
Child and family involvement in case planning	Fathers are not sufficiently involved in case planning.	35 (100)
	Children, who are of an appropriate age, are not sufficiently involved in case planning.	35 (100)
	Mothers are not sufficiently involved in case planning.	35 (100)
Workers visit with children	The frequency of face-to-face contacts between workers and children is not consistently sufficient to ensure children's safety and well-being.	27 (77)
Workers visit with children	When establishing face-to-face contacts with children, workers are not consistently focusing on issues pertinent to case planning and achieving goals.	14 (40)
Workers visit with parents	The frequency of face-to-face contacts between workers and parents is not consistently sufficient to ensure children's safety and promote attainment of case goals.	34 (97)
	The agency does not make concerted efforts to establish contact with fathers, even when fathers are involved in their children's lives.	13 (37)
	When establishing face-to-face contacts with parents, workers are not consistently focusing on issues pertaining to case planning and achieving case goals.	14 (40)
Educational needs of the child	Many children in foster care experience multiple school changes as a result of placement changes.	20 (57)
Educational needs of the child	The agency is not consistent in providing services to meet children's needs with respect to identified education-related problems.	18 (51)
Physical health of the child	The number of dentists/doctors in the State willing to accept Medicaid is not sufficient to meet the need.	27 (77)
	The agency is not consistent in providing children with preventive health and dental services.	14 (40)
	The agency is not consistent in conducting adequate, timely health assessments.	13 (37)
Mental health of the child	There is a lack of mental health services for children.	25 (71)
Mental health of the child	The agency is not consistent in conducting mental health assessments.	24 (69)

Additional information on the CFSRs is available at: http://www.acf.hhs.gov/programs/cb/cwmonitoring/index.htm.

¹ U.S. Department of Health and Human Services, Administration for Children, Youth, and Families (ACYF). (2005). Child and Family Services Review Update [On-line]. Available: http://www.acf.hhs.gov/programs/cb/cwmonitoring/cfsr/jun05.htm. back
² U.S. Department of Health and Human Services (ACYF). (2005). General findings from the federal child and family services review [On-line]. Available: http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/genfindings04/ch1.htm. back

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Child Neglect: A Guide for Prevention, Assessment and Intervention.

Appendix D Neglect and the Child and Family Services Reviews

Common Challenges Identified with Respect to CFSR Safety, Permanency, and Well-being Indicators and Number of States for Which Concerns Were Relevant—FY 2002-20042

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Appendix D
Neglect and the Child and Family Services Reviews

Common Challenges Identified with Respect to CFSR Safety, Permanency, and Well-being Indicators and Number of States for Which Concerns Were Relevant—FY 2002-2004²