Order Code RL32968
CRS Report for Congress
Received through the CRS Web
Child Welfare: State Performance on Child
and Family Services Reviews
June 29, 2005
Emilie Stoltzfus
Analyst in Social Legislation
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress

Child Welfare: State Performance on
Child and Family Services Reviews
Summary
While child welfare programs are a primary responsibility of state and local
governments, the federal government appropriates close to $7 billion annually to
support these programs (primarily for foster care and adoption assistance) and states
are required to meet certain federal policies in order to receive this funding. Child
and Family Services Reviews (CFSRs) gauge state efforts and ability to achieve the
primary goals of safety and permanence for children, and well-being for children and
their families. The review is intended both to measure state compliance with federal
child welfare policy and to strengthen and improve state child welfare programs.
The Department of Health and Human Services (HHS) conducted the initial
round of onsite reviews between March 2001 and March 2004. No state was found
to be in substantial conformity with all of the outcomes and systems assessed. Some
critics of the CFSR argue that while the outcomes reviewed are on target, the criteria
established to determine state achievement of those outcomes may give misleading
information about a state’s performance.
Although much attention has focused on states’ uniform inability to meet all of
the federal criteria, the reviews also showed certain relative strengths. States showed
the greatest ability to ensure that children were not exposed to child abuse and
neglect and remained safely in their homes whenever appropriate and possible, and
in preserving their family relationships and connections. They had the most difficulty
in achieving permanent and stable living arrangements for children, enhancing the
capacity of families to meet the needs of their children and in seeing that appropriate
mental and physical health services were available to children served. Information
regarding ensuring provision of educational services to children was more mixed.
In addition to reviewing outcomes, the CFSR assesses state compliance with
federal child welfare policy by examining certain federally required systems. States
were most likely to be found successful at operating a statewide information system;
maintaining foster and adoptive parent licensing, training, recruitment and retention;
and responding to community concerns. They were least likely to have a strong
service array or case review system in place. Ratings of state quality assurance and
training systems were more mixed.
To avoid immediate assessment of penalties for failure to comply with federal
policy, each state was required to develop a Program Improvement Plan (PIP). A PIP
must address each one of the outcomes or systems with which a state was found to
be out of substantial conformity and must describe the state’s specific plan for
moving toward full conformity with federal policy. A few states have successfully
completed their PIPS but most are still in the process of implementing them.
The Children’s Bureau has begun planning for a second round of CFSRs and
onsite reviews will likely begin in FY2006. This report will describe the origins and
design of CFSRs before turning to its primary discussion: state performance in the
initial round of CFSRs. This report will not be updated.

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Origins of the CFSR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
How Is a CFSR Conducted and What Is Assessed? . . . . . . . . . . . . . . . . . . . . . . . 4
Statewide Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Onsite Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
What Does “Substantial Conformity” Mean? . . . . . . . . . . . . . . . . . . . . . . . . 5
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Aggregate State Performance on Outcomes in the Initial CFSR . . . . . . . . . . . . . 10
Case review only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
National standards only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
State Performance by Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Outcomes Assessed by Case Review and National Standards . . . . . . . . . . . 11
Protecting Children from Maltreatment . . . . . . . . . . . . . . . . . . . . . . . . 12
Permanency and Stability in Living Arrangement . . . . . . . . . . . . . . . . 12
Outcomes Assessed by Case Review Alone . . . . . . . . . . . . . . . . . . . . . . . . 12
Families have enhanced capacity to provide for their children’s
needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Children receive adequate services to meet their physical
and mental health needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Children are safely maintained in their own homes whenever
possible and appropriate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
The continuity of family relationships and connections is maintained
for children in foster care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Children receive appropriate services to meet their educational
needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
State Performance on Individual Case Review Indicators . . . . . . . . . . . . . . 14
State System Performance in the Initial CFSR . . . . . . . . . . . . . . . . . . . . . . . . . . 17
A Closer Look at the Weaknesses Identified by the CFSR . . . . . . . . . . . . . . . . . 21
Permanent and Stable Living Arrangements . . . . . . . . . . . . . . . . . . . . . . . . 21
Common challenges to achieving permanent and stable
living arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Enhancing Families’ Capacity to Meet the Needs of Their Children . . . . . 24
Common challenges to enhancing the capacity of families to
meet the needs of their children . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Do States in System Compliance Achieve Better Outcomes? . . . . . . . . . . . 26
Assessing Penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Did the Initial CFSR Accurately Measure State Performance? . . . . . . . . . . . . . . 28
National standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
State variation in policy and caseload . . . . . . . . . . . . . . . . . . . . . . . . . 29

Accuracy of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
What is measured versus what is meant to be measured . . . . . . . . . . . 31
Measuring Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Who Is Accountable? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
The Next Round of CFSRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Appendix A. CFSR Review and PIP Implementation Schedule . . . . . . . . . . . . 35
Appendix B. Overview of State Performance on Outcomes, Systems and
National Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Appendix C. State Performance on Outcomes Assessed in the Initial Child
and Family Services Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Appendix D. Analysis of Case Characteristics and Ratings of Outcome
Achievement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Age of child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Race/ethnicity of child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Primary reason for case opening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Location of case review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
List of Figures
Figure 1. Performance Rating for All Applicable Cases Assessed in the
Initial Child and Family Services Review . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Figure 2. State Performance on Systems by Composite Strength or Area
Needing Improvement Rating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
List of Tables
Table 1. Brief Description of Common Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Table 2. The National Standards Used in the Initial Round of the Child and
Family Service Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Table 3. The Child and Family Services Review: Outcomes and Systems
with Associated Review Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Table 4. Summary of State Performance Ratings on the National Standards
Used in the Initial Child and Family Services Reviews . . . . . . . . . . . . . . . . 11
Table 5. State Ratings for Performance Indicators (23) Associated with
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Table 6. State Ratings for Performance Indicators (22) Associated with
Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Table 7. Common Challenges to Achieving Permanent and Stable
Living Arrangements for Children in Foster Care
. . . . . . . . . . . . . . . . . . . 23
Table 8. Common Challenges to Enhancing the Capacity of Families to
Meet the Needs of Their Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Table A-1. Initial Onsite Review Schedule with Final Report and PIP
Approval, Approximate Completion, and Evaluation Date . . . . . . . . . . . . . 35
Table B-1. State Performance on Outcomes in the Initial Child and Family
Services Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Table B-2. State Performance on the National Standards in the Initial
Child and Family Services Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Table B-3. State Performance on Systems in the Initial Child and Family
Services Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Table C-1. Performance Ratings for Applicable Cases Reviewed in the Initial
Child and Family Services Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Table C-2. Safety Outcome 1: Children are First and Foremost Protected
from Abuse and Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Table C-3. Safety Outcome 2: Children are Safely Maintained in Their Own
Homes Whenever Possible and Appropriate . . . . . . . . . . . . . . . . . . . . . . . . 47
Table C-4. Permanence Outcome 1: Children have Permanence and
Stability in Their Living Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Table C-5. Permanence Outcome 2: The Continuity of Family Relationships
and Connections is Preserved for Children . . . . . . . . . . . . . . . . . . . . . . . . . 52
Table C-6. Well-Being Outcome 1: Families Have Enhanced Capacity to
Provide for Their Children’s Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Table C-7. Well-Being Outcome 2: Children Receive Appropriate Services to
Meet Their Education Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Table C-8. Well-Being Outcome 3: Children Receive Adequate Services to
Meet their Physical and Mental Health Needs . . . . . . . . . . . . . . . . . . . . . . . 58

Child Welfare: State Performance on Child
and Family Services Reviews
Introduction
The Child and Family Services Review (CFSR) is the central and most
comprehensive component of federal efforts to determine state compliance with
federal child welfare policies and, equally, to help ensure that positive outcomes are
achieved for the children and families served by state child welfare programs.1 The
review intends to gauge state efforts and ability to achieve the primary goals of safety
and permanence for children, along with well-being for children and their families.
The U.S. Department of Health and Human Services (HHS) began the first onsite
reviews in March 2001 and, as of March 2004, had completed the initial round of the
CFSR in all states, the District of Columbia and Puerto Rico.2
Many states were found to have substantially achieved the goal of safety,
permanence, or well-being for a majority of the cases reviewed and to have in place
systems adequate to achieve positive outcomes for children. At the same time, the
initial round of CFSRs found that no state’s child welfare programs met the criteria
that HHS established as demonstrating “substantial conformity” with all of federal
child welfare policy requirements. As a result, all states have or are implementing
Program Improvement Plans (PIPs). To avoid financial penalties associated with
noncompliance, states must meet the improvement goals established in their PIP.
Although the final CFSR regulation states that a subsequent full CFSR is to
occur in each state two years after the approval of a state PIP, in practice this has
been judged impossible (e.g., such a time frame would mean that a state’s second-
round CFSR performance would be based on the same data that are used to assess the
1 State compliance with federal child welfare policies and procedures is also assessed
through other methods. Many of these are intended to examine only one aspect of federal
child welfare policies. These include review and approval of the Title IV-E plan and the
Child and Family Services Plan (CFSP); “partial reviews” which look at state compliance
with specific provisions (e.g., denial of certain placements due to race or ethnicity or
because of interjurisdictional issues); periodic in-depth review of a sample of foster care
cases for which Title IV-E foster care maintenance payments are made (see CRS Report
RL32836, Child Welfare: An Analysis of Title IV-E Foster Care Eligibility Reviews, by
Cheryl Vincent.); assessment of state Adoption and Foster Care Analysis Reporting Systems
(AFCARS); review of Statewide Automated Child Welfare Information System (SACWIS);
audits by the Office of the Inspector General and regional office review of quarterly Title
IV-E claims.
2 In this report, both the District of Columbia and Puerto Rico will be referred to as “states.”

CRS-2
success of the initial PIP). HHS is currently developing but has not yet released a
schedule for the second round of reviews.
This report begins with a short history of the legislation and other factors that
led to the creation of the current CFSR and then briefly describes how a CFSR is
conducted and what “substantial conformity” with federal child welfare policy means
in the context of this review. Much has been made of the fact that no state was found
to be in substantial conformity with all aspects of federal policy reviewed during the
initial (FY2001-FY2004) round of the CFSRs. This report seeks to better understand
that fact by looking closely at state performance on each of the performance
indicators that determined compliance. Taking apart this general “not in substantial
conformity” finding permits a more complex understanding of state performance, and
the report uses this analysis to identify and discuss those areas in which states
showed the greatest inability to achieve compliance with federal policy. (Readers
should note that in addition to the text describing state performance, tables included
in Appendices B and C of the report provide detailed ratings information for each
state and Appendix D presents information on the case characteristics (e.g., age or
race/ethnicity of child in case being reviewed vis a vis outcome achievement)).
Finally, the report concludes with a brief discussion of 1) how penalties for non-
compliance are assessed; 2) the requirement that states not in compliance with federal
policy develop Program Improvement Plans (PIPs) (Appendix A shows the status
of PIP implementation); 3) some of the criticisms of how the initial CFSR assessed
state performance (especially with regard to the national standards); and 4) planning
for the second round of CFSRs.
Origins of the CFSR
With the 1980 Adoption Assistance and Child Welfare Act (P.L. 96-272),
Congress established the basic framework for the current federal-state child welfare
programs. That legislation created a set of federal protections applicable to all
children in foster care (e.g., a written case plan and regular case review). States were
required to provide these protections, without regard to a child’s eligibility for federal
foster care funding, if they wished to ensure receipt of their full funding for Child
Welfare Services (authorized under Title IV-B of the Social Security Act). To
determine if states were indeed providing these protections to all children and were
thus eligible for their full Child Welfare Services allotment HHS created “427
reviews,” (which were named for the Section of the Social Security Act that
established certain voluntary protections for all foster care children). The 427
review process was established without formal regulations and it came to be viewed
as arbitrary, designed only to check policies on paper not in practice, and interested
in identifying weaknesses for the purpose of punishment only (not for designing
improvements).3
As a part of the Social Security Amendments of 1994 (P.L. 103-432) Congress
required HHS to develop a new system of review for state child welfare programs
3 For more information see “History of Federal Review Efforts” in U.S. Congress, House
Committee on Ways and Means, Greenbook 2004, Feb. 2004, pp. 11-52 to 11-53
[http://waysandmeans.house.gov/media/pdf/greenbook2003/Section11.pdf].

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that focused on outcomes achieved for children and families and that would replace
the older, and discredited, process-driven reviews. The same 1994 legislation also
repealed the former Section 427 but made each of its formerly voluntary protections
a part of the Title IV-B state plan requirements. This made the protections
mandatory for all foster care children in all states.
P.L. 103-432 (1994) further provided that the newly designed review system
must cover the full range of statutory and regulatory child welfare policies and that
the criteria used to measure states’ compliance with specific factors were to be
spelled out in formal regulations. It added that these regulations were also to detail
what the penalties were, tie the amount of any financial penalty assessed to the degree
of noncompliance found, suspend withholding of any penalties while states take
corrective action, and further, rescind the penalties if a state successfully
implemented corrective action. Finally, the legislation required HHS to offer
technical assistance to any state needing to take corrective action.
During the last half of the 1990s HHS consulted with child welfare
administrators and conducted 13 pilot reviews. In January 2000, the Department
released its final regulation on the Child and Family Services Review (CFSR).
Guided in part by the 1997 passage of the Adoption and Safe Families Act (P.L. 105-
89), HHS established the overall goals of safety and permanency for children, and
well-being for children and families, as the overarching aims of each state child
welfare program. To achieve substantial conformity with federal child welfare
policy, the final review regulation lists seven specific outcomes that a state must
achieve and seven specific systems that a state must demonstrate are in operation.4
A CFSR Procedures Manual was subsequently produced and listed 45 items — or
performance indicators — which were associated with the seven outcomes and seven
systems and used to guide the review team through an evaluation of the state’s
performance.5 HHS also issued separate policy guidance on six national standards,
the concept of which was outlined in the formal regulations, and which were
developed as complimentary performance indicators using statewide data.6 Table
1
provides definitions for certain key terms used in this report.

4 See 45 C.F.R.§§ 1355.31-1355.37 available at [http://www.access.gpo.gov/nara/cfr/
waisidx_02/45cfr1355_02.html]. HHS discussion of regulations are included in the Federal
Register
announcement of Jan. 25, 2000 available at [http://www.acf.dhhs.gov/programs/
cb/laws/fed_reg/fr012500.pdf].
5 The final regulations provide that such a guide will be made available to states, including
any significant revisions. During the course of the initial review, HHS made several
revisions to the manual. The procedure manual was under revision at the time of this report;
the final version of the manual used for the initial round of reviews (as of May 27, 2005)
could be viewed at [http://www.acf.dhhs.gov/programs/cb/cwrp/tools/index.htm].
6 The regulations provide that “to the extent practical and feasible,” the data indicators will
match those developed for the annual Child Welfare Outcomes book (required by Section
203 of Adoption and Safe Families Act, P.L. 105-89). See 45 C.F.R. §1355.34(b)(4) and
(5).

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Table 1. Brief Description of Common Terms
Goals
Overarching purposes of state child welfare programs.
Desired results of services provided for children and, in certain
Outcomes
instances, their families. The CFSR includes seven outcomes.
Policies and procedures that must be in place to ensure the state’s ability
Systems
to achieve required outcomes. The CFSR assesses seven systems.
The three kinds of performance indicators used for the CFSR are —
Case Review - Specific indicators (23) used in each applicable case
to assess whether an outcome was achieved.
Performance
National Standards - Statewide data are examined in relation to
Indicators
each of the national standards (6) to determine compliance with certain
outcomes.
System Review - Specific indicators (22) used to assess whether a
required system has been implemented and is functioning.
The state is determined to have —
— Achieved the desired outcome in 90% or more of the cases reviewed
(95% of cases for future CFSRs);
Substantial
— Met the national standards related to specified safety and
Conformity
permanency outcomes; and
— Implemented and to be successfully operating each of the required
systems.
Source: Congressional Research Service (CRS).
How Is a CFSR Conducted and What Is Assessed?
The CFSR begins with a state’s own assessment of its child welfare programs.
This self-assessment is followed by an onsite review conducted by a team of federal
and state investigators. The final determination of substantial conformity with
specific outcomes and systems is made following the onsite review and is based on
information gathered during the onsite review as well as the analysis of statewide
data for the period for which the state is under review.
Statewide Assessment
During the statewide assessment, a state must review and prepare a report on all
aspects of its program performance, including its provision of services to children in
foster care and those who have been reported to the child welfare system but who
have not been removed from their homes. As an important part of this self-
assessment, the state must analyze certain statewide program data and measure its
own performance for the period under review against established national standards.
The statewide assessment must include consultation with non-agency and community
stakeholders in the system. The report prepared from this assessment serves as a
basis for the state’s onsite review but does not constitute a final determination of
substantial conformity.

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Onsite Review
The onsite review, conducted by a team of federal and state members, follows
the statewide assessment and occurs simultaneously in three locations in the state
(including the largest city or metropolitan area). It includes intensive review of a
sample of cases (usually a total of 50, roughly half in foster care and half in-home
cases) and interviews with a variety of stakeholders (both statewide and local), who
have particular experience with or knowledge of the state child welfare programs.
Stakeholders that must be interviewed include children, parents, foster parents, case
workers and other service providers in the individual cases being reviewed and, with
regard to the local or state program more generally, the child welfare director, case
workers, foster parents, dependency or juvenile court judges, guardians ad litem, and
other representatives of groups that the state consults with to design its child welfare
program and services.
What Does “Substantial Conformity” Mean?
Both qualitative and quantitative information is solicited and analyzed to
determine whether or not a state is in substantial conformity with federal child
welfare policy. States were assessed on both the outcomes they achieved and the
systems they had in place to achieve those outcomes.
Outcomes. State conformity with the seven specific outcomes is measured
via case reviews and the national standards. These outcomes are:
! Children are first and foremost protected from abuse and neglect;
! Children are maintained in their own homes whenever possible and
appropriate;
! Children have permanence and stability in their living situations;
! Family relationships and connections are preserved for children;
! Families have enhanced capacity to provide for their children’s needs;
! Children receive appropriate services to meet their educational needs; and
! Children receive adequate services to meet their physical and mental health
needs.
In the initial round of CFSRs a state needed to achieve the desired outcome in 90%
of the applicable cases reviewed.7 Whether a state achieved one or more of the seven
outcomes in a given case was based on an onsite review of the case records combined
with interviews of case-specific individuals (e.g., the foster parents, case worker,
and/or child). Using a standardized survey instrument reviewers then determined
whether or not each specific outcome was achieved in the case by rating each of the
applicable case review indicators. (See also Table 3.)
In addition to achieving an outcome in 90% of the cases, for a state to be found
in substantial conformity with two of the outcomes (one associated with safety, the
other with permanency) it also needed to meet each of the six national standards (data
7 The regulations provide that for a state to be found in substantial conformity in a
subsequent CFSR, it must achieve the outcome in 95% of the cases.

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indicators). The national standards used in the initial round of the CFSR were based
on state administrative data regarding recurrence of maltreatment, incidence of
maltreatment while in foster care, the rate of re-entries to foster care, the stability of
foster care placements, and the state’s achievement of adoptions and reunifications
on a “timely” basis. For a state to meet the required national standards, an analysis
of statewide administrative data for the 12 months (generally) that were a part of the
formal review period must indicate that the state matched or exceeded each of the
established national standards. The national standards and a description of the data
used to determine a state’s performance with regard to these standards is provided in
Table 2.
Table 2. The National Standards Used in the Initial Round of the
Child and Family Service Review
What is measured
National standard
Recurrence of Maltreatment. Of all the children who were victims of
6.1%
child maltreatment during the first 6 month period of review, what
(or less)
percentage were again found to be victims of maltreatment based on a
second report made within 6 months of the first maltreatment report?
Maltreatment in foster care. Of all the children in foster care during
0.57%
the period of review what percentage were found to have experienced
(or less)
maltreatment at the hands of a foster parent or staff member of a foster
care facility?
Foster care re-entries. Of all the children who entered foster care
8.6%
during the year under review, what percentage were re-entering foster
(or less)
care within 12 months of a prior foster care episode?
Timely reunification. Of all the children who left foster care to be
76.2%
reunited with their parents or caretakers (during the year under review),
(or more)
what percentage did so within 12 months of their date of most recent
removal from home?
Timely adoption. Of all the children who left foster care because of
32.0%
adoption (during the year under review), what percentage did so within
(or more)
24 months of their date of most recent removal from home?
Stability of placement. Of all the children in care less then 12 months
86.7%
from the time of their latest removal (during the period under review),
(or more)
what percentage had no more than two placement settings?
Source: Prepared by the Congressional Research Service (CRS). Development of these standards
is further described in U.S. Department of Health and Human Services (HHS), Administration for
Children and Families (ACF), Background Paper: Child and Family Services Reviews National
Standards
[http://www.acf.hhs.gov/programs/cb/hotissues/background.htm].
Systems. State compliance with certain “system” requirements was also rated
and a state was found in substantial conformity with a given system requirement if
that system was in place and functioning. The systems assessed were —
! Statewide information system;
! Case review system;
! Quality assurance system;
! Staff training;
! Service array;

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! Agency responsiveness to community;
! Foster and adoptive parent licensing, recruitment, and retention.
Using a standardized survey instrument, reviewers rated 22 system indicators
— one or more of which was linked to each of these systems — as either a
“strength” or an “area needing improvement.” In general, for a state to have a system
found in substantial conformity all of the indicators associated with the system must
be in place and no more than one of those same indicators can be functioning below
the level described by the requirements. (Only one indicator was associated with the
statewide information system so that states needed to achieve a strength rating on that
single indicator to be found in substantial compliance with that system requirement.)
Table 3 shows the overarching goals of the review, with the seven outcomes
and seven systems, and each of the associated performance indicators, including the
national standards.

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Table 3. The Child and Family Services Review: Outcomes and Systems with Associated Review Criteria
Goal
Outcome
Case review item
National standard
performance indicator
performance indicator
Safety
Children are first and foremost
— Timeliness of investigation of maltreatment reports
— Recurrence of maltreatment
protected from abuse and
— Recurrence of maltreatment
— Incidence of maltreatment in foster
neglect.
care
Children are safely maintained
— Services to protect children in home and prevent removal
in their homes whenever
— Risk of harm to child

appropriate or possible.
Permanency
Children have permanency and
— Foster care re-entries
— Foster care re-entries
stability in their living
— Placement stability
— Placement stabilityLength of time
situations.
— Permanency goal (e.g. established, appropriate)
to reunification
— Timely achievement of reunification, guardianship, or kin placement
— Length of time to achieve adoption
— Timely achievement of adoption
— Appropriate use of “another planned living arrangement”
The continuity of family
— Proximity of placement to parent’s home
relationships and connections is
— Placement in foster care with siblings
preserved for children.
— Frequency of visits with parents and siblings

— Connections with family and community preserved
— Use of relatives as placement resource
— Relationship with parents maintained
Well-being of
Families have enhanced capacity — Assessment of services needs of child, parents and foster parents
children and their
to provide for their children’s
— Involvement of child and parents in case planning

families
needs.
— Frequency and quality of caseworker visits with child
— Frequency and quality of caseworker visits with parents
Children receive appropriate
— Provide for child’s education needs
services to meet their

educational needs.
Children receive adequate
— Provide for child’s physical health needs
services to meet their physical
— Provide for child’s mental health needs

and mental health needs.

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Goal
System
System item (performance indicator)
Maintain the
Statewide Information System
— State’s system can readily identify status, characteristics, location, and goals for every child in foster care.
capacity to
Case Review System
— Children in foster care have written case plans developed jointly with parents.
achieve safety and
— Children in foster care have court or administrative reviews every 6 months.
permanence for
— Children in foster care have permanency hearings at least every 12 months.
children and well-
— AFSA requirements for termination of parental rights are in place.
being for children
— Foster caretakers are notified of hearings/reviews; have opportunity to be heard.
and their families
Quality Assurance System
— State has standards to ensure children in foster care receive quality services to protect their safety and health.
— State has quality assurance system to evaluate services and provide feedback.
Staff Training
— State operates a training program for new staff who provide services.
— State operates ongoing training of staff.
— State provides for training of foster and adoptive parents, and of child care staff.
Service Array
— State has an array of services that support a safe home environment, enable children to remain safely with their
parents, and help children achieve permanency.
— The services are accessible in all political jurisdictions covered by the state plan.
— The services can be tailored to the individual needs of children and families.
Agency Responsiveness to
— State consults on an ongoing basis with other groups (e.g., tribes, courts) and includes their concerns in the state
Community
plan.
— Agency develops, in consultation with these other groups, annual reports on progress and services delivered.
— State’s services are coordinated with services or benefits of other federal programs serving the same population.
Foster and Adoptive Parent
— Standards for foster family home and child care institutions have been implemented and are reasonably in accord
Licensing, Recruitment, and
with recommended national standards.
Retention
— Standards are applied to all licensed homes or child care institutions receiving Title IV-E or Title IV-B funds.
— State complies with federal criminal background clearance requirements for licensing or approval of foster care and
adoptive placements.
— State has a process to ensure diligent recruitment of potential foster and adoptive families who reflect the ethnic and
racial diversity of children needing placements.
— State has process for effective use of cross-jurisdictional resources to aid timely adoptive or permanent placements.
Source: Prepared by Congressional Research Service (CRS) based on the CFSR procedures manual online as of May 27, 2005 . The procedures manual has been revised several times.
However, with the exception of one item (which for reviews done in 2001 assessed state provision of independent living services for children age 16 or older, and which for reviews
in 2002-2004 looked instead at appropriate and timely achievement of reunification, guardianship, or kinship placement) the goals, outcomes, systems and items have generally remained
the same.


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Aggregate State Performance on Outcomes
in the Initial CFSR
In general both the onsite case review and the analysis of statewide data showed
that states performed best with regard to safety outcomes, had greatest difficulty with
most of the permanency outcomes and showed more mixed results in relation to the
well-being outcomes.
Case review only. The case reviews indicate that, as a whole, states
performed most successfully in protecting children from abuse and neglect (outcome
substantially achieved in 85% of cases nationally) and in ensuring that children
receive appropriate services to meet their educational needs (outcome substantially
achieved in 84% of cases nationally). They were least successful in ensuring that
families have enhanced capacity to provide for their children’s needs (outcome
achieved in 55% of cases nationally) and in providing that children have permanence
and stability in their living situations (outcome substantially achieved in 56% of
cases nationally).
Figure 1 illustrates the percentage of cases in which states, cumulatively, were
found to have substantially achieved the desired outcome, partially achieved the
outcome, or not achieved or addressed the outcome. (For a list of states that achieved
substantial conformity with each outcome, see Appendix B, Table B-1.)
Figure 1. Performance Rating For All Applicable Cases Assessed in
the Initial Child and Family Services Review
Source: Figure prepared by the Congressional Research Service (CRS) based on data
provided in the final reports of the Child and Family Services Review for 50 states, the
District of Columbia and Puerto Rico.
National standards only. Table 4 shows how states performed vis-a-vis the
national standards. No state met all six of the national standards. The percentage of

CRS-11
states achieving any one of the standards ranged from about half to a little better than
one out of four. As measured against the national standards used in the initial round
of the CFSR, states were most successful in protecting children from maltreatment
while in foster care and in ensuring a low rate of children re-entering foster care.
Conversely, states were least successful at ensuring stability of placements and timely
adoptions for foster care children. (For a list of states that met or did not meet each
of the national standards see Appendix B, Table B-3).
Table 4. Summary of State Performance Ratings on the
National Standards Used in the Initial Child
and Family Services Reviews
States
Associated Statewide Data
National Median State
Outcome
Meeting
Indicator
Standard
Percentage
Standard
Safety 1:
Incidence of Recurrence of
7.3%
17
6.1%
Children are
Maltreatment
(or less)
first and
foremost
protected from
Incidence of Maltreatment in Foster
0.56%a
28
0.57%
abuse and
Care.
(or less)
neglect
Rate of Foster Care Re-entries
8.6%
8.7%
26
(or less)
Permanence 1:
Children have
Reunifications Achieved (within 12
76.2%
67.1%
19
permanence
months of entering foster care)
(or more)
and stability in
Adoptions Achieved (within 24
32.0%
23.0%
14
their living
months of entering foster care)
(or more)
situations
Rate of Placement Stability (no more
86.7%
83.5%b
14
than 2 placements in 12 months)
(or more)
Source: Table prepared by the Congressional Research Service (CRS) based on information in the
final reports of the 50 states, the District of Columbia and Puerto Rico.
a. The final report for New York did not provide data with regard to this standard and the state was
not included in this calculation.
b. The final reports of New York and Nevada did not provide data with regard to this standard and
these states are not included in this calculation.
State Performance by Outcome
Outcomes Assessed by Case Review and National Standards
To be found in substantial compliance with two outcomes: 1) children are first
and foremost protected from abuse and neglect, and 2) children have permanence and
stability in their living arrangement, states must have achieved the outcome in 90%
of the applicable cases and also must have met the applicable national standards.

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Protecting Children from Maltreatment. Although the states scored
relatively well on both the case reviews and national standards for this outcome,
when the two tests were combined, just six states (AL, AZ, AR, DC, PA, SC) were
determined to have substantially achieved the goal of protecting children from abuse
and neglect.
Nationally there were close to 2,350 applicable cases rated on this safety
outcome. The share of cases in which individual states achieved this outcome ranged
from a low of 62% (AK) to a high of 100% (NY); the median state performance was
86%. Beyond the case reviews, to determine conformity with this outcome, statewide
data were examined to measure 1) the incidence of children who were the found to
be the victims of child abuse or neglect more than once in a six month period; and
2) the incidence of child maltreatment occurring in foster care. Twelve states met
both of these national standards. (See Appendix C, Table C-2 for information on
this outcome by each state.)
Permanency and Stability in Living Arrangement. In general, states
scored relatively poorly on both the case review and data measures used to determine
conformity with this outcome and no state was found to be in conformity with this
permanency outcome.
This outcome was applicable only to those cases reviewed in which the children
were in foster care. Nationally there were close to 1,500 applicable cases rated on
this outcome. The share of cases in which individual states achieved this outcome
ranged from a low of 7% (KY) to a high of 92% (ND); the median state performance
was 51%.8 Beyond the case reviews used to determine conformity with this outcome,
statewide data were examined to measure 1)for children entering foster care, the
percentage of those who were re-entering care within 12 months of a prior entry to
foster care; 2) for foster care children who were reunified with their parents or a
caretaker, the percentage of those reunifications happening within 12 months; 3) for
foster care children who were adopted, the percentage of those adoptions happening
within 24 months; and 4) for children in foster care less than 12 months, the
percentage who were placed in no more than two settings during that time. No state
met all four of those standards. However more than half of the states (28) met the
standard related to foster care re-entries and no standard was achieved by fewer than
one in four of the states. (See Appendix C, Table C-4 for information on this
outcome by each state.)
Outcomes Assessed by Case Review Alone
Five outcomes were not associated with any national standards and states were
determined to be in conformity, or not, solely on the basis of whether 90% or more
of the applicable cases reviewed had substantially achieved the outcome. Although
8 Reviewers rated just two states (DE and ND) as having achieved this outcome in 90% or
more of their applicable case sample. However, state performance on this outcome is not
strictly comparable across all years of the initial CFSR because the case review performance
indicators for this outcome were adjusted following the 2001 reviews (conducted in 17
states). Both Delaware and North Dakota had their onsite review in FY2001.

CRS-13
the number of states that received a substantial conformity rating for any given
outcome was quite low, the range of performance on each outcome was considerable.
Families have enhanced capacity to provide for their children’s
needs. No state substantially achieved this outcome in 90% or more of its case
review sample and thus no state achieved substantial conformity with this outcome.
Nationally there were more than 2,500 cases given a performance rating for this
well-being outcome. The share of cases in which individual states achieved this
outcome ranged from a low of 18% (NJ) to a high of 86% (NY); the median state
performance was 66%.
Children receive adequate services to meet their physical and
mental health needs. Reviewers determined that only one state (DE)
substantially achieved this outcome for 90% or more of its case review sample; thus
it was the only state found in substantial conformity with this outcome. Nationally
there were more than 2,400 cases given a performance rating for this well-being
outcome. The share of cases in which individual states substantially achieved this
outcome ranged from a low of 51% (PR) to a high of 92% (DE); the median state
performance was 70%.
Children are safely maintained in their own homes whenever
possible and appropriate. Reviewers determined that 6 states (AZ, IA, KS, NM,
NY, UT) substantially achieved this outcome in 90% or more of their case review
sample and thus these states were found in substantial conformity with the outcome.
Nationally there were close to 2,400 cases given a performance rating on this safety
outcome. The share of cases in which individual states achieved this outcome
ranged from a low of 48% (NJ) to a high of 93% (IA); the median state performance
was 81%.
The continuity of family relationships and connections is
maintained for children in foster care. Reviewers determined that 7 states
(FL, ID, LA, MA, ND, OR, TX) substantially achieved this outcome in 90% or more
of their case review samples and thus these states were found in substantial
conformity with the outcome. This permanency outcome applies to children who are
in foster care only. Nationally there were close to 1,500 cases rated on this outcome.
The share of cases in which individual states achieved this outcome ranged from a
low of 38% (TN) to a high of 94% (TX and OR); the median state performance was
77%.
Children receive appropriate services to meet their educational
needs. Reviewers rated 16 states (CO, CT, HI, ID, IA, KS, KY, ME, MT, NH, NY,
ND, UT, VT, VA, WI) as having substantially achieved this outcome in 90% or more
of their case review sample and thus these states were found in substantial conformity
with the outcome. Nationally there were more than 2,000 cases rated on this well-
being outcome. The share of cases in which individual states achieved this outcome
ranged from a low of 65% (NJ) to a high of 100% (UT); the median state
performance was 83%.

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State Performance on Individual Case Review Indicators
An additional view on the areas that showed the greatest strength or need for
improvement can also be gained by studying whether each of the items, or
performance indicators, associated with the case review process was rated as an
overall “strength” or an “area needing improvement” for the state. The “strength” or
“area needing improvement” ratings for a given state represent aggregate
performance across all applicable cases for a single one of these items (performance
indicators). Because these ratings are not case-specific findings, they do not directly
affect the determination of a state’s conformity or nonconformity with a particular
outcome. Nonetheless, these aggregate item ratings are discussed in the state final
report and may be used to understand what contributed to a state’s overall rating on
an outcome (and consequently what areas should be addressed in the state PIP.)9
Ranking state outcome performance by case review indicators, produces a
pattern of strengths and weakness similar to what the case-by-case analysis suggests.
As discussed earlier no state was found to be in substantial conformity with two
outcomes: 1) families have enhanced capacity to provide for the needs of their
children and 2) (foster care) children have permanent and stable living arrangements.
Seven of the 10 separate case review indicators associated with achieving these two
outcomes were rated as a “strength” in 14% or fewer of the states. At the same time,
state performance on two of the case review indicators associated with the outcome
ensuring permanent and stable living arrangements for foster care children far
outstripped the number of strength ratings determined for any other performance
indicators. Sixty-nine percent of the states received a “strength” rating for their
efforts at “keeping brothers and sisters together in foster care” and 94% received a
strength rating for “placing children close to their birth parents or their own
communities.”
Table 5 lists each of the case review indicators assessed from those least likely
to receive a strength rating to those most likely to receive a strength rating.
9 HHS described this use of the “strength” and “area needing improvement” ratings, for
outcome indicators only
, in a Nov. 2003 memorandum. The Department noted that if a
particular outcome-related indicator was rated as a strength in 85% of applicable cases
reviewed it would receive a strength rating in the final report. Indicators for which less then
85% of the applicable cases reviewed were rated as a strength would appear in the final
report as an “area needing improvement.” See “Child and Family Services Reviews, Item
Ratings,” ACYF-CB-IM-03-05, Nov. 21, 2003. (Readers should note that a particular
indicator within an outcome may have been applicable to only a limited number of cases.
For instance, indicators related to the permanency goal for children, e.g., reunification,
adoption, another planned permanent living arrangement, would, by definition, be applicable
to only a subset of the cases being reviewed.)

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Table 5. State Ratings for Performance Indicators (23)
Associated with Outcomes
Ranked from Most in Need of Improvement to Least in Need of Improvement
States
receiving
ITEM (Indicator)
OUTCOME this item (indicator)
rating of
How effective is the agency at — a
is associated with
strength
#
%
Assessing needs of children, parents and
Well-being 1: Families have
foster parents and in providing services to
enhanced capacity to provide for
1
2%
meet those needs (including families
their children’s needs.
receiving in-home services)? (Item 17)
Identifying and addressing the emotional
Well-being 3: Children receive
and mental health needs of children
appropriate services to meet their
4
8%
receiving in-home and foster care services?
physical and mental health needs.
(Item 23)
Minimizing placement changes for
Permanency 1: Children have
children in foster care? (Item 6)
permanency and stability in their
living arrangements
Determining the appropriate permanency
Permanency 1: Children have
goals for children on a timely basis when
permanency and stability in their
5
10%
they enter foster care? (Item 7)
living arrangements
Involving parents and children in the case
Well-being 1: Families have
planning process? (Item 18)
enhanced capacity to provide for
their children’s needs.
Helping children in foster care return
Permanency 1: Children have
safely to their families when appropriate?
permanency and stability in their
11%b
(Item 8) b
living arrangements
Achieving timely adoption (within 24
Permanency 1: Children have
months or less) when that is appropriate for
permanency and stability in their
6
12%
the child? (Item 9)
living arrangements
Conducting face-to-face visits as often as
Well-being 1: Families have
needed with parents of children in foster
enhanced capacity to provide for
7
14%
care and parents of children receiving in-
their children’s needs.
home services? (Item 20)
Conducting face-to face visits as often as
Well-being 1: Families have
needed with children in foster care and
enhanced capacity to provide for
13
25%
those who receive services in their own
their children’s needs.
homes? (Item 19)
Planning and facilitating visits of children
Permanency 2: The continuity of
in foster care with their parents and with
family and community relationships
siblings placed separately in foster care?
is maintained for children.
(Item 13)
16
31%
Addressing the educational needs of
Well-being 2: Children receive
children in foster care and those receiving
appropriate services to meet their
services in their own homes? (Item 21)
education needs.

CRS-16
States
receiving
ITEM (Indicator)
OUTCOME this item (indicator)
rating of
How effective is the agency at — a
is associated with
strength
#
%
Preventing the recurrence of
Safety 1: Children are first and
maltreatment? (Item 2)
foremost protected from abuse and
neglect.
Establishing planned permanent living
Permanency 1: Children have
arrangements for children in foster care,
permanency and stability in their
who do not have the goal of reunification,
living arrangements
17
33%
adoption, guardianship, or permanent
placement with relatives? (Item 10)
Reducing the risk of harm to children
Safety 2: Children are maintained
including those in foster care and those who
in their own homes whenever
receive services in their own homes? (Item 4) possible and appropriate.
Identifying and addressing the physical
Well-being 3: Children receive
health and medical needs, including dental
appropriate services to meet their
20
39%
needs, of children receiving in-home and
physical and mental health needs.
foster care services? (Item 22)
Initiating investigations of reports of child
Safety 1: Children are first and
maltreatment in a timely manner,
foremost protected from abuse and
including at night and on weekends? (Item 1) neglect.
Providing services, when appropriate, to
Safety 2: Children are maintained
prevent removing children from their
in their own homes whenever
homes? (Item 3)
possible and appropriate.
Identifying relatives who could care for
Permanency 2: The continuity of
children entering foster care, and using
family and community relationships
them as placement resources when
is maintained for children.
21
40%
appropriate? (Item 15)
Promoting or helping to maintain the
Permanency 2: The continuity of
parent-child relationship for children in
family and community relationships
foster care when it is appropriate to do so?
is maintained for children.
(Item 16)
Preserving important connections for
Permanency 2: The continuity of
children in foster care, such as connections
family and community relationships
to neighborhood, community, faith, family,
is maintained for children.
and friends? (Item 14)
Preventing multiple entries of children
Permanency 1: Children have
into foster care? (Item 5)
permanency and stability in their
24
46%
living arrangements
Keeping brothers and sisters together in
Permanency 2: The continuity of
foster care? (Item 12)
family and community relationships
36
69%
is maintained for children.
Placing foster children close to their birth
Permanency 2: The continuity of
parents or their own communities or
family and community relationships
49
94%
counties? (Item 11)
is maintained for children.
Source: Table prepared by Congressional Research Service (CRS) based on data provided in the
CFSR final reports.
a The description of each indicator is taken from the “core question” provided for a given item as
included in the Stakeholder Interview Guide (dated Feb. 2003). Relevant stakeholders are
asked to elaborate on each of the items generally, however state performance on each of these

CRS-17
items is rated as a strength or area needing improvement based on the agency and worker’s
performance in the individual cases reviewed. The stakeholder interview guide, as well as the
instructions given regarding individual case reviews have been updated several times throughout
the course of the initial review process. However, with the exception described in table note b
the general thrust of each indicator has remained consistent.
b The focus of this indicator was significantly changed during the initial round of Child and Family
Services Reviews. For states reviewed during FY2001 (n= 17), this case review indicator
addressed appropriate provision of independent living services; the ratings given to those states
for that indicator are not reflected in this table. For reviews conducted in FY2002-FY2004
(n=35), this case review indicator addressed appropriate reunification efforts. The percentage
of states receiving a strength rating for this item is related to the 35 states for which appropriate
reunification efforts were assessed. Out of those 35 states, four were given a strength rating for
this indicator.
State System Performance in the Initial CFSR
Reviewers also rated state performance based on the state’s policy and practice
with regard to seven federally required “systems.” This part of the CFSR is intended
to measure a state’s capacity to achieve positive outcomes related to safety,
permanency and well-being for the children and families its serves. Ratings for this
part of the review are largely based on interviews with state and local stakeholders
in the child welfare system. Overall states were more likely to be assessed as having
the capacity to produce positive outcomes for children than they were to have been
rated as achieving these outcomes. At the same time, because these systems are
intended to work together, a poor rating on any one of the systems may affect a
state’s ability to achieve one or all of the outcomes assessed. Further, state capacity
was judged weakest with regard to case review system and service array and these
systems are arguably keystones of a successful child welfare program.
Of the 52 states, 49 were found to have child welfare agencies that were
“responsive to the community,” 45 were judged in substantial compliance with
federal requirements for a statewide information system, and 43 were found to have
adequate recruitment, retention, and licensing programs for foster and adoptive
parents. A less substantial majority of states were found to have a functioning quality
assurance system in place (35) and to adequately meet the federal staff training
requirements (34). States had more difficulty meeting the system requirements
related to service array and case review. Less than half of states (23) were judged to
have a service array system in compliance with federal policy and just 13 states were
found in compliance with the case review system requirements.
Compliance with the system requirements of federal child welfare policy was
determined based on stakeholder interviews and the number of “strength” or “area
needing improvement ratings” given to each of the items associated with the
implementation and proper functioning of a system. Figure 2 shows a composite
(national) rating for each system — with 100% representing a strength rating for each
of the items associated with an outcome for all states. The figure illustrates again
that service array and case review system were determined to be the most significant
areas of weaknesses in state efforts to achieve positive outcomes for children. The
findings also suggests that performance in each of these areas may be more nearly
equal than would appear simply by looking at the number of states in compliance
with each system.


CRS-18
Figure 2. State Performance on Systems by Composite Strength or Area
Needing Improvement Rating
Source: Figure prepared by the Congressional Research Service (CRS) based on the strength or area
needing improvement ratings given for each item associated with a given system factor.
Compliance with a particular system is directly determined by the number of
associated indicators that are given a strength rating. Table 6 ranks each of the
indicators associated with this compliance determination, from those least likely to
receive a strength rating to those most likely to receive this rating. As might be
expected, it shows that items associated with the service array and case review
system are more likely to be rated as areas needing improvement than are most of
those items associated with agency responsiveness to the community and foster and
adoptive parent recruitment, retention and licensing. However, a few items run
counter to this trend. For instance, despite being an indicator related to the case
review system, the large majority of states (42 states - 81%) received a strength rating
for the case review item that sought to assess how good a state was at conducting a
periodic review of the status of each child in foster care. By contrast just 21 states
(40%) received a strength rating for their efforts to ensure the diligent recruitment of
potential foster and adoptive families that reflect the ethnic and racial diversity of
children needing those homes, although the vast majority of states were found in
substantial conformity with the overall system related to licensing, recruitment and
retention of foster care and adoptive parents.

CRS-19
Table 6. State Ratings for Performance Indicators (22)
Associated with Systems
Ranked from Most Likely to Need Improvement to Least Likely
States
System (or practice)
receiving
with which
rating of
Indicator: Core question
indicator is
strength
associated
#
%
How effective is the agency in developing written case
Case review system
6
12%
plans jointly with the parents? (Item 25)
To what extent are services accessible to families and
Service array
9
17%
children in all jurisdictions in the state? (Item 36)
To what extent has the state put in place a process for
Foster and adoptive
21
40%
ensuring the diligent recruitment of potential foster
parent licensing,
and adoptive families that reflects the ethnic and racial
recruitment and
diversity of children needing foster and adoptive homes?
retention
(Item 44)
How effective is the agency in providing a process for
Case review system
22
42%
termination of parental rights for children in foster
care
, in accordance with the provisions of the Adoption
and Safe Families Act? (Item 28)
How responsive is the state’s array of services to the
Service array
25
48%
needs of the children and families it serves, including in-
home and foster care services? (Item 35)
How effective is the agency in ensuring that each child in
Case review system
26
50%
foster care has a permanency hearing in a qualified
court or administrative body no later than 12 months from
the date the child entered foster care and no less frequently
than every 12 months thereafter? (Item 27)
How effective is the agency in ensuring that foster
Case review system
26
50%
parents, pre-adoptive parents, and relative caregivers
of children in foster care receive notice of reviews or
hearings
held with respect to the child in their care, and
have an opportunity to be heard? (Item 29)
How effective is the state in providing ongoing training
Training
27
52%
for staff that addresses the skills and knowledge base
needed to carry out their duties? (Item 33)
How effectively does the agency individualize, or tailor,
Service array
30
58%
services to the unique needs of children and families?
(Item 37)
To what extent does the state operate an identifiable
Quality assurance
31
60%
quality assurance system that evaluates the quality of
services, identifies strengths and needs of the service
delivery system, provides relevant reports, and evaluates
program improvement measures? (Item 31)
How effective is the state in providing initial training for Training
34
65%
all staff who provide child welfare services? (Item 32)
How effective is the state in providing training for
Training
38
73%
current or prospective foster parents, adoptive parents
and staff of state-licensed or approved facilities
that
addresses the skills and knowledge needed to carry out
their duties? (Item 34)

CRS-20
States
System (or practice)
receiving
with which
rating of
Indicator: Core question
indicator is
strength
associated
#
%
To what extent does the agency develop, in consultation
Agency
40
77%
with the individuals or organizations identified [as
responsiveness to
major stakeholders], annual reports of progress and
community
services delivered pursuant to the state’s Title IV-B state
plan? (Item 39)
How effective is the agency in conducting the periodic
Case review system
42
81%
review of the status of each child, no less frequently
than once every 6 months
, either by a court or by
administrative review? (Item 26)
To what extent are foster care standards applied to all
Foster and adoptive
43
83%
licensed or approved foster family homes or child care
parent licensing,
institutions receiving Title IV-E or IV-B funds? (Item 42) recruitment and
retention
In what ways has the state developed and implemented
Quality assurance
44
85%
standards to ensure that children in foster care are
provided quality services
that protect their safety and
health? (Item 30)
How effective is the state’s information system in
Statewide
45
87%
readily identifying the status, demographic characteristics,
information system
location and goals for the placement of every child who is
(or within the immediately preceding 12 months, has been)
in foster care? (Item 24)
To what extent are the state’s services coordinated with
Agency
45
87%
the services or benefits of other federal or federally
responsiveness to
assisted programs serving the same population? (Item 40) community
To what extent does the state engage in ongoing
Agency
46
88%
consultation with tribal representatives, consumers,
responsiveness to
service providers, foster care providers, the juvenile court,
community
and other public and private child- and family-serving
agencies in order to include these stakeholders’ major
concerns in its state plan
? (Item 38)
How effectively does the state recruit and use families
Foster and adoptive
47
90%
who live in other jurisdictions, (for example, out of
parent licensing,
state), to facilitate timely adoptive or permanent
recruitment and
placements for waiting children? (Item 45)
retention
Does the state conduct criminal background clearances Foster and adoptive
50
96%
on prospective foster and adoptive parents before licensing parent licensing,
or approving them to care for children? (Item 43)
recruitment and
retention
To what extent has the state implemented licensing or
Foster and adoptive
51
98%
approval standards for foster family homes and child
parent licensing,
care institutions that ensure the safety and health of
recruitment and
children in foster care?(Item 41)
retention
Source: Table prepared by the Congressional Research Service based on state final reports of the
CFSR and the Stakeholder Interview Guide (Feb. 2003) prepared by the U.S. Department of Health
and Human Services (HHS). This interview guide has changed several times since the initial reviews
although the thrust of each core question (item/indicator) has remained largely the same.

CRS-21
A Closer Look at the Weaknesses Identified
by the CFSR
The following discussion looks more closely at each of the indicators explicitly
associated with the two outcomes for which no state was found to be in substantial
conformity; it also examines indicators associated with systems that might be
expected to affect state performance on those two outcomes. Many of those
indicators are related to the case review and service array systems on which states
were the least likely to have been found in substantial conformity.
Permanent and Stable Living Arrangements
Nationally, of the 1,479 foster care cases reviewed, permanent and stable living
arrangements were determined to have been substantially achieved in 56% (822) of
the cases and only partially achieved in 37% (548) of the cases. Reviewers rated 7%
of the cases (109) as not having achieved or addressed this outcome at all. In
assessing how well a state assists children in achieving permanent and stable living
arrangements, the CFSR looks at six performance indicators for each applicable case
and also examines statewide data to judge its performance with regard to four
national standards. Two states substantially achieved the outcome of permanent and
stable living arrangement in 90% or more of the cases (DE and ND) but no state
achieved compliance with all four of the national standards associated with this
outcome.10 The indicators associated with this outcome were —

! number of re-entries into foster care (case review and national standard);
! stability of placements (case review and national standard);
! timeliness and appropriateness of permanency goals (case review);
! timeliness of reunification (case review and national standard);
! timeliness of adoption (case review and national standard); and
! appropriate use of the permanency goal “another planned permanent living
arrangement” (case review).
Of these indicators, states were most successful at limiting re-entries to foster
care. Half of the states (26) met the national standard — meaning that statewide data
showed that 8.6% or less of the children who were entering foster care in the year
10 Because the case review indicators were adjusted after the first 17 states were reviewed
in 2001, state performance on this outcome is not strictly comparable across all years of the
initial round of the CFSR. (Both North Dakota and Delaware, the only states who achieved
substantial conformity on this outcome for 90% or more of the cases reviewed, were among
those first 17 states.) The case review indicators used for the first 17 states placed less
explicit attention on the timeliness of achieving a specific case goal, did not include a
specific indicator with regard to timeliness of reunification, did include an indicator
exclusively about provision of independent living services to any foster care child age 16
or older. For the reviews done in 2002-2004 (35 states), the timeliness (along with
appropriateness of a child’s permanency goal) was explicitly reviewed, an indicator
concerning the timeliness of reunification was added, and questions associated with the
provision of independent living services were incorporated in the indicator concerning the
appropriate use of another planned permanent living arrangement.

CRS-22
under review had entered foster care previously within the past 12 months — and
close to half (24) received a “strength” rating for this indicator based on the
applicable case reviews. Based on the case reviews, states were least successful in
meeting the indicators regarding minimizing the number of placements for children
and developing appropriate permanency goals for foster care children on a timely
basis. Only five states received a strength rating for either one of these indicators and
just 14 states met the national standard of 86.7% (or more) of the children who were
in care for 12 months or less experiencing two or fewer placements.
Among the indicators related to specific permanency goals, achieving timely
adoption (within 24 months of foster care entry) was the most difficult for states to
achieve — only six states achieved a strength rating in this area based on the case
reviews while 14 met the associated national standard. With regard to reunification
with a parent or caretaker within 12 months of entering foster care, 19 met the
associated national standard.11 Finally, 16 states received a strength rating for their
use of the permanency goal, another planned permanent living arrangement.
The case review system, which is spelled out in detail in Section 475 of the
Social Security Act, is a key part of federal child welfare policy designed both to
ensure the protection of children while in care and to enable them to achieve stable
and permanent living arrangements. States had the most difficulty achieving strength
ratings for indicators associated with implementing parts of the case review system
at the case level.
! Only six states received a strength rating for development of written case
plans, which are intended to guide the work done with children and families,
and which federal law states must be created jointly with parents.
! Less than half of the states (22) received a strength rating for complying with
the termination of parental rights (TPR) procedures outlined in the Adoption
and Safe Families Act (ASFA), including identifying children who have been
in foster care for 15 of the past 22 months, pursuing TPR for these children
and reviewing and documenting exceptions to seeking TPR.
! While 41 states (81%) received a strength rating for holding (administrative
or court) review of the status of each foster child no less frequently than every
six months, only one-half of the states (26) achieved a strength rating for
assuring that children in foster care received the required court permanency
hearing within 12 months of entering foster care and holding subsequent court
permanency hearings no less frequently than every 12 months thereafter.
! Half of the states (26) received a strength rating for ensuring that foster
parents, pre-adoptive parents and relative care givers received notice of
hearings or reviews held with respect to the child in their care (and had an
opportunity to be heard).
11 For reviews done in 2002-2004, states’ achievement of timely reunification or placement
with a permanent guardian or kin caregiver was also assessed. Just 11% (4 out of 35) of the
states reviewed during those years received a strength rating for this item based on their case
reviews.

CRS-23
Common challenges to achieving permanent and stable living
arrangements. In a report providing general findings on the initial CFSRs, HHS
identified “common challenges” that were related to 5 of the 6 indicators used to
assess state compliance with the outcome: children have permanent and stable living
arrangements.12 To ensure comparability, this content analysis was based only on
states that were reviewed in FY2002-FY2004 (35 states); a “common challenge” is
defined as one noted in the final report of at least one-third of those 35 states.13
Close to three-fourths of the states noted that efforts to identify adoptive or other
permanent placement settings at the same time as reunification efforts continued
(concurrent planning) did not consistently occur and more than two-thirds of them
reported that reconsideration of the goal of reunification is too often delayed. More
than half of the states suggested that placement instability is related to insufficient
provision of services to foster parents, not enough placement options for certain
special needs children, placements made based on availability rather than suitability
and frequent use of emergency shelters for temporary placements. More than half of
these states also cited inconsistent access to or provision of services to parents to
enable timely family reunification. Table 7 lists each of the reported challenges
associated with achieving a permanent and stable living arrangement for children in
foster care.
Table 7. Common Challenges to Achieving Permanent and
Stable Living Arrangements for Children in Foster Care
As reported by HHS and cited in the final reports of states reviewed during FY2002-FY2004 a
Percent of states
Performance
Challenge
reporting this
Indicator
challenge (out of 35)
Permanency
Concurrent planning efforts are not implemented on a
74%
goal is
consistent basis when appropriate.
established and
appropriate
Goal of reunification is maintained for too long a period
69%
of time before reconsideration.
The case goal “long term foster care” is often
43%
established without thorough consideration of adoption
or guardianship.
The agency does not file for termination of parental
34%
rights in a timely manner and reasons for not filing are
not provided in the case files.
12 The report is available on the Children’s Bureau website at [http://www.acf.hhs.gov/
programs/cb/cwrp/results/ statefindings/genfindings04/ genfindings04.pdf]. No title page
or author is included although the report was possibly prepared for HHS, by James Bell
Associates.
13 In addition to making some changes to the case review instrument before beginning the
FY2002 onsite reviews, HHS also established certain formats for the content of final reports
to allow comparability between those reports.

CRS-24
Percent of states
Performance
Challenge
reporting this
Indicator
challenge (out of 35)
Foster care
Agency does not consistently provide services to foster
60%
placements are
parents to prevent placement disruptions.
stable
Placements tend to be based on availability rather than
60%
appropriateness.
There are few appropriate placement options for
54%
children with developmental disabilities or with severe
behavior problems.
Emergency shelters frequently used for initial
51%
placements and as temporary placements after a
disruption occurs, even for young children.
Timely
Agency is not consistent in its efforts to provide the
51%
reunification
services to parents or ensure parents’ access to the
services necessary for reunification.
Timely
Agency is not consistent with regard to conducting
49%
adoption
adoption home studies or completing adoption-related
paperwork in a timely manner.
The appeals process for termination of parental rights
34%
decisions is extremely lengthy.
Limiting foster
Agency doesn’t have sufficient and/or adequate post-
37%
care re-entries
reunification services.
Source: Table prepared by Congressional Research Service based on Table I-4 in the report General
Findings from the Federal Child and Family Services Review,
posted on the federal Children’s Bureau
website in Oct. 2004.
a. For the purpose of identifying common challenges, the content analysis was based on the final
reports done for states reviewed in FY2002-FY2004 only, because the specific format of the
final reports was changed to ensure comparable inclusion of information. In addition, the way
that certain of the indicators associated with this outcome were judged was slightly altered
beginning with the FY2002 reviews, and the case review indicator assessing timely
reunification, guardianship or permanent relative placement replaced the previous indicator
concerning independent living services.
Enhancing Families’ Capacity to Meet the Needs of
Their Children

The performance indicators associated with the outcome discussed above,
“achieving a permanent and stable living arrangement,” applied only to children in
foster care and outcome compliance was determined via case reviews and
comparison of statewide data with the national standards. By contrast, while no
statewide data indicators were used to assess compliance with the outcome, “families
have enhanced capacity to meet the needs of their child,” virtually all of the case
review sample — in-home cases and foster care cases — was assessed with regard
to this well-being outcome. Nationally of the 2,571 cases reviewed 55% (1,426)
were rated as having substantially achieved this goal, 28% (727) were found to have
partially achieved the goal, while 16% (418) were found to have not addressed or

CRS-25
achieved this goal. In assessing how well a state meets this outcome in each of these
cases, the CFSR looks at four specific indicators:
! assessment of the needs of children, parents and foster parents and matching
the appropriate services with those individuals;
! involving parents and children in the case planning process;
! conducting regular and quality visits with children; and
! conducting regular and quality visits with parents, pre-adoptive parents, and
permanent relatives or guardians of children in care.
Only one state received a strength rating for the outcome indicator concerning
assessment of the child and parents needs and provision of needed services. States
did relatively better on the remaining three indicators associated with the outcome
“enhancing a families’ capacity to provide for their children’s needs” — but no more
than 12 states received a strength rating for any one of these indicators.(See Table
3
above.)
Common challenges to enhancing the capacity of families to meet
the needs of their children. In its content analysis of the final reports of all
CFSRs conducted in FY2002-FY2004 (35 states), HHS identified 11 “common
challenges” states had that were related to enhancing a family’s capacity to provide
for the needs of its children. All 35 states reported insufficient involvement of
mothers, fathers, and children (if age-appropriate) in case planning and all but one
of them cited insufficient frequency of face-to-face contacts between the case worker
and the parents as a concern. A large majority of the 35 states also reported
inconsistent assessments of the needs of children, parents and/or foster parents and
that even when the needs are identified appropriate services are not always provided.
Table 8 lists each of the reported challenges.
Table 8. Common Challenges to Enhancing the Capacity of
Families to Meet the Needs of Their Children
As reported by HHS and Cited in the Final Reports of States Reviewed During FY2002-FY2004 a
Percent of
states reporting
Performance
this challenge
Indicator
Challenge
(out of 35)
Involving child
Fathers are not sufficiently involved in case planning.
100%
and family in case
planning
Mothers are not sufficiently involved in case planning.
100%
Children (age-appropriate) are not sufficiently involved
100%
in case planning.
Case worker visits
Frequency of face-to-face visits is not consistently
97%
with parents
sufficient to ensure children’s safety and promote
attainment of case goals.
Workers are not consistently focused on case planning
40%
and achieving case goals when face-to-face contact is
established with parents.

CRS-26
Percent of
states reporting
Performance
this challenge
Indicator
Challenge
(out of 35)
Agency does not make concerted effort to establish
37%
contact with fathers, even when fathers are involved in
their children’s lives.
Assessing needs
Agency does not consistently provide appropriate
89%
of and providing
service to meet the identified needs of children and
services to
parents.
children, parents
and foster parents
Agency does not consistently conduct adequate
86%
assessments to determine the needs of children,
parents, and/or foster parents.
Agency does not consistently provide services to
57%
support foster parents or relative caregivers.
Case worker visits
Workers are not consistently focused on case planning
40%
with child
and achieving case goals when face-to-face contact is
established with children.
Frequency of face-to-face visits is not consistently
37%
sufficient to ensure children’s safety and well being.
Source: Table prepared by Congressional Research Service based on Table I-5 in the report General
Findings from the Federal Child and Family Services Review,
posted on the federal Children’s Bureau
website in October 2004.
a. For the purpose of identifying common challenges, the content analysis was based on the final
reports done for states reviewed in FY2002-FY2004 only, because the specific format of the
final reports was changed to ensure comparable inclusion of information.
Do States in System Compliance Achieve Better Outcomes?
Federal child welfare policy requires states to have certain systems in place that
are intended to improve how the child welfare agency functions. If these systems do
increase the ability of a state to achieve positive outcomes for a state, and assuming
that the CFSR accurately measures how well a state implements a given system, then
states that achieved higher system compliance might be expected to have achieved
the CFSR outcomes for a greater share of the cases reviewed.
Statistical analysis of the relationship between system compliance and
achievement of the desired outcomes for children shows that states whose array of
available services was determined in substantial compliance with federal policy had
a significantly higher percentage of cases in which families were found to have
enhanced capacity to meet the needs of their children and in which foster children
experienced permanent and stable living arrangements (when compared to states
found out of compliance with the service array requirement). Additionally, states
determined to have adequately implemented a quality assurance system had a

CRS-27
significantly higher percentage of cases in which families were found to have
enhanced capacity to meet the needs of their children.14
There were too few states in compliance with all of the case review system
requirements to allow for a statistical comparison based on compliance with this
system. However, achievement of a “strength” rating for several of the performance
indicators used to assess compliance with the case review system was associated with
higher performance on certain outcomes and for other performance indicators
associated with the case level review. States that received a strength rating for their
implementation of termination of parental rights (TPR) proceedings in compliance
with the provisions of the Adoption and Safe Families Act (ASFA) had a
significantly higher percentage of cases that substantially achieved the outcome of
permanent and stable living arrangements for children in foster care than did those
states that were not in compliance with the ASFA TPR provisions. States that
received a strength rating for ensuring periodic review of all cases no less often than
every 6 months had a significantly higher percentage of cases rated as having
substantially achieved the outcome of enhanced family capacity to provide for
children’s needs. Finally, states that received a strength rating for the 6-month case
review and those that received a strength rating for implementing the required 12-
month permanency hearings had a significantly higher percentage of cases that
received a strength rating for achieving timely adoptions.15
Assessing Penalties
In mandating the creation of the new review system, Congress required HHS to
specify in regulations how financial penalties would be determined for states found
to be out of conformity with federal child welfare policy and to make those penalties
commensurate with the degree of nonconformity. At the same time, it required HHS
to allow states found out of conformity with federal policy to develop and implement
a corrective action plan and to rescind any penalties if that plan was successfully
implemented.
Financial penalties for non-conformity with federal child welfare policy are to
be withheld from a specific pool of child welfare funds that, as defined in the
regulation, includes all Title IV-B funds to the state (funding for both Child Welfare
Services and Promoting Safe and Stable Families) and 10% of the foster care
administrative costs claimed by the state under Title IV-E for the specified penalty
period. For the state’s initial review, penalties may range from 1% of the specified
14 The level of significance used for this analysis was a probability equal to or less than .01;
in other words, if a finding is reported as significant, the possibility that the relationship
between system compliance and higher achievement of positive outcomes could have
occurred simply by chance is 1% or less. Because of some adjustments in the survey design
this statistical analysis was done only for those states whose reviews occurred in FY2002-
FY2004 (35 states). General Findings from the Federal Child and Family Services Review,
pp. 15-18. (No title page or author included.) Available at [http://www.acf.hhs.gov/
programs/cb/cwrp/results/statefindings/genfindings04/genfindings04.pdf].
15 Ibid.

CRS-28
penalty pool (for failure to achieve a specified level of conformity with one of the
outcomes or one of the systems studied) up to 14% (for failure to achieve a specified
level of conformity with each of the 14 outcomes or systems studied).
The regulations also specify that if a state reaches the end of its required
Program Improvement Plan (PIP) and fails to have successfully completed the plan,
HHS must withhold funds from a state (based on the number of outcomes and
systems that were found not in substantial conformity during the CFSR and for which
the state did not successfully complete the level of improvement outlined in its PIP).
This withholding is to begin with the last specified completion date in the PIP and
continue until the state successfully achieves the relevant PIP goal or is found in
substantial conformity by a subsequent full review. HHS has at times stressed that
the CFSR process is about program improvement — not recoupment of federal
funds. Through May 2005 it had completed evaluation of PIP implementation by
eight states and determined that each of them had met their PIP goals and that
therefore no penalties would be assessed. Evaluation of additional states (10 through
May 2005) that had completed their PIPs continues. (For state-by-state information
on PIP implementation and status see Appendix A.)
Did the Initial CFSR Accurately Measure
State Performance?
State officials, advocates and researchers have raised a number of concerns
about how “substantial conformity” was measured in the initial CFSR. Several of the
measurement concerns are related to the national standards and might call into
question the accuracy of the overall assessment that no state was found in substantial
conformity with federal child welfare policy. For instance, some researchers and
state officials argue that in certain cases what is actually measured does not
accurately reflect what HHS intended to measure. They further argue that accurate
measures are necessary not only to ensure correct penalty assessment but, as
important, to ensure that the required Program Improvement Plans (PIPs) are
properly focused. Other concerns raised about the CFSR raise questions about what
is not measured and ensuring that accountability for outcomes is properly assigned.
National standards
The national standards are an early effort to establish a quantitative benchmark
by which to judge state child welfare performance. State conformity with the
national standards directly effects a state’s performance rating on just two of the
seven outcomes; none of the seven systems that are assessed in the CFSR are directly
affected by a state’s rating on the national standards. Thus the ability to meet or not
meet the national standards might be understood as a relatively small factor in
achieving CFSR compliance. At the same time, no state can be found in complete
substantial conformity with federal policy until it meets each of the six national
standards. Further, if the national standards are not designed in a way that truly
measures state performance for a given issue, they might lead HHS to incorrectly
require program improvements (or not require improvements) of states who risk
financial harm if they do not comply. A number of critiques of these standards have

CRS-29
been offered. HHS, which provided in the final regulations that it could “add,
amend, and suspend any such statewide data indicator(s)” may revise these standards,
as well as other aspects of the review, before the second round of the CFSR begins.16
State variation in policy and caseload. Child welfare systems are
administered differently by each state, and, sometimes, by each county within a state,
and this can be a problem if each state is judged by a single federal standard. For
instance, the federal government largely defers to the states with regard to a
definition of child abuse and neglect and state definitions of what constitutes child
abuse and neglect; thus, how reports of child abuse and neglect are classified varies
significantly.17 This is a concern for some, who argue that requiring all states to meet
the same national standard for preventing recurrence of maltreatment in foster care
might unduly punish states that have enacted broader definitions of child
maltreatment and/or that have a well-developed system of reporting and investigation
while allowing states with more narrow definitions or less efficient reporting and
investigating systems to more easily achieve federal compliance.
During the course of the initial review and analysis HHS uncovered a separate
example of how varied state policy might affect a state’s ability to meet the national
standards established with regard to recurrence of maltreatment. Close to half of the
states reviewed in FY2002-FY2004 (35 states) indicated that child abuse and neglect
allegations for families with open child welfare cases (e.g., in-home cases) are not
reported as new allegations of abuse or neglect and therefore there is no formal
assessment of the validity of the allegation. Instead state policy or practice usually
provides that the caseworker assigned to the family would informally assess the
information and act to protect the children if necessary. In short, if child
maltreatment is identified, this information — while it is likely acted on — would not
be reported to the state’s National Child Abuse and Neglect Database and thus would
not be a part of the statewide data used to determine whether or not a state meets the
standard on recurrence of maltreatment.18
The composition of a state’s caseload may also vary for reasons that are not in
control of the child welfare agency or, again, because of state policy decisions. Some
researchers have called for “risk-adjusted” standards, although they acknowledge that
not enough is known about, for instance demographic characteristics and
achievement of certain outcomes to allow for such adjustments.19 In reviewing
16 45 C.F.R. § 1355.34 (4).
17 For a compilation of state definitions of child abuse and neglect and for reporting
procedures see [http://nccanch.acf.hhs.gov/general/legal/statutes/define.pdf] and
[http://nccanch.acf.hhs.gov/general/legal/statutes/repproc.pdf].
18 General Findings From the Federal Child and Family Services Review, p. 8. No title
page or author shown. The report is available on the Children’s Bureau website at
[http://www.acf.hhs.gov/programs/cb/cwrp/results/statefindings/genfindings04/genfindin
gs04.pdf].
19 Mark Courtney, Barbara Needall, and Fred Wulczyn, “Unintended consequences of the
push for accountability: the case of national child welfare performance standards,” Children
and Youth Services Review,
26 (Dec. 2004) 12:1141-1154.

CRS-30
findings from the initial CFSR, the report General Findings from the Federal Child
and Family Services Review,
analyzed certain characteristics of the case review
sample and the degree of success achieved on certain outcomes.20 For the most part
this analysis found that a state’s overall performance on the CFSR outcomes — when
compared to all other states — was largely unaffected by the significant state
variation in the case sample demographics (including age, race/ethnicity, primary
reason for case opening, and geographic location). The single exception to this
overall finding was in regard to the age of children in a state’s case review sample,
and state performance on the safety outcome: children are safely maintained in their
own homes whenever appropriate and possible. States with a higher percentage of
children in their case review sample that were younger than age six at the time of
their entry into foster care had a lower percentage of cases rated as substantially
achieving that outcome.
At the same time, many more significant relationships were established when
the lens of the analysis was shifted from a comparison between states’ performance
to the relationship between the particular characteristics of a child in a given case
and the performance ratings for cases with children of similar or different
characteristics. (For more information on these specific findings see Appendix D.)
Accuracy of data. Closely related to the issue of state variation are certain
concerns about data used to determine compliance with the national standards. The
most basic concerns the accuracy and comparability of the data. The majority of the
data used to set the national standards as well as to assess state performance on those
standards are collected via the Adoption and Foster Care Analysis and Reporting
System (AFCARS). An analysis by the HHS Office of the Inspector General found
that the federal “guidance on reporting AFCARS data supports states beliefs that the
lack of clear definitions leads to inconsistent reporting. States believed AFCARS data
elements were not clearly and consistently defined and expressed concerns about
foster care placement definitions, which potentially affect child welfare performance
measures. In addition, differences in states’ methods of reporting dates of discharge
and juvenile justice populations may further inhibit uniform performance measures.”
The March 2003 Inspector General report recommended that HHS provide more
precise definitions for data elements, increase accessibility of technical assistance on
data collection, and other provisions.21 An April 2004 report from the U.S. General
Accounting Office (GAO) reported some of the same concerns about data
inaccuracies and also made similar recommendations.22
HHS has and continues to work on providing more guidance, assessing what
states are doing and improving state data collection systems. The agency has also
20 This HHS analysis used data collected as part of the onsite review; however, the
characteristics of the cases reviewed are not a part of the final CFSR report.
21 U.S. Department of Health and Human Services, Office of Inspector General, Adoption
and Foster Care Analysis and Reporting Systems (AFCARS): Challenges and Limitations,
Mar. 2003, pp. 6-11.
22 U.S. General Accounting Office (GAO) Child and Family Services Reviews: Better Use
of Data and Improved Guidance Could Enhance HHS Oversight of State Performance,
April
2004, pp. 14-17.

CRS-31
solicited comments on revisions to the AFCARS data collection system.
Nonetheless, the national standards used for the initial CFSR were derived from data
collected via AFCARS in the early years of the system’s operation in most states.
Although the department worked closely with each state to ensure that the data used
to measure the state against the standards were the best possible data available, some
find this troubling. Supporters of the policy to use statewide data measured against
a national standard, however, argue that no data system is perfect, that improved data
collection is a by-product of using the data (or, in essence that you have to start
somewhere, sometime), and that the CFSR assessed state performance in multiple
ways (using both qualitative and quantitative data) so that no state could be judged
on all of the measures purely by quantitative data.
What is measured versus what is meant to be measured.
Researchers have taken particular issue with three of the data indicators that are used
in the national standards. These indicators seek to ensure that states 1) are reuniting
children with their families in a timely manner or, 2) are finding timely adoptive
placements for children who cannot be reunited with their parents; and 3) do not
allow children to exit foster care to placements that are not permanent and simply
result in the return of these children to foster care. While researchers generally
applaud the intent of these measures — that is the effort to use quantitative data to
determine how quickly and effectively states re-establish a permanent home for
children who come into care — they argue that some of the measures used in the
initial round of reviews might penalize a state even if its performance was improving.
Timely adoption and timely reunification. The national standards for
both of these measures look at only children who exit foster care in a given year.
They determine of those who were reunited with their parents, what share were
reunited within 12 months of entering care and, of those who were adopted, what
share were adopted within 24 months of entering care. Some researchers have argued
that the focus exclusively on children who exit foster care means that the overall
likelihood of a child being adopted or reunited is not being measured — i.e. the
measure does not look at all children who have been in care during the year but only
those who exit that care. Further, in the case of adoption, they note that if a state did
the hard work of moving many of its longer-staying and likely more difficult to place
children into adoptive homes, even if it held steady or improved the rate at which
newer entrants moved to adoption, it might perform badly on the official measure.
That is the longer staying children moved to adoption — and who presumably were
a legacy of older agency practice — would necessarily reduce the share of children
adopted within two years.23
23 Concerns about these measures are discussed at length in Patricia Martin Bishop,
Lawerence Grazian, Jess McDonald, Mark Testa, Sophia Gatowski, “The Need for
Uniformity in National Statistics and Improvements in Outcome Indicators for Child and
Family Services Reviews: Lessons Learned from Child Welfare Reform in Illinois,”
Whittier Journal of Child and Family Advocacy, 1 (2002) 1:1-36 (hereafter Bishop, et.al,
“Need for Uniformity”); and Britany Orlebeke, Fred Wulczyn and Susan Mitchell-Herzfeld,
“Improving Public Child Welfare Agency Performance in the Context of the Federal Child
and Family Services Reviews,” Chapin Hall Center for Children at the University of
Chicago, 2005 (hereafter Orlebeke, et.al. “Improving Public Child Welfare Agency
Performance”).

CRS-32
Rather than looking at children who exit foster care, one alternative measure of
time to reunification or adoption might follow the group of children (or “cohort” in
researcher lingo) who entered foster care in a given year to determine how many
were adopted within two years or reunited within one year. This kind of measure
however would require the administrative data to follow a single child’s records
across more than one fiscal year (i.e., it requires longitudinal data) and AFCARS is
currently not set up to enable this kind of analysis.24 Another alternative might group
certain measures together. For instance, with regard to timely adoption, in addition
to recording the share of children who exited foster care to adoption within 24
months of entering care, the measure would also look at overall likelihood of
adoptions (e.g., total children served in given fiscal year divided by number of
adoptions in that year).
Foster care re-entry rate. Criticism of the national standard that looks at
the foster care re-entry rate focuses on the fact that changes in a state’s caseload size
in the given fiscal year affect state performance in this area — even though those
caseload changes may be unrelated to how well a state did at achieving permanency
for children in the previous year. This is because the current measure looks at all the
children who enter foster care in the given year and asks what percentage of them are
re-entering care within 12 months of their prior entry to foster care. This means that
a state that experiences a decline in new entries to care may have fewer — or at least
no greater number of children re-entering than in previous years but its performance
might nonetheless be rated as worse than the previous year. By contrast a state with
an increasing number of entries to foster care might increase the number of re-entries
but show no decline in its performance. One alternative measure might compare the
number of children who re-entered care in a given year as a share of the number of
children who left foster care (via reunification, adoption, or guardianship) in the
previous year.25
Measuring Outcomes. Some critics of the CFSR also believe it does not go
far enough in its effort to measure outcomes versus processes. In particular they cite
the measurement of child and family well-being outcomes as weak. The Pew
Commission on Children in Foster Care recommended that Congress require the
National Academy of Sciences to study and make recommendations for appropriate
measures and outcomes — especially those related to child well-being and further,
that HHS convene an ongoing advisory panel of experts to periodically review the
24 Potential measurement problems related to using “point-in-time” data regarding a given
child (sometimes referred to as “cross-sectional” data) as opposed to data that follows the
outcome of a given child across time (longitudinal data), are discussed in Mark Courtney,
Barbara Needall, and Fred Wulczyn, “Unintended consequences of the push for
accountability: the case of national child welfare performance standards,” Children and
Youth Services Review,
26 (December 2004). The Pew Commission on Children in Foster
Care recommended the use of longitudinal data to measure state child welfare performance
and legislation in the 108th Congress (H.R. 1534, introduced by Rep. Cardin) would have
required HHS to consider modifying AFCARS to allow collection of longitudinal data.
25 Bishop, et al., “Need for Uniformity,” 26-29. See also Orlebeke, et al., “Improving Public
Child Welfare Agency Performance,” 3-4.

CRS-33
measures to ensure that they remain timely and appropriate.26 Such a panel would
however have to reconcile its ultimate recommendations with the federal policies
currently in law. The criteria used to judge state performance is based on the federal
statute, including its interpretation in regulation. Current law includes relatively
limited child welfare provisions specifically related to, for instance, health treatment
or education services. It requires that a child’s updated health and education record
be accessible to foster parents. While a logical interpretation of these requirements
might be that these records are supposed to be current and accessible so that children
can receive the education services and health services needed, this requires an
interpretation. And an easier case might be made for measuring states compliance
based on process. (For example: are the records up-to-date and available, as opposed
to did the availability of the records lead to adequate health and education services
for the child.)
Who Is Accountable? This same concern might also be viewed as a
question of accountability. A child welfare system must be able to count on other
agencies and, especially the courts, if it is to successfully achieve positive outcomes
for children. Is the state’s failure to achieve “substantial conformity” with the
performance measure related to the system “service array” and the well-being
outcome related to providing adequate mental health services a true problem of the
child welfare agency not making the appropriate services available and accessible?
Or is it simply a lack of widely available child mental health services in the state?
If a state is not in compliance with the statute’s termination of parental rights (TPR)
provisions, is this because the courts in the state have a tremendous backlog and
cannot hear the cases on a timely basis or is it because the child welfare agency is not
making an effort to begin these proceedings in a timely manner?
The Next Round of CFSRs
The regulation provides that for states not found in substantial conformity, a
second full CFSR is to begin two years after the date HHS approves the state’s PIP.
However, HHS has since determined that state performance may not be reasonably
re-reviewed until at least one year following the completion of its PIP. This time is
necessary to ensure data used to measure state performance are based on a period
after the state has completed its improvement plan.27 While no schedule for the next
round of the CFSRs has yet been released it is unlikely that any statewide
assessments would begin before the end of FY2005 and the first onsite review would
then likely occur in FY2006. In this second round of reviews, the regulations provide
that the onsite case review must find that the desired outcome was substantially
26 Pew Commission on Children in Foster Care, Fostering the Future: Safety, Permanency
and Well-Being for Children in Foster Care,”
May 2004, pp. 29-30. H.Con.Res. 17
(introduced by Rep. Millender-McDonald) would provide a “sense of the Congress” that the
National Academy of Sciences, through its Board on Children, Families and Youth should
convene an expert panel to “recommend the best practices and measures to use in data
collection relating to foster care.”
27 As the PIP implementation period is, by definition, a time when the state is supposed to
be moving toward compliance (as opposed to fully in compliance) launching a CFSR during
this time could simply produce more out of substantial conformity findings.

CRS-34
achieved in 95% of the cases reviewed (as opposed to 90% in the initial round).
HHS is currently revising its procedures manual and, as noted above (and provided
for by regulation) may also revise the national standards used in the second round of
the CFSR. Finally, the agency is expected to release new guidance (and regulations)
with regard to AFCARS data collection.28
28 See “Child and Family Services Review, Technical Bulletin #1, Jan. 2005,” available on
the Children’s Bureau website at [http://www.acf.dhhs.gov/ programs/cb/cwrp/geninfo/
tech_bulletin_one.pdf].

CRS-35
Appendix A. CFSR Review and PIP Implementation
Schedule
States generally have 90 days after the Final Report date to submit a Program
Improvement Plan (PIP). There is no time frame for approval of the plan by HHS,
and the Department may require changes before granting approval. The approval
date is also the formal implementation date for the plan. States generally have two
years in which to implement their PIP. In rare instances, the regulations provide that
a state may receive approval from HHS for an additional year to complete their PIP.
As of the end of May 2005, HHS had approved PIPs for every state (including
the District of Columbia and Puerto Rico) except Rhode Island, which was
continuing to develop its PIP. Eighteen states had completed their PIPs and HHS has
finished the PIP implementation evaluation in eight of those states. In each of those
eight cases, the Department determined the states had met the goals of the PIP and
therefore all penalties that would have resulted from the state’s initial CFSR were
rescinded.
Table A-1. Initial Onsite Review Schedule with Final Report and
PIP Approval, Approximate Completion, and Evaluation Date
Date
Completedb
State
PIP
Approximate
of Onsite
Final Report
Approved
PIP
PIP
Evaluation
Review
Issued
(Start date)
Completiona
Alabama
4/1/2002
6/18/2002
3/28/2003
3/28/2005
Yes
Alaska
6/24/2002
9/20/2002
9/1/2003
9/1/2005
Arizona
9/24/2001
2/4/2002
11/25/2002
11/25/2004
Yes
12/23/2004
Arkansas
7/9/2001
5/6/2002
7/1/2003
7/1/2005
California
9/23/2002
1/10/2003
7/1/2003
7/1/2005
Colorado
6/17/2002
11/12/2002
10/22/2003
10/22/2005
Connecticut
4/8/2002
8/19/2002
8/20/2003
8/20/2005
Delaware
3/12/2001
6/25/2001
12/20/2001
12/20/2003
Yes
9/17/2004
District of
7/30/2001
2/19/2002
9/19/2002
9/19/2004
Yes
Columbia
Florida
8/6/2001
4/23/2002
4/1/2003
4/1/2005
Yes
Georgia
7/16/2001
10/10/2001
10/1/2002
10/1/2004
Yes
Hawaii
7/14/2003
11/6/2003
7/1/2004
7/1/2006
Idaho
5/12/2003
8/14/2003
2/1/2004
2/1/2006
Illinois
9/15/2003
2/12/2004
12/10/2004
12/10/2006
Indiana
8/20/2001
1/8/2002
8/30/2002
8/30/2004
Yes
12/29/2004
Iowa
5/19/2003
10/14/2003
8/1/2004
8/1/2006
Kansas
8/6/2001
9/17/2001
9/16/2002
9/16/2004
Yes
10/28/2004
Kentucky
3/3/2003
6/2/2003
11/4/2003
11/4/2005
Louisiana
9/8/2003
2/9/2004
10/1/2004
10/1/2006
Maine
7/21/2003
10/27/2003
8/3/2004
8/3/2006
Maryland
11/17/2003
6/9/2004
3/25/2005
3/25/2007

CRS-36
Date
Completedb
State
PIP
Approximate
of Onsite
Final Report
Approved
PIP
PIP
Evaluation
Review
Issued
(Start date)
Completiona
Massachusetts
7/23/2001
1/29/2002
11/27/2002
11/27/2004
Yes
3/17/2005
Michigan
9/9/2002
12/19/2002
5/24/2004
5/24/2006
Minnesota
5/14/2001
8/28/2001
7/1/2002
7/1/2004
Yes
8/14/2004
Mississippi
2/9/2004
5/18/2004
4/1/2005
3/31/2007
Missouri
12/8/2003
3/10/2004
2/1/2005
2/1/2007
Montana
8/19/2002
1/14/2003
1/16/2004
1/16/2006
Nebraska
7/15/2002
10/2/2002
8/13/2003
8/13/2005
Nevada
2/23/2004
6/1/2004
3/1/2005
2/28/2007
New Hampshire
6/9/2003
9/19/2003
5/28/2004
5/28/2006
New Jersey
3/22/2004
5/5/2004
10/1/2004
10/1/2006
New Mexico
8/27/2001
4/10/2002
4/1/2003
4/1/2005
Yes
New York
6/18/2001
1/9/2002
4/14/2003
4/14/2005
Yes
North Carolina
3/26/2001
5/14/2001
12/28/2001
12/28/2003
Yes
North Dakota
9/24/2001
4/15/2002
11/13/2003
11/13/2005
Ohio
5/20/2002
1/8/2003
12/3/2003
12/3/2005
Oklahoma
3/18/2002
7/1/2002
1/22/2003
1/22/2005
Yes
Oregon
6/4/2001
8/3/2001
7/9/2002
7/9/2004
Yes
7/9/2004
Pennsylvania
8/26/2002
11/21/2002
5/1/2003
5/1/2005
Yes
Puerto Rico
8/4/2003
12/8/2003
10/22/2004
10/22/2006
to be
to be
Rhode Island
3/8/2004
9/8/2004
determined
determined
South Carolina
6/23/2003
9/2/2003
6/17/2004
6/17/2006
South Dakota
10/22/2001
5/2/2002
10/17/2003
10/17/2005
Tennessee
6/3/2002
8/19/2002
7/1/2003
7/1/2005
Texas
2/11/2002
8/23/2002
4/1/2003
4/1/2005
Yes
Utah
4/28/2003
9/4/2003
7/15/2004
7/15/2006
Vermont
4/30/2001
7/2/2001
3/27/2002
3/27/2004
Yes
6/30/2004
Virginia
7/7/2003
4/21/2004
2/1/2005
2/1/2007
Washington
11/3/2003
2/11/2004
10/1/2004
10/1/2006
West Virginia
5/6/2002
10/2/2002
6/9/2003
6/9/2005
Wisconsin
8/18/2003
1/14/2004
11/1/2004
11/1/2006
Wyoming
7/8/2002
4/1/2003
1/1/2004
1/1/2006
Source: Table prepared by Congressional Research Service (CRS) based on information received
from the U.S. Department of Health and Human Services (HHS), May 31, 2005.
a. PIP completion dates are approximate. In general states have two years from the date they
implement the PIP (PIP approval date) to complete the planned improvements. In limited
circumstances, the regulation provide that a state may seek approval of HHS for an additional
year to complete the plan.
b. A blank cell means that, as of mid-May 2005, the state had not completed its PIP or that as of mid-
May 2005, HHS had not yet completed the evaluation of state PIP implementation. (Most states
have not yet had two years to implement their PIPs and final HHS evaluation of the PIP cannot
occur until the plan is completed.)

CRS-37
Appendix B. Overview of State Performance on
Outcomes, Systems and National Standards
This appendix includes three tables that summarize state performance in the
initial round of Child and Family Services Reviews. Tables included are —
! Table B-1. State Performance on Outcomes in the Initial Child and Family
Services Review
! Table B-2. State Performance on the National Standards in the Initial Child
and Family Services Review
! Table B-3. State Performance on Systems in the Initial Child and Family
Services Review

CRS-38
Table B-1. State Performance on Outcomes in the Initial Child and Family Services Review
Based on final review status for 52 jurisdictions
Outcome
Performance indicators
States in substantial conformity
Except where otherwise noted, outcome performance measured through case review only
# (%)
name
Safety
Children are first and foremost protected from
Case Review
6 (12%)
AL, AR, AZ,
abuse and neglect.
— Timeliness of investigation of maltreatment reports
DC, PA, SC
— Recurrence of maltreatment
National Standards (statewide data)
— Recurrence of maltreatment
— Maltreatment while in foster care
Children are safely maintained in their homes
— Services to protect children in home and prevent removal
6 (12%)
AZ, IA, KS,
whenever possible and appropriate.
— Risk of harm to child
NM, NY, UT
Permanence
Children have permanency and stability in
Case Review
0
their living situations.
— Foster care re-entries
— Placement stability
— Permanency goal (e.g. established, appropriate)
— Timely achievement of reunification, guardianship, or kin placement a
— Timely achievement of adoption
— Appropriate use of “another planned living arrangement”
National Standards (statewide data)
— Foster care re-entries
— Timely achievement of reunification
— Timely achievement of adoption
— Placement stability
The continuity of family relationships and
— Proximity of placement to parent’s home
7 (13%)
FL, ID, LA,
connections is preserved for children.
— Placement in foster care with siblings
MA, ND,
— Frequency of visits with parents and siblings
OR, TX
— Connections with family and community preserved
— Use of relatives as placement resource
— Relationship with parents maintained

CRS-39
Outcome
Performance indicators
States in substantial conformity
Except where otherwise noted, outcome performance measured through case review only
# (%)
name
Child and Family Well-Being
Families have enhanced capacity to provide
— Assessment of services needs of child, parents and foster parents
0
for their children’s needs.
— Involvement of child and parents in case planning
— Frequency and quality of caseworker visits with child
— Frequency and quality of caseworker visits with parents
Children receive appropriate services to meet
— Provide for child’s education needs
16 (31%)
CO, CT, HI
their educational needs.
IA, ID, KS,
KY, ME,
MT, NH,
NY, ND, UT,
VA VT, WI
Children receive appropriate services to meet
— Provide for child’s physical health needs
1(2%)
DE
their physical and mental health needs.
— Provide for child’s mental health needs
Source: Table prepared by the Congressional Research Service (CRS) based on final review status for 50 states, the District of Columbia and Puerto Rico.
a. The case review performance indicators for this outcome were adjusted following the initial FY2001 reviews. The indicators shown were used for those reviews that occurred in
FY2002-FY2004. For the 17 states reviewed in FY2001 a performance indicator related to provision of independent living services to children age 16 or older was included
and the indicator related to timely reunification was not included.

CRS-40
Table B-2. State Performance on the National Standards in the Initial Child and Family Services Review
Based on final reviews in 52 states
Data Indicator and National Standard
States Meeting the Standard
States Not Meeting the Standard
#
name
#
name
Recurrence of Maltreatment. Of all the children who were found to
17
AL, AZ, AR, CO, DE, DC, GA, KS, ME,
35
AK, CA, CT, FL, HI, IA, ID, IL, IN, KY,
be victims of child maltreatment during the first six months of the
MI, MN, MS, PA, SC, TN, TX, VA
LA, MA, MD, MO, MT, NE, NH, NM, NJ,
period under review, 6.1% or fewer were the subject of another
NY, NC, ND, NV, OH, OK, OR, PR, RI, SD,
substantiated or indicated child maltreatment report within six
UT, VT, WA, WV, WI, WY
months.
Incidence of Child Maltreatment in Foster Care. Of all children in
28
AL, AZ, AR, DE, DC, ID, IL, IN, ME,
24
AK, CA, CO, CT, FL, GA, HI, IA, KS, KY,
foster care in the state during the period under review 0.57% or less
MD, MI, MN, MT, NE, NV, NH, ND,
LA, MA, MO, MS, NM, NJ, NY, NC, OH,
were found to be victims of child maltreatment at the hands of a
PA, PR, SC, SD, TX, UT, VT, VA, WA,
OK, OR, RI, TN, WI
foster care parent or a foster care facility staff member.
WV, WY
Foster Care Re-entries. Of all children who entered foster care
26
AL, AK, CT, DE, FL, GA, KS, LA, ME,
26
AR, AZ, CA, CO, DC, HI, ID, IL, IN, IA,
during the year under review, 8.6% or fewer of those children re-
MD, MI, MO, MS, NE, NV, NM, NJ,
KY, MA, MN, MT, NH, ND, OH, OK, OR,
entered foster care within 12 months of a prior foster care episode.
NY, NC, PR, SC, TX, VA, VT, WV, WY
PA, RI, SD, TN, UT, WA, WI
Length of Time to Achieve Reunification. Of all the children who
19
AR, CO, DE, HI, ID, IA, KY, MN, MT,
33
AL, AK, AZ, CA, CT, DC, FL, GA, IL, IN,
were reunified with their parents or caretakers at the time of
NV, NM, OK, OR, SC, SD, UT, WA,
KS, LA, ME, MA, MD, MI, MO, MS, NE,
discharge from foster care, 76.2% or more children were reunified in
WV, WY
NH, NJ, NY, NC, ND, OH, PA, PR, RI, TN,
less than 12 months from the time of the latest removal from home.
TX, VA, VT, WI
Length of Time to Achieve Adoption. Of all children who exited
14
CO, DC, FL, HI, ID, IA, KS, MI, MT,
38
AL, AK, AR, AZ, CA, CT, DE, GA, IL, IN,
foster care during the year under review to a finalized adoption, 32%
ND, RI, SD, TX, UT
KY, LA, ME, MD, MA, MN, MO, MS, NE,
or more children exited care in less than 24 months from the time of
NV, NH, NJ, NM, NY, NC, OH, OK, OR,
the latest removal from home.
PA, PR, SC, TN, VA, VT, WA, WV, WI,
WY
Stability of Foster Care Placements. Of all children who have
14
AL, CO, CT, DE, DC, GA, IA, MD, NH,
38
AK, AZ, AR, CA, FL, HI, ID, IL, IN, KS,
been in foster care less than 12 months from the time of the latest
NM, PR, WV, WI, WY
KY, LA, ME, MA, MI, MN, MO, MS, MT,
removal, 86.7% or more children had no more than two placement
NE, NV, NJ, NY, NC, ND, OH, OK, OR,
settings.
PA, RI, SC, SD, TN, TX, UT, VA, VT, WA
Source: Table prepared by the Congressional Research Service (CRS).

CRS-41
Table B-3. State Performance on Systems in the Initial Child and Family Services Review
Based on final review status for 52 jurisdictions
System
How conformity is determined
States in substantial conformity
States not in substantial
conformity

# (%)
Name
# (%)
Name
Statewide Information
— State’s system can readily identify status,
45
AL, AK, AR, AZ, CA, CO, DE,
7
CT, DC, GA, MD, MS, NY,
System
characteristics, location, and goals for every child in
(87%)
FL, HI, IA, ID, IL, IN, KS, KY,
(13%)
PR
foster care.
LA, ME, MA, MI, MN, MO, MT,
NE, NH, NJ, NM, NC, ND, NV,
OH, OK, OR, PA, RI, SC, SD,
TN, TX, UT, VA, VT, WA, WV,
WI, WY
Case Review System
— Children in foster care have written case plans
13
AZ, AR, DE, GA, IN, KS, LA,
39
AL, AK, CA, CO, CT, DC,
developed jointly with parents.
(25%)
MN, NM, NC, ND, TX, VT
(75%)
FL, HI, ID, IL, IA, KY, ME,
— Children in foster care have court or administrative
MD, MA, MI, MS, MO, MT,
reviews every 6 months.
NE, NV, NH, NJ, NY, OH,
— Children in foster care have permanency hearings at
OK, OR, PA, PR, RI, SC,
least every 12 months.
SD, TN, UT, VA, WA, WV,
— AFSA requirements for termination of parental rights
WI, WY
are in place.
— Foster caretakers notified of hearings/ reviews; have
opportunity to be heard.
Quality Assurance
— State has standards to ensure children in foster care
35
AL, AR, CO, CT, DC, DE, FL,
17
System
receive quality services to protect their safety and health.
(67%)
GA, IL, IN, KS, KY, LA, MA,
(33%)
— State has quality assurance system to evaluate
MI, MN, MO, NH, NM, NY, NC,
services and provide feedback.
ND, OH, OK, OR, PA, SC, SD,
TN, TX, UT, VA, WA, WV, WY
Training
— State operates a training program for new staff who
34
AL, AK, AR, CO, CT, DE, FL,
18
AZ, CA, DC, HI, ID, IN, IA,
provide services.
(65%)
GA, IL, KY, LA, ME, MA, MD,
(35%)
KS, MS, NJ, OR, PR, RI, TN,
— State operates ongoing training of staff.
MI, MN, MO, MT, NE, NV, NH,
VA, WA, WI, WY
— State provides for training of foster and adoptive
NM, NY, NC, ND, OH, OK, PA,
parents, and of child care staff.
SC, SD, TX, UT, VT, WV

CRS-42
System
How conformity is determined
States in substantial conformity
States not in substantial
conformity

# (%)
Name
# (%)
Name
Service Array
— State has an array of services that support a safe
23
AL, AZ, AR, CO, CT, DC, DE,
29
AK, CA, FL, GA, HI, ID, IL,
home environment, enable children to remain safely
(44%)
IN, KS, LA, MA, MI, MN, MT,
(56%)
IA, KY, ME, MD, MS, MO,
with their parents, and help children achieve
NC, ND, OH, OR, PA, TX, UT,
NE, NV, NH, NJ, NM, NY,
permanency.
VT, WV
OK, PR, RI, SC, SD, TN,
— The services are accessible in all political
VA, WA, WI, WY
jurisdictions covered by the state plan.
— The services can be tailored to the individual needs
of children and families.
Agency Responsiveness
— State consults on an ongoing basis with other groups
49
AL, AK, AR, AZ, CA,CT, DC,
3 (6%)
CO, NJ, RI
to the Community
(e.g., tribes, courts) and includes their concerns in the
(94%)
DE, FL, GA, HI, IA, ID, IL, IN,
state plan.
KS, KY, LA, ME, MA, MD, MI,
— Agency develops, in consultation with these other
MN, MO, MS, MT, NE, NV, NH,
groups, annual reports on progress and services
NM, NY, NC, ND, OH, OK, OR,
delivered.
PA, PR, SC, SD, TN, TX, UT,
— State’s services are coordinated with services or
VA, VT, WA, WV, WI, WY
benefits of other federal programs serving the same
population.
Foster and Adoptive
— Standards for foster family home and child care
43
AL, AR, AZ, CO, CT, DC, DE,
9
AK, CA, GA, HI, NE, NJ, RI,
Parent Licensing
institutions have been implemented and are reasonably
(83%)
FL, IA, ID, IL, IN, KS, KY, LA,
(17%)
VA, VT
Recruitment and
in accord with recommended national standards.
ME, MA, MD, MI, MN, MO, MS,
Retention
— Standards are applied to all licensed homes or child
MT, NH, NM, NY, NV, NC, ND,
care institutions receiving Title IV-E or Title IV-B
OH, OK, OR, PA, PR, SC, SD,
funds.
TN, TX, UT, WA, WV, WI, WY
— State complies with federal criminal background
clearance requirements for licensing or approval of
foster care and adoptive placements
— State has a process to ensure diligent recruitment of
potential foster and adoptive families who reflect the
ethnic and racial diversity of children needing
placements.
— State has process for effective use of cross-
jurisdictional resources to aid timely adoptive or
permanent placements.
Source: Table prepared by the Congressional Research Service (CRS).

CRS-43
Appendix C. State Performance
on Outcomes Assessed in the Initial Child
and Family Services Review
This appendix contains a summary table showing aggregate state performance
on the case reviews along with detailed tables showing, for each state and each
outcome, how many cases were found to have substantially achieved, partially
achieved and not addressed or achieved a given outcome. Individual state
performance on the national standards is also shown for the two outcomes where
these standards were a part of determining the state’s overall compliance. Tables
included are —
! Table C-1. Performance Ratings for Applicable Cases Reviewed in the Initial
Child and Family Services Review
! Table C-2. Safety Outcome 1: Children are First and Foremost Protected
from Abuse and Neglect
! Table C-3. Safety Outcome 2: Children are Safely Maintained in Their Own
Homes Whenever Possible and Appropriate
! Table C-4. Permanency Outcome 1: Children have Permanence and Stability
in Their Living Situation
! Table C-5. Permanence Outcome 2: The Continuity of Family Relationships
and Connections is Preserved for Children
! Table C-6. Well-Being Outcome 1: Families Have Enhanced Capacity to
Meet Their Needs of Their Children
! Table C-7. Well-Being Outcome 2: Children Receive Appropriate Services
to Meet Their Education Needs
! Table C-8. Well-Being Outcome 3: Children Receive Adequate Services to
Meet Their Physical and Mental Health Needs

CRS-44
Table C-1. Performance Ratings for Applicable Cases Reviewed
in the Initial Child and Family Services Review
Based on final reviews in 52 jurisdictions
Applicable cases reviewed
States
Outcome
found in
%
%
% Not
substantial
Substantially
Partially
achieved/
conformity
Total
achieved
achieved
addressed
(number)
(number)
(number)
(number)
(number)
Safety 1: Children are first and
6
2346
85%
12%
3%
foremost protected from abuse and
(1990)
(284)
(72)
neglect.a
Safety 2: Children are safely
6
2352
78%
10%
12%
maintained in their homes whenever
(1832)
(232)
(288)
possible and appropriate.
Permanency 1: Children have
0
1479
56%
37%
7%
permanency and stability in their
(822)
(548)
(109)
living situations.b
Permanency 2: The continuity of
7
1476
76%
22%
2%
family relationships and connections
(1119)
(326)
(31)
is preserved for children.
Well-being 1: Families have enhanced
0
2571
55%
28%
16%
capacity to provide for their children’s
(1426)
(727)
(418)
needs.
Well-being 2: Children receive
16
2012
84%
7%
9%
appropriate services to meet their
(1691)
(145)
(176)
educational needs.
Well-being 3: Children receive
1
2441
70%
18%
12%
appropriate services to meet their
(1713)
(437)
(291)
mental and physical health needs.
Source: Table prepared by Congressional Research Service (CRS) based on data included in final
reports of Child and Family Services Reviews in 50 states, the District of Columbia, and Puerto Rico.
Row percentages may not sum to 100 due to rounding.
a To be found in substantial conformity on this outcome, states had to meet the 90% threshold in
applicable cases reviewed and, based on statewide aggregate data, they also had to meet two
national standards. Twelve states met both of these national standards. See Table 2 of the
report for more information on the national standards.
b To be found in substantial conformity on this outcome, states had to meet the 90% threshold in
applicable cases reviewed and, based on statewide aggregate data, they also had to meet four
national standards. No state met all four of these standards. See Table 2 of the report for more
information on the national standards.

CRS-45
Table C-2. Safety Outcome 1: Children are First and Foremost
Protected from Abuse and Neglect
To have been found in Substantial Conformity with this outcome a state needed to substantially
achieve the outcome in no less than 90% of the applicable cases reviewed (case review
requirement) and must have met both of the national standards associated with this outcome.
Safety Outcome 1
Applicable cases reviewed
Associated national
Bold text in Substantially achieved column
standards
indicates state met case review requirement
Bold text indicates state met
national standard
Not
State
Substantially
Partially
addressed Recurrence
Abuse or
Total
(State found in
achieved
achieved
or
of abuse or
neglect while
substantial conformity if
achieved
neglect
in foster care
cell text is bolded.)
6.1% or less
0.57% or less
#
#
%
#
%
#
%
Alabama
42
40
95%
0
0%
2
5%
5.2
0.15
Alaska
50
31
62%
14 28%
5 10%
23.6
1.91
Arizona
50
45
90%
5 10%
0
0%
4.8
0.08
Arkansas
43
39
91%
4
9%
0
0%
4.5
0.29
California
48
43
90%
5 10%
0
0%
10.7
1.06
Colorado
38
34
89%
4 11%
0
0%
2.7
0.73
Connecticut
45
41
91%
2
4%
2
4%
11.4
3.07
Delaware
37
32
86%
4 11%
1
3%
2.2
0.05
District of Columbia
47
46
98%
0
0%
1
2%
4.7
0
Florida
49
42
86%
7 14%
0
0%
6.2
0.87
Georgia
48
43
90%
3
6%
2
4%
4.2
1.08
Hawaii
50
37
74%
11 22%
2
4%
7.2
0.95
Idaho
48
40
83%
1
2%
7 15%
9.3
0.4
Illinois
44
40
91%
4
9%
0
0%
10.1
0.57
Indiana
46
44
96%
1
2%
1
2%
7.8
0.42
Iowa
41
34
83%
7 17%
0
0%
11.2
0.89
Kansas
47
41
87%
4
9%
2
4%
3.2
1.55
Kentucky
48
39
81%
8 17%
1
2%
8.6
0.65
Louisiana
47
41
87%
4
9%
2
4%
6.8
0.58
Maine 48
35
73%
12 25%
1
2%
5.7
0.48
Maryland
47
41
87%
4
9%
2
4%
8.0
0.52
Massachusetts
47
42
89%
4
9%
1
2%
7.4
0.94
Michigan
49
41
84%
7 14%
1
2%
3.3
0.33
Minnesota
47
41
87%
6 13%
0
0%
5.9
0.41
Mississippi
45
38
84%
7 16%
0
0%
4.6
0.59
Missouri
47
37
79%
6 13%
4
9%
7.3
0.62
Montana
48
37
77%
10 21%
1
2%
13.1
0.19
Nebraska
31
24
77%
5 16%
2
6%
7.6
0.04
Nevada
46
32
70%
11 24%
3
7%
7.6
0.17
New Hampshire
44
43
98%
1
2%
0
0%
8.3
0.1
New Jersey
49
40
82%
8 16%
1
2%
6.9
0.69
New Mexico
50
43
86%
2
4%
5 10%
8.3
NA

CRS-46
Safety Outcome 1
Applicable cases reviewed
Associated national
Bold text in Substantially achieved column
standards
indicates state met case review requirement
Bold text indicates state met
national standard
Not
State
Substantially
Partially
addressed Recurrence
Abuse or
Total
(State found in
achieved
achieved
or
of abuse or
neglect while
substantial conformity if
achieved
neglect
in foster care
cell text is bolded.)
6.1% or less
0.57% or less
#
#
%
#
%
#
%
New York
42
42 100%
0
0%
0
0%
13.5
1.14
North Carolina
49
40
82%
9 18%
0
0%
8.0
0.83
North Dakota
47
37
79%
9 19%
1
2%
11.7
0.44
Ohio
45
38
84%
5 11%
2
4%
8.6
0.59
Oklahoma
50
40
80%
9 18%
1
2%
11.7
1.27
Oregon
50
43
86%
3
6%
4
8%
6.8
0.80
Pennsylvania
41
38
93%
3
7%
0
0%
3.5
0.25
Puerto Rico
41
38
93%
1
2%
2
5%
9.3
0.45
Rhode Island
40
31
78%
9 23%
0
0%
10.2
1.1
South Carolina
49
45
92%
4
8%
0
0%
3.1
0.51
South Dakota
50
34
68%
12 24%
4
8%
11.0
0.56
Tennessee
39
33
85%
6 15%
0
0%
2.8
0.60
Texas
50
43
86%
7 14%
0
0%
4.2
0.29
Utah
43
35
81%
7 16%
1
2%
7.4
0.57
Vermont
41
36
88%
3
7%
2
5%
6.6
0.15
Virginia
40
34
85%
5 13%
1
3%
3.8
0.34
Washington
42
36
86%
5 12%
1
2%
10.8
0.32
West Virginia
44
37
84%
7 16%
0
0%
6.4
0.04
Wisconsin
43
34
79%
6 14%
3
7%
6.9
0.61
Wyoming
34
30
88%
3
9%
1
3%
6.3
0.43
Source: Table prepared by the Congressional Research Service based on information in the CFSR
final reports from 50 states, the District of Columbia and Puerto Rico. Row percentages in Columns
4, 6 and 8 may not sum to 100 due to rounding.

CRS-47
Table C-3. Safety Outcome 2: Children are Safely Maintained in
Their Own Homes Whenever Possible and Appropriate
To have been found in substantial conformity with this outcome a state need to substantially achieve
the outcome in no less than 90% of the applicable cases reviewed.

Safety Outcome 2
Applicable Cases Reviewed
Substantially
Partially
Not achieved or
State
Total
achieved
achieved
addressed
(State found in substantial
conformity if cell text is

#
#
%
#
%
#
%
bolded.)
Alabama
49
34
69%
6
12%
9
18%
Alaska
50
30
60%
13
26%
7
14%
Arizona
46
42
91%
4
9%
0
0%
Arkansas
35
25
71%
4
11%
6
17%
California
47
40
85%
4
9%
3
6%
Colorado
39
32
82%
4
10%
3
8%
Connecticut
47
41
87%
5
11%
1
2%
Delaware
35
29
83%
1
3%
5
14%
District of Columbia
47
33
70%
3
6%
11
23%
Florida
50
39
78%
8
16%
3
6%
Georgia
49
38
78%
6
12%
5
10%
Hawaii
49
39
80%
6
12%
4
8%
Idaho
49
35
71%
5
10%
9
18%
Illinois
48
39
81%
2
4%
7
15%
Indiana
42
35
83%
2
5%
5
12%
Iowa
46
43
93%
2
4%
1
2%
Kansas
48
43
90%
4
8%
1
2%
Kentucky
50
43
86%
3
6%
4
8%
Louisiana
48
40
83%
1
2%
7
15%
Maine 49
37
76%
5
10%
7
14%
Maryland
48
39
81%
4
8%
5
10%
Massachusetts
40
33
83%
1
3%
6
15%
Michigan
49
41
84%
4
8%
4
8%
Minnesota
45
38
84%
1
2%
6
13%
Mississippi
47
36
77%
2
4%
9
19%
Missouri
50
35
70%
7
14%
8
16%
Montana
46
35
76%
8
17%
3
7%
Nebraska
35
31
89%
3
9%
1
3%
Nevada
48
30
63%
10
21%
8
17%
New Hampshire
47
39
83%
4
9%
4
9%
New Jersey
50
24
48%
6
12%
20
40%
New Mexico
50
45
90%
1
2%
4
8%

CRS-48
Safety Outcome 2
Applicable Cases Reviewed
Substantially
Partially
Not achieved or
State
Total
achieved
achieved
addressed
(State found in substantial
conformity if cell text is

#
#
%
#
%
#
%
bolded.)
New York
39
36
92%
2
5%
1
3%
North Carolina
49
34
69%
8
16%
7
14%
North Dakota
42
33
79%
7
17%
2
5%
Ohio
47
39
83%
4
9%
4
9%
Oklahoma
49
40
82%
3
6%
6
12%
Oregon
46
37
80%
5
11%
4
9%
Pennsylvania
41
34
83%
4
10%
3
7%
Puerto Rico
40
26
65%
5
13%
9
23%
Rhode Island
44
29
66%
7
16%
8
18%
South Carolina
49
35
71%
6
12%
8
16%
South Dakota
50
35
70%
7
14%
8
16%
Tennessee
38
26
68%
3
8%
9
24%
Texas
49
38
78%
8
16%
3
6%
Utah
42
38
90%
2
5%
2
5%
Vermont
32
26
81%
3
9%
3
9%
Virginia
48
39
81%
4
8%
5
10%
Washington
43
30
70%
3
7%
10
23%
West Virginia
45
31
69%
5
11%
9
20%
Wisconsin
48
40
83%
3
6%
5
10%
Wyoming
33
23
70%
4
12%
6
18%
Source: Table prepared by the Congressional Research Service based on information in the CFSR
final reports from 50 states, the District of Columbia and Puerto Rico. Row percentages may not sum
to 100 due to rounding.

CRS-49
Table C-4. Permanence Outcome 1: Children have Permanence and Stability in Their Living Situation
To have been found in Substantial Conformity with this outcome a state needed to substantially achieve the outcome in no less than 90% of the applicable cases reviewed (case
review requirement) and must have met all four of the national standards associated with this outcome.
Permanence
Applicable cases reviewed
Associated national standards
Outcome 1
Bold text in Substantially achieved column indicates state met case review
Bold text indicates state met national standard
requirement
State (No state was
Substantially
Partially
Not addressed
Foster care
Timely
Timely
Stability of
found in substantial
Total
achieved
achieved
or achieved
re-entries
reuniting
adoption
placement
conformity with this
8.6%
76.2%
32.0%
86.7%
outcome).
#
#
%
#
%
#
%
(or less)
(or more)
(or more)
(or more)
Alabama
30
15
50%
13
43%
2
7%
7.9
63.0
13.1
96.4
Alaska
23
5
22%
14
61%
4
17%
4.6
53.8
21.8
70.6
Arizonaa
31
23
74%
4
13%
4
13%
10.7
68.0
19.8
81.9
Arkansasa
26
16
62%
8
31%
2
8%
10.6
83.4
26.0
68.6
California
25
12
48%
12
48%
1
4%
10.7
53.2
18.0
77.8
Colorado
29
15
52%
13
45%
1
3%
19.3
85.7
49.5
86.9
Connecticut
26
13
50%
12
46%
1
4%
6.0
55.1
6.5
92.8
Delawarea
22
20
91%
2
9%
0
0%
6.3
83.6
7.9
97.7
District of Columbiaa
28
15
54%
13
46%
0
0%
22.3
62.8
39.0
94.7
Floridaa
29
22
76%
7
24%
0
0%
5.4
44.6
43.4
20.5
Georgiaa
28
20
71%
4
14%
4
14%
4.4
63.0
23.1
92.3
Hawaii
26
13
50%
13
50%
0
0%
10.0
80.3
51.8
83.8
Idaho
25
11
44%
13
52%
1
4%
11.9
88.9
33.6
81.1
Illinois
25
9
36%
14
56%
2
8%
8.8
51.7
8.8
81.0
Indianaa
34
30
88%
2
6%
2
6%
13.8
64.0
22.8
77.7
Iowa
28
14
50%
13
46%
1
4%
25.0
81.0
49.0
88.0
Kansasa
25
17
68%
5
20%
3
12%
2.4
50.3
57.6
64.2
Kentucky
28
2
7%
23
82%
3
11%
10.8
82.5
15.9
80.3

CRS-50
Permanence
Applicable cases reviewed
Associated national standards
Outcome 1
Bold text in Substantially achieved column indicates state met case review
Bold text indicates state met national standard
requirement
State (No state was
Substantially
Partially
Not addressed
Foster care
Timely
Timely
Stability of
found in substantial
Total
achieved
achieved
or achieved
re-entries
reuniting
adoption
placement
conformity with this
8.6%
76.2%
32.0%
86.7%
outcome).
#
#
%
#
%
#
%
(or less)
(or more)
(or more)
(or more)
Louisiana
30
19
63%
11
37%
0
0%
7.8
65
11.6
83.3
Maine 31
7
23%
18
58%
6
19%
7.3
54.2
11.9
74.1
Maryland
30
8
27%
19
63%
3
10%
8.3
53.2
14.7
94.5
Massachusettsa
32
24
75%
7
22%
1
3%
22.3
72.9
9.4
77.0
Michigan
28
21
75%
7
25%
0
0%
5.0
52.9
32.0
86.2
Minnesotaa
24
15
63%
7
29%
2
8%
22.7
80.3
27.5
82.3
Mississippi
25
9
36%
13
52%
3
12%
4.6
56.7
19.0
55
Missouri
26
9
35%
13
50%
4
15%
8.5
65.9
30.3
78.7
Montana
29
12
41%
15
52%
2
7%
20.2
87.0
42.2
80.8
Nebraska
35
16
46%
14
40%
5
14%
3.5
44.5
17.9
83.5
Nevada
24
13
54%
9
38%
2
8%
6.9
90.9
29.2
NA
New Hampshire
31
13
42%
17
55%
1
3%
13.3
48.8
5.2
88.7
New Jersey
25
7
28%
15
60%
3
12%
8.2
63.5
17.0
85.1
New Mexicoa
29
25
86%
4
14%
0
0%
7.2
86.3
23.4
88.7
New Yorka
37
20
54%
15
41%
2
5%
8.6
54.2
3.0
NA
North Carolinaa
30
22
73%
6
20%
2
7%
1.2
57.7
26.0
61.3
North Dakotaa
25
23
92%
2
8%
0
0%
16.3
72.8
44.0
86.2
Ohio
26
19
73%
6
23%
1
4%
13.7
74.0
29.2
85.9
Oklahoma
25
16
64%
8
32%
1
4%
15.3
80.2
31.3
75.9
Oregona
35
30
86%
3
9%
2
6%
20.4
79.1
24.2
83.7
Pennsylvania
25
12
48%
12
48%
1
4%
20.1
69.7
19.1
85.2
Puerto Rico
20
9
45%
11
55%
0
0%
2.4
56.1
14.9
99.6

CRS-51
Permanence
Applicable cases reviewed
Associated national standards
Outcome 1
Bold text in Substantially achieved column indicates state met case review
Bold text indicates state met national standard
requirement
State (No state was
Substantially
Partially
Not addressed
Foster care
Timely
Timely
Stability of
found in substantial
Total
achieved
achieved
or achieved
re-entries
reuniting
adoption
placement
conformity with this
8.6%
76.2%
32.0%
86.7%
outcome).
#
#
%
#
%
#
%
(or less)
(or more)
(or more)
(or more)
Rhode Island
26
11
42%
13
50%
2
8%
19.2
66.2
45.0
82.3
South Carolina
30
12
40%
16
53%
2
7%
6.6
82.1
14.0
76
South Dakotaa
38
30
79%
7
18%
1
3%
14.2
81
60.9
84.9
Tennessee
29
9
31%
14
48%
6
21%
10.1
61.3
10.5
61.1
Texas
32
23
72%
8
25%
1
3%
1.5
64.4
43.7
71.2
Utah
35
20
57%
13
37%
2
6%
15.2
81.7
70.8
80.1
Vermonta
42
30
71%
11
26%
1
2%
8.0
64.9
23.0
70.0
Virginia
27
10
37%
16
59%
1
4%
3.6
73.6
17.9
84.8
Washington
25
11
44%
9
36%
5
20%
14.8
81.6
26.7
83.7
West Virginia
29
11
38%
10
34%
8
28%
0.1
79.5
17.3
99.9
Wisconsin
25
12
48%
9
36%
4
16%
25.5
71.0
21.2
93.8
Wyoming
31
22
71%
5
16%
4
13%
8.0
81.6
26.0
87.4
Source: Table prepared by the Congressional Research Service based on information in the CFSR final reports from 50 states, the District of Columbia and Puerto Rico. Row
percentages in Columns 4, 6 and 8 may not sum to 100 due to rounding.
a State was reviewed during FY2001. The case review performance indicators used to rate state performance on this outcome were adjusted following the reviews conducted in FY2001.
Consequently, for this outcome, the performance of states reviewed in FY2001 and those reviewed in FY2002-FY2004 are not strictly comparable. For reviews conducted in
FY2001 the provision of independent living services in applicable cases (foster care children age 16 or older) was assessed as a specific case review performance indicator but
there was no specific case review performance indicator for timely achievement of reunification with parents, permanent kin placement or establishment of guardianship in
applicable cases. For all subsequent reviews the assessment of provision of independent living services was incorporated in other parts of the case assessment and a specific case
review performance indicator was added to assess the timely achievement of reunification with parents, permanent kin placement or establishment of guardianship in applicable
cases.

CRS-52
Table C-5. Permanence Outcome 2: The Continuity of Family
Relationships and Connections is Preserved for Children
To have been found in substantial conformity with this outcome a state need to substantially
achieve the outcome in no less than 90% of the applicable cases reviewed.
Permanence Outcome 2
Applicable Cases Reviewed
State
Substantially
Partially
Not achieved or
(State found in
Total
achieved
achieved
addressed
substantial conformity if
cell text is bolded.)

#
#
%
#
%
#
%
Alabama
30
21
70%
9
30%
0
0%
Alaska
23
15
65%
8
35%
0
0%
Arizona
31
25
81%
5
16%
1
3%
Arkansas
26
19
73%
7
27%
0
0%
California
25
22
88%
2
8%
1
4%
Colorado
29
23
79%
5
17%
1
3%
Connecticut
26
21
81%
5
19%
0
0%
Delaware
21
17
81%
4
19%
0
0%
District of Columbia
28
22
79%
4
14%
2
7%
Florida
29
26
90%
2
7%
1
3%
Georgia
28
21
75%
7
25%
0
0%
Hawaii
26
18
69%
7
27%
1
4%
Idaho
25
23
92%
2
8%
0
0%
Illinois
25
19
76%
6
24%
0
0%
Indiana
34
30
88%
3
9%
1
3%
Iowa
28
23
82%
4
14%
1
4%
Kansas
25
20
80%
5
20%
0
0%
Kentucky
28
20
71%
7
25%
1
4%
Louisiana
30
27
90%
3
10%
0
0%
Maine 31
19
61%
11
35%
1
3%
Maryland
28
18
64%
10
36%
0
0%
Massachusetts
32
29
91%
3
9%
0
0%
Michigan
28
21
75%
7
25%
0
0%
Minnesota
24
20
83%
4
17%
0
0%
Mississippi
25
14
56%
11
44%
0
0%
Missouri
26
16
62%
9
35%
1
4%
Montana
29
22
76%
6
21%
1
3%
Nebraska
35
23
66%
12
34%
0
0%
Nevada
24
13
54%
9
38%
2
8%
New Hampshire
31
24
77%
7
23%
0
0%
New Jersey
24
17
71%
6
25%
1
4%
New Mexico
29
23
79%
5
17%
1
3%
New York
37
31
84%
5
14%
1
3%

CRS-53
Permanence Outcome 2
Applicable Cases Reviewed
State
Substantially
Partially
Not achieved or
(State found in
Total
achieved
achieved
addressed
substantial conformity if
cell text is bolded.)

#
#
%
#
%
#
%
North Carolina
30
25
83%
5
17%
0
0%
North Dakota
25
23
92%
2
8%
0
0%
Ohio
26
22
85%
4
15%
0
0%
Oklahoma
25
21
84%
4
16%
0
0%
Oregon
35
33
94%
1
3%
1
3%
Pennsylvania
25
15
60%
10
40%
0
0%
Puerto Rico
20
14
70%
5
25%
1
5%
Rhode Island
26
15
58%
10
38%
1
4%
South Carolina
30
20
67%
9
30%
1
3%
South Dakota
38
33
87%
4
11%
1
3%
Tennessee
29
11
38%
15
52%
3
10%
Texas
32
30
94%
2
6%
0
0%
Utah
35
27
77%
8
23%
0
0%
Vermont
43
37
86%
5
12%
1
2%
Virginia
27
19
70%
7
26%
1
4%
Washington
25
16
64%
9
36%
0
0%
West Virginia
29
21
72%
6
21%
2
7%
Wisconsin
25
11
44%
14
56%
0
0%
Wyoming
31
24
77%
6
19%
1
3%
Source: Table prepared by the Congressional Research Service based on information in the CFSR final
reports from 50 states, the District of Columbia and Puerto Rico. Row percentages may not sum to 100
due to rounding.

CRS-54
Table C-6. Well-Being Outcome 1: Families Have Enhanced
Capacity to Provide for Their Children’s Needs
To have been found in substantial conformity with this outcome a state need to substantially
achieve the outcome in no less than 90% of the applicable cases reviewed.
Well-Being Outcome 1
Applicable Cases Reviewed
State (No state was
Substantially
Partially
Not achieved or
Total
found to be in
achieved
achieved
addressed
substantial conformity
with this outcome)

#
#
%
#
%
#
%
Alabama
50
27
54%
15
30%
8
16%
Alaska
50
14
28%
22
44%
14
28%
Arizona
50
35
70%
11
22%
4
8%
Arkansas
50
30
60%
11
22%
9
18%
California
49
29
59%
19
39%
1
2%
Colorado
50
30
60%
13
26%
7
14%
Connecticut
50
33
66%
14
28%
3
6%
Delaware
39
26
67%
10
26%
3
8%
District of Columbia
50
24
48%
7
14%
19
38%
Florida
50
31
62%
14
28%
5
10%
Georgia
50
36
72%
8
16%
6
12%
Hawaii
50
15
30%
24
48%
11
22%
Idaho
50
21
42%
16
32%
13
26%
Illinois
48
25
52%
17
35%
6
13%
Indiana
50
30
60%
7
14%
13
26%
Iowa
50
12
24%
27
54%
11
22%
Kansas
50
38
76%
9
18%
3
6%
Kentucky
50
32
64%
12
24%
6
12%
Louisiana
50
34
68%
13
26%
3
6%
Maine 50
21
42%
20
40%
9
18%
Maryland
49
30
61%
13
27%
6
12%
Massachusetts
50
38
76%
10
20%
2
4%
Michigan
49
35
71%
9
18%
5
10%
Minnesota
49
35
71%
6
12%
8
16%
Mississippi
50
18
36%
16
32%
16
32%
Missouri
50
21
42%
16
32%
13
26%
Montana
49
25
51%
17
35%
7
14%
Nebraska
50
16
32%
23
46%
11
22%
Nevada
49
19
39%
17
35%
13
27%
New Hampshire
50
28
56%
15
30%
7
14%
New Jersey
50
9
18%
14
28%
27
54%
New Mexico
50
38
76%
5
10%
7
14%
New York
50
43
86%
5
10%
2
4%

CRS-55
Well-Being Outcome 1
Applicable Cases Reviewed
State (No state was
Substantially
Partially
Not achieved or
Total
found to be in
achieved
achieved
addressed
substantial conformity
with this outcome)

#
#
%
#
%
#
%
North Carolina
50
34
68%
6
12%
10
20%
North Dakota
49
37
76%
10
20%
2
4%
Ohio
50
33
66%
13
26%
4
8%
Oklahoma
50
35
70%
11
22%
4
8%
Oregon
50
38
76%
9
18%
3
6%
Pennsylvania
50
32
64%
14
28%
4
8%
Puerto Rico
42
14
33%
16
38%
12
29%
Rhode Island
49
9
18%
28
57%
12
24%
South Carolina
50
20
40%
19
38%
11
22%
South Dakota
50
31
62%
12
24%
7
14%
Tennessee
50
26
52%
21
42%
3
6%
Texas
50
35
70%
11
22%
4
8%
Utah
50
33
66%
8
16%
9
18%
Vermont
50
39
78%
6
12%
5
10%
Virginia
50
33
66%
12
24%
5
10%
Washington
50
12
24%
21
42%
17
34%
West Virginia
50
20
40%
17
34%
13
26%
Wisconsin
50
27
54%
18
36%
5
10%
Wyoming
50
20
40%
20
40%
10
20%
Source: Table prepared by the Congressional Research Service based on information in the CFSR final
reports from 50 states, the District of Columbia and Puerto Rico. Row percentages may not sum to 100
due to rounding.

CRS-56
Table C-7. Well-Being Outcome 2: Children Receive Appropriate
Services to Meet Their Education Needs
To have been found in substantial conformity with this outcome a state need to substantially
achieve the outcome in no less than 90% of the applicable cases reviewed.
Well-Being Outcome 2
Applicable Cases Reviewed
Substantially
Partially
Not achieved or
State
Total
achieved
achieved
addressed
(State found in
substantial conformity if

#
#
%
#
%
#
%
cell text is bolded)
Alabama
35
25
71%
6
17%
4
11%
Alaska
39
31
79%
3
8%
5
13%
Arizona
40
34
85%
2
5%
4
10%
Arkansas
44
36
82%
5
11%
3
7%
California
37
30
81%
3
8%
4
11%
Colorado
46
42
91%
3
7%
1
2%
Connecticut
40
36
90%
4
10%
0
0%
Delaware
33
29
88%
0
0%
4
12%
District of Columbia
42
33
79%
4
10%
5
12%
Florida
38
30
79%
6
16%
2
5%
Georgia
33
25
76%
4
12%
4
12%
Hawaii
39
35
90%
1
3%
3
8%
Idaho
32
30
94%
0
0%
2
6%
Illinois
32
27
84%
3
9%
2
6%
Indiana
45
32
71%
0
0%
13
29%
Iowa
41
38
93%
0
0%
3
7%
Kansas
44
41
93%
1
2%
2
5%
Kentucky
43
41
95%
1
2%
1
2%
Louisiana
41
32
78%
7
17%
2
5%
Maine
38
34
89%
2
5%
2
5%
Maryland
37
32
86%
1
3%
4
11%
Massachusetts
43
37
86%
2
5%
4
9%
Michigan
33
26
79%
5
15%
2
6%
Minnesota
38
31
82%
2
5%
5
13%
Mississippi
29
22
76%
4
14%
3
10%
Missouri
35
28
80%
3
9%
4
11%
Montana
36
33
92%
1
3%
2
6%
Nebraska
43
37
86%
5
12%
1
2%
Nevada
27
19
70%
3
11%
5
19%
New Hampshire
39
37
95%
1
3%
1
3%
New Jersey
34
22
65%
4
12%
8
24%
New Mexico
45
37
82%
5
11%
3
7%

CRS-57
Well-Being Outcome 2
Applicable Cases Reviewed
Substantially
Partially
Not achieved or
State
Total
achieved
achieved
addressed
(State found in
substantial conformity if

#
#
%
#
%
#
%
cell text is bolded)
New York
47
43
91%
3
6%
1
2%
North Carolina
46
37
80%
3
7%
6
13%
North Dakota
45
41
91%
0
0%
4
9%
Ohio
37
31
84%
4
11%
2
5%
Oklahoma
36
29
81%
4
11%
3
8%
Oregon
39
32
82%
4
10%
3
8%
Pennsylvania
44
38
86%
4
9%
2
5%
Puerto Rico
31
24
77%
2
6%
5
16%
Rhode Island
45
33
73%
3
7%
9
20%
South Carolina
38
32
84%
0
0%
6
16%
South Dakota
39
29
74%
5
13%
5
13%
Tennessee
45
37
82%
6
13%
2
4%
Texas
38
32
84%
2
5%
4
11%
Utah
43
43
100%
0
0%
0
0%
Vermont
44
42
95%
2
5%
0
0%
Virginia
39
36
92%
0
0%
3
8%
Washington
31
24
77%
2
6%
5
16%
West Virginia
32
24
75%
4
13%
4
13%
Wisconsin
33
30
91%
1
3%
2
6%
Wyoming
39
32
82%
5
13%
2
5%
Source: Table prepared by the Congressional Research Service based on information in the CFSR final
reports from 50 states, the District of Columbia and Puerto Rico. Row percentages may not sum to 100
due to rounding.

CRS-58
Table C-8. Well-Being Outcome 3: Children Receive Adequate
Services to Meet their Physical and Mental Health Needs
To have been found in substantial conformity with this outcome a state need to substantially
achieve the outcome in no less than 90% of the applicable cases reviewed.
Well-Being Outcome 3
Applicable Cases Reviewed
State
Substantially
Partially
Not achieved or
(State found in
Total
achieved
achieved
addressed
substantial conformity if
cell text is bolded.)

#
#
%
#
%
#
%
Alabama
48
36
75%
5
10%
7
15%
Alaska
46
30
65%
5
11%
11
24%
Arizona
49
29
59%
18
37%
2
4%
Arkansas
46
34
74%
9
20%
3
7%
California
45
35
78%
6
13%
4
9%
Colorado
49
30
61%
13
27%
6
12%
Connecticut
49
35
71%
8
16%
6
12%
Delaware
38
35
92%
2
5%
1
3%
District of Columbia
49
27
55%
12
24%
10
20%
Florida
50
37
74%
11
22%
2
4%
Georgia
49
31
63%
9
18%
9
18%
Hawaii
49
28
57%
13
27%
8
16%
Idaho
42
28
67%
6
14%
8
19%
Illinois
48
32
67%
10
21%
6
13%
Indiana
50
35
70%
9
18%
6
12%
Iowa
47
37
79%
9
19%
1
2%
Kansas
46
36
78%
10
22%
0
0%
Kentucky
50
38
76%
7
14%
5
10%
Louisiana
48
35
73%
8
17%
5
10%
Maine 48
35
73%
6
13%
7
15%
Maryland
46
37
80%
5
11%
4
9%
Massachusetts
49
34
69%
9
18%
6
12%
Michigan
43
37
86%
3
7%
3
7%
Minnesota
46
31
67%
7
15%
8
17%
Mississippi
42
22
52%
11
26%
9
21%
Missouri
49
35
71%
9
18%
5
10%
Montana
46
31
67%
10
22%
5
11%
Nebraska
47
26
55%
11
23%
10
21%
Nevada
45
29
64%
8
18%
8
18%
New Hampshire
49
38
78%
8
16%
3
6%
New Jersey
47
25
53%
9
19%
13
28%
New Mexico
50
36
72%
9
18%
5
10%
New York
49
42
86%
6
12%
1
2%

CRS-59
Well-Being Outcome 3
Applicable Cases Reviewed
State
Substantially
Partially
Not achieved or
(State found in
Total
achieved
achieved
addressed
substantial conformity if
cell text is bolded.)

#
#
%
#
%
#
%
North Carolina
50
34
68%
13
26%
3
6%
North Dakota
48
38
79%
3
6%
7
15%
Ohio
43
30
70%
6
14%
7
16%
Oklahoma
49
35
71%
8
16%
6
12%
Oregon
47
38
81%
8
17%
1
2%
Pennsylvania
46
36
78%
7
15%
3
7%
Puerto Rico
39
20
51%
13
33%
6
15%
Rhode Island
48
29
60%
9
19%
10
21%
South Carolina
48
33
69%
8
17%
7
15%
South Dakota
46
30
65%
10
22%
6
13%
Tennessee
49
34
69%
8
16%
7
14%
Texas
48
35
73%
9
19%
4
8%
Utah
49
40
82%
7
14%
2
4%
Vermont
48
42
88%
5
10%
1
2%
Virginia
43
36
84%
4
9%
3
7%
Washington
49
29
59%
11
22%
9
18%
West Virginia
42
25
60%
11
26%
6
14%
Wisconsin
48
33
69%
8
17%
7
15%
Wyoming
47
30
64%
8
17%
9
19%
Source: Table prepared by the Congressional Research Service based on information in the CFSR final
reports from 50 states, the District of Columbia and Puerto Rico. Row percentages may not sum to 100
due to rounding.

CRS-60
Appendix D. Analysis of Case Characteristics and
Ratings of Outcome Achievement
As part of rating each case, reviewers collected certain data about the
characteristics of the child whose case was under review (e.g. age, race/ethnicity).
These case specific data are not available in the final reports but have been studied by
HHS (via a contract with James Bell Associates) for statistically significant
relationships between outcomes achieved and the characteristics of the case. The full
report discussing these findings is available on the Children’s Bureau web site.29 A
synthesis of some of the key findings is provided below.
Age of child
Cases involving children under the age of 6 at the start of the CFSR review
period were more likely to be rated as having substantially achieved permanency and
stability in their living situations than cases involving children of all other ages. Age
was independently established as significantly related to two of the performance
indicators — placement stability and establishment of permanency goal — used to
determine whether permanency and stability have been achieved for a child. These
analyses generally supported the anecdotal information that placement stability is
harder to achieve for adolescents and that establishing appropriate permanency goals
for children in a timely manner is easier for younger children than for adolescents. The
percentage of cases receiving a strength rating for placement stability decreased with
increasing age until age of 16; for youth age 16-18 a strength rating for placement
stability was as likely as it was for children younger than 9 at the start of the CFSR
review period. The percentage of strength ratings related to establishment of the
permanency goal was highest for children under the age of 6 at the start of the CFSR
review period and lowest for children who were 10-12 years of age at that time.30
Race/ethnicity of child
Cases involving white (non-Hispanic) children were more likely to be rated as
having substantially achieved permanency and stability in their living situations than
were cases involving children who are Alaska Native/Native American, Asian/Pacific
Islander, or black (non-Hispanic). Separate analysis shows that cases involving
children who are white (non-Hispanic) were significantly more likely than cases
involving children of any other race/ethnicity to have been rated as substantially
29 General Findings From the Federal Child and Family Services Review. No title page or
author shown. The report is available on the Children’s Bureau website at
[http://www.acf.hhs.gov/programs/cb/cwrp/results/statefindings/genfindings04/genfindin
gs04.pdf].
30 The statistical analysis regarding age and performance ratings by cases was done with
regard to cases reviewed in FY2002-FY2004 only. The total applicable cases reviewed with
regard to the outcome of permanency and stability in the living situations in those years was
951. A relationship between performance rating and age was determined significant if the
probability that the relationship occurred by chance was less than 1%.

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achieving the well-being outcome: children receive adequate services to meet their
physical and mental health needs. Finally, cases involving children who were white
(non-hispanic), black (non-Hispanic), or of “two or more races” were significantly
more likely to have substantially achieved the well-being outcome families have
enhanced capacity to meet children’s need than were cases involving children who
are Alaska Native/Indian or Asian/Pacific Islander.31
Primary reason for case opening
Cases opened primarily for issues related to a child’s behavior (e.g. child’s
substance abuse or juvenile delinquency) were more likely to be rated as having
substantially achieved permanency and stability than were cases opened for any other
reason. Cases opened primarily for all other reasons (e.g. parent’s substance abuse,
abuse or neglect of the child, mental/physical health of family) were more likely to be
rated as not having substantially achieved permanency and stability in living situation
than to have been rated as substantially achieving this outcome.32
Location of case review
As noted earlier, the onsite CFSR takes place at three locations in a state,
including the most populous city or county. Other locations in each state varied from
very rural to metropolitan/suburban. No significant relationship between case ratings
for most outcomes and review location (largest population compared to smaller
population sites) was found. However, for two of the well-being outcomes, families
have enhanced capacity to meet the needs of their children, and children receive
appropriate services for their physical and mental health needs, cases reviewed in
smaller population sites were significantly more likely to have been found to have
achieved these outcomes.33
31 The statistical analysis regarding race/ethnicity and performance ratings by cases was
done with regard to cases reviewed in FY2001-FY2004 for which race/ethnicity data were
identified. The total applicable cases analyzed with regard to the outcome children have
permanency and stability in the living situations was 1415. The total applicable cases
analyzed with regard to the well-being outcomes ranged from 2448 and 2326. A
relationship between performance rating and race/ethnicity was determined significant if the
probability that the relationship occurred by chance was less than 1%.
32 The statistical analysis regarding reason for case opening and performance ratings by
cases was done with regard to cases reviewed in FY2002-FY2004 only. The total applicable
cases reviewed with regard to primary reason for case opening and the outcome children
have permanency and stability in the living situations was 931. A relationship between
performance rating and reason for case opening was determined significant if the probability
that the relationship occurred by chance was less than 1%.
33 The review years included in the statistical analysis regarding ratings by largest or smaller
population sites and performance ratings is not stated. A relationship between performance
rating and site of review was determined significant if the probability that the relationship
occurred by chance was less than 1%.