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entitled 'D.C. Child And Family Services Agency: More Focus Needed on 
Human Capital Management Issues for Caseworkers and Foster Parent 
Recruitment and Retention' which was released on September 24, 2004.

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Report to Congressional Committees: 

United States Government Accountability Office: 

GAO: 

September 2004: 

D.C. CHILD AND FAMILY SERVICES AGENCY: 

More Focus Needed on Human Capital Management Issues for Caseworkers 
and Foster Parent Recruitment and RetentionD.C. Child and Family 
Services Agency: 

GAO-04-1017: 

GAO Highlights: 

Highlights of GAO-04-1017, a report to congressional committees: 

Why GAO Did This Study: 

The District of Columbia’s Child and Family Services Agency (CFSA) is 
responsible for ensuring the safety and well being of about 3,000 
children in its care and ensuring that services are provided to them 
and their families. In fiscal year 2003, CFSA’s total budget was about 
$200 million. Concerns have been raised about CFSA’s supply of 
caseworkers, the foster care and adoptive homes, and the quality and 
timeliness of mental health services for foster care children. To help 
address these issues, the Congress appropriated $14 million in fiscal 
year 2004 to CFSA, the Department of Mental Health (DMH), and the 
Metropolitan Washington Council of Governments (COG) specifically for 
foster care improvement. GAO examined CFSA’s (1) strategies for 
recruiting, retaining, and managing its caseworkers; (2) efforts to 
license an adequate supply of safe foster and adoptive homes; and (3) 
efforts to collaborate with DMH and the Family Court to provide timely 
mental health services to foster care children. GAO also reviewed 
plans for and use of the federal foster care improvement funds.

What GAO Found: 

CFSA actively recruited caseworkers and implemented retention 
strategies; however, caseworkers cited several management practices 
they said lowered their morale and adversely affected their ability to 
perform their duties. CFSA employed several recruitment approaches 
recommended by a number of child welfare organizations and exceeded 
most of its staffing goals for fiscal year 2003. Caseworkers cited high 
salaries and the training for new caseworkers as factors that 
encouraged them to remain at CFSA. However, GAO found a general 
consensus among the caseworkers with which GAO met that some management 
practices—poor communication, a lack of resources, poor supervision, 
and no rewards and recognition program—adversely affected their 
performance and morale. Agency officials said they had made some 
changes and were planning to take other actions to address these 
issues. 

CFSA has developed goals and strategies for recruiting new foster and 
adoptive homes and improved licensing requirements. CFSA has made 
progress licensing new families, although more families have stopped 
serving than expected. Further, CFSA does not have processes for 
identifying the reasons foster parents stop serving or for determining 
the effectiveness of its recruitment strategies. CFSA has standardized 
and raised licensing requirements for all foster and adoptive homes, 
but as of May 2004, 308 foster homes were unlicensed, with about 22 
percent of CFSA’s foster children residing in them.

CFSA has begun collaborating with DMH and the Family Court to 
centralize and track mental health services for foster care children, 
but challenges remain to ensuring timely delivery. CFSA and DMH 
designed a standard process for referring foster care children to DMH 
for assessment and treatment and for tracking service delivery. DMH has 
also started expanding its service capacity for foster care children. 
For example, it has begun recruiting additional evaluators to perform 
assessments. While CFSA began using a database to track service 
delivery in August 2004, it has not analyzed the service delivery data 
collected on paper prior to August 2004 to determine whether foster 
care children were receiving timely services. Additionally, CFSA and 
DMH still face certain challenges, such as integrating caseworkers and 
Family Court judges into the new referral process. 

CFSA, DMH, and COG have spending plans that are consistent with the 
statutory language providing the federal funds, but only a small 
portion of the foster care improvement funds had been obligated or 
spent as of June 2004, in part because funding was not received until 
March 2004. Further, it is unclear how the District and COG plan to 
support some of these programs in the long-term because future funding 
is uncertain.

What GAO Recommends: 

GAO recommends that CFSA address the human capital issues of its 
caseworkers and assess its efforts to recruit and retain foster 
parents. CFSA agreed with these recommendations.

www.gao.gov/cgi-bin/getrpt?GAO-04-1017.

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Cornelia M. Ashby, 
202-512-8403, ashbyc@gao.gov.

Contents: 

Letter: 

Results in Brief: 

Background: 

CFSA Has Actively Recruited Caseworkers and Implemented Retention 
Strategies; however, Caseworkers Cited Management Practices That 
Adversely Affected Their Performance and Morale: 

CFSA Has Developed a Recruitment Plan and Established New Licensing 
Standards for Foster and Adoptive Homes, but More Foster Families than 
Expected Have Stopped Serving: 

CFSA Has Begun Collaborating to Centralize and Track Mental Health 
Services for Foster Care Children, but Challenges Remain to Ensuring 
Timely Delivery: 

Uncertainties Exist in the Long-Term and Short-Term Funding Status for 
Some of the Projects Included in the Plan: 

Conclusions: 

Recommendations: 

Agency Comments and Our Evaluation: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: Comments from the District of Columbia's Child and Family 
Services Agency: 

Appendix III: Comments from the District of Columbia's Department of 
Mental Health: 

Appendix IV: Comments from the Metropolitan Washington Council of 
Governments: 

Appendix V: GAO Contacts and Staff Acknowledgments: 

GAO Contacts: 

Staff Acknowledgments: 

Tables: 

Table 1: Monetary Recruitment Incentives for Caseworkers in Fiscal Year 
2003: 

Table 2: Retention Incentives Offered to Caseworkers by CFSA in Fiscal 
Year 2003: 

Table 3: Examples of Existing and Planned Services in the District 
Mental Health System for Foster Care Children: 

Table 4: Types and Purposes of Assessments for Children in Foster Care: 

Table 5: Purposes and Plans for the Foster Care Improvement Funds: 

Table 6: Funds Received and Expended by CFSA, DMH, and COG as of June 
30, 2004: 

Figures: 

Figure 1: Staffing Goals Set by CFSA and Achievement Levels for Fiscal 
Year 2003: 

Figure 2: Recruitment and Attrition Pattern of CFSA's Foster Families: 

Figure 3: CFSA's Standard Process for Referring Foster Care Children to 
DMH: 

Abbreviations: 

BSU: Behavioral Services Unit: 

BSW: Bachelors of Social Work: 

CFSA: Child and Family Services Agency: 

CFSR: Child and Family Services Review: 

COG: Council of Governments: 

CSSP: Center for the Study of Social Policy: 

DMH: Department of Mental Health: 

FAPAC: Foster Parent Advocacy Center: 

HHS: Department of Health and Human Services: 

MSW: Masters of Social Work: 

NCIC: National Crime Information Center: 

RFPs: requests for proposals: 

United States Government Accountability Office: 

Washington, DC 20548: 

September 24, 2004: 

The Honorable Mike DeWine: 
Chairman: 
The Honorable Mary Landrieu: 
Ranking Minority Member: 
Subcommittee on the District of Columbia: 
Committee on Appropriations: 
United States Senate: 

The Honorable Rodney P. Frelinghuysen: 
Chairman: 
The Honorable Chaka Fattah: 
Ranking Minority Member: 
Subcommittee on the District of Columbia: 
Committee on Appropriations: 
House of Representatives: 

The District of Columbia's Child and Family Services Agency (CFSA) is 
the agency with primary responsibility for the child welfare system in 
the District of Columbia (the District). In fiscal year 2003, CFSA was 
responsible for about 3,000 children, and its operating budget, which 
was comprised of funds from the District of Columbia government, the 
federal government, and private sources, was about $200 million. Many 
parties are involved in the District's child welfare system, and 
several agencies provide essential services. For example, the 
Department of Mental Health (DMH) is responsible for arranging, among 
other things, evaluations to determine the mental health status and 
treatment needs of children in foster care. The D.C. Family Court was 
created as a court solely dedicated to matters concerning the 
District's children and families and, as such, it has jurisdiction over 
cases involving child abuse and neglect. In addition, CFSA works with 
agencies in Maryland, Virginia, and other states to arrange for 
placements of District children and also works with private agencies to 
place children in foster and adoptive homes.

Because CFSA was plagued with mismanagement and had failed to protect 
some of the children under its care, the U.S. District Court has been 
and remains involved with the agency's management and operations. In 
1995, the U.S. District Court placed CFSA in receivership.[Footnote 1] 
In 2001, the receivership ended, and CFSA then served a 1-year 
probationary period. The U.S. District Court appointed the Center for 
the Study of Social Policy (CSSP) to monitor and assess CFSA's 
performance. CSSP worked with CFSA and developed an implementation plan 
to help the agency achieve reforms ordered by the court and meet 
professional standards of care for the children it serves.[Footnote 2] 
This plan, which the court approved on May 15, 2003, covers outcomes 
and activities for CFSA through December 31, 2006, and sets performance 
benchmarks at 6-month intervals.

The court-appointed monitor and we have reported[Footnote 3] that the 
management and operations of CFSA have improved since the receivership. 
Yet, there are still concerns that the agency may not have an adequate 
supply of skilled caseworkers or safe homes for foster care and 
adoptions and that mental health services needed for some children in 
foster care have not been provided in a timely manner. To help address 
these and other concerns about the District's foster care program, the 
Congress appropriated $14 million in fiscal year 2004 to CFSA, DMH, and 
the Metropolitan Washington Council of Governments (COG)--an 
organization of government officials from the greater Washington, D.C., 
metropolitan area that works cross jurisdictionally to address issues 
facing the area. CFSA received funds to upgrade its technology, expand 
services to foster children, and implement a student loan repayment 
program for caseworkers. DMH received funds to help it provide mental 
health assessments and treatment to foster children in a timely 
fashion. Finally, COG was appropriated funds to develop a plan for 
recruiting new foster parents and a respite care program--a support 
network of individuals to care for foster children when the foster 
family needs to take a break or attend to other matters.

Congress is interested in knowing whether CFSA's strategies, processes, 
and operations will help it to sustain the improvements previously 
reported and further improve the District's foster care system as well 
as what steps are planned or have been taken to use the appropriated 
funds. Specifically, we were asked to assess (1) CFSA's strategies for 
recruiting, retaining, and managing its caseworkers; (2) CFSA's efforts 
to license an adequate supply of safe foster and adoptive homes; (3) 
CFSA's efforts to collaborate with DMH and the Family Court to provide 
timely mental health services to foster care children; and (4) CFSA's, 
DMH's, and COG's plans for and use of the federal foster care 
improvement funds.

To make these assessments, we reviewed and analyzed key documents and 
discussed these issues with knowledgeable and affected parties. Our 
steps included reviewing best practices and standards for child welfare 
agencies developed by various child welfare organizations, CFSA's 
recruitment and retention plans for caseworkers and for foster and 
adoptive parents, licensing requirements for all foster and adoptive 
homes, as well as relevant reports and data. We conducted discussion 
groups with CFSA's caseworkers and supervisors; we also held a group 
interview with foster and adoptive parents. For the discussion groups 
with caseworkers and supervisors, we selected participants on a random 
basis, with participation being voluntary. We also reviewed key DMH and 
COG documents, and we analyzed the spending plans and budget data for 
CFSA, DMH, and COG. Additionally, we interviewed CFSA, DMH, Family 
Court, and COG officials, as well as national experts.

We conducted our work between October 2003 and September 2004 in 
accordance with U.S. generally accepted government auditing standards. 
See appendix I for more details on our scope and methodology.

Results in Brief: 

CFSA has carried out various strategies to recruit and help retain its 
caseworkers; however, caseworkers told us that several management 
practices adversely affected their ability to perform their duties and 
lowered their morale. CFSA implemented several recruitment strategies 
recommended by child welfare organizations and exceeded most of its 
staffing goals for fiscal year 2003. For example, CFSA used the 
Internet to post positions, advertised in nationally circulated 
publications, and recruited at a number of schools of social work 
across the country. By doing so, CFSA was able to hire 147 new 
caseworkers and exceed its goal to have 300 caseworkers and 60 
supervisors on board at the end of fiscal year 2003. Regarding 
retention efforts, CFSA has provided several incentives to encourage 
caseworkers to remain with the agency, many of which are suggested by 
national child welfare organizations. The agency paid retention bonuses 
to staff that agreed to remain at the agency for 1 to 2 years and 
reimbursed required professional licensure fees. Further, many of the 
caseworkers we spoke with said that the relatively high salary CFSA 
paid played a big role in their decisions to remain at the agency. 
However, we found a general consensus among these caseworkers that 
CFSA's management practices hindered their performance and lowered 
their morale. They said that the agency had not provided them with 
needed resources such as reliable transportation needed to visit 
children or cell phones needed to contact families or the office. 
Caseworkers also reported that CFSA's management did not consistently 
communicate with them about policy changes and that many supervisors 
had not fulfilled their responsibilities. Further, caseworkers said and 
CFSA's management acknowledged that the agency did not have a program 
to reward and recognize caseworkers for good performance. Subsequent to 
our discussions with caseworkers, CFSA purchased cell phones and cars. 
Also, CFSA officials told us they are planning to improve their 
communication practices, establish requirements to help improve the 
quality of supervision, and develop a rewards program.

CFSA has taken several steps to license an adequate supply of safe 
foster and adoptive homes; however, more foster families stopped 
serving than expected, and many homes remained unlicensed. In January 
2004, the agency developed a plan to recruit foster and adoptive 
families. In addition to ongoing recruitment activities, such as public 
service announcements and television advertisements, CFSA intends to 
establish a second unit in October 2004 with staff dedicated to 
recruiting new homes. One of the goals in CFSA's fiscal year 2004 
recruitment plan is to license 100 new foster families. According to 
agency officials, 170 new families had been licensed as of July 7, 
2004. Further, the plan estimated that 50 families would leave the 
system during fiscal year 2004, but as of May 31, 2004, 77 families had 
left. CFSA does not have processes for evaluating its current 
recruitment methods or learning why foster parents leave. In 2004, CFSA 
also established temporary, 120-day licenses to accelerate placement of 
foster children with their relatives when such placements are available 
in the District. These homes, known as kinship homes, house about 30 
percent of CFSA's children. Additionally, CFSA closed certain foster 
care homes that did not meet its licensing standards and established a 
process to monitor homes where children have been placed outside the 
District. While CFSA planned to have 80 percent of all children in 
licensed homes by June 2003, the court-appointed monitor reported that 
it fell short of that goal. Nearly a year later, about 22 percent of 
children in foster care--495 children--remained in unlicensed homes.

In a further effort to improve services for children in foster care in 
the District, CFSA is collaborating with DMH and the Family Court to 
centralize and track the provision of mental health services, including 
assessments and treatment. In March 2004, CFSA began implementing a 
standard referral process, designed in concert with DMH, that links 
foster care children to the mental health system when assessment or 
treatment is ordered by the Family Court or requested by caseworkers. 
From March through June 2004, the Behavioral Services Unit in CFSA 
manually tracked referral data and was able to report on the number of 
assessments completed and foster care children enrolled in the mental 
health system. However, the agency did not analyze this referral 
information to determine whether or not services were being initiated 
or assessments were being completed and reported within the statutory 
timeframes. In August 2004, CFSA began entering data into a database it 
developed to track the status and timeliness of referrals of foster 
care children to DMH for mental health services. Meeting these 
timeframes depends in part on DMH's ability to expand its capacity to 
provide services to foster care children. To this end, DMH has begun 
efforts to recruit new evaluators to complete assessments, certify 
additional treatment providers, and contract with providers for new 
types of treatment targeted to the needs of foster care children. While 
CFSA's and DMH's reforms were designed to better link foster care 
children to mental health services, the agencies continue to face 
several challenges to ensuring the timely delivery of services, 
including completing complex types of assessments that may take longer 
than the specified statutory timeframes and integrating caseworkers and 
Family Court judges into the new referral process.

CFSA, DMH, and COG have plans to expend the foster care improvement 
funds on long-term projects for which future funding for some projects 
is uncertain; and all three have obligated a small portion of these 
funds as of June 30, 2004. In February 2004, as required by statute, 
the organizations developed and submitted expenditure plans to the 
Congress explaining how they intended to use the funds. Additionally, 
the organizations developed detailed budgets based on the expenditure 
plans that specify how much of the money is to be used for different 
types of expenses. CFSA's major planned expenses include student loan 
repayments for caseworkers, equipment and labor for technology 
upgrades, the hiring of new personnel, and direct support services to 
children and families. The major expenses budgeted at DMH include the 
hiring of psychologists and psychiatrists to conduct psychological 
assessments of children, the contracting of crisis intervention and 
support services to facilitate mental health treatment, and the costs 
of training and mentoring by human services support agencies. Most of 
COG's planned expenses will be used to pay personnel and to provide 
funding to community organizations to provide respite care services to 
foster parents. All three organizations' planned expenditures are 
consistent with the stated purpose of the legislation. However, most of 
these planned expenditures are for operating costs of long-term 
programs, and the funding of some of these programs in the future is 
uncertain. Only a small portion of the $14 million appropriated for 
foster care improvements has been obligated, in part, because the 
organizations did not receive funds until March 2004. Specifically, as 
of June 30, 2004, about 90 percent of the $14 million remained 
unobligated.

We are making recommendations to the Director of CFSA that would (1) 
help address human capital management issues for caseworkers by 
establishing processes to ensure consistent and effective communication 
with caseworkers about agency operations and developing strategies to 
help ensure that supervisors fulfill their responsibilities, (2) 
provide a process for evaluating the strategies used to recruit foster 
parents, and (3) identify factors affecting foster parents' decisions 
to stop serving.

We received comments from the Acting Director of CFSA, the Director of 
DMH, and the Executive Director of COG. CFSA agreed with our 
recommendations and identified additional steps it has taken or plans 
to take to address the issues raised in the report. Additionally, CFSA, 
DMH, and COG provided information to help clarify the report, and DMH 
and COG included information on their plans to sustain their programs 
in the future. We incorporated this information as appropriate. See 
appendixes II, III, and IV, respectively, for CFSA, DMH, and COG 
comments.

Background: 

The child welfare system is designed to promote the well being of 
children by ensuring their safety and permanency and by strengthening 
families to enable them to successfully care for their children. 
Families become involved with the child welfare system after a report 
of abuse or neglect has been made and confirmed. When agency officials 
determine that a child may be further harmed or mistreated if left in 
the home, the child may be placed in foster care. The federal 
government has allocated about $7 billion each year to investigate 
abuse and neglect of children in this country, provide placements to 
children outside their homes, and deliver services to help keep 
families together. The federal Department of Health and Human Services 
(HHS) is responsible for the administration and oversight of federal 
funding to states to support the child welfare system. Title IV-E of 
the Social Security Act, as amended, is a major source of federal 
funding and is primarily used to pay for the room and board of children 
in foster care.

While HHS is responsible for setting standards and monitoring the 
nation's child welfare system, state child welfare agencies are 
responsible for administering the programs and monitoring the children 
and their families. Child welfare caseworkers, assisted by their 
supervisors, are at the core of the child welfare system. They are 
responsible for the management of individual cases and for performing 
many critical tasks. For example, child welfare caseworkers investigate 
reports of abuse and neglect; arrange placements when children must be 
removed from their homes; develop plans for the care of individual 
children; conduct visits with the children and foster families; attend 
court hearings; maintain records on each case; and coordinate with 
other agencies to obtain services for the children, including mental 
health care. The primary role of supervisors is to help caseworkers 
perform these functions, thereby meeting the needs of families and 
carrying out the agency's mission.

Child welfare agencies face a number of challenges in recruiting and 
retaining caseworkers and supervisors. We previously reported that low 
salaries hindered agencies' abilities to attract and retain child 
welfare workers and their supervisors.[Footnote 4] Furthermore, we 
found that high caseloads, administrative burdens, a lack of 
supervisory support, and insufficient time to take training were issues 
that impacted caseworkers' abilities to work effectively and their 
decisions about staying in the child welfare profession.

CFSA manages the child welfare system for the District. CFSA receives 
Title IV-E funding as well as other funds to support its programs. In 
fiscal year 2003, CFSA's budget included $65 million primarily from two 
federal sources--Medicaid[Footnote 5] and Title IV-E. The Medicaid 
funds are used to cover various expenses related to services for 
children in foster care, such as specific therapeutic and medically 
necessary care. Other sources of funding for CFSA include the District 
government and private grants. In fiscal year 2003, CFSA's operating 
budget was $208 million. CFSA's strategic goals for 2002-2004 are to 
(1) recruit and retain caseworkers, (2) investigate abuse and neglect 
reports, (3) expedite permanency for children, (4) recruit and retain 
foster homes, (5) promote agency and neighborhood-based resources, (6) 
enhance agency information system, and (7) complete court requirements.

Like CFSA, the District's mental health service agency was placed in 
receivership in the 1990s.[Footnote 6] When DMH was established in 
2001, the mental health system lacked the infrastructure to meet the 
needs of children, youth, and their families.[Footnote 7] Among other 
problems, DMH lacked a sufficient number of providers to accommodate 
the needs of the District's foster care children. To better link foster 
care children to mental health services, CFSA began to contract 
directly with mental health providers for services. Consequently, the 
mental health service delivery system for foster care children was 
fragmented with no single system of providers or service standards and 
no centralized information system to track the provision of services to 
foster care children. Further, the courts had no aggregate information 
on court-ordered mental health services for foster care children.

Mental health services are considered critical for children who have 
suffered abuse or neglect. For children in the District, assessment and 
treatment are among the mental health services available through DMH. 
Assessments are evaluations conducted by mental health professionals to 
determine the mental health status and treatment needs of an 
individual. For children in foster care, assessments are generally 
requested or ordered on a case-by-case basis. Treatment, such as 
individual or family counseling and group therapy, can be initiated 
when the result of an assessment indicates that it is needed.

Over the years, the Congress has enacted laws and provided funds to 
help improve the District's child welfare system. The D.C. Family Court 
Act of 2001[Footnote 8] established the D.C. Family Court and, among 
other things, established procedures intended to improve interactions 
between the court and social service agencies in the District. Also, 
the Congress authorized funds to the District in fiscal year 2002 for 
the completion of a plan to integrate the District's computer systems 
with those of the Family Court and for CFSA's caseworks to help 
implement family court reform.[Footnote 9] On January 23, 2004, the 
Congress passed the District of Columbia Appropriations Act, 
2004,[Footnote 10] (the act), which included an appropriation of $14 
million for foster care improvements in the District. Funds were 
appropriated for fiscal year 2004 only, to CFSA, DMH, and COG for 
specific programs.

The act appropriated the funds as follows: 

* $9 million for CFSA, of which $2 million would be to establish an 
early intervention program to provide intensive and immediate services 
to foster children; $1 million would be to establish an emergency 
support fund to purchase necessary items to allow children to remain in 
the care of a licensed, approved family member; $3 million would be to 
establish a student loan repayment program for caseworkers; and $3 
million would be to upgrade CFSA's automated case management system, 
known as FACES, to a Web-based system and to provide computer 
technology to caseworkers;

* $3.9 million for DMH to provide all court-ordered or agency-required 
mental health screenings, assessments, and treatment to children in the 
care of CFSA; and: 

* $1.1 million for COG to develop a program in conjunction with the 
Foster and Adoptive Parents Advocacy Center[Footnote 11] to provide 
respite care for and recruitment of foster parents.

The act also stipulates a timeframe for DMH to provide mental health 
services to foster care children. The law requires the DMH Director to 
(1) initiate court-ordered or agency-required mental health services 
within 3 days of notification, (2) complete court-ordered or agency-
required assessments within 15 days of the request, and (3) provide the 
court with all assessments within 5 days of completion.

CFSA Has Actively Recruited Caseworkers and Implemented Retention 
Strategies; however, Caseworkers Cited Management Practices That 
Adversely Affected Their Performance and Morale: 

CFSA has implemented various caseworker recruitment and retention 
strategies; however, caseworkers told us about several management 
practices that adversely affected their ability to perform their duties 
and lowered their morale. The recruitment strategies included posting 
announcements on the Internet, visiting schools of social work across 
the country, developing relationships with local schools of social 
work, and offering monetary incentives. CFSA successfully hired 147 new 
caseworkers, which enabled the agency to exceed most of its staffing 
goals and lower caseworkers' caseloads. Additionally, CFSA has held 
discussions with staff, established partnerships to allow caseworkers 
to pursue graduate degrees, and offered monetary incentives to help 
recruit and retain caseworkers. However, caseworkers and supervisors 
reported some human capital management issues that were not 
contributing to a positive work environment. CFSA caseworkers and their 
supervisors told us about a lack of resources and poor communication 
and supervision, and that the agency did not have a program to reward 
good performance. We heard these concerns consistently from caseworkers 
with varying lengths of service and found these same concerns in agency 
records of exit interviews.

CFSA Conducted Several Recruitment Activities and Exceeded or Met Its 
Staffing Goals: 

In fiscal year 2003, CFSA conducted several recruitment activities, 
some of which were new. These recruitment activities followed the 
recommendations of the court monitor and included several of the 
strategies endorsed by public and private child welfare organizations. 
The recruitment activities CFSA used include the following: 

* Recruiting on the Internet. CFSA posted job announcements on the 
agency's Web site, and used Internet job sites such as "monster.com", 
"ihiresocialworkers.com", and the Web site for the National Association 
of Social Workers to recruit caseworkers.

* Recruiting at schools of social work across the country. CFSA 
targeted a number of schools across the country by sending recruitment 
teams, mailing announcements to the schools, and using schools' 
internal Web sites to generate employment interest. According to agency 
officials, targeted schools were located in Delaware, Maryland, New 
Jersey, New York, North Carolina, Pennsylvania, South Carolina, and 
Virginia.

* Advertising in media publications. CFSA advertised in media 
publications such as the Washington Post, Social Work Today--a national 
magazine for social workers seeking jobs and wanting to connect with 
others in the social work profession--and the Employment Guide--a 
national weekly employment magazine.

* Developing ongoing relationships with local schools of social work. 
CFSA developed relationships with Howard University, the Catholic 
University of America, the University of the District of Columbia, 
George Mason University, Virginia Commonwealth University, and Bowie 
State University--universities located in the Washington, D.C., 
metropolitan area.

* Attending regional and local career fairs. CFSA attended career fairs 
in New Orleans, New York, and Pennsylvania, and local job fairs in 
Washington, D.C., and Maryland.

* Targeting universities and colleges for bilingual and/or bicultural 
staff. CFSA conducted outreach activities directed to students at 
colleges focused on producing licensed caseworkers that speak Spanish 
and are well acquainted with the Latino/Hispanic culture. CFSA 
recruited at San Diego State University and New Mexico State 
University--universities with large Hispanic populations.

* Using monetary incentives. CFSA introduced a number of monetary 
incentives to attract new caseworkers. CFSA awarded bonuses to newly 
recruited caseworkers that had achieved a high academic grade point 
average, needed to relocate, or had bilingual skills. CFSA also 
established an employee referral program. CFSA employees can receive a 
$1,000 or 2 days off, if they refer a licensed caseworker to CFSA who 
joins the agency and completes 6 months of continuous service. Table 1 
lists the monetary recruitment incentives CFSA offered and paid in 
fiscal year 2003.

Table 1: Monetary Recruitment Incentives for Caseworkers in Fiscal Year 
2003: 

Recruitment incentive: Academic achievement bonus; 
Description of incentive: Designed to make CFSA more competitive with 
other agencies. Eligible applicants must have a grade point average of 
3.5 or above. The bonus amounts ranged from about $1,000 to $3,500; 
Number awarded: 28; 
Total dollar value awarded: $59,460.

Recruitment incentive: Reimbursement for relocation expenses; 
Description of incentive: Designed to attract qualified licensed 
caseworkers that reside in areas outside the Greater-Washington-
Baltimore Metropolitan area. Candidates must agree to remain at least 
one year. The amount reimbursed cannot exceed $3,000; 
Number awarded: 5; 
Total dollar value awarded: $6,857.

Recruitment incentive: Bonus for bilingual caseworkers; 
Description of incentive: Designed to attract licensed caseworkers 
that speak Spanish or any other language for which CFSA has a current 
or projected need. The bonuses are for $500; 
Number awarded: 2; 
Total dollar value awarded: $1,000.

Recruitment incentive: Employee referral fee; 
Description of incentive: Designed to encourage CFSA employees to 
refer licensed caseworker applicants. The referred caseworker must 
complete six months of continuous employment before the referral fee 
is paid. The referring employee can receive $1,000 or a 2-day time off 
award; 
Number awarded: 1; 
Total dollar value awarded: $1,000. 

Source: CFSA data.

[End of table]

CFSA's recruitment activities and the resulting new hires enabled the 
agency to meet or exceed its staffing goals. CFSA hired 147 caseworkers 
in fiscal year 2003 and by doing so was able to exceed its staffing 
goals of 300 caseworkers and 60 supervisors. At the end of fiscal year 
2003, the agency employed 309 caseworkers of which 285 had masters of 
social work degrees (MSWs) and 24 had bachelors of social work degrees 
(BSWs). Additionally, CFSA met its goal to double the agency's 
bilingual staff by hiring 5 caseworkers that can communicate in English 
and other languages such as Spanish and sign language. CFSA's staffing 
goals and achievements are summarized in figure 1.

Figure 1: Staffing Goals Set by CFSA and Achievement Levels for Fiscal 
Year 2003: 

[See PDF for image]

[End of figure]

Furthermore, according to CFSA managers, the new hires have facilitated 
reduction of each caseworker's caseload, as required by the court 
monitor. As of December 26, 2003, CFSA reported that the average 
caseload was 17 cases, down from the average of 27 in 2002. However, 
the court monitor reported that some caseworkers had caseloads that 
exceeded the September 30, 2003, benchmark for caseload standards set 
forth in CFSA's implementation plan.[Footnote 12] For example, while 
caseworkers responsible for investigations should carry no more than 16 
cases, the caseload ranged from 1 to 39 cases, and 15 workers had 
caseloads higher than the benchmark.

CFSA analyzed its caseworker recruitment effort and identified areas 
for improvement. CFSA's June 2004 recruitment and retention plan 
identified several fruitful recruitment efforts such as its efforts to 
advance relationships with local schools of social work and its use of 
the Internet to identify candidates. Also, the plan states that the 
agency will revise its recruitment efforts based on further analysis of 
the results.

CFSA Has Begun to Implement Strategies to Help Retain Caseworkers: 

Retaining caseworkers is a challenge that CFSA as well as other child 
welfare agencies face. In fiscal year 2003, CFSA's attrition rate for 
caseworkers was about 15 percent. We could not determine if this was an 
improvement because CFSA did not have data for 2002[Footnote 13]. As of 
June 2004, about 45 caseworkers had left CFSA in fiscal year 2004--just 
over 15 percent of the staff. Our previous work on child welfare 
caseworker retention identified several causes of caseworker turnover 
and identified practices to help improve retention, such as university 
training partnerships and bonuses.[Footnote 14]

In 2003, CFSA developed a work plan that included strategies to help 
retain well-qualified caseworkers by improving the agency's work 
environment. Experts in the child welfare community endorsed several of 
these strategies. The plan's goals are to create a supportive and 
professionally stimulating environment and promote continuing 
education for its supervisors. To help meet these goals, the agency has 
done the following: 

* Sought employee feedback to identify good practices as well as areas 
in need of improvement. CFSA officials conducted surveys, held 
discussions with staff, and reviewed data from exit interviews to 
identify good practices as well as areas for improvement. CFSA began 
conducting exit interviews and issued an exit interview analysis report 
in fiscal year 2003. The report contained data on the employee's 
position, program division, and the reasons given for leaving the 
agency. Agency officials told us they used this information to improve 
recruitment and retention efforts.

* Required supervisory training. Supervisors of caseworkers are 
required to attend training classes for 12 days, over a 5-month period. 
The classes cover topics such as leadership effectiveness, case 
consultation, and other topics designed to improve supervisors' skills.

* Established partnerships to allow caseworkers to pursue graduate 
degrees. CFSA has agreements with Howard University and the Catholic 
University of America, two universities in the District of Columbia, to 
allow its caseworkers to pursue master's level degrees in social work. 
CFSA, in partnership with these universities, will provide 
scholarships, stipends, and other sources of financial support. 
Employees who receive this benefit must agree to remain with the agency 
for a period of time or repay any financial support provided. A pilot 
program is scheduled to begin in September 2004.

* Developed financial incentives. To encourage workers to remain at the 
agency, CFSA offered service agreement bonuses, reimbursement for 
first-time licensure fees, and additional income allowances. Table 2 
describes the financial retention incentives and the number awarded in 
fiscal year 2003.

Table 2: Retention Incentives Offered to Caseworkers by CFSA in Fiscal 
Year 2003: 

Retention incentives: Service agreement bonus; 
Description of incentive: Designed to encourage new caseworkers to 
remain at the agency. This is a one-time bonus to licensed caseworkers 
that have been with the agency for at least 90 days and sign a 1-or 2-
year continued service agreement. The bonus amount ranged from $800 to 
$2,500 and varied based on the length of the service agreement and the 
caseworker's base salary; 
Number awarded: 39; 
Total dollar value awarded: $62,300.

Retention incentives: First-time licensure fee reimbursement; 
Description of incentive: Designed to assist newly hired caseworkers 
with the cost of obtaining licenses for the first time. CFSA reimburses 
the application fee after the license is obtained. Caseworkers must 
sign a 1-year continued service agreement. The maximum fee 
reimbursement was $176; 
Number awarded: 22; 
Total dollar value awarded: $2,890.

Retention incentives: Additional income allowance; 
Description of incentive: Designed primarily to retain experienced 
caseworkers in case management and supervisory positions who have been 
with the agency for at least 1 year and agree to remain for 1 or 2 
additional years. This allowance may be renewed. If employment is 
terminated early the employee must repay the allowance. The amount of 
the allowance depends on the caseworkers experience and the length of 
the service agreement. Allowances ranged from $2,080 to $6,500; 
Number awarded: 109; 
Total dollar value awarded: $512,705. 

Source: CFSA data.

[End of table]

In addition to these retention strategies, caseworkers told us that 
CFSA's training program for new caseworkers and the higher than average 
salary paid by CFSA were important factors that contributed to their 
decisions to remain with the agency. CFSA's pre-service training for 
new caseworkers was cited as a positive experience by several 
caseworkers that participated in our discussion groups and several who 
completed exit surveys. This training lasts 8-½ weeks and greatly 
exceeds the average training time of about 3-½ weeks offered by most 
child welfare agencies. CFSA's training program involves both classroom 
study and on-the-job training, and gradual assumption of case 
responsibilities under close supervision. Caseworkers also cited CFSA's 
high salaries as a key incentive for continuing to work with the 
agency. CFSA's current average salary for a master's level caseworker 
is $41,440 compared with the national average of $37,097 at other 
public agencies.

The student loan repayment program funded by the Congress in fiscal 
year 2004 may further help CFSA's retention and recruitment efforts, 
once the program has been implemented. Caseworkers who have worked or 
will work full-time for CFSA in a nonsupervisory capacity are eligible 
to apply for CFSA's loan repayment program. In addition, CFSA states 
that it determined caseworkers in a private agency under contract to 
CFSA will also be eligible for the loan repayment program.[Footnote 15] 
According to agency officials, the program offers up to $18,000 to 
caseworkers with MSWs and $10,000 for those with BSWs toward repayment 
of student loans. The exact amount will depend on the size of the loan 
and the number of qualified program applicants. Caseworkers must 
complete 2 years of service before any loan payments are made. CFSA 
pays one-half the total payment at the end of the caseworkers third 
year and the remaining half at the end of the fourth year. Initially, 
applications for the program were due August 16, 2004, and candidates 
had to sign a continuing service agreement to work for CFSA by 
September 3, 2004. According to agency officials, CFSA extended its 
application deadline to September 16, 2004.

Many Caseworkers Cited Management Practices That Affected Their Ability 
to Perform Their Duties and Their Morale: 

During discussion sessions and in exit interviews, caseworkers said 
that they did not have adequate support in terms of resources to do 
their jobs. The caseworkers said that they did not have cell phones 
needed to maintain contact with foster families or with the office, and 
they did not have enough cars to make needed visits to monitor children 
under their care. Also, they reported not having adequate office space 
to hold confidential discussions with families and others involved with 
their cases. Supervisors also cited the lack of resources as a problem 
that hindered caseworkers' abilities to perform their duties. According 
to CFSA managers, in May the agency bought a fleet of new cars, and in 
June of 2004, the agency bought new cell phones for every caseworker. 
Additionally, CFSA is planning on adding shuttles to drop and pick up 
caseworkers from regularly traveled destinations to help reduce the 
need for cars.

CFSA caseworkers also told us that management did not consistently 
communicate with them about issues affecting the agency and its 
operations. We also reported on this concern in our December 2000 
report.[Footnote 16] During our recent meetings with caseworkers and 
supervisors, they said, for example, that changes in policy and 
procedures were not always communicated effectively or consistently 
throughout the agency. Many caseworkers said that they were not aware 
of such changes until they were in the process of completing an 
essential task, such as requesting a clothing voucher for a foster care 
family, and that caseworkers often heard of policy changes from each 
other. In exit interviews from January 2003 through May 2004, some 
employees suggested that communication be improved between all levels 
of management and staff, especially related to policy changes. For 
example, one employee filling out the exit interview form said that, 
"What is policy on Monday may not be policy on Friday…. CFSA must 
improve the way it communicates policy to its caseworkers. E-mails do 
not appear to be effective. The trickle down method of providing 
information to supervisors is also ineffective." National child welfare 
organizations and other human capital experts suggest that management 
should maintain clear lines of communication and involve employees in 
the decision making process of changing policies. CFSA managers 
explained that while they have a formal procedure for communicating 
policy changes and routinely include caseworkers in the decision making 
process, changes to practice standards that affect day-to-day 
operational matters are communicated through less formal methods. 
According to agency officials, these changes are communicated during 
staff meetings, via e-mail messages, and newsletters.

In addition, caseworkers said that many supervisors had not fulfilled 
their responsibilities. They cited examples of supervisors not being 
available to help them during a crisis to provide guidance and support 
and not providing answers to questions affecting their work. One 
caseworker said in an exit interview, "My supervisor seldom kept our 
supervisory conferences or team meetings scheduled. She pushed tasks 
down that were managerial duties and failed to state priorities when 
assigning multiple tasks." Several caseworkers said that their 
supervisors had not provided them feedback about their performance. We 
reviewed a random sample of caseworkers' personnel files and analyzed 
those for 31 caseworkers who were hired on or before December 31, 2000. 
According to a CFSA official, these caseworkers should have had 
performance appraisals in their files for 2001, 2002, and 2003. While 
nearly all of the performance appraisals for 2003 were in the files, 
only 1 of the 31 files included an appraisal for all 3 years. The 
primary role of child welfare supervisors is to help caseworkers 
perform their duties. In addition to assigning cases, supervisors 
should monitor caseworkers' progress in achieving desired outcomes, 
provide feedback to caseworkers in order to develop their skills, 
support the emotional needs of caseworkers, and help make decisions 
about cases. The quality of supervision of caseworkers at CFSA is not a 
new issue. We also reported that social workers cited the quality of 
supervision as a reason for their decisions to resign in December 2000. 
Subsequently, to help improve the quality of supervision, CFSA required 
its supervisors to complete several training courses. However, as of 
August 2004, 12 of CFSA's 59 case-carrying supervisors have completed 
the training, as required. Furthermore, according to agency officials, 
CFSA's supervisors were not held accountable for performing their 
supervisory duties. CFSA officials indicated in 2000 that they planned 
to take steps to help enhance accountability for management and 
supervisory employees, including developing a new agency performance 
appraisal system. CFSA's managers acknowledged in 2004 that the 
performance of some of its supervisors still needed to improve. The 
agency's 2004-2005 recruitment and retention plan includes a new goal 
that focuses on providing supervisors and managers with more training 
and support to help increase the quality of supervision. Also, agency 
officials said that CFSA is developing new performance measures to 
better hold caseworkers and supervisors accountable for performing 
their duties.

Furthermore, caseworkers said and CFSA managers confirmed that the 
agency does not have a program to reward or recognize individuals who 
perform well, make outstanding contributions, or achieve exceptional 
results. The agency honors all of its caseworkers annually during the 
month of May for Social Worker Appreciation Month with a Social Worker 
Appreciation Day celebration. Human capital experts have said that an 
individual recognition program is an important element and that workers 
who are recognized and rewarded for hard work are more likely to 
achieve maximum performance. Some caseworkers said in discussion groups 
with us and during exit interviews that a formal rewards and 
recognition program would enhance their morale, help create a positive 
work environment, and improve staff retention. Agency officials said 
that they are planning to develop policies and procedures for a formal 
rewards and recognition program.

CFSA Has Developed a Recruitment Plan and Established New Licensing 
Standards for Foster and Adoptive Homes, but More Foster Families than 
Expected Have Stopped Serving: 

CFSA has taken several steps to recruit and license an adequate supply 
of safe foster and adoptive homes.[Footnote 17] The agency developed a 
recruitment plan and intends to establish a second recruitment unit 
devoted to recruiting new foster families[Footnote 18] and finding 
homes for children who are difficult to place, including teens and 
children with special needs.[Footnote 19] Also, CFSA has established 
new licensing requirements for congregate care[Footnote 20] and kinship 
homes.[Footnote 21] While CFSA has placed new emphasis on recruitment 
of foster and adoptive families, as of May 30, 2004, more foster 
families stopped serving than expected. Further, CFSA does not have a 
process for evaluating its recruitment strategies or the attrition of 
families from the foster care program. In addition, according to CFSA 
data, about 22 percent of foster children in CFSA's care were residing 
in unlicensed homes as of May 2004. Agency officials said that they 
were attempting to license these homes on a case-by-case basis.

CFSA Has Developed Strategies and Goals for Recruiting New Homes, but 
Does Not Have a Process to Evaluate Its Strategies: 

In January 2004, the CFSA created a recruitment plan that includes 
strategies and goals for recruiting foster and adoptive homes. 
According to agency officials, this is the first such plan. The 
recruitment plan identifies specific strategies for recruiting new 
families. For example, the agency plans to invite current foster 
parents to hold social gatherings to interest others in becoming foster 
families and to continue the "Wednesday's Child" program which uses 
television commercials to feature individual District children who are 
available for adoption. In addition, the plan calls for increasing the 
roster of licensed foster families by 50 at the close of fiscal year 
2004. For 2005, the agency plans to increase its supply of foster 
families by another 100 homes. In order to have an additional 50 
families licensed, CFSA estimated that it must bring approximately 
1,000 interested families to its orientation sessions since about one-
tenth of the families who have attended past sessions became licensed, 
and an average of 50 families have left the program each year. Figure 2 
summarizes the foster family recruitment and attrition patterns.

Figure 2: Recruitment and Attrition Pattern of CFSA's Foster Families: 

[See PDF for image]

[End of figure]

In addition to CFSA's own recruitment plan, COG prepared a report for 
CFSA in 2003 that identifies specific, targeted recruitment 
strategies.[Footnote 22] This report identifies strategies designed to 
attract potential foster and adoptive parents with certain demographic 
characteristics from different neighborhoods in the District. For 
example, the COG report suggests that CFSA should partner with a local 
women's professional sports team to host a "Foster Care Day" and 
conduct a presentation on foster parenting during halftime. The report 
states that this recruitment strategy would reach families from various 
District neighborhoods who would work well with children who have 
special needs. In commenting on a draft of this report, agency 
officials said that they have incorporated some of the suggestions in 
the COG report, such as involving coaches and others working with 
children in sports by partnering with the District's Department of 
Parks and Recreation.

CFSA also plans to establish a second unit dedicated to recruiting new 
foster and adoptive parents. The agency currently has one recruitment 
unit that includes a seven-person team--a supervisor, a social services 
assistant, and five recruiters, each of whom carries a caseload of 20-
30 hard-to-place children targeted for adoption. The team plans to 
recruit new foster and adoptive parents through community outreach 
activities and child-specific recruiting, a strategy used to find 
permanent homes for children who are traditionally the most difficult 
to place. CFSA plans to launch a second recruitment unit in October 
2004. The new unit will also have seven staff members and will focus on 
community outreach activities and child-specific recruiting.

Although CFSA's plan calls for the evaluation of its foster parent 
recruitment efforts, we found that CFSA had not developed a process to 
measure the effectiveness of its recruitment strategies and to learn 
why prospective families do not complete the licensing process. CFSA's 
recruitment plan alludes to the agency's FACES database as a potential 
tool for collecting such data, but agency officials told us that the 
system does not capture the information. Such evaluation is commonly 
considered good practice.

CFSA Established and Enforced Its Licensing Standards, Broadened Its 
Oversight of Homes, and Has Taken Steps to Strengthen Contracts: 

In April 2004, CFSA established a process for issuing temporary 
licenses for kinship foster homes in the District. Kinship homes house 
about 30 percent of the children in CFSA's care. Requirements for the 
temporary license include a home study, criminal background check via 
the National Crime Information Center (NCIC), and a health history of 
primary caregivers. [Footnote 23] Once a child is placed, the family 
must apply for a nontemporary foster family license. Temporary licenses 
are good for 120 days and may be renewed once for 90 days as long as 
the family has made a good faith effort to comply with the nontemporary 
licensing process. According to agency officials, CFSA's goal is to be 
able to issue a temporary license in 3 days. As of May 2004, two 
temporary licenses had been issued and both took 2 weeks to process. 
Agency officials reported that they are currently working with Maryland 
officials to develop a temporary license for Maryland kinship 
placements--a step designed to further expand safety checks and 
decrease the length of time some children spend in emergency 
placements.

In August 2001, CFSA instituted new licensing standards for congregate 
care homes, and in 2003 CFSA closed those that did not meet these 
standards. Prior to these new standards, congregate care facilities 
received a facility inspection but were not licensed. The standards 
cover the physical safety of the facility, staff credentials, staffing 
ratios, and required background checks for staff. In 2002, just after 
the publication of the new licensing standards, most of these 
facilities--25 of the 28 facilities--were issued provisional licenses 
in order to allow them time to make physical upgrades required in the 
new standards. However, as of June 2003, 4 of the 25 congregate care 
homes had been closed because they could not meet these licensing 
requirements. Like traditional foster homes, congregate homes are 
monitored regularly and licenses must be renewed each year. Agency 
officials reported that although some challenges remain--for example, 
facilities have had difficulty finding staff with the credentials 
needed to meet CFSA's requirements--the new licensing requirements have 
greatly improved the quality of congregate care.

CFSA broadened its oversight of out-of-state and private agency 
placements in order to help ensure a consistent level of safety. In 
2003, the agency added staff to a unit that reviews the licenses of 
out-of-state[Footnote 24] homes and manages contracts with private 
agencies that help place CFSA's children in neighboring states. This 
oversight process gives CFSA the opportunity to remove a child from a 
home if it finds a serious problem with a family's license and, in the 
case of a less significant licensing issue, the agency can work with 
the private agency to help correct the problem. Because of previous 
problems, CFSA began requiring out-of-state private agencies to provide 
foster families with support workers--caseworkers who make monthly 
visits and act as a liaison between the agency and the foster parent. 
Foster parents who live in Maryland and participated in our discussion 
groups told us that in the past they experienced many problems 
obtaining a support worker but for the most part these problems had 
been resolved.

Additionally, CFSA has taken steps to establish performance-based 
contracts with congregate care providers and private agencies. Agency 
officials expect performance-based contracting to further improve the 
quality of foster care homes by requiring contractors to achieve 
specific, measurable outcomes on the level of safety and quality of 
care they provide to foster children. As a first major step in moving 
toward performance-based contracting, CFSA issued two requests for 
proposals (RFPs). The first RFP, which closed in September 2003, sought 
contracts for congregate care facilities that provide emergency care, 
group homes, homes for teen parents and their children, and/or 
independent living services. CFSA received 30 viable proposals for 
congregate care providers, and agency officials planned to make awards 
for congregate care in August 2004. The second RFP closed in February 
2004 and sought contracts to help place children in traditional foster 
homes. As of August 2004, CFSA was in the process of evaluating the 
proposals it received. The implementation plan requires all CFSA 
contracts to be performance-based by September 2005, and officials said 
that CFSA plans to meet this requirement.

CFSA Has Made Progress in Licensing New Families; however, More 
Families Stopped Serving than Expected, and CFSA Has Not Determined 
Reasons Why: 

While fewer families than expected have participated in CFSA's 
orientation programs, more families than expected have been licensed 
but more stopped serving. As of June 30, 2004, the agency reported 
having processed 448 families through orientation, just under 50 
percent of its goal to have 1,000 interested families participate in an 
orientation session. CFSA also reported that about 170 new families 
were licensed--exceeding its goal of 100 new families. However, agency 
officials also reported that as of May 30, 2004, 77 families stopped 
serving--significantly more than the agency's projected loss of 50 
families for fiscal year 2004. Nonetheless, as of June 30, 2004, there 
was a net gain of about 90 families. If in the last quarter of fiscal 
year 2004, the number of newly licensed families continues to exceed or 
at least equals the number of families who stop serving, CFSA should be 
able to exceed its goal to have a net increase of 50 newly licensed 
families. With respect to adoption, CFSA finalized 288 adoptions as of 
June 30, 2004, a number that exceeds the 208 adoptions finalized as of 
June 2003. If CFSA continues to find adoptive homes for children at its 
current rate, the agency should exceed the 315 adoptions it finalized 
at the close of 2003.[Footnote 25]

However, CFSA has not determined why foster families stop serving each 
year. Child welfare experts recommend that agencies conduct exit 
interviews with foster families and use these data to help improve the 
program. Agency officials said that they believe the main reasons 
families stop serving as foster parents are that they become adoptive 
families, have served for many years, and are "retiring" from service, 
or cannot meet licensing requirements because of issues such as a 
change in employment status. However, agency officials could not 
provide documented support for these statements and, therefore, cannot 
be certain that foster parents do not stop serving for other reasons. 
In addition to systematically identifying the reasons families leave 
the foster program, agency officials can learn about ways to improve 
the program from exit interviews. Foster parents we met with identified 
several ways that CFSA could improve the program. For example, foster 
parents suggested that CFSA change some of its training requirements 
and that CFSA improve the way information about a foster child is 
maintained because information has been lost when a child's caseworker 
changed. We previously reported that CFSA's automated case management 
system, FACES, lacked data on many foster care cases and noted that 
information missing from the automated systems can be lost and that 
such missing information requires caseworkers to spend more time to 
become familiar with children's cases that are transferred.[Footnote 
26]

By increasing the net supply of foster homes available, the agency 
reports that it expects to achieve other important benefits. If there 
are more traditional foster homes, CFSA can reduce the number of 
children placed in congregate homes as required by the implementation 
plan. Further, with more traditional foster homes, CFSA reports that it 
will likely be able to facilitate more adoptions, given that foster 
parents often decide to adopt once they live with a child. For example, 
as of March 2004, 614 foster children (about 62 percent of children 
under CFSA's care with a goal of adoption) were living with a family 
who intended to adopt them.

Furthermore, the respite care program being developed by COG with the 
foster care improvement funds may also help increase the net supply of 
homes. Foster parents said during congressional hearings and group 
interviews that a respite program would, in the long run, reduce 
attrition because it would reduce stress and burn-out. COG has designed 
a respite program that will recruit families from the District and 
other surrounding jurisdictions who will voluntarily provide respite 
care. COG's goal is to make 700 respite care placements by March 2005; 
however, the organization does not yet know how many respite families 
will be required to provide this number of placements. As of August 9, 
2004, COG officials reported that 6 families already licensed as foster 
care providers had verbally committed to serving as respite families. 
In addition, 10 families had completed training but were not yet 
licensed. COG officials also reported that on August 6, 2004, they 
began soliciting respite requests from foster families and that they 
plan to begin offering respite services on August 30, 2004. In 
commenting on a draft of this report, COG officials said that they were 
assessing the number of foster families that need respite and will use 
that information to gauge the number of respite families required to 
meet the need.

Some Foster Children Remain in Unlicensed Homes: 

CFSA has taken a number of steps to ensure that children are placed in 
licensed foster care homes, yet as of May 2004, 495 children--about 22 
percent of children in CFSA's care--were in unlicensed homes. It is the 
agency's policy not to place children in unlicensed homes, and measures 
such as the temporary license for kinship homes and greater oversight 
of out-of-state placements have been taken to prevent children from 
being placed in unlicensed homes. CFSA officials told us that the 
majority of the 308 unlicensed homes that remained as of May 2004 
entered the foster care program before the new licensing standards were 
issued and that many are kinship homes and homes located in Maryland. 
CFSA is working to correct this situation by examining these homes on a 
case-by-case basis to identify the specific barrier each home faces in 
becoming licensed and, if possible, to resolve that issue. The 
emergency support fund made possible by Congress's 2004 appropriation 
may help by providing money to help families make improvements--such 
as, installing a ramp for a disabled child or splitting a larger 
bedroom into two for greater privacy for siblings--that will help them 
become licensed.

CFSA Has Begun Collaborating to Centralize and Track Mental Health 
Services for Foster Care Children, but Challenges Remain to Ensuring 
Timely Delivery: 

CFSA has begun implementing a centralized mental health referral 
process in collaboration with DMH and the Family Court and has 
developed a database to track service delivery; however, challenges 
remain in meeting the statutory timeframes for initiating services and 
for completing and reporting on assessments. To increase the continuity 
of care between the foster care and mental health systems, CFSA and DMH 
designed a standard process for referring foster care children to DMH 
for mental health assessment and treatment and for tracking service 
delivery. In addition, officials from each agency have met routinely 
with Family Court judges to discuss the referral process and other 
issues that may affect efforts to link foster care children to mental 
health services. CFSA and DMH began using the referral process in March 
2004, and CFSA began using its newly developed database for tracking 
service delivery in August 2004. In conjunction with CFSA's efforts to 
centralize and track mental health services, DMH has started expanding 
its capacity to provide services to foster care children. Efforts 
include recruiting additional evaluators to perform assessments, 
certifying additional mental health providers to deliver treatment, and 
contracting with providers for new types of treatment. While progress 
has been made to better link foster care children to mental health 
services, several challenges remain for CFSA and DMH in order to meet 
the statutory timeframes, such as completing complex and time-intensive 
assessments and integrating caseworkers and judges into the new 
referral process.

CFSA Has Created a Referral Process and Designed a Database for 
Tracking Service Delivery: 

In March 2004, CFSA--in concert with DMH--began implementing a standard 
process for referring foster care children to mental health services. 
CFSA and DMH staff developed the new referral process to increase 
continuity of care between systems and to ultimately improve the 
effectiveness of mental health services for foster care children. In an 
effort to collaborate on the new referral process, CFSA and DMH 
officials have held regular meetings and workgroups to plan, make 
decisions, and share information regarding mental health services for 
foster care children. For example, the agencies have made hiring and 
contracting decisions together and have begun efforts to co-locate 
staff. These strategies are consistent with those cited by a national 
expert as indicators of a state's commitment to coordinate care for 
children across multiple public systems.[Footnote 27] In addition to 
working together, both CFSA and DMH have been meeting with Family Court 
judges to present information on the new referral process and to 
discuss ways to ensure that judges are ordering the most appropriate 
services and that services are delivered on a timely basis.

Under the new referral process, CFSA's newly established Behavioral 
Services Unit (BSU) coordinates referrals for mental health assessments 
or treatment, which are then delivered primarily by DMH through its 
network of evaluators and providers.[Footnote 28] A child's case is 
forwarded to BSU when a Family Court judge issues an order for mental 
health services or when a caseworker makes a request for 
services.[Footnote 29] In the case of assessments, a BSU specialist 
determines whether the type of assessment requested or ordered is 
clinically appropriate for the child.[Footnote 30] When the assessment 
request or order is deemed appropriate, the caseworker submits a 
referral package to BSU. After reviewing the package for quality and 
completeness, BSU forwards it to DMH's Assessment Center, which is 
responsible for coordinating assessments of foster care children for 
the Family Court and CFSA.[Footnote 31] Unless an evaluator is 
specified in a court order, the Assessment Center assigns the child to 
the first available evaluator to conduct the assessment. Upon 
completion of the assessment, DMH sends the report to BSU and to the 
Family Court. When a child is referred for treatment, BSU contacts 
DMH's Access Helpline--a telephone hotline providing crisis emergency 
services, enrollment assistance and information, and referral 24 hours 
a day and 7 days a week--to enroll the child in the mental health 
system. Enrollment, which the Access Helpline is to complete within 24 
hours of referral, includes assigning the child to a core services 
agency.[Footnote 32] The core services agency is notified of the 
enrollment and is required to contact the child's caseworker within 7 
days of enrollment to set the first appointment for treatment. Figure 3 
summarizes the referral process.

Figure 3: CFSA's Standard Process for Referring Foster Care Children to 
DMH: 

[See PDF for image]

[A] The referral package for an assessment includes extensive 
information on a child, such as demographic information; previous 
school, police, or health reports; and a developmental history.

[B] If the referral package for an assessment is incomplete, the 
Assessment Center will send it back to BSU without assigning an 
evaluator.

[C] In some cases, Family Court judges order that a specific DMH 
evaluator perform an assessment. In addition, judges occasionally order 
specialized assessments, such as neuropsychological evaluations, that 
are only performed by some evaluators.

[D] DMH's contracts with evaluators require that an assessment be 
completed and the final report on the assessment be submitted to DMH 
and the Family Court, when applicable, within 14 days of when the 
evaluator last saw the child.

[E] The referral for treatment includes basic information on the child, 
such as the child's Social Security number and assigned caseworker.

[F] The child's caseworker is expected to accompany the child to the 
first appointment for treatment.

[End of figure]

To electronically track mental health service delivery, CFSA created a 
database to capture data on new referrals for services for foster care 
children and, began entering service delivery information in August 
2004.[Footnote 33] Prior to the implementation of the database, BSU was 
using paper referral forms to manually collect information on foster 
care children being referred for mental health services. According to 
CFSA officials, preliminary data showed that as of July 2004, BSU was 
receiving between 80 and 100 referrals for mental health services a 
week, 40 percent of which were for assessments and 60 percent for 
treatment. CFSA and DMH also reported that, from mid-March 2004 through 
May 2004, CFSA completed 141 assessments and DMH's Assessment Center 
completed 111 assessments.[Footnote 34] With regard to treatment, from 
mid-March 2004 through May 2004, DMH enrolled 286 foster care children 
to begin treatment in a certified core services agency, of which there 
are 13. According to CFSA officials, DMH's core services agencies were 
able to accept 95 percent of the referrals of foster care children for 
treatment. CFSA treatment providers accepted the remaining 5 percent, 
which were for specialized services that a DMH provider did not offer, 
such as attachment therapy.[Footnote 35] While officials were able to 
report some of the data collected manually, CFSA had not analyzed the 
information to determine whether foster care children were receiving 
mental health services within the statutory timeframes. [Footnote 36] 
However, Family Court judges and a CFSA report noted that completed 
assessments could take from 30 to 60 days.

BSU officials indicated that once CFSA's database is fully operational, 
every child's electronic file would include information from 
caseworkers, court orders, and DMH. For example, the file will capture 
demographic data, the assigned caseworker, the child's mental health 
diagnosis, and, where applicable, the judge assigned to the case. 
Additionally, the database will allow BSU to establish an electronic 
record for each service referral. According to CFSA officials, these 
electronic records would reflect when the service was requested or 
court-ordered, the mental health evaluator or treatment provider that 
accepted the referral, and the date the service was delivered.[Footnote 
37] To collect data on the first treatment appointment, BSU staff plan 
to call the child's core services agency to ensure that treatment was 
delivered. This approach may be burdensome for BSU, since approximately 
50 to 60 children are being referred to the core services agencies on a 
weekly basis. CFSA officials anticipate that the database will capture 
information on all referrals made after the initial date of 
implementation. CFSA officials also said that temporary staff were 
hired to enter the data for the referrals made since March 17, 2004. It 
was also noted that the agency intends to link this database to FACES, 
the District's automated case management system. As of September 2004, 
CFSA officials said that revisions to FACES to allow the linkage was 
being planned.

DMH Has Started Expanding Its Capacity to Serve Foster Care Children: 

Timely delivery of mental health services will largely depend on DMH's 
ability to expand and sustain its existing capacity to provide 
services. DMH plans to increase the number of evaluators available to 
conduct assessments, certify and train additional providers to deliver 
treatment, and contract for new types of treatment. The new types of 
treatment for foster care children will add to the variety of services 
previously available to foster care children in DMH's system. Table 3 
identifies examples of key existing and planned services for foster 
care children. According to DMH officials, expanding its capacity to 
provide services to foster care children is a formidable task. For 
example, recruiting qualified evaluators is difficult due to the level 
of education needed to perform assessments, as well as competition with 
neighboring jurisdictions for qualified staff.

Table 3: Examples of Existing and Planned Services in the District 
Mental Health System for Foster Care Children: 

Services/initiatives: In operation as of July 2004[A]: School-based 
program; 
Description: Primary prevention strategies for all students; early 
intervention provided at first occurrence of emotional, behavioral, or 
social concerns; treatment for students with a variety of mental 
health problems; crisis service for emergent needs; and family support.

Services/initiatives: In operation as of July 2004[A]: Mental health 
rehabilitation services; 
Description: Nine services, including services such as crisis and 
emergency care, medication treatment, and community-based intervention, 
covered by Medicaid and intended to facilitate a consumer's recovery 
from mental illness.

Services/initiatives: In operation as of July 2004[A]: Alternative 
Pathways; 
Description: Intervention strategies implemented at truancy centers, 
the courts, and police department processing centers that are aimed at 
diverting children and youth with mental health concerns from the 
juvenile justice system and preventing them from further penetration 
into the justice system.

Services/initiatives: In operation as of July 2004[A]: Crisis services; 
Description: Emergency response available 24 hours a day and 7 days a 
week via the Access Helpline, on- site assessment within one hour of 
referral by the Helpline, and coordination for hospitalization.

Services/initiatives: In operation as of July 2004[A]: Acute care; 
Description: Inpatient care provided by private hospitals in the 
community.

Services/initiatives: Planned as of July 2004: Multisystemic therapy; 
Description: Family-and community-based treatment delivered in homes, 
neighborhoods, schools, and communities for foster care youth with 
complex clinical, social, and educational problems.

Services/initiatives: Planned as of July 2004: Mobile crisis; 
Description: Face-to-face mobile response and stabilization services 
provided at the site of a child's escalating behavior available for 
children in foster care.

Services/initiatives: Planned as of July 2004: Intensive home and 
community-based services; 
Description: Intensive services provided in the home and community 
where the child lives by a team of professionals available 24 hours a 
day and 7 days a week.

Services/initiatives: Planned as of July 2004: Trauma treatment; 
Description: Specialized traumatic stress treatment interventions, 
such as cognitively based therapy. 

Source: GAO analysis of DMH data.

[A] The table lists examples of key services available for foster care 
children as of July 2004, but is not a comprehensive list.

[End of table]

DMH has made some progress in expanding its capacity to meet the 
assessment and treatment needs of foster care children. DMH officials 
noted that efforts are underway to recruit additional evaluators and 
transition CFSA evaluators to DMH's Assessment Center. For example, 
CFSA officials meet with their evaluators to encourage them to 
contract with DMH. Regarding treatment providers, as of June 2004, 10 
organizations specializing in serving children and families had applied 
for DMH certification to be a core services agency, specialty provider, 
or subprovider. In addition to new evaluators and treatment providers, 
DMH has begun a competitive grant process to make several new types of 
treatment available to foster care children. As of August 2004, DMH had 
approved grants for providers to deliver multisystemic therapy, 
intensive home and community-based services, and mobile crisis services 
and was awaiting proposals to deliver trauma treatment. DMH estimated 
that 300 to 500 foster care children would be served under these grant 
programs within 1 year of the grant contracts being signed. DMH 
officials noted that providers would not be able to begin delivering 
services before the end of fiscal year 2004.

Initially funded by the $3.9 million in federal foster care improvement 
funds, DMH has strategies in place aimed at sustaining the additional 
assessment and treatment capacity. In terms of financing the increased 
capacity for assessments, DMH's director said that the department would 
continue to fund evaluators to provide assessments, which represents 
approximately $1.1 million of the federal funds; however, the volume of 
assessments presents a challenge to meeting the statutory timeframes 
after fiscal year 2005. As for treatment, which represents 
approximately $2.5 million of the federal funds, DMH expects that 
Medicaid will largely cover the cost of the new types of treatment 
under the mental health rehabilitation services option.[Footnote 
38],[Footnote 39]

Challenges Remain to Ensuring the Timely Delivery of Mental Health 
Services: 

While significant steps have been taken to better link foster care 
children to mental health services, CFSA and DMH face challenges to 
ensuring the timely delivery of these services due to the complex 
working environment in which they operate. For example, before 
assessments can be conducted, caseworkers must prepare referral 
packages, which include extensive amounts of information on a child. 
The caseworkers' ability to prepare and submit referral packages to BSU 
quickly can depend in part on how well they know the child or can 
obtain access to information about the child's demographics; previous 
school, police or health reports; and developmental history. A CFSA 
official estimated that it could take caseworkers from 2 days to 
several weeks to prepare a referral package. Further, the need for more 
intensive, complex assessments for some foster care children can affect 
the extent to which services are provided on a timely basis. In 
particular, DMH officials noted that meeting the statutory timeframes 
for completing and reporting on assessments could be problematic, 
because some complex assessments such as bonding studies, which 
determine the extent to which a child has bonded with his or her 
caregiver, require multiple appointments, and may take longer to 
complete than other assessments. (See table 4 for a list of the types 
and purposes of assessments for children in foster care.) Additionally, 
some types of assessments have prerequisites that can lengthen the time 
needed for completion. For example, to complete a neuropsychological 
assessment, the child must first undergo a psychological assessment. To 
the extent that some foster care children may require more complex, 
time-consuming assessments than others, it may be difficult for DMH to 
meet the statutory timeframes of completing the assessment within 15 
days of the request or court order and providing the results to the 
Family Court within 5 days of its completion. According to one national 
expert in mental health system reform, other jurisdictions generally 
have not legislated timeframes for mental health systems to provide 
services, in part because different assessments vary in the length of 
time required for completion.[Footnote 40]

Table 4: Types and Purposes of Assessments for Children in Foster Care: 

Type: Behavioral; 
Purpose: To determine the cause or function of behavior to develop the 
most effective treatment plan.

Type: Bonding/attachment; 
Purpose: To report on the relationships that a child has with 
biological and substitute caregivers by use of direct observation of 
interactions and play.

Type: Neuro-psychological; 
Purpose: To measure a person's cognitive, perceptual, and motor 
performance to obtain clues to the extent and locus of brain damage.

Type: Psychiatric; 
Purpose: To evaluate individuals based on their behavior in relation 
to physical, genetic, environmental, social, cognitive, and emotional 
components.

Type: Psycho-educational; 
Purpose: To determine an individual's cognitive and educational 
functioning.

Type: Psychological; 
Purpose: To determine an individual's cognitive, emotional, behavioral, 
and social functioning.

Type: Sexual abuse; 
Purpose: To determine if sexual abuse occurred and victims' mental 
health status as a result of the abuse.

Type: Sexual offender; 
Purpose: To determine if an individual has a propensity towards sexual 
abuse of a child. 

Source: GAO analysis of CFSA and DMH data, as of May 2004.

[End of table]

In addition to operating in a working environment that has extensive 
information requirements and variations regarding individual need, CFSA 
and DMH are working to better integrate caseworkers and judges into the 
new referral system. While BSU is in place to provide clinical 
expertise in making mental health service referrals, caseworkers and 
judges may not be aware of or understand how to use the office. For 
example, one Family Court official said that some judges have ordered 
that a specific DMH evaluator perform an assessment, which may delay 
its completion due to the evaluator's availability. A CFSA official 
working as a liaison to the Family Court also indicated that 
caseworkers continue to contact DMH directly to link children to mental 
health services, which may delay the court order going through BSU for 
processing. To help educate caseworkers about the new referral process, 
officials from BSU created a fact sheet providing caseworkers guidance 
on how to link children to mental health services. In addition, in May 
2004, a BSU official began meeting with caseworkers to formally present 
the new process and answer questions. As mentioned previously, CFSA has 
also presented the referral process to Family Court judges, and DMH is 
exploring ways to have its staff available during Family Court hearings 
to answer questions related to mental health services.

Uncertainties Exist in the Long-Term and Short-Term Funding Status for 
Some of the Projects Included in the Plan: 

In February 2004, CFSA, DMH, and COG submitted spending plans to the 
Congress outlining how they intended to use the foster care improvement 
funds, and in March 2004, they received the funds. As of June 30, 2004, 
they reported obligations of about $1.5 million of their appropriated 
funds, with about $419,000 of that total having been expended. Most of 
the planned expenditures outlined in the spending plans are for 
operating costs that would continue in the future once the programs are 
established. How the District and COG plan to fund some of these 
initiatives in the long term is uncertain.

CFSA, DMH, and COG Have Planned Expenditures for Purposes Identified in 
the Act: 

Following the passage of the act on January 23, 2004, the organizations 
could not receive funding until 30 days after they submitted a plan. 
The District submitted a spending plan for CFSA and DMH on February 9, 
2004, and COG submitted its spending plan on February 13, 2004. The 
expenditures included in the plans are consistent with the stated 
purposes in the legislation. Table 5 summarizes the purposes for the 
funds as designated in the law and the planned expenditures listed in 
the spending plans.

Table 5: Purposes and Plans for the Foster Care Improvement Funds: 

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an early 
intervention program to provide intensive and immediate services to 
foster children; 
Public Law 108-199: Appropriated funds: $2 million; 
Spending plans: Proposed expenditures: $700,000; 
Spending plans: Description: Personnel costs (salaries & benefits).

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an early 
intervention program to provide intensive and immediate services to 
foster children; 
Spending plans: Proposed expenditures: $500,000; 
Spending plans: Description: Training and communications.

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an early 
intervention program to provide intensive and immediate services to 
foster children; 
Spending plans: Proposed expenditures: $200,000; 
Spending plans: Description: Meeting expenses (e.g., facilities & 
transportation).

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an early 
intervention program to provide intensive and immediate services to 
foster children; 
Spending plans: Proposed expenditures: $530,000; 
Spending plans: Description: Services for children and families that 
are not currently available at sufficient levels (e.g., substance 
abuse treatment).

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an early 
intervention program to provide intensive and immediate services to 
foster children; 
Spending plans: Proposed expenditures: $70,000; 
Spending plans: Description: Overhead.

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an Emergency 
Support Fund to purchase necessary items to allow children to remain 
in the care of a licensed, approved family member; 
Public Law 108-199: Appropriated funds: $1 million; 
Spending plans: Proposed expenditures: $920,000; 
Spending plans: Description: Emergency expenses for relatives (e.g., 
furnishings & home repairs). 

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an Emergency 
Support Fund to purchase necessary items to allow children to remain 
in the care of a licensed, approved family member; 
Spending plans: Proposed expenditures: $73,000; 
Spending plans: Description: Personnel costs (salaries & benefits).

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish an Emergency 
Support Fund to purchase necessary items to allow children to remain 
in the care of a licensed, approved family member; 
Spending plans: Proposed expenditures: $7,000; 
Spending plans: Description: Overhead.

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish a loan repayment 
program for social workers; 
Public Law 108-199: Appropriated funds: $3 million; 
Spending plans: Proposed expenditures: $2,750,000; 
Spending plans: Description: Student loan repayments for qualified 
social workers with masters and bachelors degrees to accept and extend 
their tenure in the District.

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To establish a loan repayment 
program for social workers; 
Spending plans: Proposed expenditures: $250,000; 
Spending plans: Description: Contract for Loan Repayment Program 
design and administration.

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To upgrade (FACES) computer 
database and technology as well as to provide computer technology for 
social workers; 
Public Law 108-199: Appropriated funds: $3 million; 
Spending plans: Proposed expenditures: $2,170,000; 
Spending plans: Description: Upgrade FACES to Web-based architecture.

Organization and total funding: Child and Family Services Agency; 
$9 million; 
Public Law 108-199: Purpose of funding: To upgrade (FACES) computer 
database and technology as well as to provide computer technology for 
social workers; 
Spending plans: Proposed expenditures: $830,000; 
Spending plans: Description: Computer technology for caseworkers (e.g., 
new laptops or tablet PCs).

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Spending plans: Proposed expenditures: $300,000; 
Spending plans: Description: Staffing of project team to oversee the 
implementation and coordination of all program services outlined below.

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court- ordered 
or agency-required mental health screenings and assessments for 
children under the supervision of CFSA; 
Spending plans: Proposed expenditures: $1,030,000; 
Spending plans: Description: Costs for expanded psychologists and 
psychiatrists. 

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court- ordered 
or agency-required mental health screenings and assessments for 
children under the supervision of CFSA; 
Spending plans: Proposed expenditures: $70,000; 
Spending plans: Description: Staff and home visits/ assessments.

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court- ordered 
or agency-required mental health screenings and assessments for 
children under the supervision of CFSA; 
Spending plans: Proposed expenditures: $47,000; 
Spending plans: Description: Supplies and materials.

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court-ordered or agency required mental health treatments for children under the supervision of CFSA; 
Spending plans: Proposed expenditures: $1,725,000; 
Spending plans: Description: Mobile crisis and community based 
intervention teams to provide immediate assistance. 

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court-ordered 
or agency required mental health treatments for children under the 
supervision of CFSA; 
Spending plans: Description: Community support teams to provide a 
range of interventions to high risk children involved in multiple 
systems.

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court-ordered 
or agency required mental health treatments for children under the 
supervision of CFSA; 
Spending plans: Description: Community treatment setting for older 
adolescents who are aging out of care.

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court-ordered or 
agency required mental health treatments for children under the 
supervision of CFSA; 
Spending plans: Description: Specialized therapy and child traumatic 
stress treatment.

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court-ordered or 
agency required mental health treatments for children under the 
supervision of CFSA; 
Spending plans: Proposed expenditures: $150,000; 
Spending plans: Description: Staffing coordination between DMH and 
CFSA.

Organization and total funding: Department of Mental Health; 
$3.9 million; 
Public Law 108-199: Purpose of funding: To provide all court-ordered 
or agency required mental health treatments for children under the 
supervision of CFSA; 
Spending plans: Proposed expenditures: $578,000; 
Spending plans: Description: Training.

Organization and total funding: Metropolitan Washington Council of 
Governments; 
$1.1 million; 
Public Law 108-199: Purpose of funding: To develop a program in 
conjunction with the foster and adoptive parents advocacy center to 
provide respite care for and recruitment of foster parents; 
Spending plans: Description: Although COG presented a detailed 
spending plan, it did not include a breakdown of expenditures. The 
plan indicated that COG would (1) provide services for resource 
parents caring for children in the DC child welfare system, (2) 
recruit and train respite care families to care for foster children 
covering emergency, planned or ongoing respite care situations, and 
(3) assist CFSA in developing a recruitment video and purchasing media 
ads targeted to demographics most likely to foster children with 
special needs.

Source: District of Columbia government and the Metropolitan Washington 
Council of Governments.

[End of table]

CFSA's spending plan outlined a strategy for accomplishing the 
objectives of each of its programs as established under the act. 
According to the plan, CFSA would: 

* establish an early intervention program through the implementation of 
Facilitated Family Team Meetings that would focus on permanency options 
for foster children;

* create an emergency support fund for kinship caregivers to pay for 
necessary expenses such as lead abatement, home repairs and renovation, 
and child care, in order to help these caregivers become or remain 
licensed foster homes;

* establish a student loan repayment program for caseworkers; and: 

* enhance CFSA's ability to share information within and outside the 
agency by upgrading the agency's child welfare tracking database, 
FACES, to a Web-enabled system, providing laptop computers for 
caseworkers and enhancing CFSA's networking capabilities to enable this 
Web-based initiative.

The budgets from the three organizations provided details about the 
planned expenses. The major expenses detailed in CFSA's budget are 
related to the hiring of new personnel for Facilitated Family Team 
Meetings, student loan repayments to caseworkers, equipment and labor 
for technology upgrades, and direct support services to children and 
families. DMH's spending plan identified funding for expanded 
psychiatrist and psychologist hours for assessment and mental health 
treatment, such as that provided by mobile crisis intervention teams 
and specialized therapy. DMH's budget confirmed these as the major 
portions of the federal funds. COG's spending plan outlined programs 
for providing respite care for and the recruitment of foster parents, 
but it did not provide a monetary breakdown of how the funds would be 
spent. However, COG's budget identified the expenditures for the 
respite care and recruitment programs, and the major expenses budgeted 
were for personnel costs and funds that would be passed through to 
contractors and community organizations to provide respite, 
recruitment, and related training services. Furthermore, COG officials 
indicated that they have until March 2005 to expend all of its funds.

Future Funding for Some of the Long-Term Projects in the Plan Is 
Uncertain: 

While the expenditures proposed in the District and COG spending plans 
appear to be in line with the intentions of the act, it is unclear how 
the District and COG plan to support all of the programs and 
initiatives outlined in the spending plan in the long-term. Although 
the District's fiscal year 2005 proposed budget for CFSA reflects 
realignment of agency funds as a means to continue the early 
intervention program that was funded in fiscal year 2004 with federal 
funds, it does not address funding for continuing the other CFSA 
programs. Also, CFSA has reported that the student loan repayment 
program would be made available only to staff currently on board due to 
the expiration of the funds on September 30, 2004, although these funds 
are intended to support a multiyear strategy that would allow CFSA to 
retain highly qualified caseworkers over time. The District's proposed 
budget for fiscal year 2005 for DMH includes a realignment of funds to 
support some mental health treatment services. For fiscal year 2005, 
the budget includes funds to support programs designed to help foster 
care children, such as Multi-Systemic Therapy services. Also, DMH 
officials said that they are working to include the new types of 
treatment in the services reimbursed under the District's Medicaid 
program as a longer-term mechanism to fund additional services. With 
regard to assessment, it is unclear how the District plans to sustain 
the funding necessary for the additional evaluators. According to the 
DMH director, DMH would continue to fund evaluators to provide 
assessments. In addition, COG officials told us that they would likely 
need an additional $500,000 from the federal government to continue 
their respite care initiative through the end of fiscal year 2005 and 
hope that private sources would support the respite program in the 
future. In commenting on a draft of this report, COG officials said 
that they had received a partnership commitment from a private source 
and would seek further funding as needed.

As of June 30, 2004, Only a Small Portion of the $14 Million Had Been 
Obligated or Spent: 

The District and COG did not receive authority over their funding until 
6 months into fiscal year 2004. Following passage of the act on January 
23, 2004, the District and COG could not receive funding until 30 days 
after they submitted a spending plan. On March 17, 2004, the District 
received the $14 million payment, less a 0.59 percent 
rescission,[Footnote 41] for a total of $13,917,400. The District's 
Office of Budget and Planning granted CFSA budget authority for its 
share of funds, $8,946,900 on March 22, 2004, and granted DMH budget 
authority for its funds totaling $3,876,990 on March 17, 2004. The 
District sent COG its payment of $1,093,510 on March 25, 2004.

As of June 30, 2004, CFSA, DMH, and COG reported a small portion of the 
funds appropriated for foster care improvements were obligated or 
spent. CFSA reported that it had outstanding contractual obligations of 
$183,105 and had expended $31,998, resulting in 2.4 percent of its 
funding under the act being expended or obligated. DMH reported that it 
had $704,527 in outstanding contractual obligations of the funds and 
had expended $190,538, totaling 23.1 percent of its funding under the 
act. COG reported that it had expended $196,307 of its funds, and that 
it had incurred $145,043 in outstanding contractual obligations, 
representing 31.2 percent of its funding under the act. In all, over 
$12.4 million of the foster care improvement funds, appropriated for 
fiscal year 2004 only, remained available 9 months into fiscal year 
2004. Table 6 provides details on the organizations' expenditures and 
obligations as of June 30, 2004.

Table 6: Funds Received and Expended by CFSA, DMH, and COG as of June 
30, 2004: 

Organization: CFSA; 
Funds received: $8,946,900; 
Expenditures and obligations: Funds Expended: $31,998; 
Expenditures and obligations: Outstanding Contractual Obligations: 
$183,105; 
Total funds expended and obligated: Amount: $215,104; 
Total funds expended and obligated: Percent: 2.4; 
Funds remaining: Amount: $8,731,796; 
Funds remaining: Percent: 97.6.

Organization: DMH; 
Funds received: $3,876,990; 
Expenditures and obligations: Funds Expended: $190,538; 
Expenditures and obligations: Outstanding Contractual Obligations: 
$704,527; 
Total funds expended and obligated: Amount: $895,065; 
Total funds expended and obligated: Percent: 23.1; 
Funds remaining: Amount: $2,981,925; 
Funds remaining: Percent: 76.9.

Organization: COG; 
Funds received: $1,093,510; 
Expenditures and obligations: Funds Expended: $196,307; 
Expenditures and obligations: Outstanding Contractual Obligations: 
$145,043; 
Total funds expended and obligated: Amount: $341,350; 
Total funds expended and obligated: Percent: 31.2; 
Funds remaining: Amount: $752,160; 
Funds remaining: Percent: 68.8.

Organization: Total; 
Funds received: $13,917,400; 
Expenditures and obligations: Funds Expended: $418,844; 
Expenditures and obligations: Outstanding Contractual Obligations: 
$1,032,675; 
Total funds expended and obligated: Amount: $1,451,519; 
Total funds expended and obligated: Percent: 10.4; 
Funds remaining: Amount: $12,465,881; 
Funds remaining: Percent: 89.6. 


Source: GAO analysis of data from the District of Columbia government 
and the Metropolitan Washington Council of Governments and GAO 
analysis. Data are unaudited. Differences are due to rounding.

[End of table]

Conclusions: 

Many steps have been taken to help improve the District's foster care 
system, but most of the programs and initiatives will need sustained 
attention and ongoing support. CFSA has implemented effective 
recruitment strategies and established retention incentives to help 
recruit and retain skilled caseworkers. CFSA has also developed a plan 
to recruit foster and adoptive families and instituted practices to 
better ensure the safety of foster and adoptive homes. While these 
efforts are promising, CFSA will need to continue to support these 
initiatives and monitor their effectiveness. Several other initiatives 
have just begun and will need sustained attention to ensure they are 
fully implemented. COG has not yet licensed families to provide respite 
or offered respite placements and is not certain about the number of 
families that will be needed to support the program. CFSA's and DMH's 
process for providing mental health services for foster care children 
was recently initiated, and it is uncertain whether these services are 
being provided in a timely fashion. In addition, there are several 
challenges remaining to ensuring the timely delivery of mental health 
services, including DMH's ability to expand its capacity to provide 
services. Furthermore, while the expenditures proposed in the District 
and COG spending plans appear to be in line with the intentions of the 
act, it is unclear how the District and COG plan to support some of the 
programs and initiatives outlined in the spending plan in the long-
term.

However, some of CFSA's management practices have not created a 
positive work environment for its caseworkers. Caseworkers play a 
critical role in the District's child welfare system, and CFSA needs 
its caseworkers to be productive, motivated, and committed in order to 
make further improvements to the District's child welfare system. 
Without making further changes in its management practices, CFSA may 
experience decreases in productivity and increases in attrition of its 
caseworkers. Further, low morale may affect caseworkers efforts to 
fulfill their duties and provide adequate care to the children they 
manage. Without consistent and effective communication strategies, 
caseworkers may not be aware of what services they can provide to 
foster care children and their families or the processes for obtaining 
such services. Without supervisors fulfilling their responsibilities, 
CFSA caseworkers are left without guidance and direction on how to 
improve on their performance and fulfill their case management duties. 
Additionally, caseworkers may not be making the best decisions about 
their cases, which in turn can affect the care and services provided to 
children and their families.

In addition to having a cadre of highly skilled and motivated 
caseworkers, an adequate number of safe, foster, and adoptive homes is 
a critical factor to improving foster care in the District. Despite 
CFSA's new efforts and attention to recruiting foster and adoptive 
families, the agency does not have a process for assessing the 
effectiveness of its recruitment efforts. Therefore, the agency does 
not know which efforts are most productive and which strategies should 
be continued or abandoned. Additionally, CFSA does not have sufficient 
information about the reasons foster families stop serving and leave 
the foster care system because it does not have a process to solicit 
feedback from them. Such information could help the agency improve its 
program and help reduce the attrition of foster families.

Recommendations: 

To build upon the improvements underway, we recommend that the director 
of CFSA take the following three actions: 

* Address human capital management issues that affect caseworkers by 
establishing processes to consistently and effectively communicate 
information about agency operations and developing strategies to help 
ensure that supervisors fulfill their responsibilities.

* Develop a systematic method to evaluate its foster parent recruitment 
efforts to help identify the most effective strategies.

* Conduct exit interviews with foster parents who stop serving to 
identify the factors affecting their decisions and develop an action 
plan to address those factors that relate to systematic issues.

Agency Comments and Our Evaluation: 

We received written comments from CFSA on a draft of this report. These 
comments are reprinted in appendix II. CFSA agreed with each of our 
recommendations and said that it plans to implement them. CFSA provided 
additional information to clarify the issues in the report, and we made 
changes to the report to reflect several of these comments. 
Specifically, we (1) revised the maximum student loan repayment amounts 
and the application deadline, (2) updated the number of finalized 
adoptions, (3) changed the new recruitment unit operational date from 
August to October, (4) noted that CFSA has implemented some suggestions 
from the COG report, (5) corrected the information on licensing for 
kinship homes, and (6) noted that CFSA has begun entering data on 
mental health referrals made since March 2004. CFSA provided other 
information and data that we did not incorporate because the data could 
not be corroborated in time for this report.

We also received written comments on a draft of this report from DMH. 
These comments are reprinted in appendix III. DMH provided information 
to clarify and provide context for three areas in the report: 
sustainability, building provider capacity, and improving the 
timeliness of evaluations and assessments. We made changes to recognize 
DMH's plan to sustain the programs begun with federal funding. 
Specifically, we note a realignment of funds to support various mental 
health services that could help the District's foster care children. 
Also, we added information on DMH's plans to include new types of 
treatment in the services reimbursed under the District's Medicaid 
program. With regard to DMH's efforts to meet the timeliness 
requirements for completing evaluations and assessments, we did not 
change the report to reflect the new information provided. DMH did not 
include supporting documentation for the timeframes reported, and we 
could not verify the data on the timelines for completing assessments.

Additionally, we received written comments on a draft of this report 
from COG. These comments are reprinted in appendix IV. COG provided us 
with information on its plans to obtain long-term funding for its 
program and to assess the number of respite providers it will need. We 
modified the report to reflect these comments.

We will send copies of this report to the Acting Director of CFSA, the 
Director of DMH, the Executive Director of COG, appropriate 
congressional committees, and other interested parties. We will also 
make copies of this report available to others on request. In addition, 
the report will be available at no charge on GAO's Web site at http://
www.gao.gov: 

If you have any questions about this report, please contact me on (202) 
512-8403. Other contacts and staff acknowledgments are listed in 
appendix V.

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

[End of section]

Appendix I: Objectives, Scope, and Methodology: 

To identify Child and Family Services Agency's (CFSA) strategies for 
recruiting, retaining, and managing its caseworkers, we reviewed key 
CFSA documents, analyzed data, and interviewed several experts and 
agency officials. Specifically, we reviewed CFSA's strategic and annual 
plans for fiscal years 2003 and 2004 and CFSA's recruiting and 
retention plans for fiscal years 2003, 2004, and 2005. We reviewed CFSA 
data, such as worker caseload counts, attrition data, and exit 
interviews. To check the frequency with which performance appraisals 
were being held, we reviewed personnel folders for a random sample of 
80 caseworkers, of which we excluded 49 caseworker files to include 
only those hired on or before December 31, 2000. We reviewed national 
standards for child welfare agencies set by the Child Welfare League of 
America and the Council on Accreditation. Additionally, we met with 
several CFSA program officials and the court-appointed monitor, the 
Center for the Study of Social Policy (CSSP). We also interviewed 
national child welfare experts from the Child Welfare League of 
America, Council on Accreditation, the Department of Health and Human 
Services (HHS) Children's Bureau, Institute for Social Welfare 
Research, Council on Social Work Education, National Association of 
Social Workers, and Casey Family Services.

We also used discussion groups to obtain the opinions and insights of 
CFSA supervisors and caseworkers regarding their opinions of CFSA's 
recruiting, retention, and management support of caseworkers. 
Discussion groups are a form of qualitative research in which a 
specially trained leader, the moderator, meets with a small group of 
people who have similar characteristics and are knowledgeable about the 
specific issue. The results from the discussion groups are descriptive, 
showing the range of opinions and ideas among participants. However, 
the results cannot serve as a basis for statistical inference because 
discussion groups are not designed to (1) demonstrate the extent of a 
problem or to generalize results to a larger population, (2) develop a 
consensus for an agreed-upon plan of action, or (3) provide 
statistically representative samples with reliable quantitative 
estimates. The opinions of many group participants showed a great deal 
of consensus, and the recurring themes provide some amount of 
validation.

After an initial group interview with supervisors selected by CFSA 
officials, we conducted four discussion groups--one with supervisors 
and three with caseworkers. We randomly selected participants to help 
ensure that they represented a cross section of the organization. 
Attendance on the part of invited participants was voluntary. For the 
three discussion groups that were held with caseworkers, we had one 
with employees who had been at CFSA for 1 year or less, one discussion 
group with employees who had been at CFSA 1-6 years, and one with 
employees who had been at CFSA more than 6 years. A trained discussion 
group moderator led the discussions while our analysts took notes. We 
developed a discussion group guide to assist the moderator in leading 
the discussions.

To assess CFSA's efforts to license an adequate number of safe homes 
for foster care placements and adoptions, we reviewed CFSA documents, 
analyzed related data, interviewed agency officials, and held group 
interviews with foster and adoptive parents. Specifically, we examined 
CFSA's plan for foster and adoptive parent recruitment and retention 
and its resource development plan. We also reviewed CFSA's licensing 
policies for traditional foster, kinship, and congregate care 
placements. We analyzed CFSA data on the number of children in 
unlicensed foster homes, people attending orientation sessions, foster 
homes issued a license from October 2003 through June 2004, and the 
attrition rates for foster families from October 2003 to May 2004. We 
also evaluated the number of foster families with the intent to adopt 
their foster children as of March 2004, and the number of children in 
CFSA's care waiting to be adopted as of March 2004. We reviewed HHS' 
Child and Family Services Review (CFSR) on CFSA, the Implementation 
Plan issued by CFSA's court-appointed monitor, and other national 
studies on recruiting foster parents. We met with CFSA program 
officials and the court-appointed monitor to discuss CFSA's processes 
and goals for licensing foster parents. We coordinated with D.C.-based 
organizations, the Foster Parent Advocacy Center (FAPAC) and the Foster 
Parent Association, to hold group interviews with foster parents. 
Additionally, we interviewed officials from the Adoption Resource 
Center in Washington, D.C. and the Metropolitan Washington Council of 
Governments (COG).

To determine how CFSA has collaborated with the Department of Mental 
Health (DMH) and the D.C. Family Court to provide mental health 
services to foster care children and what challenges remain, we 
analyzed CFSA and DMH planning documents, notices of available funding, 
provider contracts, and documentation of internal procedures for 
referring foster care children to mental health services. Prior to its 
implementation, we previewed CFSA's database for tracking mental health 
referrals and reviewed the documents used to collect and log the data. 
We also reviewed preliminary data on the number of assessments 
completed and the number of children enrolled with DMH treatment 
providers from mid-March 2004 through May 2004. We interviewed CFSA and 
DMH program officials and D.C. Family Court judges. In addition, we 
interviewed national experts in coordinating care for children across 
public systems, including the court monitors for the District's child 
welfare and mental health systems, respectively.

To report on CFSA's, DMH's, and COG's plans and use of their fiscal 
year 2004 federal funds for foster care improvements, we reviewed the 
agencies' spending plans, budget data, and unaudited reports of 
obligations and expenditures. We interviewed financial and program 
personnel from all three organizations and from within the District's 
central Chief Financial Officer's office.

[End of section]

Appendix II: Comments from the District of Columbia's Child and Family 
Services Agency: 

GOVERNMENT OF THE DISTRICT OF COLUMBIA:
Child and Family Services Agency:

Office of the Acting Director:

September 16, 2004:

Cornelia M. Ashby:
Director, Education, Workforce, and Income Security Issues: 
Government Accountability Office:
Washington, D.C. 20548:

Re: CFSA Comments on GAO Draft Report No. 04-1017:

Dear Ms. Ashby:

Thank you for the opportunity to comment on your September, 2004 draft 
report. As you know, CFSA serves approximately 2,800 children in foster 
care and another 3,150 children living in their birth homes and 
receiving services. We appreciate that the report recognizes many 
improvements CFSA has already made in social worker and foster and 
adoptive parent licensing, recruitment and retention; access to mental 
health services; and use of specially appropriated federal dollars.

We also appreciate your thoughtful recommendations that should 
translate into even better results. We agree with each of your 
recommendations and plan to implement them this fall. However, we wish 
to discuss several areas in which additional information will clarify 
issues raised in your draft report and to identify a few areas in which 
modifications are in order.

Social Worker Recruitment and Retention:

As the draft report recognizes, CFSA has made considerable strides in 
social work recruitment, exceeding ambitious recruitment targets for 
FY03. We have done so by using new advertising strategies combined with 
incentives. Now that we have been successful in bringing new workers 
into CFSA, we must turn our attention to retention. To do so, we 
focused significant portions of the upcoming year's recruitment plan on 
retention efforts. Strategies already identified in the June 2004 plan 
include implementation of the student loan repayment program as well as 
a rewards and recognition program for workers.

Specifically, participants in the student loan repayment program must 
sign an agreement to remain with CFSA for a total of four years, 
although workers who have already been here two or more years need to 
agree to stay only another two years. In late August, we increased the 
maximum repayment amounts from $10,000 to $18,000 for MSWs and from 
$5,000 to $10,000 for BSWs (see Draft report, page 16) with a tenure 
bonus for workers with five years' tenure at CFSA. [NOTE 1]

We are currently meeting with union representatives and social work 
staff to develop a tailored rewards-and-recognition program for 
employees. In the meantime, CFSA uses incentives such as academic 
achievement incentives, bonuses for bilingual workers and reimbursement 
for relocation expenses, as well as District of Columbia incentive 
awards, which include quality step increases and other monetary awards 
as well as time off of up to three full days without charge to leave. 
Our intent is to develop a program that encompasses all staff and 
rewards superior performance or recognizes specific accomplishments. 
Clearly, social workers are the backbone of any child welfare system, 
but they rely heavily on a highly motivated and qualified support team 
who should also benefit from this new program. We expect this program 
to be implemented this fall.

We also agree that improvements in policy dissemination to workers and 
infusion into case practice will have a positive impact on retention, 
and are working to improve in this area. (Report, page 16-17.) Thus, 
now policy is presented in several ways-through meetings with 
supervisors who, in turn, present new policies to staff, Program All 
staff meetings held each month; incorporating new policies into 
existing training; training sessions specifically about new policies; 
and notices in CFSA's employee newsletter. In addition, our computer 
system notifies staff through "version notes" and "alerts" that advise 
when online policies are updated. We also have recently established a 
process for issuance of administrative directives and protocols to 
provide guidance to staff while we finalize formal policy. This multi-
faceted approach should help to reduce worker frustration.

Quality supervision is another essential factor in social worker 
retention that we have begun to address. First, we improved management 
tools so that supervisors now know each worker's caseload and the 
status of case plans and visits for each worker on each case. We 
developed a case consultation supervisory guide, [NOTE 2] which is 
intended to standardize supervision in Program Operations, so that 
supervisors review all key aspects of cases during weekly supervision. 
Supervisors will participate in a peer review process where they will 
have an opportunity to review cases of their peers and provide feedback 
and consultation. We will also use this year's Performance Management 
Plans (PMPs) to ensure supervisors are held accountable for providing 
quality supervision to their units. The PMPs will include clear 
standards for weekly supervision as well as requirements for 
completion of mandatory supervisory training. We will tie the award of 
any incentives to these standards.

On the issue of training of supervisors, information in the draft is 
not wholly accurate. We require all new supervisors to complete the 
five-module "Mastering the Art of Supervision." One module is offered 
per month (with the exception of August and December). Supervisory 
staff enroll in the module closest to their hire date and continue each 
month until they complete all five modules. [NOTE 3] Modules cover the 
following topics:

Table 1:

[See PDF for image]

[End of table]

In 2003, out of a total of 20 (not 61) new case-carrying supervisors, 
11 (not 5) completed all five modules; 7 completed four modules; 1 
completed 3 modules; and 1 supervisor, who was on maternity leave, 
completed no modules. [NOTE 4] Two supervisors hired in 2004 and each 
supervisor who has not completed all five modules are currently 
scheduled for the relevant training.

In addition to this basic course, we are requiring additional training 
for supervisors in 2004, which focuses on applying what is learned in 
training and the supervisors' role in incorporating the learning in 
case practice. Required courses include Transfer of Learning Process (9 
hours given by Child Welfare League of America), Writing Effective 
Court Reports (12 hours), Safety Model Training (Intake and 
Investigation Supervisors - 9 hours and for other administrations - 1 
hour overview), Engaging Families in the Process of Change: A 
Supervisor's Guide (9 hours), Engaging Fathers (3 hours), and 
Supervisory Case Consultation Tools (6 hours). Our Training Director is 
currently reviewing automated data to provide status reports to 
supervisors and their managers of their status in completing these 
required courses.

We also recognize the need to continue to focus on caseload 
equalization. As you note in the draft, page 13, while our average 
caseload is below 17, we have a number of workers with caseloads 
greater than that and others with caseloads well under 17. In an 
attempt to address this issue, and in addition to aggressive 
recruitment of workers, we are reviewing how cases are assigned and how 
we are using training units to determine if changes in these areas will 
positively affect caseloads distribution. We are also evaluating other 
strategies to address caseload equalization.

Foster and Adoptive Home Licensing, Recruitment, and Retention:

We are pleased that you recognize our progress in licensing, 
recruiting, and retaining foster and adoptive homes. We are proud of 
our first-ever Foster and Adoptive Parent Recruitment/Retention Plan 
and expect to learn much from our efforts this year.

As of August 31, 2004, we have exceeded our FY 04 goals for finalized 
adoptions, with 368 finalized adoptions. [NOTE 5] We also have 
finalized 242 guardianships, where kin who become legal guardians for 
children receive subsidies from the District. This means that so far 
in FY 04, 600 children have gained permanent families.

Recruitment effortrs:

We have concentrated improving our foster/adoptive parent recruitment 
efforts in several areas. We reallocated positions to create a second 
recruitment unit. Hiring will be completed this month, and the unit 
will be operational in October. We are developing a short survey to 
gain information about why families decide to stop fostering, which we 
will distribute in early October to every foster parent who dropped out 
in FY04. (Response to report, page 24). We will use information from 
this survey to update next year's recruitment/retention plan. We also 
worked with foster parents on a policy relating to information CFSA 
provides to foster parents when a child is placed, which includes, for 
example, a board and care agreement, medical screening and immunization 
information, birth certificate, social security and Medicaid cards, 
visitation plans, and any court orders. (Response to report, page 25). 
Foster parent support workers follow up with foster parents to ensure 
they received a placement packet. We have just completed training all 
Program Operations staff about the placement packet, and implementation 
is underway. Additionally, our new contracts with our child placement 
licensing agencies require them to provide foster parent support 
workers who will provide support to foster parents and also monitor 
licensing status.

We have implemented some suggestions from the Council of Governments 
(COG) report referred to on page 21 of your draft. For example, we 
identified a contact affiliated with the Mystics, the local women's 
basketball team, who we hope will assist us in events or programs 
designed to improve community awareness. To involve coaches and others 
working with children in sports, we partnered with the District's 
Department of Parks and Recreation, which now advertises our need for 
foster and adoptive homes in its magazine and through flyers at its 
recreation centers. We are also finalizing several media strategies 
aimed at foster and adoptive parent recruitment. Using grant funding 
from the Freddie Mac Foundation, which we expect to receive shortly, we 
will hold "foster ware" parties, purchase promotional items for 
giveaways at community events, and develop exhibits and informational 
kits for prospective parents. We are working with COG to develop a 
recruitment video, one of the initiatives from the federal 
appropriation.

Licensing:

Turning now to the licensing issues, we wish to correct the discussion 
in the report related to kin licensing (page 22). The District has had 
licensing requirements and standards for kin homes since 2001, not 
April 2004. In 2004, with the consent of the Court Monitor, we 
instituted emergency, temporary licensing of kin, which provides for 
preliminary key safety checks and prompt placement of children. Kin 
must then complete the full procedure for regular licensing. We have 
licensed 26 kin homes under this program, and have denied several 
licenses based upon results of the preliminary safety check. We were 
able to establish this program because we now have direct access to 
national criminal background data from the National Criminal 
Information Center (NCIC). We recently proposed this temporary kin 
placement program to Maryland (page 26), and are optimistic about 
reaching an agreement that would permit us to implement it for Maryland 
kin homes.

We continue to work to ensure all of our children are placed in 
licensed foster homes. As you know, when the agency came out of 
receivership, most of our foster homes did not have licenses. According 
to the Court Monitor, 33% of foster homes had a current license in May 
2001. As of July 31, 2004, 75% of foster homes have a current license. 
We are using multiple strategies to address the two categories of 
unlicensed caretakers--those who have never been licensed and those who 
were previously licensed but whose licenses have expired. Our initial 
efforts concentrated on those caretakers who had never been licensed. 
This group, in large part, includes both traditional and kin foster 
parents who have been caring for children for years, including before 
the requirement for licensure. While focusing on this group, we have 
learned that some licenses of licensed homes are expiring without 
timely renewal, which we are also working to address.

The rise in license expirations and continued work with the never-
licensed families have required us to revise strategies to ensure that 
all children reside in licensed homes. Those strategies include 
improved internal tracking of license status and correction of our own 
records. We have held several licensing fairs that provided caretakers 
with a convenient, "one-stop" means of completing a number of licensing 
requirements: In-service, First Aid, and CPR training are typically 
offered as well as scheduling of fire inspections, fingerprinting, and 
other services. We also reviewed our contracts with licensing agencies 
and, as a result, modified statements of work, increased oversight, and 
limited new referrals to selected contractors. The former CFSA Director 
and Deputy Director for Licensing & Monitoring conducted site visits to 
contractors with high rates of unlicensed homes to discuss improved 
performance. Last month, contractors received letters from the Deputy 
Director for Licensing & Monitoring to reinforce CFSA's continued 
expectations for performance improvement. We also expect to address 
this issue through the performance-based contracts that are now being 
finalized.

Access to Mental Health Services:

As noted in the draft report, CFSA created a referral process and 
internal database for tracking service delivery. CFSA and Department of 
Mental Health (DMH) plan to co-locate staff from DMH by October 31, 
2004, after they have completed orientation with DMH. Temporary staff 
have been hired to enter the data for the 1600 referrals that have been 
made since March 17, 2004. This process should be completed by the end 
of September. CFSA will begin recruitment of two data entry personnel 
early in October, who will maintain the database. The database includes 
demographic information about the child or parent and the date and type 
of service requested. Under the new system of care, children and 
families are linked to a Core Service Agency, through Department of 
Mental Health, that will provide the requested services. Core Services 
Agencies are Medicaid certified therapeutic providers who provide 
services such as individual therapy, grief counseling and individual 
therapy.

Update on Use of Federal Dollars:

With the federal dollars not available until March 12, 2004, CFSA 
developed a strategy with the District's Office of the Chief Financial 
Officer whereby we expect to obligate nearly all of the federal dollars 
by September 30, 2004, consistent with our spending plan.

With respect to the Student Loan Repayment program, we modified the 
program to increase the maximum repayment amounts. As of September .9, 
2004, after we announced the modification, we had signed service 
contracts or approved applications awaiting signature from 102 workers, 
for a total of $1,499,059. We have another 71 in the applications 
process. If all 71 are approved, the combined amount of loan 
commitments will be $2.4 million dollars. We also extended the 
application deadline to September 16, 2004. We have executed a three-
year contract with a consultant to serve as project manager. Projected 
cost of this contract (which includes project management and 
communication materials) is $200,000. Our revised projections show us 
being able to obligate most of the money by September 30.

We anticipate obligating the $2,982,300 for Upgrading Computer 
Technology for Social Workers by September 30, 2004. A total of $2 
million is being obligated to a competitive contract for upgrading the 
FACES case management system to web-based architecture; $500,000 is 
allocated to purchasing laptops (with contract award within the next 
week); $249,223 is paying for District staff and consultants performing 
the work; and $120,000 has been transferred to the District's Office of 
the Chief Technology Officer to purchase network routers and switches. 
The remaining $113,077 will purchase software and hardware to improve 
network reliability and security.

To date, we have spent $122,356 of the Early Intervention Fund and 
obligated an additional $990,011 and spent $50,478 of the Emergency 
Support Fund for Kin. We update expenditures and obligations weekly to 
ensure we will use all of the Congressional appropriation.

Thank you once again for the opportunity to respond to your draft 
report. Feel free to contact me at 442-4177 if you have any questions.

Signed by: 

Brenda Donald Walker:
Acting Director, CFSA:

Cc: Carolyn Taylor: 
GAO:

Robert Bobb: 
City Administrator:

Neil Albert: 
Deputy Mayor for Children, Youth and Elders: 
Natwar Gandhi: 
Chief Financial Officer:

Brenda Donald Walker: 
Acting Director:
400 Sixth Street, SW: 
Suite 5039: 
Washington, DC 20024: 
Phone: (202) 442-6175: 
Fax: (202) 727-7700: 
E-mail: Bdonald@cfsa-dc.org:

NOTES: 

[1] We have the following additional technical corrections to the 
sections relating to social worker retention and recruitment. Page 10 
at the bottom: targeted recruitment focused on schools in Maryland, 
Virginia, New York, New Jersey, Pennsylvania, North Carolina, Delaware, 
and South Carolina but not in California and Florida. On page 16, the 
average CFSA MSW salary with one year of experience is $48,380, not 
$41,440.

[2] Training on the use of the tool began September 8, 2004.

[3] Enrolling supervisors in the module closest to their hire date 
began recently. Previously, supervisors had three months to enroll in 
the course per the LaShawn Implementation Plan.

[4] Since 2002, 12 supervisors completed all five modules, 14 others 
completed four modules, 7 completed three modules, 2 completed two 
modules, and 6 completed one module. Eighteen did not complete any 
modules.

[5] Your report refers to 288 as of June 30, 2004 (page 24).

[End of section]

Appendix III: Comments from the District of Columbia's Department of 
Mental Health: 

GOVERNMENT OF THE DISTRICT OF COLUMBIA: 
DEPARTMENT OF MENTAL HEALTH:
Office of the Director:

September 15, 2004:

Ms. Cornelia M. Ashby: 
Director, Education, Workforce, and Income Security Issues: 
441 G Street, N.W., Room 5928: 
Washington, D.C. 20548:

Dear Ms. Ashby:

I am writing to thank you for the opportunity to review and comment on 
the preliminary draft report titled "D.C. CHILD AND FAMILY SERVICES 
AGENCY: More Focus Needed on Human Capital Management Issues for 
Caseworkers and Foster Parent Recruitment and Retention" (GAO-04-1017), 
which includes the 3.9 million dollars in congressionally appropriated 
funds to improve mental health services for foster care youth allocated 
to the District of Columbia's Department of Mental Health (DMH).

I would like to clarify and provide additional context for three areas 
in this report, they include: sustainability, building provider 
capacity and improving the timeliness of evaluations and assessments.

First concerning sustainability, I would like to address the two 
references in the report, found on pages 36 and 40, which state that 
the GAO is unclear as to how DMH plans to sustain its major services 
initiatives once the congressional funds have been exhausted. In 
anticipation and in preparation for receipt of these funds, DMH and 
CFSA identified sustainability as key criteria in its selection of the 
types of service capacity that was needed and would be developed for 
foster care youth using these funds. DMH and CFSA identified best or 
promising practice service interventions that could be substantially 
financed through Medicaid, entirely or partially, utilizing DMH's 
current menu of Mental Health Rehabilitation Services (MHRS) as the 
funding mechanism to accommodate Multisystemic Therapy, Intensive Home 
and Community Based Services and Mobile Response and Crisis 
Stabilization Services beyond year one of the start-up period for the 
service providers selected to deliver these services. Each of the 
Notices of Funding Availability (NOFA) contained the following 
statement:

"The ongoing nature of these funds is not certain; therefore, CFSA and 
DMH have adopted a strategy to assure that the MST, IHCBS, MRSS 
described in this RFA and supported through these grant funds can be 
sustained beyond the grant period. It is envisioned and expected that 
grantee/s must currently be or become certified as a Core Service 
Agency, Sub-Provider or Specialty Provider through the DMH 
certification process. To sustain the MST, IHCBS, MRSS model described 
in this RFA beyond the grant period, the successful grantee/s shall 
accept Medicaid reimbursement through the DMH's Mental Health 
Rehabilitation Services (MHRS) option to assure the continuation of the 
services after year one. Therefore, certification is required within 
six months of the grant award, with the capability to begin billing for 
Medicaid for these services in the last quarter of the grant period."

The DMH and CFSA sustainability strategy was articulated/conveyed to 
member/s of the GAO review team as follows:

* Copies of all the NOFA's were transmitted to the GAO DMH review team; 
* Sustainability strategy was described by the contract Project Manager 
at the exit briefing held in July with CFSA; and: 
* Sustainability strategy was conveyed in an e-mail transmission to the 
GAO DMH review team on August 19, 2004.

I am requesting that the report reflect the sustainability effort, as 
detailed in this transmittal, in the final report and as briefly 
referenced on page 32 of the draft report by the following statement:

"Officials further said that DMH is working to include the new types of 
treatment in the services reimbursed under the District's Medicaid 
program as a long-term plan to fund the additional services."

Secondly, the DMH has utilized this federal payment to purchase expert 
training and technical assistance consultation to organize and build 
administrative and operational capacity within seven service provider 
agencies that serve CFSA youth and their families. The purpose of this 
support is to assure that the administrative infrastructure within 
these agencies is aligned with the expectations of the MHRS 
requirements that are necessary to be clinically prepared and 
financially viable child and adolescent rehabilitation provider.

Finally, regarding meeting the timeliness requirement to perform 
assessments and evaluations, the draft report discusses ". . .DMH's 
ability to expand its capacity and states, in part, that both agencies 
continue to face challenges ensuring the timely delivery of services, 
including completing complex types of assessments that may take longer 
than the specified statutory timeframes..."

An update to this section of the report should include the following 
progress that has been made in meeting the timeliness requirements 
includes:

* DMH evaluator capacity has grown from six to twenty; and:

* DMH wait time for a psychiatric exam from the point of referral has 
gone from three months to less than one month and from two months to 
one week for psychological exams.

Thank you for the opportunity to comment and clarify this issue. If you 
have any questions, I can be reached at 202-673-7440.

Signed by: 

Martha B. Knisley: 
Director: 

Cc: Brenda Donald-Walker, Director, CFSA: 
Roque Gerald, Director, OCP, CFSA: 
Ella Thomas, Director, OPPPs, DMH: 
John Gibbons, Project Manager, DMH:

[End of section]

Appendix IV: Comments from the Metropolitan Washington Council of 
Governments: 


METROPOLITAN WASHINGTON COUNCIL OF GOVERNMENTS:

September 16, 2004:

Carolyn M. Taylor: 
Assistant Director: 
Education, Workforce and Income Security: 
U.S. General Accounting Office:
441 G. Street, NW Room 5G333: 
Washington, DC 20548:

Dear Ms. Taylor:

Please find enclosed the Metropolitan Washington Council of 
Governments' response to the D.C. Child and Family Services Agency 
report draft of September 2004. We appreciate the opportunity to 
participate in the study and look forward to continuing our exciting 
work on the "Work of Heart" Respite and Recruitment Project.

If you have any further questions, I can be contacted at 202-962-3260. 
I look forward to receiving the final copy of the report.

Sincerely,

Signed by: 

David J. Robertson: 
Executive Director:

Metropolitan Washington Council of Governments:

The Metropolitan Washington Council of Governments is pleased and 
honored to be the recipients of this appropriation and have worked 
diligently to plan and implement a proven model of respite care for the 
District of Columbia's foster children and foster families. We are sure 
that making respite services available to the District's foster 
families will greatly reduce the burnout rate, reduce attrition and 
therefore stabilize placements for children.

We have also made great strides in partnering with the District's Child 
and Family Services Agency to provide quality foster parent recruitment 
and training services to District of Columbia residents interested in 
providing foster care. By providing these recruitment services, the 
District of Columbia will have a greater pool of foster families within 
the District, therefore enabling foster children to be placed in 
communities and environments in which they are familiar.

Long-term funding for the Respite Project: It is COG's plan to continue 
to apply for additional federal and local government funds, as well as 
private funds, to support this project. COG has already received a 
partnership commitment from a corporate funder for the "Work of Heart" 
recruitment project and will continue to seek further private funding 
as needed.

Number of Respite Foster Families Needed: COG is currently assessing 
the number of foster families that need respite and will use that 
number to gauge how many respite families are required to meet the 
need. Currently, we have 28 families participating in the licensing 
process.

[End of section]

Appendix V: GAO Contacts and Staff Acknowledgments: 

GAO Contacts: 

Carolyn M. Taylor, (202) 512-2974, or at taylorcm@gao.gov: 
Anjali Tekchandani (202) 512-7149, or at tekchandania@gao.gov: 

Staff Acknowledgments: 

The following individuals also made important contributions to this 
report: Susan Barnidge, Joah Iannotta, JoAnn Martinez, Deborah Peay, 
James Rebbe, Lori Ryza, Norma Samuel, Vernette Shaw, Zakia Simpson, 
Walter Vance, and Carolyn Yocom.

FOOTNOTES

[1] The receivership was an arrangement in which the U.S. District 
Court appointed a person to temporarily manage the agency with broad 
authority to ensure full compliance with requirements established by 
the court in an expeditious manner.

[2] On October 23, 2000, the court signed the LaShawn A. v. Williams 
Consent Order (C.A. No. 89-1754), which outlined a process for 
terminating the receivership upon the satisfaction of certain specified 
conditions. 

[3] GAO, D.C. Child and Family Services: Better Policy Implementation 
and Documentation of Related Activities Would Help Improve Performance, 
GAO-03-646 (Washington, D.C; May 27, 2003); Center for the Study of 
Social Policy, LaShawn A. v. Williams: An Assessment of the District of 
Columbia's Progress as of September 30, 2003 in Meeting the 
Implementation and Outcome Benchmarks for Child Welfare Reform 
(Washington, D.C; Feb. 9, 2004). 

[4] GAO, Child Welfare: HHS Could Play a Greater Role in Helping Child 
Welfare Agencies Recruit and Retain Staff, GAO-03-357 (Washington, 
D.C; Mar. 31, 2003).

[5] Medicaid is a joint federal-state health insurance program for 
certain low-income, aged, and disabled people.

[6] The U.S. District Court for the District of Columbia placed the 
D.C. Commission on Mental Health Services, DMH's predecessor agency, in 
receivership in 1997. The first receiver was appointed in October 1997 
and resigned in March 2000. The court then issued a consent order 
establishing a transitional receiver to develop a plan for the District 
to resume full control of its mental health system. This transitional 
receivership was terminated in May 2002, and the court appointed a 
monitor to oversee the District's implementation of the plan.

[7] See GAO, District of Columbia: Receiver's Plan to Return Control of 
Mental Health Commission Is Evolving, GAO-01-157 (Washington, D.C; 
Oct. 30, 2000) and District of Columbia: Status of Reforms to the 
District's Mental Health System, GAO-04-387 (Washington, D.C; Mar. 31, 
2004).

[8] Pub. L. 107-114, 115 Stat. 2100 (Jan. 8, 2002).

[9] Pub. L. 107-96, 115 Stat. 929 (Dec. 21, 2001). For more details on 
the planned reform practices in the District's Family Court see GAO, 
D.C. Family Court: Additional Actions Should be Taken to Fully 
Implement Its Transition, GAO-02-584 (Washington, D.C; May 2002). 

[10] Pub. L. 108-199, 118 Stat. 3, 111. Div. C, Tit. 1, (Jan. 23, 
2004).

[11] The Foster and Adoptive Parents Advocacy Center (FAPAC) is an 
organization that assists foster, kinship, and adoptive parents of 
children in the District of Columbia.

[12] CFSA's Implementation Plan was developed in conjunction with CSSP, 
the court-appointed monitor. The plan covers outcomes and activities 
for CFSA through December 31, 2006, and sets interim performance 
benchmarks to assess improvements at 6-month intervals. 

[13] CFSA officials previously estimated that the agency lost about 
one-third of its caseworkers between January 1999 and July 2000.

[14] GAO-03-357.

[15] As part of a related review on the use of federal foster care 
improvement funds, we will review CFSA's expenditures of those funds.

[16] GAO, District of Columbia Child Welfare: Long-Term Challenges to 
Ensuring Children's Well-Being, GAO-01-191 (Washington, D.C; Dec. 
2000).

[17] Licensing requirements for foster homes in the District are the 
same as those for adoptive homes with one exception--the social 
evaluation focuses on questions relevant to adoption or providing 
foster care as appropriate. A license approves both the family and 
the physical space of their home. Licensed homes and families are used 
interchangeably in this section.

[18] Families are recruited to provide (1) traditional foster homes--
families who provide 24-hour care, supervision, and support for 
children, or (2) therapeutic foster care--24-hour care, supervision, 
and support for children who require more structure and therapeutic 
services to address their physical, emotional, and behavioral needs. 

[19] Children with special needs include those who have physical or 
developmental disabilities, who are 5 years old or older, or are 
adopted with sibling groups.

[20] Congregate care homes include group homes, independent living 
placements (ILPs), and therapeutic facilities. Group homes provide 
services to children in large family-type settings, ILPs are monitored 
apartments for teens who are preparing to live independently when they 
turn 18, and therapeutic facilities offer specialized medical and 
mental health care for children and teens. Congregate care homes are 
designed to provide placement for children who have not done well in 
the family setting or for those awaiting placement with traditional 
foster families.

[21] Kinship homes are those in which a relative or unrelated person 
with longstanding ties to the child provides care for a child that has 
been neglected, abused, or is at risk for neglect and abuse.

[22] Center for the Support of Families and the Metropolitan Washington 
Council of Governments. Strategic Recruitment: Finding Foster and 
Adoptive Families in Your Communities. Internal report produced for 
D.C. Child and Family Services Agency, (Washington, D.C; 2003).

[23] NCIC is an information center managed by the Department of 
Justice.

[24] The majority of CFSA's out-of-state placements are in Maryland and 
Virginia.

[25] According to agency officials, as of August 2004, CFSA finalized 
368 adoptions. 

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

[27] This expert, who has worked with several states to coordinate care 
for children across systems, outlined the following strategies as 
indicators of commitment to collaboration: (1) state agencies have a 
mechanism to make decisions together, (2) agencies are working together 
at the level of care, (3) staff members are co-mingling either through 
co-location or multiagency teams, (4) financial incentives support 
collaboration at the level of care, and (5) agencies are measuring the 
effect of collaboration on the child.

[28] In the event that DMH cannot accept the referral, BSU will forward 
it to a CFSA contractor to complete the assessment or provide the 
treatment.

[29] In addition to requests from caseworkers, health professionals 
participating in D.C. KIDS--a health program for children in the 
District's foster care system--can contact BSU to make a referral for 
mental health services. According to CFSA officials, all children 
should receive a medical examination, which includes a behavioral 
screening, through D.C. KIDS within 30 days of entering care. If the 
examination suggests the need for a more in depth mental health 
assessment or treatment, the child is referred to BSU to begin the 
process. 

[30] BSU's determination of the clinical appropriateness of the 
assessment is based on whether the type of assessment is age-
appropriate, warranted by the child's behavior, and will result in 
additional information about the child's mental health needs. The 
determination also takes into account whether the child had been 
assessed previously. 

[31] In addition to providing evaluations of foster care children, the 
Assessment Center completes assessments of children in the juvenile 
justice system and some adults involved in child custody dispute cases. 


[32] Core services agencies are DMH-certified rehabilitative services 
providers that are responsible for determining the needs of its 
consumers--including adults and children and youth--working with 
consumers to develop treatment plans, providing and/or coordinating 
services to meet objectives of the treatment plans, and billing DMH for 
services.

[33] These data were not available through DMH's information system, 
which tracks claims for reimbursement of treatment delivered but does 
not separately identify children in foster care. Further, 
reimbursements for assessments are not captured in DMH's system.

[34] From fiscal year 2001 to fiscal year 2003, CFSA increased its 
referrals to the Assessment Center by 35 percent. DMH projected the 
increase in CFSA demand for assessments to continue in fiscal year 
2004.

[35] Attachment therapy is used to help children who experienced 
neglect or abuse so that they can form healthy relationships and 
attachments to others.

[36] These timeframes require DMH to initiate services within 3 days of 
notification, complete assessments within 15 days of the request, and 
provide the Family Court with all assessments within 5 days of 
completion.

[37] To ensure the reliability of information in the database on a 
continuing basis, a CFSA official said that DMH will co-locate a staff 
person who will focus on data quality and integrity by overseeing the 
database and monitoring the ongoing relationship between CFSA and DMH.

[38] This option, which expands the services reimbursable under 
Medicaid, includes nine services, such as emergency and crisis care and 
community-based interventions, intended to facilitate the recovery from 
mental illness.

[39] In the District of Columbia, the federal government contributes 70 
cents of each Medicaid dollar spent.

[40] Another expert also noted that while assessments and treatment 
must have timeliness components to ensure that children receive needed 
services, the definition of what is timely will vary according to the 
needs of the child.

[41] The Consolidated Appropriations Act, 2004, Pub. L.108-199, 
included a provision for an across-the-board 0.59 percent rescission to 
be deducted from the budget authority provided for any discretionary 
accounting in the act. 

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