D.C. Child and Family Services Agency: Performance Has Improved, but Exploring Health Care Options and Providing Specialized Training May Further Enhance Performance

In 2009, CFSA redesigned their training curriculum for caseworkers new to the agency, as well as the ongoing training provided to their more experienced caseworkers. To develop these training courses, CFSA worked with child welfare experts, both internal to the agency as well as outside the agency. Some of the new courses that were developed include training on responding to trauma, mental health in child welfare, and best practices on dealing with fathers.

To address the mental health needs of children in CFSA's custody, in 2008 CFSA established contracts with seven mental health providers to address the needs of children in foster care. These providers offer specific services identified through the 2007 Mental Health Needs Assessment including evidence-based and non-traditional therapies. To help address the medical needs of children in CFSA's custody, CFSA opened the Healthy Horizons Assessment Center (an on-site Agency clinic) in December 2009. According to agency officials, the clinic is designed to address the medical pre-placement and replacement screening needs of all children/youth in the custody of CFSA, and provides comprehensive physicals for children entering care. This in-house screening process has the potential for providing more timely identification and initiation of medical and mental health services for the children CFSA serves. The Healthy Horizons Assessment Center staffing consists of five Certified Medical Assistants and five Advance Practice Registered Nurses (Nurse Practitioners). Nurse Practitioners practice independently and are authorized to write prescriptions. In July 2010, CFSA is launching a Nurse Care Management (NCM) Program, which is a mechanism for integrating health and social services planning. Registered nurses staff the NCM Program to ensure that children in foster care receive necessary health care services to address their comprehensive health needs. In this new role the Nurse Care Manager will provide administrative health expertise and will serve as the designated Agency (CFSA) skilled professional medical representative. The major functions of the NCM will include collecting and updating health information, accessing and coordinating health services, health education, discharge planning and facilitating communication between families and health care professionals. Experts believe that an increase in case managers and in-house nurse practitioners could help decrease the demand on area providers, but the number of staff dedicated to these programs may not be sufficient to address the needs of all CFSA foster children.