Child Protective Services: Complex Challenges Require New Strategies

Published by the Government Accountability Office on 1997-07-21.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                  United States General Accounting Office

GAO               Report to the Honorable
                  Nydia Velazquez, House of

July 1997
                  CHILD PROTECTIVE
                  Complex Challenges
                  Require New Strategies

      United States
GAO   General Accounting Office
      Washington, D.C. 20548

      Health, Education, and
      Human Services Division


      July 21, 1997

      The Honorable Nydia Velazquez
      House of Representatives

      Dear Ms. Velazquez:

      Each year, nearly 1 million American children are the victims of abuse and
      neglect by their parents or other caregivers. For almost 20 years, the
      country has seen a steady rise in reports of child abuse and neglect,
      including a 14-percent increase, from 1990 to 1994 alone, in the number of
      children who were the subject of maltreatment reports.1 These
      children—many from homes with multiple problems, such as parents with
      serious substance abuse problems—are among our nation’s most
      vulnerable citizens. Tragically, an estimated 2,000 children die each year
      from maltreatment.

      The responsibility for receiving and investigating reports of child
      maltreatment falls primarily on a system of child protective services (CPS)
      units within state and local child welfare agencies, which are responsible
      for the day-to-day operation of these units. The rising number of child
      maltreatment reports, the difficulties presented by substance-abusing
      parents, and diminished resources have placed these units and agencies
      under increasing stress. The federal government has an important role in
      the nation’s response to these problems. Through the Child Abuse
      Prevention and Treatment Act (CAPTA), enacted in 1974, and recent
      amendments, the federal government has underscored its commitment to
      provide funding and technical assistance for CPS to state and local
      governments, which are striving to find the most effective ways to protect

      Because of your concern over the increase in child maltreatment cases
      and the barriers CPS units face when protecting children, you asked us to
      identify (1) problems confronting CPS units that affect the system’s
      capacity to protect children from abuse and neglect, (2) state and local
      responses to these problems, and (3) opportunities for the federal
      government to assist in improving the system’s capacity to respond to the
      needs of abused and neglected children. In conducting this work, we
      reviewed the literature on child maltreatment and interviewed state and
      federal officials and other experts. To obtain first-hand information on CPS

       The term maltreatment refers to children who are the victims of child abuse and neglect. Many types
      of abuse—such as physical, sexual, or emotional—and neglect—such as educational or medical—can

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                   practices, we visited four states—California, Florida, Missouri, and New
                   York—in different stages of reforming their CPS systems. In addition, we
                   convened a panel of experts in the areas of child maltreatment and CPS to
                   examine what role the federal government can play in assisting states and
                   localities in improving their CPS activities. We conducted our work
                   between February 1996 and April 1997, in accordance with generally
                   accepted government auditing standards. A complete discussion of our
                   scope and methodology appears in appendix I.

                   The CPS system is in crisis, plagued by difficult problems, such as growing
Results in Brief   caseloads, increasingly complex social problems underlying child
                   maltreatment, and ongoing systemic weaknesses in day-to-day operations.
                   The states we visited have experienced large increases in maltreatment
                   reports in recent years, thus increasing the CPS caseload to an
                   overwhelming level. In addition, states report that families are entering the
                   system with multiple problems, among the most common of which is an
                   increase in substance abuse. Experts consider this increase to be a
                   significant factor in maltreatment, which has caught all parts of the CPS
                   system unprepared. Moreover, CPS units have been plagued by
                   long-standing systemic weaknesses in day-to-day operations, including
                   difficulty in maintaining a skilled workforce; consistently following key
                   policies and procedures designed to protect children; developing useful
                   case data and recordkeeping systems, such as automated case
                   management; and establishing good working relationships with the courts.
                   Highly qualified staff who have the necessary resources and support to
                   carry out the complex tasks involved in protecting children are essential to
                   ensure that maltreated children find safety in the CPS system. Therefore,
                   without these critical elements, the effectiveness of CPS is undermined.

                   In response to this crisis, states and localities are testing new strategies for
                   service delivery. Given the increased volume and severity of the cases, CPS
                   units find that using traditional approaches, they can no longer handle all
                   reports alleging abuse or neglect. As a result, states and localities are
                   developing new strategies, depending on the severity of the maltreatment,
                   to respond to CPS reports. States and localities are also focusing on
                   forming partnerships with families, friends, churches, and community
                   organizations to help keep children safe from maltreatment. These
                   partnerships enable CPS units to share responsibility for intervening in
                   various types of maltreatment cases. For example, in Missouri, CPS
                   caseworkers teamed with community partners to develop and deliver
                   services to families in which they consider the imminent risk of harm to

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             the child to be low, such as in child neglect. These new strategies,
             however, are not without certain challenges. They include such challenges
             as (1) adapting to new caseworker roles, required by new responsibilities,
             and (2) the underlying systemic weaknesses that diminish day-to-day
             operational effectiveness. For example, without a highly trained and stable
             workforce to mobilize and build trust among the diverse group of partners,
             realizing reform goals may be difficult. More importantly, there is little or
             no research to assess whether these new strategies effectively solve the
             problems of abused and neglected children and their families.

             As state and local CPS units experiment with new strategies aimed at better
             coping with rising and complex caseloads, units will need more focused
             support and improved technical assistance from the federal government.
             Previous federal research has concentrated on the causes of maltreatment
             and on ways to treat abused and neglected children and their families,
             rather than on topics that support the states’ community-based response
             to the CPS crisis. Similarly, federally provided technical assistance has also
             been limited in helping the states develop new strategies to address this
             crisis. In addition, dissemination of federal research findings and practical
             information for improving daily CPS operations is lacking. By focusing its
             efforts on the new strategies within states, the federal government could
             provide states with much needed information on what other CPS units have
             tried and the outcomes of these experiments.

             CPS units within local child welfare agencies serve as a community’s first
Background   line of defense for children whose families are having difficulty caring for
             them or are no longer able to care for them. CPS units represent the
             front-end of the child welfare system since the majority of children
             receiving child welfare services (such as foster care) first come to the
             attention of the system through CPS. CPS caseworkers investigate reports of
             child abuse and neglect to verify the alleged maltreatment, conduct
             assessments to determine what services may help stabilize a family and
             reduce the risk of further maltreatment, and coordinate the delivery of
             treatment services by a variety of public and private providers. These
             activities are often conducted under adverse and sometimes dangerous
             circumstances. In addition, caseworkers must balance the often
             conflicting roles of investigator and social worker. As investigators, CPS
             caseworkers collect evidence and work with law enforcement officials; as
             social workers, they work with families to identify services needed to
             improve conditions in the home and provide a safe environment for the

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                 States generally follow a common set of procedures when investigating a
                 report that a family is either neglecting or abusing a child under its care.
                 Most reports of maltreatment are by telephone and are received by staff
                 trained to collect information concerning the alleged incident. These staff
                 then assess whether the circumstances described in the telephone call
                 match the state definition for maltreatment and whether there is sufficient
                 cause to believe that the child is in danger of further harm.2 If the report
                 meets these conditions, the staff refers the report to the CPS unit for

CPS Activities   Referred reports are generally categorized into two groups. In the first
                 group, CPS caseworkers are dispatched immediately for children believed
                 to be in imminent risk of harm. In the second group, investigations are
                 usually initiated within 24 to 72 hours, depending on state statute.
                 Caseworkers usually check if the child’s family has had a prior validated
                 report of abuse or neglect. Caseworkers then visit and interview the
                 family, including initiating face-to-face contact with the child, and begin
                 collecting information about the alleged maltreatment incident. This
                 information includes physical evidence, such as the results of a physical
                 examination of the child showing any marks or bruises, and statements
                 from family members and other individuals who may have information
                 relevant to the case. Law enforcement officials may be asked to
                 accompany a caseworker on this visit if the caseworker believes the child
                 may need to be immediately removed from the home or that the situation
                 may become dangerous or violent. Finally, caseworkers determine the
                 report’s validity and record and summarize the information. These
                 determinations are based on the agency’s criteria for an acceptable level of
                 risk to the child and caseworkers’ training, prior experience, and
                 judgment. Since a faulty evaluation can endanger a child’s life, CPS
                 protocols usually recommend specialized training for caseworkers and
                 regular and close supervisory review of these difficult decisions.

                 If a CPS caseworker, during the initial investigation, believes that a child
                 has been maltreated and needs the court to protect the child’s safety, the
                 caseworker must initiate judicial oversight of the case, which can be

                  State definitions of the various types of maltreatment are generally based on definitions found in
                 CAPTA, which defines abuse and neglect as “at a minimum, any recent act or failure to act on the part
                 of a parent or caregiver, which results in death, serious physical or emotional harm, sexual abuse or
                 exploitation, or an act or failure to act which presents an imminent risk of serious harm.”
                  Reports that do not meet state definitions for abuse or neglect and are not referred to local CPS units
                 can be referred to other state or local information telephone numbers, local law enforcement agencies,
                 or other state social service agencies.

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                         time-consuming and complicated. The caseworker begins by filing a
                         petition with the court, detailing the alleged maltreatment and how it
                         meets the legal definition in that state. Then, depending on the course of
                         the CPS investigation and state requirements, a series of court hearings may
                         follow. First, the court decides whether the risk to the child is great
                         enough to warrant removing the child from the home on a temporary
                         basis. Next, the court decides whether the alleged maltreatment occurred.
                         This determination is made based on evidence gathered by the caseworker
                         during the investigation, which usually must be completed within 30 days.
                         Finally, the court decides who will have control over the child and what
                         steps must be taken by the family and the child welfare agency to improve
                         the family situation. The court can allow the child to remain in, or return
                         to, the home or place the child with a foster family, in a group home, or
                         with a relative.

                         While the caseworker is following the procedures involved in investigating
                         the alleged maltreatment, he or she is also developing a tentative plan to
                         address those conditions in the home that CPS believes contributed to the
                         maltreatment of the child. This plan ultimately becomes the case plan that
                         outlines treatment services for the child and the family. The plan describes
                         what actions are required of all the parties involved to correct the
                         conditions that caused the maltreatment and, in some cases, the
                         placement outside the home, as well as the time frames for accomplishing
                         them. In addition, the plan must address a child’s health and education
                         needs, including arrangements for any specialized treatment by health care
                         providers. The causes of child abuse and neglect are complex, and a case
                         plan can involve referrals to an array of individuals, including caseworkers
                         from other units in the child welfare agency, such as adoption or foster
                         care specialists; private service providers, such as mental health and
                         counseling professionals on contract with CPS to provide treatment
                         services; other public agencies that can assist with nonhealth services,
                         such as housing; and organizations providing transportation or other
                         support services. Maintaining the services outlined in the case plan is key
                         to avoiding further exacerbation of the family’s problems and a return to
                         the crisis mode that often precipitated the initial report.

Federal Involvement in   Federal activities directed specifically at child maltreatment prevention
CPS Activities           and treatment began in 1974, with the passage of CAPTA. This legislation
                         and subsequent amendments have influenced CPS in important areas. For
                         example, CAPTA provides (1) federal guidelines for states to use in their

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                        definitions of child abuse and neglect and (2) for states to have in effect
                        laws for the reporting of suspected maltreatment.

                        The CPS activities of investigating and verifying suspected maltreatment
                        are almost entirely funded by state governments; however, the federal
                        government provides some funding for support activities, such as research
                        and technical assistance. CAPTA authorizes and funds three key entities that
                        support state CPS units: (1) the Office on Child Abuse and Neglect (OCAN),
                        within the Department of Health and Human Services (HHS), which
                        oversees federal research on child abuse and neglect, demonstration
                        projects, and other activities; (2) The National Resource Center on Child
                        Maltreatment, under a contract with HHS, which provides technical
                        assistance to states on child welfare issues; and (3) The National
                        Clearinghouse on Child Abuse and Neglect, also under an HHS contract,
                        which gathers and disseminates information on child maltreatment. In
                        addition, CAPTA charges HHS with providing state and local agencies with
                        support and technical assistance, as well as ensuring that CPS activities are
                        executed and coordinated among all agencies involved with CPS-related
                        activities. For fiscal year 1996, CAPTA provided over $50 million for federal
                        research and demonstration grants, program grants, and training and
                        technical assistance. Other sources of federal funding provide states with
                        (1) support while a child is in foster care or (2) the ability to make services
                        available to help prevent the removal of a child from the home.4

                        Increases in the number of maltreatment cases, the changing nature of
CPS System Plagued      family problems, and long-standing systemic weaknesses have placed the
by Difficult Problems   CPS system in a state of crisis and undermined its ability to fully carry out
                        the responsibilities for abused and neglected children. First, child
                        maltreatment reports have risen steadily across the country. The caseloads
                        of CPS units have grown correspondingly, and CPS units often cannot keep
                        pace with this workload.5 Second, these caseloads are increasingly
                        composed of families whose problems have grown more troubling and
                        complicated, with substance abuse a common and pervasive condition.
                        Finally, systemic weaknesses—such as difficulty maintaining a

                         The Social Security Act, Title IV-B, subpart 1 (Child Welfare Services), provides funds for support
                        services, to prevent abuse and neglect, and for foster care services, to reunite families, arrange
                        adoptions, and ensure adequate foster care placements; Title IV-B, subpart 2 (Family Preservation and
                        Support), provides funds to support families and prevent the need for foster care; Title IV-E provides
                        funds for food and shelter for children in foster care; and Title XX (Social Services Block Grant)
                        provides funds for support services to families at risk of child abuse and neglect.
                          The Continuing Child Protection Emergency: A Challenge to the Nation, U.S. Advisory Board on Child
                        Abuse and Neglect, U.S. Department of Health and Human Services, Administration for Children and
                        Families (Washington, D.C.: U.S. Government Printing Office [GPO], Apr. 1993).

                        Page 6                                               GAO/HEHS-97-115 Child Protective Services

                    professional and skilled workforce, inconsistently implementing policies
                    and procedures, a lack of automated case management in recordkeeping
                    systems, and poor working relationships between CPS and the
                    courts—have further weakened CPS units. The combined effect of difficult
                    caseloads and systemic weaknesses (1) overburdens caseworkers and
                    dilutes the quality of their response to families and (2) may further
                    endanger the lives of children coming to the attention of CPS.

CPS Caseloads Are   In 1990, the U.S Advisory Board on Child Abuse and Neglect concluded
Growing             that child abuse and neglect was a national emergency.6 According to the
                    study, reports of child maltreatment steadily increased over the years,
                    from about 60,000 cases reported in 1974 to 1.1 million in 1980. Reports
                    then doubled to about 2.4 million during the 1980s. More recently, HHS
                    reported that between 1990 and 1994, the number of children that were the
                    subject of reports of abuse and neglect rose approximately 14 percent, to
                    over 2.9 million.7 Although reasons for the high number of reports are
                    complex, research indicates that the number has risen, in part, due to
                    (1) increased child maltreatment by drug-dependent caretakers, as a result
                    of the cocaine epidemic during the 1980s, (2) the mandate for certain
                    groups of professionals to report suspected maltreatment, and (3) the
                    stresses of poverty among families. Since HHS began collecting data in
                    1990, neglect has been the predominant type of maltreatment. For
                    example, in 1995, approximately 52 percent of the maltreated children
                    were neglected, while approximately 25 percent were physically abused.
                    Sexually abused children accounted for about 13 percent. HHS recently
                    reported that for the first time, a leveling off—in both the annual number
                    of reports nationwide and the annual number of confirmed cases—is
                    occurring. However, some state and local officials told us they are
                    concerned about the effect welfare reform will have on the number of CPS

                    The U.S. Advisory Board on Child Abuse and Neglect reported in 1995 that
                    state and local CPS caseworkers are often overextended and cannot

                    Child Abuse and Neglect: Critical First Steps in Response to a National Emergency, U.S. Advisory
                    Board on Child Abuse and Neglect, U.S. Department of Health and Human Services (Washington, D.C.:
                    GPO, Aug. 1990).
                     Child Maltreatment 1994: Reports from the States to the National Center on Child Abuse and Neglect,
                    U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect
                    (Washington, D.C.: GPO, 1996). Data in this report are collected by the National Child Abuse and
                    Neglect Data System, a voluntary reporting system, funded by HHS. Differing state CPS policies,
                    programs, designs of information systems, and resources influence the capacity of states to provide
                    child abuse and neglect data to the system and, thus, affect the collection and interpretation of data at
                    the national level.

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adequately function under their current caseloads. As a result,
breakdowns occur in their ability to protect children. The report also
stated that in many jurisdictions, caseloads are so high that CPS response is
limited to taking the complaint call, making a single visit to the home, and
deciding whether or not the complaint is valid, often without any
subsequent monitoring of the family.

Of the four states we visited, three—Missouri, California, and New
York—also experienced a rise in maltreatment reports, which is consistent
with the national trend. In Missouri, child abuse and neglect reports have
increased over 18 percent since 1991. In California, the total number of
reports received by county CPS units have increased approximately
25 percent since 1988. In New York, reports to the state’s child abuse and
neglect central register have increased almost 330 percent since 1974. Only
in 1990 and 1994 did the state see a slight drop in reports.

Likewise, all four sites we visited indicated that increased caseloads affect
the amount of time and resources that can be invested in individual cases,
which can result in insufficient services for families and children. For
example, in Florida, CPS staff in the counties we visited stated that high
caseloads delay their initial response to new cases, hinder the quality of
the work they perform, and limit the ability of supervisors to review cases.
Service providers who work with CPS staff also noted that caseworkers are
unable to sufficiently monitor families and that they respond only to
crises. Similarly, a 1996 report8 on Sacramento County, California—where
calls to the CPS hotline have tripled from 1980 to 1993, to over 3,000 calls
per month—stated that (1) the demand for CPS exceeds current capacity,
(2) caseloads exceed recommended levels,9 and (3) caseworkers’
decisions are strongly influenced by the pressure to limit the number of
active cases. High caseloads require caseworkers either to accept greater
levels of risk to the child while with the family or to decide to remove the
child inappropriately, county staff said. In addition, county service
providers indicated that high caseloads can result in procedural failures,
such as an inadequate review of prior case history or incomplete
documentation of casework conducted.

  Critical Case Investigation Committee Final Report, Office of the County Executive, County of
Sacramento (May 1996).
 The Child Welfare League of America, a professional organization for child welfare officials, has
developed guidelines for optimal caseload size.

Page 8                                                GAO/HEHS-97-115 Child Protective Services

Substance Abuse in   CPS caseworkers must increasingly deal with families that suffer from
Families Becoming    multiple problems, including substance abuse. The escalating cocaine
Common               epidemic during the 1980s exacerbated the already challenging work of CPS
                     caseworkers. According to OCAN, the number of women who abuse drugs
                     has increased, resulting in a growing number of infants who are exposed
                     to illegal substances before birth. In addition, intoxication is a
                     precipitating factor for every kind of abuse; many children experience
                     neglect as a result of their parents’ physical or psychological absence
                     while seeking alcohol and other harmful drugs or being under the
                     influence. The recognition of this link between child maltreatment and
                     substance abuse was identified in 1990 in the first report of the U.S.
                     Advisory Board on Child Abuse and Neglect.10 The board reported that the
                     vast increase in child maltreatment associated with substance abuse and
                     the extent of the problem caught CPS units unprepared. On the basis of a
                     national survey, HHS reported that the number of CPS cases involving
                     substance abuse can range from 20 to 90 percent, depending on the area of
                     the country. As a result, CPS units must not only develop more effective
                     ways to work with parents who use drugs, but must also address the
                     problems of substance-exposed infants and increasing concerns for
                     caseworker safety in the field.

                     Officials in the states we visited echoed the findings of research and
                     identified substance abuse of caregivers as one of the most difficult
                     problems CPS units address when responding to child abuse and neglect
                     cases. In New York City, for example, approximately three-quarters of the
                     confirmed cases involve drug addiction of at least one caregiver.
                     According to the Manhattan Field Office staff, a majority of cases involve
                     substance-abusing parents, many of whom live in drug-infested and poor
                     neighborhoods, intensifying family problems. CPS caseworkers visiting
                     these families do so at considerable risk to their own safety. In
                     Sacramento County, where substance abuse affects an estimated 75 to
                     80 percent of the CPS cases, a county official identified poverty and
                     substance abuse as the two biggest problems the CPS unit faces. Moreover,
                     the presence of these problems can delay case progress and limit clients’
                     ability to change their lives, the official noted. According to St. Louis City
                     and County supervisors, developing service plans for drug-abusing
                     mothers poses one of their greatest challenges.

                     Although substance abuse has increased among CPS cases, many
                     communities lack treatment services. Across the country, the demand for
                     drug treatment slots exceeds the supply. According to state and local

                       Child Abuse and Neglect: Critical First Steps in Response to a National Emergency, p. 55.

                     Page 9                                                GAO/HEHS-97-115 Child Protective Services

                                 officials in the sites we visited, clients cannot obtain needed services
                                 because of the shortage of appropriate treatment programs and the
                                 waiting lists for many programs in their communities. In addition, the
                                 more commonly available services are short-term rather than long-term,
                                 and are less likely to have a lasting effect, according to a 1993 HHS study of
                                 high-risk child abuse and neglect groups. Finally, even when substance
                                 abusers do receive treatment, the relapse rate is high. Both the lack of
                                 treatment services and the likelihood of relapse may necessitate more
                                 involvement by CPS.

Systemic Weaknesses              Long-standing systemic weaknesses within CPS units further hamper their
Hampering CPS                    capacity to protect children. These weaknesses have plagued CPS units for
Effectiveness                    a number of years, and we observed these problems to varying degrees
                                 across all four sites we visited. These problems include (1) difficulty
                                 maintaining a professional and skilled workforce, (2) inconsistently
                                 implementing policies and procedures, (3) a lack of case data and
                                 automated case management, and (4) poor working relationships between
                                 CPS and the courts. Taken together, these weaknesses can undermine the
                                 effectiveness of CPS’s response to child maltreatment. In particular,
                                 without a quality staff who have the necessary resources and support to
                                 carry out the complex tasks involved in protecting children, the CPS system
                                 will continue to lag behind in dealing with the growing problem of child
                                 abuse and neglect.

Skilled Workforce Difficult to   Hiring, training, and retaining a skilled workforce is essential to
Maintain                         maintaining a professional and competent staff; however, CPS units were
                                 often unable to attract and retain qualified staff and to provide relevant
                                 training. CPS staff in sites we visited reported that some new hires were not
                                 qualified for their positions, either due to inadequate hiring policies or low
                                 entry-level salaries. For example, in New York City, until recently, new
                                 hires were required to have only a college degree, rather than a degree in
                                 social work or a related field. In Sacramento County, some staff were
                                 hired without the qualities needed to fulfill their job responsibilities,
                                 resulting in poor performance, according to county staff. In addition,
                                 training programs were often inadequate in terms of content and
                                 frequency. In Missouri, for example, funding has limited the amount of
                                 inservice training the state can provide, and some staff report that training
                                 manuals are out-of-date and that trainers are not up-to-date on the
                                 environment in which caseworkers operate today. In New York City,
                                 experienced staff reported that new caseworkers did not need to obtain
                                 passing grades in their entry-level training classes. New York City,

                                 Page 10                                  GAO/HEHS-97-115 Child Protective Services

                          however, began taking steps to reform its CPS system in 1996. Hiring and
                          training requirements have been improved, and the city is developing a
                          system for providing all personnel with needed inservice training.

                          Finally, in all the sites we visited, retaining an experienced workforce was
                          often cited as a problem. In Florida, Missouri, and New York, low salaries
                          contributed to staff leaving for better paying positions. Likewise, in
                          Florida, a 1995 panel appointed by the governor found that Florida’s
                          salaries were too low to attract and retain qualified CPS caseworkers.
                          These conditions affect caseworkers’ ability to consistently serve clients
                          and result in a lack of experience among supervisory staff.

Policies Inconsistently   In CPS, where staff are sometimes dealing with life-and-death issues, the
Implemented               knowledge of and consistent application of appropriate policies and
                          procedures are critical. CPS policies and procedures—such as those that
                          define acceptable levels of risk to the child and those that outline the time
                          frames, methods, and protocols for sharing information with local service
                          providers, as well as documentation requirements for collecting evidence
                          during the investigation—are important safeguards for children. These
                          policies and procedures provide structure in the stressful environment in
                          which caseworkers function and reduce the probability of making serious
                          mistakes. Clear policies and procedures can also provide important
                          guidance when staff receive inadequate or inconsistent supervision.

                          In some of the sites we visited, however, CPS staff were unable to
                          consistently apply existing policies. For example, a 1995 state review of
                          New York City’s CPS operations found numerous problems in
                          implementing policies, such as inadequate safety assessments for all
                          children within the home in over 20 percent of the cases, inadequate
                          investigations in over 50 percent of the cases, excessive time frames for
                          conducting investigations in 50 percent of the cases, and missing service
                          plans in 18 percent of open cases for which abuse was validated.
                          Moreover, the review identified a lack of supervisory involvement in
                          determining the validity of alleged maltreatment in 21 percent of the cases.
                          Bronx and Manhattan Field Office managers, supervisors, and
                          caseworkers reported that they lack knowledge on policies and
                          procedures, in part, because policies change frequently, no procedures
                          manual exists, and information is inconsistently distributed to all staff. In
                          addition, a 1996 report on Sacramento County operations identified a need
                          for clearer procedures and found that consultation with supervisors
                          appears to take place on an informal, ad hoc basis. The report also stated

                          Page 11                                 GAO/HEHS-97-115 Child Protective Services

                            that written policies and procedures are not always consistent with verbal
                            communications and directions to staff.

Lack of Automated Case      Lack of automated case management in recordkeeping systems can result
Management Leads to         in inefficiencies, such as reliance on burdensome paper files and lost or
Inefficiencies              inaccessible client files. Although some CPS data are automated for state
                            and federal reporting purposes, these data are not useful in the day-to-day
                            management of cases, according to staff we met with in Florida’s District
                            12 and in Sacramento County. As a result, CPS workers in all four sites we
                            visited still work primarily in a paper environment. They and their
                            supervisors generally do not have access to automated information
                            systems for individual case planning and monitoring, and must rely on
                            paper files to conduct their day-to-day activities. For example, New York
                            City caseworkers and supervisors relied on hand-written case information
                            on 5”-by-8” cards for the current status of cases and their history.
                            Retrieving case records from agency archives or transferring the files from
                            one field office to another can take weeks and files can become lost,
                            according to New York City caseworkers. Agencywide computerization,
                            which is being partially funded through federal grants, was not fully
                            operational at the time of our visits. In developing these systems, CPS units
                            will have the opportunity to add automated features that could assist CPS
                            staff in managing workload, identifying available resources, and preparing
                            and tracking court documents. If properly implemented, these systems
                            could provide caseworkers with essential information for intervening in
                            maltreatment situations, as well as reduce paperwork and manual

Working Relationship With   By necessity, CPS units should work efficiently and effectively with the
Courts Poor                 courts to protect children. However, the court system, like CPS, also faces
                            problems associated with the large volume of increasingly complex cases.
                            For example, according to the American Bar Association, overcrowded
                            dockets, inefficient case scheduling, unprepared or overburdened
                            attorneys, and frequent rotation of judges who may or may not have
                            expertise in child welfare law all contribute to significant delays in making
                            decisions about children. Linked, in part, to these problems, all sites we
                            visited noted poor working relationships between CPS staff and the courts.
                            CPS staff reported a lack of respect for the caseworkers’ experience,
                            insufficient preparation time with attorneys assigned to help them, and
                            minimal assistance in preparing court records in a professional manner. In
                            some cases, staff resorted to turning in court documents in handwritten
                            form. Because the courts do not schedule specific court times for
                            individual cases, a caseworker must often spend many hours waiting for

                            Page 12                                 GAO/HEHS-97-115 Child Protective Services

                         his or her case to be called on the day it appears on the docket.
                         Unnecessary time spent in court diverts the caseworker from performing
                         investigative activities on other open cases. Federally funded initiatives,
                         designed to address these problems, are just beginning; thus far, they have
                         focused on states’ self-assessment of problems.

                         Different types of maltreatment require dramatically different prevention
States and Localities    and treatment strategies. Each of the four states we visited has been
Focus on New             moving towards new strategies—in different stages of development—in its
Strategies to Cope       CPS system. Missouri and Florida, for example, have been developing
                         responses to match the severity of various types of maltreatment; they
With Rising and          have been forming partnerships between CPS and community service
Complex Caseloads        providers. These early partnerships have been generally characterized by
                         sharing physical space with community agencies and including these
                         organizations in case planning.

                         Experts, state agency officials, and caseworkers believe that these new
                         strategies show promise, but their ultimate success will depend, in part, on
                         the CPS staff’s ability to overcome certain challenges, such as developing a
                         willingness within the community to become more active in protecting
                         children from maltreatment and to adapt to new roles and responsibilities.
                         In addition, states reported that regardless of reforms in place, systemic
                         problems continue to affect day-to-day operations and the quality of
                         assistance provided to families; these problems may threaten the success
                         of any new strategies.

States Experiment With   In two of the states we visited, Missouri and Florida, state child welfare
New Service Delivery     agencies have implemented new service delivery models. These agencies
Models                   and local CPS units have turned to the broader community of churches,
                         schools, mental health providers, and others to expand their reach. By
                         developing partnerships with these community groups, CPS units are able
                         to quickly increase the number of people available to serve children and
                         their families, without increasing CPS staffing levels. The models in these
                         two states are also based on the premise that all CPS cases do not require
                         the same traditional approach. Instead, the models incorporate a flexible
                         response, whereby CPS cases can be grouped according to the nature of the
                         allegation, recognizing that different types of allegations require different
                         responses. For example, the level of investigation needed to clearly

                         Page 13                                 GAO/HEHS-97-115 Child Protective Services

establish facts and gather evidence in a sexual abuse case may be
unnecessary for a report of educational neglect.11

In 1994, Missouri developed a new strategy to handle the overwhelming
number of reports coming into its CPS system. Missouri recognized that
state government, acting alone, had neither the resources nor the local
community, neighborhood, or family base to effectively alter the cycle of
abuse and neglect. In response, Missouri began a demonstration initiative
designed to divide incoming reports into two categories. Cases in the first
category, called investigations, require law enforcement be contacted;
these cases focus on reports of serious physical or emotional abuse and all
reports of sexual abuse. CPS caseworkers conduct investigations jointly
with law enforcement officials and then refer the cases to other
caseworkers, as necessary, for foster care or services to preserve the
family. All other cases, such as reports of neglect and mild physical
abuse,12 are in the second category and handled differently, without a
traditional protective investigation. For these cases, for which the risk of
imminent harm is less, a caseworker conducts a thorough assessment,
called a family assessment, according to state guidelines. The caseworker
determines the degree of risk to the child’s safety and the family’s need for
assistance from the CPS unit or the community. Family assessment staff are
expected to collaborate with their community partners.

Parts of St. Louis City and St. Louis County, Missouri, are participating in
this demonstration. In cases screened using the family assessment model,
caseworkers make the initial visit and then work with the family, generally
providing services for up to 90 days. The majority of the incoming reports
are placed in this category, and family assessment caseworkers work
closely with their community partners. For example, some caseworkers
are located with their partners in a community education center, which
provides on-site services and linkages to a variety of community supports,
such as family counseling, housing assistance, and drug abuse prevention
programs. This arrangement allows for better communication and
collaboration among the caseworkers and service providers. At the time of
our review, Missouri was also considering developing a process in which
community partners could conduct family assessments themselves,
although the CPS units would still be ultimately responsible and approve

 Educational neglect includes permitting chronic truancy, failing to enroll a child of mandatory school
age, and not attending to a special educational need.
  Child neglect is characterized by failure to provide for a child’s basic needs and can be physical,
educational, or emotional. Research has shown that neglect tends to be chronic and long-term, and can
result in long-term developmental consequences. Research also shows that intervention does not
always result in improvements or fewer subsequent reports to CPS.

Page 14                                               GAO/HEHS-97-115 Child Protective Services

                          the final assessment. Evaluation of the impact of Missouri’s flexible
                          response strategy is required by the Missouri State Legislature, and a final
                          report is due in January 1998.

                          Like Missouri, Florida has been reworking its approach to child
                          protection. In 1992, Florida’s legislature and governor mandated that the
                          State Department of Health and Rehabilitative Services develop a strategic
                          plan to more clearly delineate how Florida would protect its children. The
                          resulting plan addressed a fundamental lack of community involvement in
                          CPS operations. For example, historically, Florida’s human services
                          programs, such as CPS, were designed and administered at the state level
                          and thus were removed from local community problems. Under the new
                          plan, Florida decentralized the management of CPS from the state to the
                          district level.

                          To further strengthen the link between child welfare services and local
                          communities, the governor signed legislation in 1993, directing local child
                          welfare officials to jointly develop a CPS program with community
                          agencies. Under this program, similar to Missouri’s strategy, incoming
                          child abuse and neglect reports are separated into two categories: (1) for
                          the more serious cases, such as sexual abuse and severe physical abuse,
                          caseworkers use the traditional approach, an investigation by CPS and law
                          enforcement, and (2) for the remaining cases, rather than using the
                          traditional approach, caseworkers assess the child’s safety, as well as
                          family strengths and resources that could help to reduce risk.

                          Florida’s District 12, where we focused our review, developed a
                          community-based strategy to enhance its handling of sexual and serious
                          physical abuse cases. The resulting Child Advocacy Center is a
                          collaborative effort between a not-for-profit agency that provides
                          treatment for child victims of abuse, CPS, law enforcement, the Young
                          Women’s Christian Association, and the state attorney. The center’s goal is
                          to provide a warm, nonthreatening environment for joint CPS and law
                          enforcement investigations, case reviews, medical examinations and
                          evaluation, mental health treatment, victim advocate support services,
                          training, and community education. Since all team members are generally
                          located together, the lag time between case initiation and service provision
                          is decreased.

Other States Make Early   Sacramento County, California, and New York City are making early
Efforts at New Models     efforts to reorganize the delivery of CPS services. In both cases, state and

                          Page 15                                  GAO/HEHS-97-115 Child Protective Services

                             local officials have recognized the critical role communities will play in the
                             future effectiveness of CPS. At the time of our visit, however, these sites
                             had not fully developed their new strategy to implement reforms.
                             Sacramento County is beginning by using a team approach. Team
                             members include clinical experts from CPS and other county
                             departments—such as mental health, alcohol and other drug treatment,
                             and public health—as well as representatives from the community and the
                             state’s Department of Social Services. The goals of the team are to
                             (1) protect children, by bringing together county functions—such as
                             mental health treatment, alcohol and other drug treatment, public health
                             services, and public assistance—to provide a unified approach to planning
                             interventions and (2) ensure the community is involved in improving the
                             county’s CPS system.

                             To overcome its history of ineffective approaches to protecting children,
                             New York City is undergoing major structural reforms, designed to
                             streamline and clarify its processes to ensure that all efforts are directed
                             to the safety and well-being of children. As part of this reform, the city
                             recently acknowledged that it must galvanize its residents, neighborhoods,
                             churches, and community-based organizations to become partners in the
                             drive to make certain that every child is safe. One of New York City’s first
                             planned actions is consistent with reforms observed in the other states we
                             visited. New York City plans to (1) realign the boundaries of its CPS offices
                             to coincide with community-district boundaries and (2) assign managers
                             and caseworkers to specific communities. This realignment will allow staff
                             to have greater access to individuals and institutions that are familiar to
                             the child and family, as well as to local services.

Child Fatality Panels Help   State and local officials are using the tragic circumstances of child deaths
Build Community              to mobilize community resources. These officials realize the value of
Partnerships                 reviewing the circumstances surrounding the death of a child to determine
                             not only whether the death was the result of abuse, but also what can be
                             learned to further improve how CPS cases are handled and families are
                             served. In all sites, either state or local officials have established child
                             fatality review teams, generally composed of physicians, law enforcement
                             officials, social workers, and other child welfare experts; each member of
                             the team brings his or her own expertise and skills to each review. These
                             child fatality review teams are often the first step in recognizing the value
                             of building relationships between community partners.

                             Page 16                                 GAO/HEHS-97-115 Child Protective Services

                      In Missouri, representatives on county-based panels include the
                      prosecuting attorney or circuit attorney, the coroner or medical examiner,
                      law enforcement personnel, child welfare staff, public health care service
                      providers, juvenile court staff, and emergency medical services staff.
                      Conclusions drawn from fatality reviews are used for targeting prevention
                      strategies, identifying specific community needs, and developing trend
                      information, as well as improving the services provided by each team
                      member’s discipline. The multidisciplinary nature of the panels increases
                      the likelihood that the correct cause of death is identified. In St. Louis
                      County, for example, panel members reported that some deaths are
                      initially classified as Sudden Infant Death Syndrome (SIDS). However,
                      when these cases are reviewed by the fatality panel, information shared by
                      individual members may lead the panel to conclude that the death was
                      caused by abuse rather than SIDS.

                      Two fatality panels, also composed of team members from various
                      disciplines, operate in New York City. A few members are common to both
                      panels. One panel reviews deaths in cases known to the CPS units,
                      examining case practice and policies and making recommendations when
                      necessary. This panel is operated by the child welfare agency and is
                      composed of representatives from other local government agencies, as
                      well as external health and social work experts. The other panel is
                      independently operated by the Office of the Chief Medical Examiner of
                      New York City and has a broader mission. This panel investigates all child
                      deaths in New York City that meet the panel’s critieria to, among other
                      things, (1) identify broader social issues of child abuse and neglect, as well
                      as public health concerns relating to the safety of children, and (2) devise
                      policies and procedures that will decrease the likelihood of a child’s death.
                      In addition, the state of New York reviews cases involving the death of a
                      child if the child was in the custody of an authorized agency or if the
                      child’s death was reported to the state central register.

New Strategies Show   While new strategies hold the promise of helping CPS units better respond
Promise but Many      to increases in child abuse and neglect, with responsibility for intervention
Challenges Remain     shared with the community, little research has been done to determine
                      whether these new strategies result in improvements in families and
                      children or a reduction in the number of subsequent referrals. A
                      December 1996 evaluation of the Florida program, for example, found
                      improvements in service delivery, but noted some differences based on a
                      district’s level of implementation of the new strategies. For example, the
                      study found that in those districts that had more fully implemented the

                      Page 17                                 GAO/HEHS-97-115 Child Protective Services

new strategy, early decisions to place children were more consistent with
later decisions on the safest option for the child. On other measures of
success, all districts improved. These measures included the extent to
which caseworkers were able to resolve family issues without involving
the court.

However, this evaluation also confirms what officials during our site visits
said: Creating successful community partnerships is difficult, and many
challenges exist that can hinder progress. Some of these challenges reflect
the long-standing problems that CPS units recognize as barriers to their
overall effectiveness; others stem from the new strategies being tested.
One of the long-standing problems CPS units will continue to struggle with
is finding appropriate treatment slots for substance-abusing parents. In
addition, states we visited have found that forging new community
partnerships represents a significant change in operations for both CPS
caseworkers and their new allies. These caseworkers traditionally have
operated independently and represent agencies with their own sets of
policies and priorities. The evaluation found that some districts were
successful in establishing partnerships across both policy and practice
levels; others had difficulty in clearly delineating their relationships and
roles with local partners. Representatives of community organizations in
St. Louis report that these partnerships can be slow to form, as funding,
teambuilding, issues of developing trust among members, and agreement
on sharing information about children and families are gradually worked
out. St. Louis County staff reported that one community claimed child
abuse and neglect did not exist among its families and was reluctant to
become involved with the pilot program. In addition, some community
groups initially came to meetings seeking funding for services they
provide. Over time, however, their involvement has reflected an increased
level of commitment.

The Florida evaluation found that employees’ attitudes and ownership of
the new philosophy, as well as the level of support received from
supervisors and administrators, affect the success of the program. The
transition can be difficult for CPS caseworkers since most caseworkers
were previously traditional CPS investigators. They must adapt to their new
roles, learning how to conduct family assessments. Such new roles
represent a fundamental change, requiring a new perspective and a new
set of skills. In addition, caseworkers must sometimes manage their
existing caseloads while transitioning to the new method of delivering
services. Caseworkers in St. Louis City and St. Louis County, for example,
report that they are responsible for managing their ongoing cases using the

Page 18                                 GAO/HEHS-97-115 Child Protective Services

                          traditional approach, while at the same time managing new cases using the
                          new strategy, the family assessment model.

                          While new strategies to serve families may help CPS units reduce the
                          burden of addressing child abuse and neglect, these strategies should not
                          be expected to resolve the underlying systemic problems many CPS units
                          face. These problems remain and may jeopardize the future success of
                          these promising strategies. For example, regardless of the new strategies
                          taken to handle abuse and neglect reports, state officials recognize that
                          without skilled and trained caseworkers, these strategies could flounder.
                          In addition, these officials reported that keeping new and existing staff
                          abreast of changing procedures and policies is difficult, given that training
                          resources are already stretched to capacity. In Florida, staff reported that
                          inconsistencies in practice still occur because of inadequate supervision. A
                          recent Florida Governor’s Panel on Child Protection Issues found that high
                          staff turnover, unmanageable caseloads, poorly trained staff, and
                          inconsistent procedures continue to plague the CPS system. Poorly trained
                          staff or inconsistent policy implementation can undermine the credibility
                          of CPS caseworkers among their community partners and hamper

                          The new strategies of states and localities call for a new partnership
Changed Federal           between state child welfare agencies and the federal government.
Response Would            Although the federal government has played an important role over the
Better Assist the         last two decades, opportunities exist to enhance and refocus its assistance
                          to states and localities. Important legislation, such as CAPTA, generated
States                    federal mandates that are responsible for many of the reforms of the past
                          20 years, including mandatory reporting systems for child abuse and
                          neglect, as well as judicial review of decisions to remove children from
                          their homes. This legislation has enhanced state and local CPS systems. But
                          HHS’s research agenda has not focused on new strategies of direct service
                          to families, and HHS’s provision of technical assistance to CPS units has
                          been limited.

Federal Research Agenda   Members of our expert panel believe the federal research agenda is too
Too Broad                 broad and is not developed in conjunction with the needs of the states. For
                          example, they believe that the major research questions that are relevant
                          to CPS units today are inadequately addressed because the total amount of
                          funds authorized for research is low and is spread among too many other
                          projects. Such research can result in findings that may apply only to

                          Page 19                                 GAO/HEHS-97-115 Child Protective Services

                            limited locations and may not be generalizable to the larger CPS
                            community. CAPTA outlines topics for research, such as the causes of
                            maltreatment and its prevention and the national incidence of child abuse
                            and neglect. CAPTA also recognizes emerging collaborative CPS and
                            community partnerships as a relevant field of inquiry. However, the final
                            research agenda is left in large part to the discretion of HHS, although
                            legislation and input from other organizations are considered. In our
                            analysis, we found that approximately two-thirds of the research and
                            demonstration grants, funded by HHS between fiscal year 1992 and the first
                            quarter of fiscal year 1997, focused on the various causes and effects of
                            sexual abuse, maltreatment prevention strategies, and the relationship
                            between substance abuse and maltreatment. The remainder cover a broad
                            spectrum of projects, ranging from funding a national data archive to using
                            children as witnesses in court cases. While developing a research agenda
                            is difficult in the face of limited resources and competing needs, HHS has
                            not funded projects that reflect the emerging direction of CPS units, such as
                            how to build collaborative relationships with multiple community and
                            local government partners or the advantages, for some CPS cases, of using
                            family assessments over a traditional approach. An HHS research official
                            acknowledged that HHS has given many researchers a small part of the
                            available funding, thus attempting to keep a number of researchers
                            interested in the child abuse and neglect area and to attract new
                            researchers to the field.

Dissemination of Research   Disseminating the results of research on child abuse and neglect to
Results Critical            practitioners in the field is critical. The National Clearinghouse for Child
                            Abuse and Neglect is charged with maintaining and disseminating
                            information on programs that show promise of success in preventing,
                            identifying, and treating child abuse and neglect. However, members of
                            our expert panel and state officials reported that dissemination efforts are
                            often not timely or do not meet state needs. Although state officials were
                            aware that the clearinghouse disseminated information on maltreatment,
                            they were unable to see a connection between their work in developing
                            new strategies in their local communities and the information being
                            offered. HHS agrees that dissemination of information has been a problem,
                            and an HHS official attributes this situation to a lack of publishing and
                            distribution funds, as well as the lack, sometimes, of a requirement for the
                            researcher to produce a final report. Researchers funded under CAPTA,
                            however, must submit reports that include implications for policy and

                            Page 20                                 GAO/HEHS-97-115 Child Protective Services

Technical Assistance   The federal government provides technical assistance to states, through
Could Be Expanded      means such as The National Resource Center on Child Maltreatment and
                       HHS regional offices.13 HHS defines the workplan for the Resource Center,
                       which includes developing a training and technical assistance plan for
                       each of HHS’s regions, conducting on-site training or technical assistance
                       activities, sponsoring symposia on relevant topics and, in cooperation with
                       the clearinghouse, compiling CPS assessment tools. However, center
                       documents state that the small amount of funding for each year severely
                       limits the amount of services that can be provided to each state. For
                       example, the center estimates that each state would be entitled to only
                       $17,000 of services, including administrative costs, conference costs, and
                       tribes and territories costs.

                       HHS regional offices also play a role in providing technical assistance to the
                       states. Under ordinary circumstances, these offices do not work with
                       county or local agencies. They are, rather, charged with overseeing the
                       programmatic and financial management of child welfare programs,
                       including ensuring compliance with applicable laws and regulations and
                       issuing grant awards. These offices are also charged with assisting in the
                       management of cross-cutting initiatives and activities among the regions.
                       Since regional office personnel can have regular contact with local
                       programs, these offices are uniquely positioned to monitor the progress of
                       various strategies and share their insights with other state and local
                       officials. These offices, however, have not played a leadership role in
                       providing assistance to states on topics that are relevant to the changing
                       strategies in the states. Such topics include knowledge of the reform
                       efforts of other states and whether these programs have achieved positive
                       outcomes in child welfare. Because this type of information is not readily
                       available, states report that they independently call other states for
                       information when attempting to design new programs.

                       Getting comprehensive information to CPS units on different state
                       initiatives, as well as on ways states are addressing systemic problems,
                       could greatly assist the child welfare community in areas that are integral
                       to developing new CPS strategies. CPS units could benefit from information
                       on such issues as the appropriate levels of risk and child safety, ways to
                       build and sustain community partnerships, and appropriate outcomes by
                       which to measure these reform programs. The regional offices vary in how
                       proactively they assist their states, according to experts, HHS officials, and
                       state officials. HHS agrees that some regions perform better than others and

                          HHS has 10 regional offices across the country that represent HHS—to state, county, city or town, and
                       tribal governments, as well as to grantees and public and private local organizations—in the
                       administration of programs that assist vulnerable and dependent children and families.

                       Page 21                                               GAO/HEHS-97-115 Child Protective Services

              that they tend to act independently in developing ways of interacting with
              their assigned states. But these offices, HHS believes, provide considerable
              technical assistance to states. One HHS official stated, however, that
              becoming more proactive in CPS reform could be difficult for some
              regional offices. Existing communication technologies offer enhanced
              opportunities to be more proactive and widely share this information with
              a variety of audiences. HHS told us it is beginning to take advantage of its
              ability to communicate electronically.

              Public agencies responsible for protecting children have faced increased
Conclusions   reports of child abuse and neglect, as well as a disturbing increase in the
              number of families with severe and multiple problems. The high incidence
              of substance abuse found in these families places CPS caseworkers on the
              front line of one of our nation’s biggest social problems. While the
              commitment of these workers to protect abused children is strong, the
              obstacles facing CPS units are daunting. A decade of calls for reform by
              national advisory boards and commissions has produced few
              improvements in many of the fundamental problems found in CPS units.

              The burden to improve the ways CPS units respond to children at risk of
              abuse and neglect falls on state and local governments. However, the
              responsibility for the safety and well-being of a community’s children
              cannot rest solely on an overwhelmed CPS system. CPS units have
              recognized that the traditional approaches to child protection cannot keep
              pace with the demand for services. CPS units are now reaching out to
              communities to establish partnerships among service agencies, attempting
              to share the responsibility for the safety of a neighborhood’s children
              among a community’s service providers, as well as its citizens, and
              increasing the attention given to support services. However, state child
              welfare officials responsible for CPS operations must not lose sight of the
              potential effect that long-standing systemic problems may have on these
              reform efforts. These officials must seek ways to correct deficiencies and
              to build and maintain the personnel and information systems that will
              support the new strategies. Without addressing these problems, reform
              goals may not be fully realized. In addition, state officials must be cautious
              about implementing new strategies for handling maltreatment reports,
              given the limited information available on their effectiveness.

              A new era of federal partnership is needed to help CPS units respond to the
              rising rates of child maltreatment. While the federal government has
              funded research efforts on abuse and neglect, HHS needs to better support

              Page 22                                  GAO/HEHS-97-115 Child Protective Services

                         the emerging needs of state and local CPS units. Local governments can ill
                         afford to independently develop, test, and implement new strategies to
                         protect our nation’s children. New federal strategies are needed to provide
                         focused assistance to CPS units and to evaluate and disseminate
                         information about local efforts. Without federal assistance, states and
                         localities will continue to find their own solutions to combat the problems
                         of abuse and neglect, not benefitting from the collective experience of the
                         entire nation.

                         We recommend that the Secretary for Health and Human Services
                     •   use the current research agenda, allowed under CAPTA, to facilitate better
                         targeting of future funding for those areas that support local efforts to
                         explore collaborative partnerships with other community agencies;
                     •   develop new cost-effective strategies to disseminate and deliver the results
                         of these local efforts and other related work through the National
                         Clearinghouse and the National Resource Center; and
                     •   develop specific techniques, such as regional seminars, white papers, and
                         on-site technical assistance, to promote community-based approaches to

                         In commenting on a draft of this report, HHS noted that the CPS system
Agency Comments          operates in the broader context of child welfare services and is thus
and Our Evaluation       integrally related to other federal programs beyond those authorized by
                         CAPTA. HHS further stated that strategies taken from these programs, such
                         as a demonstration of the use of multidisciplinary teams to provide
                         intensive services to families whose children might otherwise have to be
                         placed or remain in foster care, directly influence and benefit CPS. We
                         agree that these programs, whose primary purposes do not emphasize CPS,
                         can also assist states and localities find ways to become partners with
                         community and other governmental groups to help children. In our work,
                         however, we focus on the initial stages of report intake and investigation,
                         for abuse and neglect cases, and the associated problems. We did not
                         review community services available to prevent or treat victims of child
                         abuse and neglect.

                         HHS also commented that we did not address the issue of conflicting
                         confidentiality provisions among agencies that handle and treat families
                         that are brought to CPS’s attention. HHS noted that these conflicting
                         policies, for example, can prohibit local CPS agencies from obtaining

                         Page 23                                GAO/HEHS-97-115 Child Protective Services

information on a client’s participation in substance abuse treatment
programs. We recognize the importance of developing confidentiality
policies that help, rather than hinder, social worker access to important
client information that may affect decisions concerning a child’s safety; we
discussed this topic with state and local CPS personnel, as well as with CPS
experts. While they agreed that confidentiality barriers exist, we focused
on the systemic issues that surfaced as the most pressing. In addition,
social work practices can be developed to help alleviate the magnitude of
the confidentiality problem, some experts said. For example, if a client is
not willing to sign a waiver to allow information on treatment to be
obtained, the client’s participation in the drug program may not be
considered in CPS decisions affecting the child’s safety.

As to our recommendation that the Secretary use the current research
agenda to better target funding for topics that support local efforts to
explore collaborative partnerships, HHS acknowledged the importance of
developing these partnerships and making system improvements. HHS
stated that current CAPTA legislation places emphasis on CPS system
functions and that HHS demonstration priorities address the development
of community networks and CPS operations. At the time of this report,
however, HHS had not published its final research priorities. HHS concurred
with our remaining two recommendations and noted several strategies it is
implementing to enhance dissemination and communication and to
expand technical assistance.

HHS also made a number of technical comments, which we have
incorporated where appropriate. A copy of all HHS’s comments, both
general and technical, is included in appendix II.

We are sending copies of this report to the Secretary of Health and Human
Services, state child welfare agencies, and other interested parties. Copies
will also be made available to others on request. If you or your staff have
any questions about this report, please call me at (202) 512-7215. Other
major contributors to this report are listed in appendix III.

Sincerely yours,

Jane L. Ross
Director, Income Security Issues
Page 24                                 GAO/HEHS-97-115 Child Protective Services
Page 25   GAO/HEHS-97-115 Child Protective Services

Letter                                                                                            1

Appendix I                                                                                       28

Scope and
Appendix II                                                                                      30

Comments From the
Department of Health
and Human Services
Appendix III                                                                                     40

GAO Contacts and
Related GAO Products                                                                             44


                       CAPTA     Child Abuse Prevention and Treatment Act
                       CPS       Child Protective Services
                       GPO       Government Printing Office
                       HHS       Department of Health and Human Services
                       OCAN      Office on Child Abuse and Neglect
                       SIDS      Sudden Infant Death Syndrome

                       Page 26                             GAO/HEHS-97-115 Child Protective Services
Page 27   GAO/HEHS-97-115 Child Protective Services
Appendix I

Scope and Methodology

             We reviewed the relevant literature on child maltreatment, as well as
             national and state statistical data on child maltreatment, and analyzed
             various reports and evaluations that examined CPS policies, programs, and
             activities. In addition, we interviewed various experts in the area of child
             maltreatment and CPS, representatives from professional associations, and
             state and local officials. We also interviewed officials at HHS’s
             Administration for Children and Families, including officials from the
             Childrens’ Bureau and the Office on Child Abuse and Neglect (OCAN).

             We conducted field visits in New York City’s boroughs of the Bronx and
             Manhattan; Sacramento County, California; Florida’s District 12 (Volusia
             and Flagler Counties); and the City and County of St. Louis, Missouri. In
             addition, we visited the state child welfare offices in each state capital.
             These sites were selected, in part, to review states in different stages of
             changing their traditional approaches to CPS. The CPS unit in New York City
             is making early efforts at organizational change. The CPS unit in
             Sacramento County, California, is making early efforts to reexamine its
             processes and its links to the community. The CPS units in New York and
             California were also selected because the two states represent a
             significant portion of the population of children under 18 years old and the
             population in the child welfare system. Florida and Missouri were
             identified by experts as examples of states in which CPS units were furthest
             along in efforts to change from traditional approaches to new strategies
             based on community and family services. The CPS unit in Florida’s District
             12 was selected to illustrate efforts to improve the investigation and
             validation of abuse cases by integrating CPS, medical, judicial, and law
             enforcement professionals under a community-based nonprofit
             organization. The CPS unit in Missouri had implemented a pilot program to
             test new ways of responding to reports of abuse and neglect in five areas
             of the state.

             At each site, we interviewed officials responsible in the areas of CPS policy,
             program activities, training and professional development, quality
             assurance, budget, and information management. In addition, we collected
             relevant evaluations, reports, and analyses of CPS policies, operations, and
             practices. To develop a complete understanding of CPS units’ operations
             and the barriers that exist, we interviewed groups of managers,
             supervisors, and caseworkers at each site. We also interviewed private
             organizations that provide child protection and child welfare services to
             these units. Lastly, we interviewed local officials from community child
             advocacy groups and child fatality review panels.

             Page 28                                  GAO/HEHS-97-115 Child Protective Services
Appendix I
Scope and Methodology

Finally, we convened a panel of six experts for a 1-day discussion to solicit
their perspectives on what role(s) the federal government can play in
assisting states and localities in improving their CPS activities. The
panelists were asked to identify areas in which the federal government can
provide leadership and strategies or specific activities that can support
state efforts to manage CPS systems. This expert panel was held on
December 3, 1996, and included Diana English, Office Chief, Office of
Children’s Administration Research, Department of Social and Health
Services, Washington; Mark Hardin, Director, Foster Care and Family
Preservation, Center on Children and the Law, American Bar Association,
Washington, D.C.; Robert Lindecamp, State Liaison Officer, Division of
Family Services, Department of Services for Children, Youth and Their
Families, Delaware; Robert McKeagney, Director, National Center for
Excellence in Child Welfare, Child Welfare League of America,
Washington, D.C.; Susan Notkin, Director, Program for Children, The Edna
McConnell Clark Foundation, New York, New York; and Michael Weber,
Associate Director, National Committee to Prevent Child Abuse, Chicago,

We conducted our work between February 1996 and April 1997, in
accordance with generally accepted government auditing standards.

Page 29                                 GAO/HEHS-97-115 Child Protective Services
Appendix II

Comments From the Department of Health
and Human Services

              Page 30       GAO/HEHS-97-115 Child Protective Services
Appendix II
Comments From the Department of Health
and Human Services

Page 31                                  GAO/HEHS-97-115 Child Protective Services
Appendix II
Comments From the Department of Health
and Human Services

Page 32                                  GAO/HEHS-97-115 Child Protective Services
Appendix II
Comments From the Department of Health
and Human Services

Page 33                                  GAO/HEHS-97-115 Child Protective Services
Appendix II
Comments From the Department of Health
and Human Services

Page 34                                  GAO/HEHS-97-115 Child Protective Services
Appendix II
Comments From the Department of Health
and Human Services

Page 35                                  GAO/HEHS-97-115 Child Protective Services
Appendix II
Comments From the Department of Health
and Human Services

Page 36                                  GAO/HEHS-97-115 Child Protective Services
                        Appendix II
                        Comments From the Department of Health
                        and Human Services

Now on p. 4.

Now on p. 4, para. 2.

Now on p. 8.

                        Page 37                                  GAO/HEHS-97-115 Child Protective Services
                        Appendix II
                        Comments From the Department of Health
                        and Human Services

Now on p. 7.

Now on p. 8.

Now on p. 20.

Now on pp. 21 and 22.

                        Page 38                                  GAO/HEHS-97-115 Child Protective Services
                           Appendix II
                           Comments From the Department of Health
                           and Human Services

Now on pp. 6, 9, and 28.

                           Page 39                                  GAO/HEHS-97-115 Child Protective Services
Appendix III

GAO Contacts and Staff Acknowledgments

                  Kay E. Brown, Assistant Director, (202) 512-3674
GAO Contacts      Diana M. Pietrowiak, Evaluator-in-Charge, (202) 512-6239

                  In addition to those named above, David D. Bellis and John Vocino
Staff             contributed significantly to the writing of the report and all data-gathering
Acknowledgments   and analysis efforts.

                  Page 40                                 GAO/HEHS-97-115 Child Protective Services
Page 41   GAO/HEHS-97-115 Child Protective Services
Page 42   GAO/HEHS-97-115 Child Protective Services
Page 43   GAO/HEHS-97-115 Child Protective Services
Related GAO Products

              Child Welfare: Complex Needs Strain Capacity to Provide Services
              (GAO/HEHS-95-208, Sept. 26, 1995).

              Child Welfare: Opportunities to Further Enhance Family Preservation and
              Support Activities (GAO/HEHS-95-112, June 15, 1995).

              Foster Care: Health Needs of Many Young Children Unknown and Unmet
              (GAO/HEHS-95-114, May 26, 1995).

              Foster Care: Parental Drug Abuse Has Alarming Impact on Young Children
              (GAO/HEHS-94-89, Apr. 4, 1994).

              Residential Care: Some High-Risk Youth Benefit, but More Study Needed
              (GAO/HEHS-94-56, Jan. 28, 1994).

              Foster Care: Services to Prevent Out-of-Home Placements Are Limited by
              Funding Barriers (GAO/HRD-93-76, June 29, 1993).

              Foster Care: State Agencies Other Than Child Welfare Can Access Title
              IV-E Funds (GAO/HRD-93-6, Feb. 9, 1993).

              Child Abuse: Prevention Programs Need Greater Emphasis (GAO/HRD-92-99,
              Aug. 3, 1992).

              Child Abuse and Neglect: Progress of the National Center Since May 1991
              (GAO/T-HRD-92-14, Mar. 6, 1992).

              Child Abuse and Neglect: NCCAN’s Implementation of CAPTA of 1988
              (GAO/T-HRD-91-29, May 9, 1991).

              Child Abuse Prevention: Status of the Challenge Grant Program
              (GAO/HRD-91-95, May 9, 1991).

              Foster Care: Children’s Experiences Linked to Various Factors; Better
              Data Needed (GAO/HRD-91-64, Sept. 11, 1991).

              Child Welfare: Monitoring Out-of-State Placements (GAO/HRD-91-107BR, Sept.
              3, 1991).

(106711)      Page 44                                GAO/HEHS-97-115 Child Protective Services
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