November 2005Vol. 6, No. 9Print issueSpotlight on National Adoption Month

The Children's Bureau has announced the award of discretionary grants that will provide funding for projects, services, and training in five areas:

• Abandoned infants comprehensive service demonstration projects (7 grantees)
• Demonstration projects that improve child well-being by fostering healthy marriages within underserved communities (10 grantees)
• Grants to tribes, tribal organizations, and migrant programs for community-based child abuse prevention programs (3 grantees)
• Model development or replication to implement the CAPTA requirement to identify and serve substance-exposed newborns (4 grantees)
• Training of child welfare agency supervisors in the effective delivery and management of Federal independent living services for youth in foster care (6 grantees)

In addition, the Children's Bureau announced the award of competitive cooperative agreements in four areas:

• Developing adoption services and supports for youth who wish to retain contact with family members in order to improve permanency outcomes (9 awards)
• National Quality Improvement Center on the Privatization of Child Welfare Services (1 award)
• National Data Archive on Child Abuse and Neglect (1 award)
• Consortium for Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) (6 awards)

For more information about Children's Bureau programs and funding go to http://www.acf.hhs.gov/programs/cb/grants.

The U.S. Department of Health and Human Services' Children's Bureau has just released Child Welfare Outcomes 2002: Annual Report to Congress. This is the fifth year in which data from the Federal Adoption and Foster Care Analysis and Reporting System (AFCARS) and the National Child Abuse and Neglect Data System have been used to provide information on national child welfare outcomes. In addition, discussions of State performance are included that incorporate information from the Child and Family Services Reviews.

Results indicate that States are moving toward improvement in the following areas:

• Reducing maltreatment of children in foster care by foster parents or facility staff members
• Achieving permanency for children in foster care
• Ensuring placement stability for children during the first 12 months they are in foster care

However, as in previous years, many States continue to face challenges in a number of areas:

• Reducing maltreatment recurrence
• Finding permanent homes for children with a diagnosed disability
• Finding homes for children who enter foster care as adolescents
• Finding homes for children who are Black or Alaska Native or Native American

The full report is available on the Children's Bureau website at http://www.acf.hhs.gov/programs/cb/resource/cwo-2002.

Young children involved with the child welfare system have an urgent need for comprehensive health and developmental assessments, and they often need medical services. However, obtaining assessments and services for these infants and toddlers is challenging, especially for those in foster care. Responding to these needs, the Children's Hospital of Philadelphia developed the Starting Young program, which provides evaluations and referrals for early intervention services, primary health care, and medical specialty care for children under 3 who are in foster care, kinship care, or living with biological parents with child welfare involvement. Children are referred to the program by child welfare workers from many different agencies throughout the region.

As part of the Starting Young program, an interdisciplinary team conducts an extensive pediatric developmental evaluation for each child that includes:

• Speech and language assessment
• Gross motor development assessment
• Cognitive development assessment
• Assessment of child’s behavioral health
• Pediatric assessment, including physical health and growth
• Interviews with the family’s social worker, parent(s) and/or foster parent(s)

In order to help ensure that infants have access to Early Intervention (EI) services to which they are entitled (Part C services under the Individuals with Disabilities Education Act/IDEA), a service coordinator from the county’s EI program is a member of the clinical team. This service coordinator facilitates the development of an EI Individual Family Service Plan (IFSP) for those children whose Starting Young evaluation indicates eligibility for EI. Immediately after the assessment, a preliminary report and recommendations are shared with the parent or foster parent and with the family’s social worker. Evaluation follow-up is carried out by a research assistant who checks with the infant’s caregiver and caseworker to see if referrals and recommendations are being followed and identifies any barriers to accessing needed services. The team conducts an extensive re-evaluation of children every 6 months.

Besides conducting the hands-on assessments of infants and toddlers referred to the program, the Starting Young clinical team provides training for child welfare workers on the importance of linking young children to health care, specialty care, and early intervention services. They also offer educational programs for foster parents and for health care professionals. Clinical training is provided to graduate and postgraduate health care professionals, allowing them to work with the interdisciplinary evaluation team and providing exposure to situations involving the child welfare system.

Now in its fourth year, the Starting Young program is conducting an ongoing evaluation of its activities and outcomes. Preliminary results indicate that successful strategies include the use of an interdisciplinary team, comprehensive clinical assessment practices, collaboration with caregivers and social workers, educational programs, and alliances with community groups. Challenges have included difficulty in obtaining parental permission for sharing of information, and the fact that certain recommendations are less likely to be followed, notably, referrals for hearing evaluations with pediatric audiologists and testing for HIV infection. Preliminary results suggest that this nonoptimal compliance is due to (1) problems obtaining consent to authorize these recommended tests and (2) the fact that child welfare caseworkers and supervisors are not convinced of the urgency of these recommendations for infants and toddlers.

Through collaboration, assessment, training, and education, Starting Young is changing the culture of child welfare workers and improving health care for young children in the child welfare system in greater Philadelphia. Community partners report that child welfare workers are much more aware of the need to refer infants and toddlers for comprehensive assessments. The Starting Young program has demonstrated the value of providing interdisciplinary assessments and is making referrals that have been shown to help these at-risk children access the health and developmental services they need.

For more information about the Starting Young program at Children's Hospital of Philadelphia, contact:

Dr. Judith Silver, Program Director
Starting Young Program
Children's Hospital of Philadelphia
3615 Civic Center Boulevard
Philadelphia, PA 19104-4318
Phone: 215.590.7723
Email: silverj@email.chop.edu

Note: The Starting Young Project was funded by the Children's Bureau, Grant 90-CA-1697, under the Children’s Bureau Priority Area: 2001B3: Field-Initiated Demonstration Projects Advancing the State of the Art in the Child Abuse and Neglect Field. This article is part of a series highlighting successful Children's Bureau Grant-funded projects around the country, emerging from official Children's Bureau site visits.

State child welfare agencies have developed a variety of programs to respond to substance abuse by parents. To aid in the dissemination of promising practices for dealing with issues that involve substance abuse, child welfare, and the courts, the National Center on Substance Abuse and Child Welfare (NCSACW) has collected and made available on its website many examples of the measures that States are taking to respond to substance abuse by parents.

The types of products that have been collected include States' strategic plans, interagency agreements, communication protocols, outcome measures, screening and assessment protocols, training tools, and statements of underlying values. [Editor's note: This link is no longer available.]

A list of resources is available on the NCSACW website at http://www.ncsacw.samhsa.gov/resources/default.aspx

Federal, State, and local governments continue to respond to the needs of children and families affected by Hurricanes Rita and Katrina. Families at risk before the hurricanes are particularly vulnerable, and many more families and children have been placed at risk because of loss of homes, jobs, or loved ones.

At the Federal level, the U.S. Department of Health and Human Services (HHS) continues to provide information, funding, and services to those in need. One month after Katrina hit the Gulf Coast, HHS Secretary Mike Leavitt announced that it was estimated that 41 percent of the 857,000 evacuees were receiving HHS help. Flexibility in enrollment allowed citizens who had lost documents such as tax returns to enroll for HHS services.

"Based on preliminary reports, we estimate that more than 40 percent of hurricane evacuees who have been displaced from their homes are getting help from HHS," Secretary Leavitt said in late September. "Working with our partners at the State and local level, we have streamlined the process for all evacuees who may need access to the range of benefits we can provide to get back on their feet."

HHS also introduced its "Help Is on the Line" campaign designed to get information out to displaced citizens who need medical, mental health, childcare, Head Start, or other services by connecting them with a national phone number or a phone number in their own State to link them to resources. Information about this campaign is available at www.hhs.gov/katrina/poster.html.

In order to help States restore essential child welfare services, the Administration for Children and Families (ACF) within HHS is awarding $2.8 million to its National Resource Centers (NRCs). The Federal money will be for training and technical assistance to help States rebuild child welfare service delivery and family court systems disrupted by Hurricane Katrina. The NRCs will assist States to develop and implement strategies to deal with a variety of urgent issues such as coordinating services for foster children evacuated from other States; locating foster children, foster families, and birth families; reestablishing and sharing records; reestablishing information systems; and reinstating court functions.

More specific information on the services and resources provided by the Administration for Children and Families is available at www.acf.hhs.gov/katrina/index.htm. (Editor's note: Link no longer active)

The Fall 2005 issue of Child Welfare Matters, published by the National Resource Center for Organizational Improvement (NRCOI), is devoted to the importance of stakeholder involvement in effective delivery of child welfare services. The lead article describes the reasons for engaging stakeholders; identifies the individuals, groups, and systems that can be important agency partners; lists the stages of collaboration and the key factors to success; and provides models of stakeholder involvement.

Other articles provide examples of two States that have experienced some success at developing community partnerships and collaboration. Articles on State-tribal partnerships that include strategies for successful partnering and examples of States and tribes that have done so are also featured.

Child Welfare Matters can be found online at http://www.nrcoi.org/cwm.htm.

All States were required to develop and implement Program Improvement Plans (PIPs) after the first round of Federal Child and Family Services Reviews (CFSRs). As States developed these PIPs, they were also tasked with funding the implementation. A report from the National Conference of State Legislatures (NCSL), which reviewed States' PIP-related documents and conducted interviews with staff in 24 States, shows that States funded their PIPs in two ways:

• Using new resources made available by the State legislature
• Reallocating existing resources

A few States reported that they were able to fund their PIP implementation with new resources. In some cases, development of the PIP coincided with lawsuits brought against State child welfare systems or with other reform efforts that prompted legislative appropriations. In other cases, States were able to use the results from their CFSRs to obtain legislative approval for additional resources. New funding was related to a variety of PIP activities, including child welfare workforce improvements, comprehensive system reform, and State support of county PIP-related efforts.

Most States reallocated existing resources to implement PIPs, with the most frequent allocations targeted at enhancing quality assurance, coordinating PIP implementation, and providing technical assistance to local offices. For instance, in some States, certain staff were reassigned to quality assurance positions or technical assistance positions. In other cases, funds were reallocated to create new staff positions. Some of the creative ways that States reallocated funds allowed them to stabilize and increase the frontline workforce.

The full report on funding PIPs, Funding of Child and Family Services Reviews Program Improvement Plans, is available on the NCSL website at http://www.ncsl.org/print/cyf/fundingcfsr.pdf

The U.S. Department of Health and Human Services (HHS) announced $41 million in funding to 50 States, the District of Columbia, and the U.S. territories for community-based child abuse prevention programs. The funding, for fiscal year 2005, marks an increase of 28 percent over the previous fiscal year for community-based child abuse prevention programs.

"Through these grants, the Bush Administration is helping States and community-based groups ensure that every child is free from harm," said HHS Secretary Mike Leavitt. "This increased funding will help lower instances of child maltreatment, abuse, and neglect."

Community-based child abuse prevention grants are provided to agencies designated by the governor of each State. Funds are used to enhance community-based efforts to prevent child abuse and neglect. They also foster the development of child abuse prevention services through State and community-based partnerships and public information activities focusing on the healthy and positive development of families.

"These grants will support President Bush's ongoing efforts to make every home a safe and healthy environment for children," said HHS Assistant Secretary for Children and Families Wade F. Horn, Ph.D. "They will help support healthy marriages and responsible fatherhood and strengthen positive child and youth development in families throughout the nation."

For a complete list of the community-based child abuse prevention awards, view http://archive.acf.hhs.gov/news/press/2005/CBCAP_FY2005.htm.

Since the mid-1990s, the Federal Government has encouraged innovative child welfare practices through the use of waivers that permit States more flexibility in spending Federal dollars. Under the waivers, regulations that restrict title IV-E monies to reimbursement for foster care maintenance payments are broadened, giving States greater latitude to fund alternative services to promote safety and permanency for children. Since 1996, 17 States have implemented 25 child welfare waiver demonstration components, using title IV-E funding for a variety of projects. Three new reports from the Children's Bureau synthesize characteristics and key findings from a number of these waiver demonstration projects:

• Assisted Guardianship Child Welfare Waiver Demonstrations examines programs in Delaware, Illinois, Maryland, Montana, New Mexico, North Carolina, and Oregon that offered financial support for guardians of children previously in foster care. While outcome evaluations tracked different data in different States, evidence from one or more States suggested a decrease in length of out-of-home placements, improved permanency rates, and overall satisfaction on the part of children, guardians, and child welfare workers.
• Substance Abuse Child Welfare Waiver Demonstrations examines programs in Delaware, New Hampshire, Illinois, and Maryland that focused on the early identification of parents with substance abuse disorders and the provision of service referrals for these parents. Outcomes indicated no strong positive effects on foster care placement rates, placement stability, reunification rates, or permanency rates. However, there was some evidence that a substance abuse demonstration project may reduce the duration of foster care placements and lower the risk of maltreatment recurrence.
• Title IV-E Flexible Funding Child Welfare Demonstrations examines the diverse programs of Indiana, North Carolina, Ohio, and Oregon in implementing title IV-E capped allocation flexible funding waivers. Indiana focused on building local capacity for community-based services and home-based alternatives to institutional placements. Counties in North Carolina were permitted to develop their own initiatives to provide services, while Ohio counties developed their own managed care strategies. Local child welfare agencies in Oregon implemented innovative services such as early childhood assessments and one-time payments to prevent foster care placement.

All child welfare waiver demonstration projects were required to be cost neutral and to undergo rigorous program evaluation. They also met all requirements regarding periodic foster care reviews, safety for children, permanency hearings, and case plan information.

The three reports were prepared under the direction of the Children's Bureau by James Bell Associates, Inc. Syntheses of findings are available at http://www.acf.hhs.gov/programs/cb/programs_fund/index.htm#child. (Editor's note: This link is no longer active. For more information about the child welfare waiver demonstration projects, including recent reports, visit http://www.acf.hhs.gov/programs/cb/programs/child-welfare-waivers.)

Related Item

Children's Bureau Express reported on State child welfare waivers in "HHS Approves Child Welfare Waivers for Indiana and Arizona" in the September 2005 issue.

The National Resource Center for Community-Based Child Abuse Prevention (FRIENDS) has released another issue in its series of Learning Tools. This issue, "Promoting Father Involvement in Early Childhood," provides recommendations and guidelines for Head Start programs for reaching out to the fathers of young children. The article provides an overview of policies and practices that can encourage fathers to become involved in their children’s lives in more meaningful ways. Parent engagement activities that specifically target fathers are also provided.

FRIENDS is the National Resource Center for Community-Based Child Abuse Prevention (CBCAP) program grants. This issue of Learning Tools is available online at http://friendsnrc.org/direct-download-menuitem/doc_download/72-male-participation-in-early-childhood-english