September/October 2015Vol. 16, No. 7Print issueSpotlight on Back to School

Child Welfare Information Gateway wants to hear from you! Visit the Family Engagement Inventory and tell us what you think!

The Family Engagement Inventory is an informational tool designed to familiarize users with family engagement practices across child welfare, juvenile justice, behavioral health, education, and early education. Access the following domains for links to organizations, agencies, and information that support family engagement:

• The Practice Level Strategies domain includes methods, plans of action, processes, and/or policies designed to be used by frontline staff of each discipline to enhance or achieve family engagement.
• The What Works domain includes links to and information on selected practices and programs that are validated and supported by a documented, evaluative process as they relate to family engagement.
• The Resources domain includes links to useful or valuable information and websites that provide additional literature about family engagement processes, methods, and programs.

Check out the website and take the survey at http://www.surveygizmo.com/s3/2177961/Family-Engagement-Inventory-Website-Survey.

If you have any materials you would like us to consider adding to the Family Engagement Inventory, please submit them via email to info@childwelfare.gov.
 

The Children's Bureau published a Notice of Proposed Rule Making (NPRM) in the Federal Register on August 11, 2015. When final, these regulations will replace the Statewide/Tribal Automated Child Welfare Information System (S/TACWIS) regulations at 45 CFR 1355.50 – 57. This Comprehensive Child Welfare Information System (CCWIS) NPRM is the first significant change in these regulations in over 20 years. The CCWIS NPRM provides State and Tribal title IV-E agencies with significant flexibility to take advantage of modern technology to build smaller, flexible, and less expensive systems to support changes in child welfare business practice.

Download a copy of the CCWIS NPRM at http://www.gpo.gov/fdsys/pkg/FR-2015-08-11/pdf/2015-19087.pdf (452 KB).

The Children's Bureau also published explanatory materials on its website. Go to the Bureau's State & Tribal Information Systems webpage (https://www.acf.hhs.gov/programs/cb/research-data-technology/state-tribal-info-systems) and scroll down to "Proposed Rule on SACWIS/TACWIS" to access additional information about the CCWIS NPRM.

We encourage you to submit comments on the CCWIS NPRM at http://www.regulations.gov.

Comments are due by October 13, 2015.

 

The Children's Bureau website carries information on child welfare programs, funding, monitoring, training and technical assistance, laws, statistics, research, Federal reporting, and much more.

Recent additions to the site include:

• Grants to Tribes, Tribal Organizations, and Migrant Programs for Community-Based Child Abuse Prevention Programs HHS-2016-ACF-ACYF-CA-1119 - Funding opportunity announcement (FOA) to provide financial support to selected Tribes, Tribal organizations, and migrant programs for child abuse prevention programs and activities that are consistent with the goals outlined by title II of the Child Abuse Prevention and Treatment Act (CAPTA): http://www.acf.hhs.gov/hhsgrantsforecast/index.cfm?switch=grant.view&gff_grants_forecastInfoID=72983
• Foster/Adoptive Parent Preparation, Training and Development Project HHS-2016-ACF-ACYF-CO-1122 - FOA to award one cooperative agreement to an organization to develop a state-of-the-art foster/adoptive parent training program: http://www.acf.hhs.gov/hhsgrantsforecast/index.cfm?switch=grant.view&gff_grants_forecastInfoID=72986
• State and Tribal Indian Child Welfare Act (ICWA) Implementation Partnership Grants HHS-2016-ACF-ACYF-CT-1123 - FOA to support the creation of effective practice model partnerships between State courts and/or Court Improvement Programs, State public child welfare agencies, and a Tribe, group of Tribes, or Tribal consortia, including the Tribal child welfare agency and Tribal court, for effective implementation of the Indian Child Welfare Act (ICWA) of 1978 (Pub.L. 95-608): http://www.acf.hhs.gov/hhsgrantsforecast/index.cfm?switch=grant.view&gff_grants_forecastInfoID=72987
• Quality Improvement Center (QIC) on Permanency and Placement Stability for LGBTQ Youth in Foster Care HHS-2016-ACF-ACYF-CW-1126 - FOA to establish a QIC that will conduct four to six projects with State child welfare systems to produce a system of supports and interventions focused on the permanency and stability of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth: http://www.acf.hhs.gov/hhsgrantsforecast/index.cfm?switch=grant.view&gff_grants_forecastInfoID=73020 
• IM-15-04 - This Information Memorandum (IM) informs State and Tribal title IV-E agencies about State and Tribal Child Welfare Information Systems and Information Security Data Breach Response Plans: http://www.acf.hhs.gov/programs/cb/resource/im1504
• IM-15-05 - This IM provides information on New Legislation - Public Law 114-22, the Justice for Victims of Trafficking Act of 2015: http://www.acf.hhs.gov/programs/cb/resource/im1505
• PI-15-05 - This Program Instruction (PI) provides information on support from State and Tribal child welfare information systems for the extension of Medicaid eligibility to young adults formerly in foster care and under age 26: http://www.acf.hhs.gov/programs/cb/resource/pi1505
• PI-15-08 - This PI provides instruction on Adoption and Legal Guardianship Incentive Payments: http://www.acf.hhs.gov/programs/cb/resource/pi1508
• Texas Secondary Title IV-E Foster Care Eligibility Review (2015) - This report describes the results of the secondary review of Texas' title IV-E foster care program: http://www.acf.hhs.gov/programs/cb/resource/texas-secondary-title-iv-e-2015
• Texas Title IV-E Foster Care Eligibility Review Report Addendum (2015) - This document is supplementary material to the primary review of the Texas title IV-E foster care program: http://www.acf.hhs.gov/programs/cb/resource/texas-eport-addendum-title-iv-e-2015
• North Carolina Subsequent Primary Title IV-E Foster Care Eligibility Review (2014) - This report describes the results of the subsequent primary review of North Carolina's title IV-E foster care program: http://www.acf.hhs.gov/programs/cb/resource/north-carolina-subsequent-primary-title-iv-e-2014
• Child and Family Services Reviews Fact Sheet for Courts - This fact sheet provides information about the Child and Family Services Reviews (CFSRs) for the courts: http://www.acf.hhs.gov/programs/cb/resource/cfsr-fact-sheet-for-courts
• Tri-Agency Letter on Detail of Cost Allocation Waiver - Provides specific exception to the cost allocation requirements set forth in the Office of Management and Budget Circular A-87 (Section C.3), which requires benefitting programs to share the costs associated with building State-based information technology systems: http://www.acf.hhs.gov/programs/cb/resource/sacwis-tacwis-other
• Creating Business Intelligence for West Virginia's Bureau for Children and Families - This presentation highlights how data from the Statewide Automated Child Welfare Information System is transformed into usable information by the West Virginia Bureau for Children and Families: http://www.acf.hhs.gov/programs/cb/resource/cwit-creating-business-intelligence

Visit the Children's Bureau website often to see what's new at http://www.acf.hhs.gov/programs/cb.
 

Children and youth in foster care are more likely to develop health problems than any other group of children, according to a guide produced by the American Academy of Pediatrics. These health conditions are often underidentified, undertreated, and can be chronic, impacting children's lives in multiple ways, both after they have exited foster care and throughout their adult lives. Children in foster care should receive regular and periodic health and developmental screenings in order to recognize and address potential delays in their growth and development.

The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is a service of Medicaid that focuses on child health and is required in every State. The program includes services such as mental health, developmental, dental, and preventive care for eligible children and youth. EPSDT benefits are intended "to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible. When children's health problems are not diagnosed or treated, they not only require more costly treatment later but can inhibit healthy development in other areas as well."¹

In 2010, the Office of Inspector General (OIG) issued a report that found 76 percent of children in nine States did not receive the required health screening services. The report, Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services, also found that nearly 60 percent of children who received health screenings did not receive a complete screening, missing at least one component.

The OIG cited a number of barriers to ensuring children receive health screenings, including:

• Not all eligible children are enrolled
• Increase in Affordable Care Act's (ACA) provider rates for primary care services
• Lack of dependable and consistent data
• Incomplete reporting by managed care companies in States that contract for Medicaid services

The OIG report recommended that the Center for Medicare and Medicaid Services (CMS) improve both the low participation and incomplete screenings by:

• Requiring States to report the number of vision and hearing screenings of eligible children and youth
• Strategizing ways to encourage participation of beneficiaries in EPSDT screenings
• Developing incentives for providers to encourage complete screenings
• Identifying State practices to increase children's participation in and provider delivery of complete screenings

In an effort to improve the number of eligible children who receive health-care screenings and preventive care, CMS organized a National EPSDT Improvement Workgroup. The development of a set of strategy guides is one outcome of the workgroup. The guides, which each focus on a specific topic, present approaches to improving the access to and utilization of the EPSDT benefit for eligible children.

The U.S. Departments of Health and Human Services and Education also created a guide for child welfare caseworkers that is focused on the importance of behavior screening and child development. The guide, produced in 2014, is part of the Birth to 5: Watch Me Thrive initiative, a part of a Federal effort to encourage healthy development in children.

While there are issues that disrupt the rate at which eligible children receive health screenings, there are some States that have been successful in their implementation. The Center for Health Care Strategies (CHCS) and the Annie E. Casey Foundation's report, Making Medicaid Work for Children in Child Welfare: Examples From the Field, provides case studies of Arizona, Massachusetts, Michigan, and New Jersey. The 2013 report provides a snapshot of the collaborative work the States implemented to "make Medicaid work" for children and families involved in the child welfare system.

Some of the lessons learned reported across each State include:

• Understand the importance of delivering customized responses to children and families. The States interviewed recognized that the life experiences of children and youth in foster care can include types of trauma, separation from family and friends, and multiple placements, meaning a customized response strategy is necessary. No case or need is the same, requiring tailored health-care plans for children in foster care.
• Recognize the importance of cross-agency relationships and collaboration. Interviewees in each State discussed the significance in sharing responsibilities when it comes to meeting the needs of children in foster care, noting that State-level collaboration is essential. However, relationships at the local level are also critical. This can include collaboration with local system leaders and front line staff; cross-agency relationships not only help solve problems, but can also help develop new strategies.
• Create multiple strategies instead of relying on just one approach. Each State in the report had numerous strategies for each of the areas discussed, including service coverage, screening, and financing, among others. "It's hard to identify the most effective strategy. It's a combination—one can't work without the others," said an interviewee.

To find information about the Medicaid program and the Children's Health Insurance Program in your State, call 1.877.KIDS.NOW (1.877.543.7669) or visit http://www.insurekidsnow.gov/qa/index.html.

Birth to 5: Watch Me Thrive!: A Child Welfare Caseworker's Guide for Developmental and Behavioral Screening is available at https://www.acf.hhs.gov/sites/default/files/ecd/child_welfare_guide_march2014.pdf (155 KB).

Making Medicaid Work for Children in Child Welfare: Examples From the Field is available at http://www.chcs.org/media/Making_Medicaid_Work.pdf (821 KB).

The OIG report Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services, OEI-05-08-00520, May 2010, is available at http://oig.hhs.gov/oei/reports/oei-05-13-00690.asp.

¹ Health Resources and Services Administration. (n.d.). EPSDT & Title V Collaboration to Improve Child Health. Retrieved from http://mchb.hrsa.gov/epsdt/

The National Resource Center for Diligent Recruitment at AdoptUSKids recently released a guide to assist State child welfare agencies in recruiting foster, adoptive, and kinship families for Native American children. The guide, Recruiting Families for Native American Children: Strengthening Partnerships for Success, provides an overview of Federal laws (including the Indian Child Welfare Act and the Adoption and Safe Families Act) that regulate how States place Native American children in foster, adoptive, and kinship families. It also outlines ways in which State agencies can work with Native American communities to recruit and support resource families and how State agencies can assess their current practices and needs. Lastly, the guide provides key considerations when strengthening or establishing partnerships with Tribal child welfare systems, including recognizing that Tribes are independent governments.

To view the guide, visit http://www.nrcdr.org/_assets/files/NRCDR-org/recruiting-families-for-native-american-children.pdf (107 KB).
 

In 2012, the Children's Bureau partnered with the National Resource Center for Youth Development and a collaborative committee of young people and professionals to produce Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care. The guide (available in English and Spanish at https://www.childwelfare.gov/pubs/makinghealthychoices) presents valuable information for youth in foster care related to making decisions about their mental health, treatment options, and the use of psychotropic medications.

This year, the Children's Bureau and its partners collaborated to publish a companion guide intended to help caseworkers, foster parents, other caregivers, or other caring adults to use Making Healthy Choices with youth. This guide aims to provide all the caring adults in a youth's life with information about trauma experienced by youth in foster care and treatment options, including approaches other than psychotropic medication. The guide presents strategies for seeking help for youth, identifying appropriate treatment, and supporting youth in making decisions about their mental health. Additionally, specific sections that can be used in conjunction with sections of the Making Healthy Choices youth guide are clearly indicated with relevant instructions for each.

Access Supporting Youth in Foster Care in Making Healthy Choices: A Guide for Caregivers and Caseworkers on Trauma, Treatment, and Psychotropic Medications at https://www.childwelfare.gov/pubs/mhc-caregivers/.

On August 5 of this year, the U.S. Senate confirmed Rafael López as the new commissioner for the Administration for Children and Families' (ACF's) Administration on Children, Youth and Families (ACYF). Mr. López brings with him a strong track record of public service on behalf of children and families. He was a senior policy advisor in the Office of Science and Technology Policy within the Executive Office of the President and with the Domestic Policy Council. Prior to his work at the White House, Mr. López advocated for and promoted the well-being of children and families in a number of positions. From 2010 to 2013, he was an associate director at the Annie E. Casey Foundation, and from 2009 to 2010, he served as the president and CEO of the Family League of Baltimore City, Inc.

Mr. López held several offices in his home State of California, including executive director of the City of Los Angeles Commission for Children, Youth and Their Families; deputy director of the City and County of San Francisco Department of Children, Youth, and Their Families; and senior deputy for Health and Human Services for Los Angeles County Supervisor Gloria Molina. From 1999 to 2004, he served as the founding executive director of First 5 Santa Cruz County. Mr. López received his B.A. from the University of California, Santa Cruz, and an M.P.A. from the John F. Kennedy School of Government at Harvard University.

The ACYF commissioner, who is appointed by the President and confirmed by the Senate, leads ACYF's two bureaus, the Children's Bureau and the Family and Youth Services Bureau. These bureaus are responsible for different issues involving children, youth, and families and a crosscutting unit charged with research and evaluation.

Read Mr. López's testimony before the Senate Finance Committee, in which he discusses his commitment to public service and his concerns regarding issues such as abuse, mental health, violence, and poverty, at http://www.finance.senate.gov/imo/media/doc/Rafael%20Lopez%20WrittenTestimony%20042215.pdf (23 KB).
 

Child Trends recently released a series of products to assist organizations with the evaluation of healthy marriage and relationship education programs. These products were developed as part of a project funded by the Office of Planning, Research and Evaluation (OPRE) in the Administration for Children and Families, U.S. Department of Health and Human Services. The products focus on two target populations: parents in complex families and adolescents. A complex family is one in which the couple is in a committed relationship and have a child together and one or both parents have a child from a prior relationship. Child Trends developed two products for each population: a set of recommended measures to assess project outcomes and a tip sheet providing guidance on data collection.

These products are available from the OPRE website at http://www.acf.hhs.gov/programs/opre/resource/healthy-marriage-relation-ed-consider-data-recommend-outcome-measures-adolescents-complex-families.
 

The following is the monthly message from JooYeun Chang, the Associate Commissioner of the Children's Bureau. Each message focuses on the current Children's Bureau Express Spotlight theme and highlights the Bureau's work on the topic.

Dear friends and colleagues,

It is with deep gratitude that I write my last "Associate Commissioner's Page." I am leaving the Children's Bureau after serving as Associate Commissioner for the past 2 years and will return to Casey Family Programs at the end of the month. It has been a privilege to be part of the Bureau—a team made up of people with expertise, commitment, and passion to our shared work of helping vulnerable children and families. In my short tenure at the Children's Bureau, we have accomplished a great deal:

In 2014 and 2015, President Obama's Federal Budget called for increased assistance to vulnerable populations by investing in efforts to improve outcomes for children in foster care and support the prevention of human trafficking and direct services for domestic victims. In September of 2014, we saw a vital piece of legislation enacted in support of these priorities. The Preventing Sex Trafficking and Strengthening Families Act (P.L. 113-183) amends the title IV-E foster care program to define sex trafficking and set title IV-E requirements for identifying, reporting, and determining services to victims; limits another planned permanency living arrangement as a plan for youth; and reauthorizes and amends Family Connections Grants and the Adoption Incentives Program (read more in the April 2015 issue of CBX). The law includes provisions requiring States to implement a "reasonable and prudent parent standard" that will empower foster parents or other designated decision-makers to make decisions to allow youth in foster care to participate in healthy and developmentally appropriate activities such as field trips, sleepovers, and other extracurricular activities. This standard is intended to expand opportunities for youth in care to engage in activities that will promote their well-being.

During the past 2 years, the Bureau also continued to support States in implementing title IV-E child welfare waiver demonstration projects. The Child and Family Services Improvement and Innovation Act, P.L. 112-34, signed into law on September 30, 2011, provided the Department of Health and Human Services with authority to approve up to 10 demonstration projects in each of fiscal years 2012–2014. These demonstration projects involve the waiver of certain requirements of titles IV-E and IV-B of the Social Security Act to allow for more flexible use of Federal funds in order to test new approaches to service delivery and financing structures, in an effort to improve outcomes for children and families involved in child welfare. Currently, there are 30 active demonstration projects in 29 States, the District of Columbia, and one Tribe. For more information, including summaries and profiles of the projects, visit the Children's Bureau website at http://www.acf.hhs.gov/programs/cb/programs/child-welfare-waivers.

The Children's Bureau kicked off the third round of the Child and Family Services Reviews in 2015, incorporating improvements to the process for reviewing titles IV-B and IV-E of the Social Security Act through the CFSR. Round 3 reviews will be done this year in Delaware, North Carolina, Vermont, New Mexico, Georgia, Kansas, Massachusetts, and Arizona, and reviews will be carried out in the remaining States through 2018. You can read more about the CFSRs in CBX's June 2014 Spotlight.

During February of this year, the Administration for Children and Families (ACF) published a Notice of Proposed Rule Making (NPRM) (PDF - 665 KB) on the Adoption and Foster Care Analysis and Reporting System (AFCARS) that proposed to update the AFCARS requirements and included changes made as a result of the enactment of the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351) and the Preventing Sex Trafficking and Strengthening Families Act. Just last month, an NPRM was published for Tribal and State title IV-E agencies on the Comprehensive Child Welfare Information System (CCWIS) (PDF - 452 KB). This NPRM addresses changes in child welfare practice and technology related to the case management and data collection needs of children receiving foster care and adoption services, and it provides agencies with increased flexibility to build smaller systems that more closely mirror their practice models. These are only a few examples of the improvements and advances we have seen during my time with the Children's Bureau, and I have every confidence that the Bureau will continue to work hand-in-hand with Federal, State, and local partners to further advance the well-being of the children and families we serve.

I have enjoyed this chance to speak directly to child welfare leaders, frontline workers, advocates, families, and perhaps most importantly, youth who are or were formally in care. Thank you for embracing the changes we have initiated and for your partnership in creating policies that will ensure that children and families who come to our attention receive the services and supports they need, not merely the ones we currently have available. Thank you for your tireless efforts to make a difference in the lives of all children and families, regardless of race, religion, creed, ethnicity, or sexual orientation. A special thanks to the Children's Bureau staff for your kindness, commitment, and flexibility during times of transition. It has been a privilege to be part of this team.

Sincerely,

JooYeun Chang
Associate Commissioner
Children's Bureau
Administration for Children, Youth & Families
Administration for Children and Families
U.S. Department of Health and Human Services
202.205.7747
Jooyeun.chang@acf.hhs.gov