2006 Jordan Institute
11, No. 3
NC Reviews Focus on Outcomes for Families and Children
As you undoubtedly know, every two years North Carolina reviews the performance of the child welfare unit in every county department of social services. These reviews, formerly called the biennial reviews but now called Child and Family Services Reviews (CFSRs), have long been known for the emotions they inspire. But they are also increasingly being recognized for how they can help county agencies and the state as a whole improve child welfare practice and enhance outcomes for families and children.
A Brief History
To enhance our ability to address the issues identified by federal reviewers and to help us prepare for future federal reviews, the NC Division of Social Services redesigned its county-level review protocol, process, and instruments to mirror the federal review process. It began using this new process in October 2001.
Thanks in part to this new review process, by June 2005 North Carolina had successfully rectified all areas that were in nonconformity on the federal review and met all requirements of the federal Program Improvement Plan. Our state will probably participate in its next federal review within the next year.
Purpose of the Reviews
Because it is based on the federal process, these reviews assess each county’s performance relative to the federal outcomes and indicators described in the box on page 3. By measuring outcomes and the practices behind them, the reviews provide public accountability for all 100 county departments of social services and for the child welfare system statewide.
The Review Process
Notification. Three months prior to the review, the Division informs the county DSS director when the site review will take place.
Data submission and analysis. Within 10 days of notification, the county agency must submit certain data to the Division for analysis. The county must also provide reviewers with names and contact information for individuals who will be involved in the survey of community stakeholders.
Survey of community stakeholders. In the period leading up to the review a survey is sent to social services board members, the guardian ad litem administrator, and other community stakeholders to help reviewers assess the strengths and needs of the agency.
County self-report and self-survey. In the period leading up to the review the agency completes a self-report and self-survey. This survey gives the agency an opportunity to talk about its use and understanding of its data, its strengths, areas needing improvement, and relevant community issues.
Site review. A review team from the Division visits the agency. During this visit they:
(a) Select and review case records. Case records are randomly selected for the areas of placement and case planning/case management. A sample of cases that were either unsubstantiated or substantiated and closed, and a sample of reports that were not accepted (i.e., “screened out”) are also reviewed. The number of records reviewed depends on county size.
(b) Conduct interviews. In addition to the records themselves, the review of selected cases involves interviews with social workers, age-appropriate children, family members, foster parents, GALs, and others involved.
An important aspect of the CFSR is that each site visit is conducted using a partnership model. In this approach reviewers work in pairs—one person from the county and one person representing the Division—for reviewing records, conducting interviews, and rating the items and outcomes.
Historically, being reviewed was often nerve-wracking for counties simply because it involved scrutiny from outside evaluators. Cindy Holman, a children’s program representative (CPR) for the Division, says she has seen a lessening of this effect since the Division moved to the partnership model. She says this approach has helped counties understand the Division’s motivations, and that “We are truly focused on outcomes for families, service quality, and supporting counties.”
(c) Debriefing. When the case review instrument, appropriate interviews, and the case rating summary have been completed, each state/county review team makes a presentation to the entire review team. These debriefings often occur several times during the course of the on-site review. After all of the cases have been debriefed, the entire review team completes the county rating summary in preparation for the exit conference.
Exit conference. An exit conference is held at the conclusion of the review to present general findings from the review process and provide closure. At this meeting there is an opportunity for questions about the review team’s findings, comments about the findings, and identification of anything that the county would like reflected in the review report. The director is also given the opportunity to complete a form evaluating the review process itself.
CFSR final report. Within 30 days of the site visit the Division shares with the director a draft copy of the county’s Child and Family Services Review Report. This report includes analysis of all outcomes of the review and relevant data. It focuses on broad program issues and identifies strengths and areas for improvement. Information provided by the county DSS in the agency self-report is incorporated into the final report. After considering any requests from the county for changes, the Division sends a final version of the CFSR report to the agency director, the chair of the social services board, the chair of the county commissioners, and the county manager.
Follow-up visit. The agency’s CPR contacts the county within 30 days after the agency receives the draft report. This visit provides an opportunity for the agency and the CPR to discuss the issues and recommendations contained in the report. During this visit the CPR also shares positive feedback regarding practice issues.
Program Improvement. A formal Program Improvement Plan (PIP) is required from each county for any outcome area that does not meet substantial conformity. The PIP is developed by the county with assistance from its CPR. The process for developing the PIP is much like the process of developing a case plan with families—it is done collaboratively and realistically, with a focus on the county’s strengths.
After the PIP is drawn up, supervisors and others within the agency monitor performance in the area(s) of concern. When the county believes it is ready, it asks the CPR to review its progress. When the CPR believes the county is ready, she or he recommends to the Division that the county be released from program improvement status.
More detailed information about North Carolina’s Child and Family Services Review process is described in the CFSR protocol (http://www.dhhs.state.nc.us/dss/stats/docs/protocol.pdf).
The intent of the Child and Family Services Review process is to enhance the quality of practice in North Carolina’s children’s services system. The reviews give the Division and county departments of social services a structural assessment of their programs and allow them to direct energy to the areas most needing improvement. Counties can use the results of their review to document their compliance with accreditation requirements for child welfare services. Counties that do well have the opportunity to use the review process to provide their community with documentation of their successes.
The reviews also identify needs for training and technical assistance from the Division, and fulfill the need for public reporting of children’s services issues. At the end of each two-year review cycle the Division of Social Services publishes a summary report containing an analysis of the findings from the Child and Family Services reviews. The summary report for the 2003-2005 biennium is available at <http://www.dhhs.state.nc.us/dss/stats/docs/2003-2005%20CFSR%20Report-v4.pdf>.