	Introduction

The Child and Family Services Review (CFSR) is the central and most comprehensive component of federal efforts to determine state compliance with federal child welfare policies and, equally, to help ensure that positive outcomes are achieved for the children and families served by state child welfare programs. The review intends to gauge state efforts and ability to achieve the primary goals of safety and permanence for children, along with well-being for children and their families. The U.S. Department of Health and Human Services (HHS) began the first onsite reviews in March 2001 and, as of March 2004, had completed the initial round of the CFSR in all states, the District of Columbia and Puerto Rico. At the same time, the initial round of CFSRs found that no state's child welfare programs met the criteria that HHS established as demonstrating "substantial conformity" with all of federal child welfare policy requirements. Finally, the report concludes with a brief discussion of 1) how penalties for non-compliance are assessed; 2) the requirement that states not in compliance with federal policy develop Program Improvement Plans (PIPs) ( Appendix A shows the status of PIP implementation); 3) some of the criticisms of how the initial CFSR assessed state performance (especially with regard to the national standards); and 4) planning for the second round of CFSRs. The CFSR begins with a state's own assessment of its child welfare programs. This self-assessment is followed by an onsite review conducted by a team of federal and state investigators. These outcomes are:
Children are first and foremost protected from abuse and neglect; Children are maintained in their own homes whenever possible and appropriate; Children have permanence and stability in their living situations; Family relationships and connections are preserved for children; Families have enhanced capacity to provide for their children's needs; Children receive appropriate services to meet their educational needs; and Children receive adequate services to meet their physical and mental health needs. The systems assessed were—
Statewide information system; Case review system; Quality assurance system; Staff training; Service array; Agency responsiveness to community; Foster and adoptive parent licensing, recruitment, and retention. Permanency and Stability in Living Arrangement

In general, states scored relatively poorly on both the case review and data measures used to determine conformity with this outcome and no state was found to be in conformity with this permanency outcome. Table 5 lists each of the case review indicators assessed from those least likely to receive a strength rating to those most likely to receive a strength rating. State System Performance in the Initial CFSR

Reviewers also rated state performance based on the state's policy and practice with regard to seven federally required "systems." A less substantial majority of states were found to have a functioning quality assurance system in place (35) and to adequately meet the federal staff training requirements (34). Of these indicators, states were most successful at limiting re-entries to foster care. Statistical analysis of the relationship between system compliance and achievement of the desired outcomes for children shows that states whose array of available services was determined in substantial compliance with federal policy had a significantly higher percentage of cases in which families were found to have enhanced capacity to meet the needs of their children and in which foster children experienced permanent and stable living arrangements (when compared to states found out of compliance with the service array requirement).
While child welfare programs are a primary responsibility of state and local governments, the federal government appropriates close to $7 billion annually to support these programs (primarily for foster care and adoption assistance) and states are required to meet certain federal policies in order to receive this funding. Child and Family Services Reviews (CFSRs) gauge state efforts and ability to achieve the primary goals of safety and permanence for children, and well-being for children and their families. The review is intended both to measure state compliance with federal child welfare policy and to strengthen and improve state child welfare programs.
The Department of Health and Human Services (HHS) conducted the initial round of onsite reviews between March 2001 and March 2004. No state was found to be in substantial conformity with all of the outcomes and systems assessed. Some critics of the CFSR argue that while the outcomes reviewed are on target, the criteria established to determine state achievement of those outcomes may give misleading information about a state's performance.
Although much attention has focused on states' uniform inability to meet all of the federal criteria, the reviews also showed certain relative strengths. States showed the greatest ability to ensure that children were not exposed to child abuse and neglect and remained safely in their homes whenever appropriate and possible, and in preserving their family relationships and connections. They had the most difficulty in achieving permanent and stable living arrangements for children, enhancing the capacity of families to meet the needs of their children and in seeing that appropriate mental and physical health services were available to children served. Information regarding ensuring provision of educational services to children was more mixed.
In addition to reviewing outcomes, the CFSR assesses state compliance with federal child welfare policy by examining certain federally required systems. States were most likely to be found successful at operating a statewide information system; maintaining foster and adoptive parent licensing, training, recruitment and retention; and responding to community concerns. They were least likely to have a strong service array or case review system in place. Ratings of state quality assurance and training systems were more mixed.
To avoid immediate assessment of penalties for failure to comply with federal policy, each state was required to develop a Program Improvement Plan (PIP). A PIP must address each one of the outcomes or systems with which a state was found to be out of substantial conformity and must describe the state's specific plan for moving toward full conformity with federal policy. A few states have successfully completed their PIPS but most are still in the process of implementing them.
The Children's Bureau is preparing for a second round of CFSRs, and onsite reviews are scheduled to begin in early 2007. This report will describe the origins and design of CFSRs before turning to its primary discussion: state performance in the initial round of CFSRs. This report will not be updated.