Performance audit, Department of Economic Security, Division of Children, Youth, and Families, Child Protective Services foster care placement stability and foster parent communication

              A REPORT
TO THE
ARIZONA LEGISLATURE
Debra K. Davenport
Auditor General
Department of
Economic Security
Division of Children, Youth,
and Families
Child Protective Services 
Foster Care Placement Stability and
Foster Parent Communication 
Performance Audit Division
JULY     2003
REPORT NO. 03   05
Performance Audit
The Auditor General is appointed by the Joint Legislative Audit Committee, a bipartisan committee composed of five senators
and five representatives. Her mission is to provide independent and impartial information and specific recommendations to
improve the operations of state and local government entities. To this end, she provides financial audits and accounting servic-
es to the State and political subdivisions, investigates possible misuse of public monies, and conducts performance audits of
school districts, state agencies, and the programs they administer.
The Joint Legislative Audit Committee
Senator Robert Blendu, Chair Representative John Huppenthal, Vice Chair
Senator Gabrielle Giffords Representative Tom Boone
Senator Peter Rios Representative Ken Clark
Senator Thayer Verschoor Representative Ted Downing
Senator Jim Weiers Representative Steve Yarbrough
Senator Ken Bennett (ex-officio) Representative Jake Flake (ex-officio)
Audit Staff
Dot Reinhard, Manager and Contact Person
Sandra Tulloss, Team leader Lori Babbitt
Anne Hunter Stephen Jackson
Copies of the Auditor General s reports are free.
You may request them by contacting us at:
Office of the Auditor General
2910 N. 44th Street, Suite 410   Phoenix, AZ 85018   (602) 553-0333
Additionally, many of our reports can be found in electronic format at:
www.auditorgen.state.az.us
2910 NORTH 44th STREET • SUITE 410 • PHOENIX, ARIZONA 85018 • (602) 553-0333 • FAX (602) 553-0051
DEBRA K. DAVENPORT, CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
WILLIAM THOMSON
DEPUTY AUDITOR GENERAL
July 23, 2003
Members of the Arizona Legislature
The Honorable Janet Napolitano, Governor
Ms. Mary Gill, Acting Director
Department of Economic Security
Transmitted herewith is a report of the Auditor General, A Performance Audit of two areas
related to foster care services provided by the Department of Economic Security, Division
of Children, Youth, and Families, Child Protective Services: the stability of foster care
children’s living situations and communication with foster parents. This report specifically
addresses a legislative request approved by the Joint Legislative Audit Committee on
August 9, 2001, and was conducted under the authority vested in the Auditor General by
Arizona Revised Statutes §41-1279.03. I am also transmitting with this report a copy of the
Report Highlights for this audit to provide a quick summary for your convenience.
As outlined in its response, the Department agrees with all of the findings and plans to
implement all of the recommendations.
My staff and I will be pleased to discuss or clarify items in the report.
This report will be released to the public on July 24, 2003.
Sincerely,
Debbie Davenport
Auditor General
Enclosure
The Office of the Auditor General has conducted a performance audit of two areas
related to foster care services provided by Child Protective Services (CPS): the
stability of foster care children’s living situations and communication with foster
parents. CPS is a function of the Division of Children, Youth, and Families within the
Department of Economic Security. This audit specifically addresses a legislative
request approved by the Joint Legislative Audit Committee on August 9, 2001, and
was conducted under the authority vested in the Auditor General by A.R.S. §41-
1279.03.
As of March 31, 2003, over 6,800 children were in foster care in Arizona. Children may
be initially placed in shelters or receiving foster homes while their needs and available
care options are identified. If children cannot subsequently be placed with a relative,
CPS looks to other alternatives, such as placement with trained foster parents or in a
group home. Foster care is intended to be a short-term or temporary solution. Once
a child is placed in foster care, CPS case managers develop a plan for permanent
placement and work to achieve this plan. Approximately 2,300 children left foster
care for a variety of reasons between October 1, 2002, and March 31, 2003, the most
current 6-month reporting period for which data is available, including being returned
to their parent, adopted into a new family, or being placed with relatives.
Foster care placement stability can be improved (see
pages 9 through 15)
The Division should continue its efforts to ensure foster care placements are stable.
Research indicates that there are significant negative impacts for foster children
when they are moved frequently while in out-of-home care. The U.S. Department of
Health and Human Services has established national standards for child welfare and
child protection programs and monitors states to determine whether they are
meeting them. The 2001 federal review found that Arizona, like most other states, is
not meeting the standards for foster care placement stability.
Office of the Auditor General
SUMMARY
page i
Over 6,800 children
were in foster care as of
March 31, 2003.
Like most states,
Arizona is not meeting
federal placement
stability standards.
In response to the federal review, the Division has developed an improvement plan
with steps for improving placement stability. For example, the federal review
determined that foster families needed greater preparation and support. The Division
revised its policy to specify in the child’s Out-of-Home Care Plan the services that the
foster parent needs to care for the foster child. In addition to the changes being
implemented through the improvement plan, the Division can also enhance some
other processes to help improve placement stability. These include:
l Clarifying its policy regarding case manager face-to-face visits with foster
children. Current policy calls for the case manager to visit foster children
monthly, but the policy also allows visits by others, such as other CPS staff or
counselors, to substitute for the case manager visits. In contrast, Alabama and
Delaware, both states found to be doing well in the area of placement stability,
report they rarely, if ever, allow substitute visitation.
l Evaluating the potential costs and benefits of adopting innovative approaches
other states use. These include placing children from only one family in a foster
home rather than mixing foster children from several different families, or
determining if temporary shelter care placements can be reduced by making the
child’s first placement a foster home rather than a shelter. Currently, children
may be initially placed in shelters or receiving foster homes while their needs
and available care options are identified. However, children may then have to be
moved to another placement, such as a family foster home.
To ensure that these potential changes and other changes that the Division is already
undertaking to improve placement stability have the desired results, the Division
should use its existing internal quarterly review process to assess their impact.
Foster parents report good communication, but
improvements can be made (see pages 17 through 25)
Although there are several good mechanisms for foster parents to receive and
provide information about the children in their care, additional steps can be taken to
improve communication. This audit was approved by the Joint Legislative Audit
Committee, in part, as a response to some foster parents’ concerns raised to the
Legislature about their ability to provide input regarding their foster children.
Research indicates that to successfully care for children, foster parents need
adequate information about the children in their care, including knowledge of case
plans and medical and behavioral information.
Foster parents report that several communication mechanisms provide them with
helpful information and allow them to actively participate in their foster children’s
State of Arizona
page ii
cases. For example, CPS case manager visits help foster parents to ask questions,
or request things that they or the child need. Of the 26 foster parents auditors
interviewed, 15 reported that they see the CPS case manager regularly and are able
to ask questions, or request things that they or the child need during the visits.
Additionally, foster parents report that they participate in Foster Care Review Board
hearings. The Board is required to review all cases where a child is in an out-of-home
placement within 6 months of the child’s removal and every 6 months thereafter.
Twenty-three of the 26 foster parents interviewed reported that they attend board
hearings, they can speak openly about the child’s needs, and their input is positively
received. Similarly, 18 foster parents reported that the Division’s newsletter for foster
parents contains useful information.
Although several existing communication mechanisms are helpful, others need
improvement. Specifically, the majority of foster parents auditors interviewed reported
that while they received information when children were initially placed in their home,
the information was insufficient. For example, a foster parent indicated that she was
not told about a child’s medical condition and another stated that she had not been
told about the behavioral problems of two children placed in her care. Of special
concern, 16 of the 26 foster parents auditors interviewed said that they believed CPS
had withheld known medical or behavioral information. In some cases, CPS may not
know the information and, therefore, cannot provide it to foster parents. In other
cases, however, such as when a child is initially placed in a shelter before moving to
a family foster home, CPS has an opportunity to gather the information foster parents
need. To address these problems, the Division should form a work group, including
foster parents, to review what type of information is provided to foster parents about
the children in their care, and how best to ensure this information is provided in a
timely manner and updated regularly.
The Division also needs to address other foster parent communication problems. For
example, the Division could use foster parent training to ensure that foster parents
are informed of their right to attend Juvenile Court hearings and are made aware of
all the appeal and grievance processes available to them. The Division should also
take additional steps to ensure that training provided to foster parents is consistent
and provides more practical information on handling medical and behavioral
problems.
A review of best practices and other states’ activities also suggests that the Division
should increase its support mechanisms for foster parents and improve its Internet
resources. First, the Division needs to establish a more comprehensive method of
surveying foster parents so that they can provide meaningful input about their
experiences. Second, the Division needs to enhance foster parent support groups.
According to the National Foster Parent Association, Arizona is one of the few states
that do not have a state-wide foster parent association. While there are some local
foster parent support groups, a state-wide association could ensure all foster parents
have access to needed support, while providing additional resources to existing
Office of the Auditor General
page iii
groups. Strong support groups or mentoring systems are important because nine of
the foster parents auditors interviewed noted that they rely on information and
support they receive from other foster parents. Finally, the Division could better
support foster parents by improving its Web site to include a special section that is
devoted solely to providing information and support to foster parents, as is done in
Arkansas, Colorado, Illinois, Iowa, and Vermont.
State of Arizona
page iv
Office of the Auditor General
TABLE OF CONTENTS
1
9
9
10
11
13
15
17
17
18
19
22
25
1
2
2
4
Introduction & Background
Finding 1: Foster care placement stability can be
improved
Placement changes negatively impact foster children
Arizona did not meet federal placement stability standards
Division taking steps to address stability problems
Areas for further improvement
Recommendations
Finding 2: Foster parents report good communication,
but improvements can be made
Good support and communication important to foster parents
Some communication practices helpful
Some communication mechanisms need improvement
Three additional improvements suggested by other states’ review
Recommendations
Figures:
1 Number of Children in Foster Care by District
As of March 31, 2003
2 Children in Foster Care by Age
As of March 31, 2003
3 Number of Children in Foster Care by Placement Type
As of March 31, 2003
4 Reasons Children Left Foster Care
October 2002 through March 2003
Agency Response
page v
State of Arizona
page vi
Over 6,800 children
were in foster care as of
March 31, 2003.
Office of the Auditor General
INTRODUCTION
& BACKGROUND
page 1
The Office of the Auditor General has conducted a performance audit of two areas
related to foster care services provided by Child Protective Services (CPS): the stability
of foster care children’s living situations and communication with foster parents. CPS
is a function of the Division of Children, Youth, and Families within the Department of
Economic Security (Department). This audit specifically addresses a legislative request
approved by the Joint Legislative Audit Committee on August 9, 2001, and was
conducted under the authority vested in the Auditor General by A.R.S. §41-1279.03.
Abused and neglected children placed in foster care
CPS has statutory authority to remove abused and neglected
children from their homes and place them in out-of-home care,
often referred to as foster care. Arizona Revised Statutes §8-
821 provides that a child may be removed if he or she is either
“suffering or will imminently suffer abuse or neglect” or
“suffering serious physical or emotional damage that can only
be diagnosed by a medical doctor or psychologist.” Although
the Department has the authority to initially remove a child from
his or her home, it must receive approval from the Juvenile
Court or a Voluntary Foster Placement Agreement with the
child’s parents in order for the child to remain in foster care. As
of March 31, 2003, over 6,800 children were in foster care, as
illustrated in Figure 1, ranging in age from less than 1 year to
over 18 years, as illustrated in Figure 2 (see page 2).
Children, upon removal from their homes, may be initially
placed in shelters while their needs and available care options
are identified. Federal law requires that children be placed in
the least restrictive, or most family-like, setting possible.
Therefore, CPS attempts to locate relatives to care for removed
children, rather than placing them in another setting. If a
suitable relative cannot be found, a variety of other foster care
settings are available, including:
Figure 1 Number of Children in
Foster Care by District
As of March 31, 20031
Source: Data provided by the Department of Economic Security.
1 In addition, 68 children were not included in this district
breakout for reasons such as being placed with a
relative outside the State of Arizona.
l Family foster care homes—A licensed person maintains a home and is
reimbursed by the Department to provide room, board, and care to foster
children. The largest percentage of children in foster care are in family foster
care homes, as shown in Figure 3.
State of Arizona
page 2
Figure 2 Children in Foster Care by Age
As of March 31, 2003
Source: Auditor General staff analysis of Child Welfare Reporting Requirements Semi-Annual Report for the period
of October 1, 2002 through March 31, 2003.
Figure 3 Number of Children in Foster Care by Placement Type
As of March 31, 2003
Source: Auditor General staff analysis of Child Welfare Reporting Requirements Semi-Annual Report for the period
of October 1, 2002 through March 31, 2003.
l Group home—A licensed foster home that
cares for five to ten children.
l Residential treatment—A licensed behavioral
health agency hires trained professional staff to
provide daily care and treatment to a group of
children. These facilities typically include an
onsite school.
l Independent living subsidy program—
Dependent youth who are at least 17 years old
can live on their own in the community while still
receiving services from the Department until
they reach the age of 21.
l Trial home visit—Foster children can be
returned to their family on a trial basis but still
remain under the court’s jurisdiction. The
Department retains legal custody and provides
ongoing supervision.
Case plans identify children’s needs
and goals
Once a child is removed from his/her home and
placed in foster care, CPS case managers must
develop a case plan for the child and his/her
parent(s) or legal guardian(s). Case plans identify
permanency care goals for the child, such as return
to parent, or adoption, and the services a child may
need. A wide variety of services is available to foster
children, including medical, dental, and
psychological care. The case plan also identifies the
services the child’s parent and caregiver needs.
The Division and Juvenile Court monitor the child’s
and the parent’s progress in meeting case plans. For
example, CPS case managers are required to
conduct a face-to-face visit with children in foster
care at least monthly. At least one visit in every 3-
month period must be in the foster care provider’s
home. However, the case manager’s supervisor may
approve another division employee or another
Office of the Auditor General
page 3
Facts about Arizona Family
Foster Homes
l Family foster homes are paid an average of $570 per
month per child.1
l 1,865 homes held licenses as of March 31, 2003.
l To become licensed, potential foster parents must meet
numerous requirements, including:
t Provide information about their health, employment,
budget, family relationships, daily routine, spiritual
beliefs, and child care experience;
t Provide at least five character references;
t Complete a CPS background check;
t Complete a Department of Health Services inspection
of their home for sanitation and safety verification,
including their heating and cooling systems, electrical
wiring, sewer disposal system, waste storage and
removal, and other health and safety elements; and
t Complete at least 12 hours of initial training.
Key Parties Involved with Foster Care
l CPS case manager—Plans, coordinates, and monitors
foster child’s care on behalf of the State.
l Foster parent—Provides room, board, and care to the
child.
l Licensing agency—Recruits, trains, and monitors foster
homes. This may be a private organization under contract
with the Department, or the Department’s Office of
Licensing, Certification, and Regulation.
l Service providers, such as counselors—Provides
services as directed in the child’s case plan.
l Foster Care Review Board—Reviews each foster care
child’s case at least once every 6 months to determine
and advise the Juvenile Court on progress toward the
case plan goal.
l Juvenile court judge—Reviews the Division’s request to
place the child in foster care, and permanency goals for
the child.
1 State of Arizona Department of Economic Security, Division of
Children, Youth and Families Fiscal Year 2003 Legislative Briefing
Book, 2003. Daily rates for family foster homes per child range from
$12.57 to $30.44, based on the child’s age and needs.
involved professional person, such as a counselor, to make the face-to-face
contacts, but not the quarterly in-home visits. Other parties also monitor the case’s
progress, such as the Foster Care Review Board, which reviews foster children’s
cases every 6 months and makes recommendations to the Juvenile Court about the
child’s future.
Children leave foster care for a variety of reasons
Because foster care is intended to be a short-term or temporary solution, CPS case
managers work to move foster care children to the permanent placement outlined in
their case plans. As illustrated in Figure 4 ,
2,275 children left foster care for a
variety of reasons during the most
recent reporting period (October 1,
2002, through March 31, 2003)
including:
l Reunification with parent(s)—
Almost half of the children were
reunited with their parent(s) or
primary caretaker.
l Living with other relatives—If the
child cannot return safely to his/her
parent, the Division may identify
relatives who are willing to care for
the child.
l Adoption—If the child cannot be
safely returned home and no
relatives are available, the child can
become legally free to be adopted
into a new family. Most children are
adopted by relatives or their foster
parents.
l Guardianship—The court can appoint a permanent legal guardian for the child.
Relatives or foster care providers can act as legal guardians.
l Reaching age of majority—Children may reach adulthood while under the
Division’s supervision.
Over 2,200 children left
foster care between
October 2002 and
March 2003.
State of Arizona
page 4
Case managers are
required to visit foster
children at least
monthly.
Figure 4 Reasons Children Left Foster Care
October 2002 through March 2003
Source: Auditor General staff analysis of Child Welfare Reporting Requirements Semi-Annual Report for the
period of October 1, 2002 through March 31, 2003.
l Transfer to another agency—Some children’s cases are moved to another
agency’s jurisdiction. For example, some Native American children’s cases can
be transferred to tribal courts.
l Runaway—Sometimes a child may run away from foster care. If the case
manager and the police are unable to locate the child, the Juvenile Court may
dismiss the child’s petition.
Recent reviews
During the course of this audit, the Department was undergoing three other outside
reviews, which included work related to the same topics as this audit.
Accreditation—First, the Division is seeking accreditation by the nationally
recognized Council on Accreditation, which was co-founded by the Child Welfare
League of America. Division management envisions that the accreditation process
will help improve the agency’s credibility, standardize the Division’s policies and
procedures, engage staff in self-evaluation and self-improvement efforts, and provide
staff with a sense of being part of a profession that adheres to standards and goals.
Many public and private organizations are accredited, such as the State of Illinois’
Department of Children and Family Services.
In order to meet accreditation requirements, the Division first completed a self-study
in June 2002. The Division was then visited by several teams of child welfare experts
and professionals who, during different on-site visits, reviewed 600 case files from
across the State, and talked to staff, foster and kin care providers, adoptive parents,
children in care, and community stakeholders. The Council then provided a series of
preliminary accreditation reports to the Division between September and November
2002. The Council found that the Division currently does not meet all requirements
for accreditation. For example, four of the Division’s six regions did not meet
standards related to intake, assessment, and service planning. In contrast, all of the
Division’s regions met numerous other standards, including ethical practice,
organizational integrity, human resource management, culturally competent practice,
and compliance with legal and regulatory requirements. The Council is allowing the
Division to make program improvements before responding to all the preliminary
reports, and no specific time frame for completing accreditation has been
established.
Federal review—Additionally, the Department underwent a Child and Family
Services Review (CFSR) by the U.S. Department of Health and Human Services.
Conducted in 2001, this review evaluated how well the Department provides for child
safety, permanency, and well-being.
Office of the Auditor General
page 5
Similar to the accreditation process, the federal review started with the Division
conducting a state-wide assessment. Specifically, the Division compiled child welfare
and child protection program information regarding systemic factors and outcome
indicators. In the second phase, a group of 54 federal and state representatives
conducted onsite reviews in Maricopa, Cochise, and Yavapai Counties. Reviewers
examined a total of 50 cases, including cases where children received services in
their own homes or were placed in foster care, and conducted interviews with
approximately 125 state and local stakeholders, including foster parents, case
managers, supervisors, citizen review boards, judges, and other community
partners.
The results of the state-wide assessment, onsite reviews, and stakeholder interviews
were compiled into a final report issued on February 1, 2002. The federal government
found that the Division substantially complied with some, but not all, national child
welfare standards. Specifically, the Division substantially complied with national child
welfare standards in five out of seven systemic areas, including its state-wide
information system, case review system, service array, agency
responsiveness, and foster parent recruitment, licensing, and
retention. Likewise, the Division substantially met some national
standards for child welfare outcomes, including child safety. In
contrast, the Division did not substantially meet standards related
to two systemic factors, including quality assurance and training,
as well as child welfare outcomes related to permanency, and
child and family well-being. The Division subsequently developed
a mandated Program Improvement Plan (PIP), which identifies
how it will rectify identified problems.1
Governor’s initiatives—Finally, the Governor issued an
executive order in January 2003 that focused attention on the
Division and other child and family service providers. Specifically,
Executive Order 2003-4 created two groups: (1) the Children’s
Cabinet, to focus attention and resources on problems facing
Arizona’s children; and (2) the Advisory Commission on Child
Protective Services Reform, to make recommendations to the
Governor and the Cabinet on how Arizona can carry out its
mission of serving the best interests of children, particularly those
in the greatest need of protection. The Commission formed seven
sub-committees specializing in Health Services, Education
Services, Community Services, CPS Structure and Location,
Juvenile Justice Issues, Records and Hearings, and Reports to
CPS, which met between February and June 2003. The final
report of the Governor’s Advisory Commission was released on
June 30, 2003 and includes more than 40 recommendations. Some
of these recommendations pertain to foster care, including a recommendation to
establish a policy indicating that, unless there are safety concerns, children should
The Division is in
substantial compliance
with some, but not all,
federal review areas.
1 Deficiencies related to foster care placement stability and foster parent communication will be discussed in Finding 1 (see
pages 9 through 15) and 2 (see pages 17 through 25), respectively.
State of Arizona
page 6
Under Executive Order 2003-4,
the Children’s Cabinet includes:
a. The Governor.
b. The Director of the Arizona Department of Economic
Security or his/her designee.
c. The Director of the Arizona Department of Health
Services or his/her designee.
d. The Director of the Arizona Health Care Cost
Containment System or his/her designee.
e. The Superintendent of Public Instruction or his/her
designee.
f. The Director of the Department of Juvenile
Corrections or his/her designee.
g. The Director of the Arizona Department of Adult
Corrections or his/her designee.
h. The Chair of the Arizona Supreme Court’s
Committee on Juvenile Courts or his/her designee.
i. The Executive Director of the Governor’s Community
Policy Office.
j. The Director of the Governor’s Division for Children.
k. The Governor’s Human Services Policy Advisors.
be placed with their siblings and relatives in their own neighborhoods and
communities; and a recommendation to enhance the recruitment, support, and
payment for family foster homes and reduced reliance on group homes or other non-family
placement settings.
Audit scope and methodology
Consistent with the legislative request, this audit focuses on the stability of foster care
children’s placements and the Division’s communication with foster parents. This
report includes findings and recommendations in two areas:
l The Division should continue its efforts to ensure foster care placements are
stable.
l The Division should take additional steps to improve communication.
Auditors used a variety of methods to study the issues addressed in the report and,
to the extent possible, used information from the other division reviews to evaluate
foster care placement stability and the quality of foster parent communication. For
example, to gather existing information and understand current division efforts to
improve foster care stability and communication with foster parents, auditors
reviewed the preliminary results of the accreditation process, documents related to
the federal CFSR report including the Division’s Program Improvement Plan, and
Executive Order 2003-4 and related planning documents regarding child welfare
initiatives.
To understand the foster care process and the Division’s responsibilities, auditors
reviewed state statute, Arizona Administrative Code, federal law, and the Division’s
policy manual. Additionally, auditors interviewed more than 20 field staff including
case managers, unit supervisors, and district administrators. Auditors also
interviewed officials from the U.S. Department of Health and Human Services, Child
Welfare League of America, and the National Resource Center for Foster Care and
Permanency Planning to identify best practices in foster care.
To evaluate the actions the Division was taking to ensure the stability of foster care
placements, auditors interviewed division staff, including policy and computer
system staff. Additionally, auditors reviewed research articles to identify behavioral
and situational factors that lead to foster care placement disruptions and impacts on
foster children. Likewise, auditors interviewed representatives from Alabama’s,
Delaware’s, and New Mexico’s departments that provide foster care services to
identify best practices regarding foster parent communication and placement
stability. These states were selected because the federal Child and Family Service
Review found that they were doing a good job of ensuring that foster children’s
placements were stable.
Office of the Auditor General
page 7
Auditors interviewed 26
foster parents from
across Arizona.
To evaluate the adequacy of mechanisms used to communicate with foster parents,
auditors conducted telephone interviews with 26 foster parents throughout the State.
Additionally, auditors observed a foster care provider meeting and foster parent
support group and orientation meetings to gain first-hand understanding of the foster
care placement process, foster parent issues, and information presented to foster
parents. Likewise, auditors interviewed administrative and field staff from the
Department’s Office of Licensing, Certification, and Regulation; representatives from
licensing agencies; and the Department’s Family Advocacy Office to obtain
information about the licensing of foster homes and foster parents’ concerns.
Additionally, auditors reviewed Family Advocacy Office telephone call logs and
grievance forms to identify past complaints from foster parents.
This audit was conducted in accordance with government auditing standards.
The Auditor General and staff express appreciation to the acting director and staff of
the Department of Economic Security for their cooperation and assistance during the
audit.
State of Arizona
page 8
Foster care placement stability can be improved
The Division should continue its efforts to ensure that foster care placements are
stable. Research indicates that there are significant negative impacts for foster
children when they are moved between numerous placements. However, in 2001, the
federal government found that Arizona did not meet the national standard for
placement stability. Although the Division is already taking steps to improve
placement stability, it should consider additional enhancements and innovative
practices.
Placement changes negatively impact foster children
Numerous studies and researchers report that children are adversely affected by
placement disruptions and unnecessary moves while in out-of-home care. For
example, a policy statement from the American Academy of Pediatrics indicates that
children who have experienced abuse or neglect have an elevated need for
permanency, security, and a constant emotional attachment.1 Another study reveals
that multiple placements produce unstable relationships that can negatively affect
children’s ability to form attachments to significant others.2 Similarly, others report
that children can face mental health issues, such as low self-esteem, distrust of
others, mood disorders including depression and anxiety, social and moral
immaturity, and cognitive and language delays.3,4
Abused and neglected
children have an
elevated need for
permanency, security,
and a constant
emotional attachment.
1 American Academy of Pediatrics—Committee on Early Childhood, Adoption, and Dependent Care. Developmental
Issues for Young Children in Foster Care. Pediatrics, Vol. 106, No. 5. November 2000. 1145-1150.
2 Usher, Charles, Karen Randolph, and Harlene Gogan. Placement Patterns in Foster Care. Social Service Review, March
1999. 22-36.
3 Wulczyn, Fred, Joseph Kogan, and Brenda Jones Harden. Placement Stability and Movement Trajectories. Provided by
the Child Welfare League of America.
4 Bradbard, Jacquelyn J. Children’s Adjustment to Foster Care Placement: Perceptions of Foster Parents and Former Foster
Youth. A thesis presented to the Department of Social Work, California State University, Long Beach. May 2000.
Office of the Auditor General
FINDING 1
page 9
Despite the importance of stable placements, foster children in Arizona may be
moved for a variety of reasons. In some instances, a placement change may be
made so that a child can be reunited with his or her siblings in a different foster care
placement or to live with relatives in a kinship care arrangement. At other times, a
placement interruption may occur as a child is transitioned to a less restrictive setting,
such as movement from a residential treatment center to a family foster home. Other
reasons for placement interruption can include child safety concerns, inappropriate
initial matching of a child and provider, and problems between the foster parent and
foster child.
Arizona did not meet federal placement stability
standards
The federal government has established standards for placement stability and
regulates and monitors states’ efforts to ensure placement stability through the use
of two evaluation tools: state data submissions and onsite file reviews. The most
recent review of Arizona, based on 1999 data and a file review in September 2001,
found that the State did not meet the standards for foster care placement stability.
States provide federal government with placement stability data—The
federal Department of Health and Human Services (DHHS) requires states to submit
key child welfare and child protection program data, including the number of
placements foster care children experience while in care. This data must be
submitted every 6 months to the federal government and is reported annually to
Congress. States must count virtually all placements that occur for each foster care
child, including changes to and from shelter and group home care, relative or kinship
care, residential treatment, and family foster care. Changes that would not be
counted include trial home visits and temporary respite visits.
DHHS uses the data it receives to assess how well states are doing by comparing
the data to the national standards it established for placement stability. The national
standard for placement stability was set at the 75th-percentile of all state
performance in the area of foster care placement stability and requires that 86.7
percent or more of each state’s foster care children who have been in care for less
than 1 year have no more than two placements. According to the 1999 federal fiscal
year data Arizona was required to submit for the federal Child and Family Services
Review (CFSR) conducted in 2001, about 82 percent of Arizona’s foster children in
care for less than 1 year have met this criterion.
Federal government conducts onsite file reviews—In addition to reviewing
data, DHHS also evaluates how well states are doing to provide placement stability
for foster children and other performance measures by reviewing foster children’s
files as a part of its CFSR. Unlike the data analysis, which simply considers the total
State of Arizona
page 10
A child may be moved
to be placed with
siblings or with relatives.
number of children’s placement changes regardless of reason, the file review allows
DHHS to examine individual cases and determine whether specific placement
changes are necessary to achieve and are consistent with the child’s case plan. For
example, if a file demonstrates that a child moved from a mental health facility to a
family foster home because the child’s mental health sufficiently improved, the move
would be considered consistent with the case plan and DHHS would consider it
appropriate. DHHS requires that at least 90 percent of the cases its reviewers
examine demonstrate that children were in stable placements, unless the moves
were consistent with the child’s case plan objectives. The 2001 Child and Family
Services onsite review of case files found that only 71 percent (22 of 31) of Arizona’s
foster care cases met this standard.
Like Arizona, most states have not yet met the national standard for placement
stability. For example, only 4 of the 31 states that had completed a CFSR in 2001 and
2002 had placement stability rated as an area of strength. Arizona was one of the 27
states rated as needing improvement.1 When compared to the other 29 states
reporting review outcomes, Arizona ranked 16th on the data submission portion and
24th for the onsite case file review.2
Division taking steps to address stability problems
During the CFSR, both division staff and federal reviewers discovered several
reasons why Arizona is not meeting the stability standards. As a result, the Division
worked with DHHS to formulate a Program Improvement Plan to address identified
problems, including placement stability. The Division’s plan to improve stability calls
for changes in three main areas:
l Placement options and support for older youth—During the CFSR process, the
Division and federal reviewers determined that stability was a particular problem
for older children. For example, federal reviewers found that in more than half of
the cases examined where a child experienced multiple placements, the child
was between the ages of 11 and 15. As a result, the program improvement plan
calls for the Division to improve the availability of foster homes able to provide
stability to older children. Increasing the number of homes available for these
children, who can be difficult to place, may increase the likelihood they can be
matched to a home that can ideally meet their needs and thus stay in the home
for a longer period of time. Contractors in District I that recruit and monitor foster
care homes are now required to develop and show specific recruitment plans
for homes that accept older children, sibling groups, and children from diverse
ethnic groups.
Improvement plan
addresses homes for
older children, the need
to properly assess
children, and data
problems.
Like most other states,
Arizona does not meet
the national standards
for placement stability.
1 Alabama, Delaware, New Mexico, and Oregon were the four states that had the placement stability portion of their CFSR
rated a “strength.” A total of 32 states participated in these reviews in 2001 and 2002, but Wyoming’s results were not
released at the time of this report.
2 No data submission outcome was reported in the CFSR final reports for New York and West Virginia, and no onsite file
review outcome was reported for Arkansas and Kansas in their final reports. As a result, the state rankings for both
placement stability indicators were based upon the reported outcome for 29 of the 31 states that participated in CFSRs
in 2001 and 2002.
Office of the Auditor General
page 11
l Identification of foster placement needs and planning—Federal reviewers also
found that there was a need to prepare and support foster families to meet the
needs of children, noting that the primary reason for placement disruption was
inadequate preparation and support of foster parents. For example, reviewers
noted that some children were moved for relatively minor behavioral infractions.
Therefore, the program improvement plan directs the Division to improve the
identification of needs for both foster children and out-of-home care providers
and of services to address those needs. Also noted in the plan is a step to
increase child-specific planning during placement transitions to ensure stability
in the next placement.
In response, the Division has revised its case planning and case management
policies to place a greater emphasis on evaluating and providing for children’s
needs, thereby increasing the likelihood that the child will be placed in the most
appropriate setting possible and that he or she will succeed in care. For
example, an exhibit that was added to the Division’s policy manual provides
guidance to case managers on what questions to ask during visits with the child
and provider to help them assess foster child safety and developmental
progress, adjustment to the placement, and the suitability of the child’s and
provider’s services. Additionally, the Division revised its policy to require that
services the out-of-home caregiver will need to adequately care for the child be
included in the child’s Out-of-Home Care Plan. Similarly, the Division has
modified its core training for unit supervisors to include information on identifying
children’s needs and monitoring case managers’ efforts to assess and meet
them.
l Accuracy of foster care placement stability data—In the state-wide assessment
portion of the CFSR, the Division identified problems with the way the placement
stability data was extracted and counted. According to the Division, these
problems led to some over-counting of placement changes. The Division has
worked to improve the accuracy of the regular data submissions to the federal
government since 2001. For example, the Division selected a sample of cases
and followed up to ensure the system was accurately counting each child’s
placements and that placements were accurately recorded. Similarly, it
improved its procedures for counting placements and enhanced its computer
programming to detect some potential data entry errors. Arizona’s placement
stability data provided to the federal government for federal fiscal year 2001
indicates that Arizona had moved from 81.9 percent in 1999 to 82.9 percent in
2001.
Additional guidance
provided on how to
assess children’s safety,
developmental
progress, and
adjustment to the
placement.
State of Arizona
page 12
Areas for further improvement
In addition to continuing to implement the planned improvements mentioned above,
the Division can improve foster care stability by enhancing existing procedures and
foster parent support mechanisms, and considering the potential costs and benefits
of innovative practices used by better-performing states.
Enhance existing procedures or mechanisms—First, the Division should
revise its policies regarding case manager visits with foster children to only rarely
allow substitute visitations. Current division policy requires case managers to meet
face-to-face with foster children at least once per month.1 However, the policy also
allows case managers to rely on other division staff, such as human service workers,
and other professional service providers, such as counselors, to fulfill this
requirement. According to the Division, this policy exists in part because of workload
issues. However, the Division recognizes the case manager is in the best position to
identify and address problems that arise in foster homes and provide supplemental
support before a child in placement reaches a crisis and must be moved. While other
division staff and service providers can ensure the child’s safety, their contact with the
child serves different purposes, such as providing transportation or medical services,
and does not necessarily identify potential problems in the foster home that could
eventually result in a placement change.
In contrast, Alabama and Delaware, both states found to be doing well in the area of
placement stability, rarely if ever allow substitute visitation. Additionally, DHHS
analysis of outcomes for states participating in the CFSR in 2002 found significant
relationships between case manager visits with children and achievement of
reunification, involvement of children and parents in case planning, and in meeting
the children’s educational, physical, and mental health needs. Therefore, the Division
should clarify its policy to ensure that substitutes be used only under rare
circumstances.
Second, the Division should increase its support for foster parents. As discussed in
Finding 2 (pages 17 though 25), foster parents would benefit from additional support
mechanisms, which can also impact placement stability. For example, Delaware
reports improving its placement stability by organizing groups of foster homes into
small, geographically based clusters that allow for sharing of best practices,
provision of respite care, and additional support among foster parents. Additionally,
New Mexico’s child welfare system utilizes foster parents who contract with the state
to liaison with other foster parents, or identifies experienced foster parents to act as
mentors, and has active state and county foster parent associations. New Mexico’s
child welfare administration notes that foster parents credit the liaisons with
improving placement stability, adding that state and county foster parent
The Division should only
rarely allow substitutes
for required monthly
case manager visits with
foster children.
1 Division policy indicates that, for certain placements such as emergency shelter and receiving home care, case
managers are supposed to have face-to-face contact with the child and provider every 2 weeks. Shelter care and
receiving homes are often the initial placements for children entering foster care and are considered short-term
placements.
Office of the Auditor General
page 13
associations work together to furnish foster parents with information and training, and
provide general support.
Finally, the Division can use its existing peer review process to ensure that these and
other policy changes are having the desired effect of increasing placement stability.
As a part of the peer review process, division staff review a sample of cases involving
children under the Division’s jurisdiction on a quarterly basis. Consistent with the
federal CFSR procedures, the Division can use this peer review to ensure that the
new practices and policies are properly implemented and that placement stability is
increasing.
Consider whether innovative practices would be beneficial—In addition
to improving existing procedures, the Division should evaluate the benefits of
adopting innovative practices used by other states to increase placement stability.
Because Arizona is currently considering the future of its child protective service
function through such initiatives as the Governor’s Advisory Commission on Child
Protective Services Reform, there is a unique opportunity to consider options that
may not be feasible under existing operations and resources. Although these
practices might require additional resources, the Division should consider whether
any potential benefits justify the possible costs. For example, the Division should
consider the feasibility of:
l Allowing foster parents to care for only one sibling group at a time—Alabama
currently uses this practice for therapeutic foster homes and places children
from only one family in each therapeutic foster home, rather than mixing children
from different families.1 As a result, foster parents’ burden can be minimized by
focusing on the needs of just one family and working with only one CPS case
manager. Although Alabama uses this practice for therapeutic foster homes, the
Division should consider the feasibility of using this practice in general family
foster care settings because the benefits to foster care children and foster
parents might outweigh any additional resource needs, such as the need to
recruit and retain a larger number of foster families. The Division reports that
between October 2002 and March 2003, 283 foster homes were licensed, while
196 homes exited the foster care system. Additionally, the most frequently cited
reason foster parents reported for exiting the system was because they had
adopted a foster child. The Division also indicated that they are trying to increase
the number of placements able to provide care for siblings but that more
resources are needed, including more homes of the right type, number, and
location.
l Decreasing use of shelter care—Some other states’ experiences suggest that
the Division should consider decreasing its reliance on shelter care placements.
Arizona foster children may be initially placed in a shelter setting, during which
time their needs are assessed, and then they are moved to a family foster home
or other appropriate setting. This virtually ensures that these children must be
Arizona has a unique
opportunity to consider
adopting innovative
ideas.
1 Therapeutic foster homes typically provide more intensive treatment services for children with greater mental health or
behavioral management needs.
State of Arizona
page 14
moved at least once. In contrast, New Mexico and Alabama immediately place
children in foster care and then conduct an assessment of their needs. Only
those children who are found to need more intensive services than can be
provided in a family foster care home must be subsequently moved.
Recommendations
1. The Division should continue to implement its federally mandated Program
Improvement Plan, including increasing the number of homes available for older
and other difficult to place youth, better preparing and supporting foster families,
continuing to work to improve the accuracy of foster care data, and continuing
other efforts to improve placement stability.
2. The Division should revise its policy to clarify that substitutes be allowed to
replace case managers in the required monthly face-to-face visits with foster
children only under rare circumstances.
3. The Division should use its peer review process to ensure that policy changes
are having the desired effect of increasing placement stability.
4. As Arizona considers the future of child protective services, the Division should
evaluate the benefits of adopting innovative practices other states used to
increase placement stability, such as single family-group placements and a
decreased use of shelter care.
Office of the Auditor General
page 15
State of Arizona
page 16
Foster parents report good communication, but
improvements can be made
Although there are several good mechanisms for foster parents to receive and
provide information about the children in their care, additional steps can be taken to
improve communication. Foster parents report that several communication
mechanisms provide them with helpful information and allow them to actively
participate in their foster children’s cases, such as case manager visits and Foster
Care Review Board hearings. However, foster parents report that they would also
benefit from improved information about the children in their care and believe CPS
withholds some information. Additionally, the Division can improve communication
by enhancing its foster parent survey mechanism, support groups, and Web site.
Good support and communication important to foster
parents
This audit was approved by the Joint Legislative Audit Committee, in part, as a
response to some foster parents’ concerns raised to the Legislature about their ability
to provide input about the children they were fostering. Research indicates that to
successfully care for children, foster parents need to have adequate information
about the children in their care, including knowledge of case plans and medical and
behavioral information. For example, one research article indicates that foster parents
need the support of the child welfare agency and a network of other foster parents
who can serve as mentors, and foster parents need the opportunity to provide
feedback to the agency without fear of reprisal.1 In addition, another research article
indicates that some foster parents resign because of poor agency support, case
worker communication, and services, or because of the many stresses associated
Research suggests that
good communication
helps retain foster
parents.
1 Christian, Steve. Supporting and Retaining Foster Parents. National Conference of State Legislatures, State Legislative
Report. 27:11: April 2002.
Office of the Auditor General
FINDING 2
page 17
with caring for foster children such as a lack of respite care,1 the children’s difficult
behavior, and interactions with birth parents.2
Some communication practices helpful
There are several communication mechanisms that provide foster parents with
information and allow them to actively participate in their foster children’s cases.
Auditor analysis of 26 foster parent interviews found that some communication
processes are beneficial.
Case manager visits useful—CPS case manager visits help foster parents to
receive and provide information about children in their care. Division policy requires
CPS case managers to have face-to-face contact with foster children and foster
parents monthly. These visits must occur specifically with the child and caregiver
together in the caregiver’s home at least once every 3 months. Case managers use
the visits to assess the safety and progress of the child, the adjustment of the child
and foster parent to each other, and the adequacy of the services and supports
provided to both the child and the foster parents. According to the Division, 68
percent of the required monthly visits were completed during March 2003.3
More than half of the foster parents interviewed reported that case manager visits
provided useful communication opportunities. For example, of the 26 foster parents
interviewed, 15 reported that they see the case manager regularly and are able to ask
questions, or request things that they or the child need during the visits. Eighteen
foster parents said that they also have contact with case managers by telephone. In
addition, seven foster parents said that each case manager is different and some will
share more information than others.
Licensing agency specialist visits helpful—Similarly, licensing agency
specialist visits often enable foster parents to provide and receive information about
the children in their care. The licensing agencies that contract with the Division to
recruit, train, and monitor foster parent homes require their own specialists to
periodically visit the homes.4 The Division reports that 91 percent of the foster homes
1 Respite care is the provision of short-term care for a foster child to temporarily relieve a foster parent from the duty of
caring for him or her.
2 Rhodes, Kathryn, et al. “A Comparison of Family Foster Parents Who Quit, Consider Quitting, and Plan to Continue
Fostering,” Social Services Review, March 2001.
3 Child Welfare Reporting Requirements Semi-Annual Report for the Period of October 1, 2002 through March 31, 2003. The
Division reports that it has verified that more than the reported number of children received the required visit. However, it
is unable to compile and tabulate this information because of how it is stored in the Division’s database.
4 In some parts of the State, the Division contracts with private agencies for foster parent recruitment, training, monitoring,
and retention. In other parts of the State, the Department’s Office of Licensing, Certification, and Regulation performs
some of these functions, including monitoring through licensing case manager visits.
State of Arizona
page 18
CPS case manager
visits help foster
parents.
that required a licensing specialist to visit between January 2003 and March 2003
were visited as required.1
Thirteen foster parents reported that the visits from licensing specialists provide an
opportunity for them to ask questions and to talk about how the children are doing.
Eighteen said that licensing specialists are responsive to their concerns and help
them if they need something. In addition to home visits, eight foster parents reported
having telephone contact with licensing specialists.
Foster parents participate in Foster Care Review Board hearings—
Foster parents auditors interviewed attend and speak at Foster Care Review Board
hearings. The Board is required to review all cases where a child is in an out-of-home
placement within 6 months of the child’s removal and every 6 months thereafter.2
These hearings are held so that the Board can review the efforts that have been
made to carry out the case plan. Twenty-three of the foster parents auditors spoke
with reported that they attend Foster Care Review Board hearings, they can speak
openly about the children’s needs, and their input is positively received.
Newsletter provides valuable information—The Division collaborates with a
vendor to publish a bimonthly newsletter for foster parents. Auditors reviewed several
issues of the newsletter and found that it regularly contains useful information such
as articles on child development, back-to-school advice, and safety reminders.
Eighteen foster parents auditors interviewed reported that they receive the newsletter
and find it to be somewhat interesting and useful.
Some communication mechanisms need improvement
Some foster parent input mechanisms were identified by foster parents or federal
reviewers as needing improvement.
Evaluate information provided to foster parents—The majority of foster
parents auditors interviewed report that the information CPS provides to them about
children in their care is not sufficient and they believe CPS withholds some
information from them. Division policy requires that the CPS case manager provide
each foster parent with a foster child placement packet within 5 days of placement.
The packet contains a series of forms with medical, educational, and behavioral
information about the child. Foster parents are responsible for completing and
updating some of the forms in the packet. For example, foster parents are
responsible for updating a form about the child’s personal habits such as what they
like to eat, when they go to bed, etc. All of this information is important because it
helps ensure foster parents can adequately care for the children placed with them
Newsletter published for
foster parents is useful.
Most foster parents
interviewed reported
positive experiences
with the Foster Care
Review Board.
1 Child Welfare Reporting Requirements Semi-Annual Report for the Period of October 1, 2002 through March 31, 2003. Due
to a lack of automation in reporting foster home visits, the Division believes that this number does not reflect all of the
foster homes that received the required visitation.
2 A.R.S. §8-515.03, Duties of local foster care review boards.
Office of the Auditor General
page 19
and provides information to other foster parents if the child moves to a new
placement.
The majority of foster parents auditors interviewed reported that they receive
placement packets, but the packets do not contain enough information. Six foster
parents reported that they understood the Division may not always know much about
the children and, therefore, cannot provide them with needed information. However,
16 of the 26 foster parents interviewed said that they believed CPS had withheld
known medical or behavioral information. For example:
l One foster parent reported that a premature baby who was placed with her
when the baby was about 6 weeks old had a virus, but the child’s placement
packet contained no medical information.
l Another foster parent said that an 11-year-old child who had been in foster care
since the age of 3 was placed in her home, but she was not told that the child
had been in foster care for that long nor were the child’s behavioral problems
explained. This lack of information caused the child to be removed from the
foster home.
l Another foster parent said that the placement packets she receives are
“absolutely not adequate.” For example, she received two children late in the
summer of 2002 who had been originally removed from their home in early 2002
and the packets she received with the children were empty. Both children
exhibited extreme sexual behavior for their age and the foster parent indicated
she was not told about these issues.
Division officials indicated that policy and practice promotes and requires that all
information pertinent to the care of the child must be shared with caregivers, but in
some instances the case managers may be newly assigned to the case and may not
know the information. The Division also indicated that there may be other factors
contributing to foster parents’ perception that information is withheld, such as some
packets containing too much information or the information in the packet not being
presented in terms that the foster parent can easily understand. For example, a
completed, up-to-date packet of a child who has been in foster care for an extended
period of time could include more than an inch-thick file of documents. Foster
parents might find it difficult to identify critical information. However, division officials
agreed that they could form a work group to review what type of information should
be contained in the placement packet and how best to ensure that information is
provided in a timely manner and updated regularly. The Division should include foster
parents in this work group.
Improve information foster parents receive about Juvenile Court
hearings—Foster parents are not always notified about or allowed to speak in
The majority of foster
parents interviewed
believe CPS had
withheld known
information about their
foster children.
State of Arizona
page 20
Juvenile Court hearings. When a child is removed, numerous Juvenile Court hearings
are held to affirm the case plan goals, determine progress toward those goals, and
make decisions on the case, such as whether a child should be returned home or
parental rights should be terminated. Most foster parents auditors interviewed
reported that they attend court hearings. Eleven mentioned that the court allows them
to testify, while seven said that they are invited by the court just to observe. However,
three foster parents reported that they do not receive notice that the hearings are
occurring and two said CPS had discouraged them from attending. While foster
parents should be receiving notice of hearings from the court, if a foster child is
moved to a new placement or a foster parent moves after a hearing has been set,
the notice may have gone to the previous foster parent or old address. However, the
Division could address this issue by ensuring that the placement packets contain
information on upcoming hearings and ensuring through case manager visits and
training that foster parents are informed of their right to attend court hearings.
Ensure foster parents are aware of appeal and grievance
processes—Although the Division provides some information to foster parents
about their right to appeal certain CPS decisions, additional steps can be taken to
ensure that foster parents are adequately informed of available options. State law or
division policy provides three appeal/grievance processes:
l The Family Advocacy Office, which foster parents can use to make an informal
complaint or inquiry about individual cases that involve the child welfare system.
For example, a foster parent might report that he or she is experiencing
communication problems with the foster child’s case manager. The Family
Advocate would help by contacting the case manager or the case manager’s
supervisor to facilitate improved communication.1
l The client complaint/grievance process, which foster parents can use to file a
formal grievance with the Division. For example, a foster parent might file a
formal grievance because she had ongoing concerns about a child’s case
manager that had not been resolved through less formal mechanisms.
l The foster parent child removal appeal process, which foster parents can use to
appeal the planned removal of a foster child from their home when he/she will
be placed into another family foster home, unless the move is due to specific
circumstances, such as safety and risk of harm concerns or to reunite the child
with siblings or relatives.2
Almost all of the foster parents auditors interviewed reported that they were unaware
of at least one of these mechanisms. The Division can do more to provide information
on these mechanisms, such as making sure that they are well covered in the training
foster parents receive when renewing their license and adding information about
these processes to its Web site.
Some foster parents are
unaware of available
appeal and grievance
processes.
Most foster parents
interviewed reported
that they attend court
hearings.
1 A.R.S. §8-828, Family Advocacy Office; duties; program termination.
2 A.R.S. §8-515.05, Removal of child from foster parent’s home; requirements; notification; review.
Office of the Auditor General
page 21
Standardize and improve foster parent training—The Division can take
additional steps to ensure that training provided to foster parents is consistent and
contains more practical information on handling health and behavioral problems.
Foster parents receive training before they are licensed and on an annual, ongoing
basis from either a private agency that contracts with the Division to recruit, train, and
monitor foster parent homes, or from the Department’s Office of Licensing,
Certification, and Regulation.
The 2001 CFSR process identified a need for the Division to develop a process to
monitor the consistency and quality of training for foster parents. As a result, the
Division has contacted the licensing agencies throughout the State to gather
information about their individual foster parent training curricula, and has held an
initial meeting with them to discuss standardizing the foster parent training.
As the Division revises the foster parent training, it should continue to seek foster
parent input about what their training needs are and how those needs can best be
met. For example, six foster parents auditors interviewed indicated that they would
like to have other foster parents teach and share their experiences in training classes.
Likewise, eight foster parents reported that they would like to have more detailed
training about how to handle medical and behavioral issues.
Three additional improvements suggested by other
states’ review
A review of best practices and the activities of other states suggest that the Division
should systematically solicit foster parent feedback, increase its support
mechanisms for foster parents, and improve its Internet resources.
Solicit additional foster parent feedback—Although the Division already
solicits some feedback from foster parents, a more comprehensive mechanism
should be established. The Division has three mechanisms for soliciting foster parent
input, including a foster parent wrap-up form, which foster parents complete when a
child is removed from their home; a customer satisfaction survey, which is sent to
1,000 clients and providers, including foster parents, every month; and a foster
parent survey, which mainly focuses on foster parent recruiting practices. However,
none of these mechanisms solicits foster parents’ impressions of the foster care
system as a whole and uses that information to make changes that are important to
foster parents.
The Division should improve one of its three survey mechanisms or try some other
method to ensure foster parents can regularly provide meaningful input. For
example, South Dakota reports that it hopes to increase its understanding of foster
families’ experiences and concerns by improving its monthly reporting mechanism.
Foster parents reported
they would like more
detailed training about
how to handle medical
and behavioral issues.
State of Arizona
page 22
South Dakota found that, in part, poor retention of foster parents was due to a lack
of meaningful and ongoing dialogue between agency personnel and foster families.
Therefore, foster families will complete an improved monthly report to the agency that
provides information about the child’s well-being, the stressors on the family, and the
foster parents’ perceptions of the placement’s stability. Staff will be trained on how to
respond to the needs expressed in the reports.
Strengthen foster parent support groups, mentoring, and respite
systems—The Division can help strengthen Arizona’s foster parent
support/mentoring network by collaborating with its licensing agencies to establish a
more comprehensive system of support groups, mentoring, and respite care
systems. According to the National Foster Parent Association, Arizona is one of only
a few states that do not have a state-wide foster parent association. While some of
the licensing agencies sponsor local foster parent support groups, state-wide foster
parent associations can provide important supports to local foster parent groups and
often sponsor activities, conferences, and training events that foster parents can take
advantage of. In addition, there are some portions of Arizona where foster parents do
not have access to any local foster parent support groups. For example, in District 5,
which includes Pinal and Gila Counties, foster homes are licensed by the
Department’s Office of Licensing, Certification, and Regulation, which does not
sponsor a foster parent support group. Similarly, some parts of other districts are not
served by a foster parent support group. Strong support groups or mentoring
systems are important because nine of the foster parents auditors interviewed noted
that they rely on information and support from other foster parents. In addition, four
of the foster parents auditors interviewed reported that there is a need to improve
their access to respite care, which can be facilitated through local support groups.
States such as Alabama and Delaware have implemented strong, active state and
local foster parent associations or mentoring systems. For example, Delaware
groups foster parent homes into geographic clusters of 12 foster homes. Unlike
Arizona, these clusters are available throughout the state and are financially
supported by the state agency. Specifically, the agency pays a monthly stipend of
$100 to one foster family in the cluster that organizes a foster parent support network
with the other homes in the cluster. In addition to providing a venue for foster parents
to share information and support each other, these cluster groups are used to
facilitate respite care for foster families. Additionally, the state agency employs staff
dedicated to assist these cluster groups. Similarly, Alabama has county, regional,
and state foster parent associations. Alabama’s regional groups offer trainings and
CPR classes, and work with area food banks to provide low-cost food to foster
parents.
Improve Division’s Web site—The Division should also update its Web site to
include a special section that would be useful to Arizona foster parents. Currently,
there are no specific portions of the Division’s Web site that are devoted solely to
providing information and support to foster parents. Auditors reviewed child welfare
The Division’s Web site
could contain
information useful for
foster parents.
Some parts of Arizona
do not have foster
parent support groups.
Office of the Auditor General
page 23
agencies’ Web sites from five other states that contain information pertaining to foster
parents. For example:
l Arkansas’ Division of Children and Family Services Web site contains
information about the responsibilities of foster families and links to other useful
sites on the Web that provide information useful to foster parents;
l Colorado’s Department of Human Services Web site has links to foster parent
associations, as well as lists of books, magazines, and online resources;
l Illinois’ Department of Children and Family Services Web site contains links to its
policy manual and the state’s administrative rules concerning foster care, as well
as handbooks and other information about foster parenting;
l Iowa’s Department of Human Services Web site has information about training
opportunities, medical insurance, support groups, and respite care services;
and
l Vermont’s Social and Rehabilitative Services Web site contains department
policy information pertaining to foster parenting as well as a link to the Vermont
Foster Parent Association. The Association’s Web site has information about
foster parent licensing, available training classes, and links to local foster parent
support groups.
State of Arizona
page 24
Recommendations
1. The Division should ensure that case managers provide all known medical and
behavioral information about the child to the foster parents. To do so, the
Division should form a work group, including foster parents, to review the type
of information that should be contained in the placement packet and how best
to ensure the information is provided in a timely manner and updated regularly.
2. The Division should ensure that foster parents are aware of their right to attend
court hearings by informing them during case manager visits and ensuring this
information is covered in foster parent training.
3. The Division should ensure that foster parents receive adequate information
about its complaint/grievance processes including the Family Advocacy Office,
the client complaint/grievance process, and foster child removal appeal process
through means such as foster parent training or information provided on the
Division’s Web site.
4. The Division should continue its plans to improve foster parent training. When
improving the training, the Division should continue to seek input from foster
parents about what their training needs are and how those needs can best be
met.
5. The Division should enhance an existing survey mechanism or implement a new
one to solicit more comprehensive input from foster parents.
6. The Division should ensure that all foster parents in Arizona have an opportunity
to participate in support groups, mentoring, and respite care systems by
organizing foster homes into clusters, or developing another method.
7. The Division should update its Web site to include information that would be
useful to Arizona foster parents, such as links to pertinent portions of the
Division’s policy manual, state statutes, administrative rules, and information
about foster parent support groups and training classes.
Office of the Auditor General
page 25
State of Arizona
Office of the Auditor General
AGENCY RESPONSE
State of Arizona
_____________ARIZONA DEPARTMENT OF ECONOMIC SECURITY_______________
1717 W. Jefferson - P.O. Box 6123 - Phoenix, AZ 85005
Janet Napolitano Mary Gill
Governor Acting Director
July 18, 2003
Debbie Davenport
Auditor General
Office of the Auditor General
2910 North 44th Street, Suite 410
Phoenix, Arizona 85018
Dear Ms. Davenport:
Thank you for the opportunity to provide comments on the evaluation of the Department’s foster
care services as related to foster care placement stability and foster parent communication. We
concur with the recommendations made by your office, and will begin our implementation of the
recommendations using current resources.
Our Department is very committed to the children of Arizona, especially those children who
cannot safety remain in their own homes and require foster care placement. These children and
their foster parents deserve our greatest attention. We must assure that the services we
provide to foster children and foster parents are the services that will best meet their needs.
Foster parents are viewed as an essential part of a child’s service team. Open communication
between Department staff and foster parents is needed for foster care placement stability and
the successful achievement of permanency for children in out of home care.
As described in our enclosed response, improving foster care placement stability and enhancing
our relationship with the foster parent community will remain a high priority for our Department.
These efforts are also consistent with recommendations made by the Governor’s Advisory
Commission on Child Protective Services and the federal Child and Family Services Review.
Full implementation of the recommendations made by your office will require the Department to
devote additional resources. This comes at a time of extreme budget reductions. Nevertheless,
because of our commitment to the children, the children’s families, and the children’s foster
parents, the Department plans on implementing the recommendations.
Please feel free to call me at (602) 542-5678, or Mary Lou Q. Hanley, Assistant Director for the
Division of Children, Youth and Families at (602) 542-3598 if additional information is needed.
Sincerely,
Mary Gill
Acting Director
Enclosure
1
DEPARTMENT OF ECONOMIC SECURITY’S RESPONSE
to the
AUDITOR GENERAL’S RECOMMENDATIONS
for
FOSTER CARE PLACEMENT STABILITY and FOSTER PARENT COMMUNICATION
The Office of the Auditor General’s evaluation of the Department’s efforts to ensure that foster care
placements are stable and that communication mechanisms with and from foster parents are
effective includes two findings with eleven recommendations. Four of the recommendations pertain
to foster care placement stability. Seven recommendations pertain to foster parent communication.
The Department of Economic Security is pleased to provide the following comments regarding these
recommendations.
The Department’s Division of Children, Youth and Families administers the Child Protective Services
Program, and is referred to as “the Division” in this response.
FINDING 1: FOSTER CARE PLACEMENT STABILITY CAN BE IMPROVED.
Recommendation 1:
The Division should continue to implement its federally mandated Program Improvement Plan,
including increasing the number of homes available for older and other difficult to place youth,
better preparing and supporting foster families, continuing to work to improve the accuracy of foster
care data, and continuing efforts to improve placement stability.
DES Response:
The finding of the Auditor General is agreed to and the audit recommendation will be implemented.
The Division is pleased to report several efforts that are currently underway or planned for the
future. The Division plans to:
· increase the number of homes available for older and other difficult to place youth;
· better prepare and support foster families;
· continue to work to improve the accuracy of foster care data; and,
· continue efforts to improve placement stability.
2
First, the Division’s efforts to increase the number of foster homes available for older children
include:
· specific outcome-based incentives are included within the foster home recruitment, study and
supervision (HRSS) contracts with private agencies for increasing and maintaining the placement
of older children; and
· incentives are included in specific HRSS contracts in Maricopa County for developing and
implementing targeted recruitment plans for older children, sibling groups, and other difficult to
place children.
The outcomes of these contract tasks and provisions will continue to be assessed during the next year
to determine their effectiveness.
The Division’s Recruitment Plan includes general, targeted, and child specific goals and objectives
that, as a whole, are designed to increase the number of foster and adoptive homes available for all
ages of children, including children with specialized needs. This statewide Division-driven Plan is
implemented, in part, through contracts with private agencies.
One of the most significant resources to enhance communication of the Division’s need for foster and
adoptive homes for children is the Arizona Foster Care and Adoption Coalition (AFCAC). AFCAC
is chaired by the Division and includes statewide representation from the private agencies
responsible for recruiting foster and adoption homes for the Division. This year, AFCAC developed
the following Mission Statement: “The Arizona Foster Care and Adoption Coalition is a statewide
collaboration that increases public awareness of children in the child welfare system through
education and training. By capitalizing on Arizona resources and maximizing communication, the
Arizona Foster Care and Adoption Coalition supports system changes to improve recruitment and
retention of families for children”. AFCAC consistently requests the active participation of foster
and adoptive parents at meetings.
The statewide toll-free information line 1-877-KIDS NEEDU is one of the Division’s links to the
public for disseminating information about foster and adoptive parenting. Information on the toll-free
information line is also made available on the Division’s Website, posters, brochures, bookmarks,
magnets, license plate frames, and other recruitment promotional materials. Recently, this telephone
line was expanded to provide information in Spanish.
To better prepare and support foster parents, the Division has intensified its collaboration with the
behavioral health system. In-service training opportunities for foster parents at conferences will
include more sessions related to the mental and behavioral health needs of children and effective
strategies to meet the children’s needs, including supports needed by the care giving family.
The Division is currently pursuing the use of a standardized, nationally-recognized foster and
adoptive parent training curricula for statewide use. Within the next thirty days, the Division
anticipates reviewing two nationally-recognized training packages.
Recently, discussions within the foster parent community have focused on the need for a foster
parent association in Arizona. An initial meeting to discuss the feasibility of forming a foster
3
parent association is being scheduled for late August 2003. Information regarding the meeting will
be disseminated through AFCAC, other contract agencies, and through the Arizona Statewide, a
newsletter for foster and adoptive parents. Additional local support resources can also be provided
to foster families through their foster home agencies.
The Division continues efforts in improving the accuracy of foster care data. The Division is using a
quarterly Peer Record Review process to thoroughly review case-specific data from a randomly-selected
sample of child protective service cases. Foster placement stability is one of the areas
examined during the Peer Record Review process.
Recommendation 2:
The Division should revise its policy to clarify that substitutes be allowed to replace case managers in
the required monthly face-to-face visits with foster children only under rare circumstances.
DES Response:
The finding of the Auditor General is agreed to and the audit recommendation will be implemented.
The Division will modify policies and procedures regarding case manager’s face-to-face contact with
foster children to clarify the rare circumstances in which face-to-face contact between the child and
another child welfare professional is permissible.
The Division will use the Peer Review Process to monitor compliance with the revised policy.
Recommendation 3
The Division should use its peer review process to ensure that policy changes are having the desired
effect of increasing placement stability.
DES Response:
The finding of the Auditor General is agreed to and the audit recommendation will be implemented.
As previously stated, the Division is pleased to report that the use of the Peer Review Process is fully
operational on a statewide basis. The Division will continue to enhance the Peer Review Process to
ensure that policy and practices related to stable foster care placements are effective.
4
Recommendation 4:
As Arizona considers the future of child protective services, the Division should evaluate the benefits
of adopting innovate practices other states used to increase placement stability, such as single family-group
placements and a decreased use of shelter care.
DES Response:
The finding of the Auditor General is agreed to and the audit recommendation will be implemented.
The Division will consider the options in the Report as methods for improving placement stability.
The Division will explore innovative practice options, such as foster homes that provide care for only
one sibling group at a time and increased use of “emergency receiving” foster care services in family
foster homes. Since these options impact both licensing procedures and contract agency tasks,
coordination with the Department’s Office of Licensing, Certification and Regulation (OLCR) and
the private foster home agencies is required when considering these options.
FINDING 2: FOSTER PARENTS REPORT GOOD COMMUNICATION, BUT IMPROVEMENTS
CAN BE MADE.
Recommendation 1:
The Division should ensure that case managers provide all known medical and behavioral
information about the child to the foster parents. To do so, the Division should form a work group,
including foster parents, to review the type of information that should be contained in the placement
packet and how best to ensure the information is provided in a timely manner and updated
regularly.
DES Response:
The finding of the Auditor General is agreed to and the recommendation will be implemented.
The Division has started a review of the methods used by case managers for providing children’s
medical and behavioral health information to foster caregivers. A workgroup of case managers has
been formed to make recommendations regarding improving the “Child Placement Packet” process.
The Division will also use the Peer Review Process to monitor compliance with the Placement Packet
process. In addition, the Division will actively request the input of foster parents in the development
of recommendations for improving the Child Placement Packet process. It is essential that the most
efficient and effective methods for sharing information about foster children with caretakers be
expeditiously implemented.
5
Recommendation 2:
The Division should ensure that foster parents are aware of their right to attend court hearings by
informing them during case manager visits and ensuring this information is covered in foster parent
training.
DES Response:
The finding of the Auditor General is agreed to and the recommendation will be implemented.
The Division will implement this recommendation through basic and advanced foster parent
training. The Division will also explore ways to expeditiously update information, such as changes
in foster parent’s addresses, in applicable forms. This will improve the Court’s ability to send official
notice of court hearings to foster parents.
Recommendation 3:
The Division should ensure that foster parents receiving adequate information about its
complaint/grievance processes including the Family Advocacy Office, the client
complaint/grievance process, and the foster child removal appeal process through means such as
foster parent training or information provided on the Division’s Web site.
DES Response:
The finding of the Auditor General is agreed to and the recommendation will be implemented.
The Division will include information about the complaint/grievance process, including the Family
Advocacy Office and the foster child removal “appeal “process, on the Department’s Web site. This
will better assure that foster parents will have access to this information. In addition, the Division
will consider other opportunities to provide this information to foster parents, such as including the
information in foster parent training and the Arizona Foster Home Handbook. The information will
also be made available in alternate formats and languages, upon request.
Recommendation 4:
The Division should continue its plans to improve foster parent training. When improving the
training, the Division should continue to seek input from foster parents about what their training
needs are and how these needs can best be met.
6
DES Response:
The finding of the Auditor General is agreed to and the recommendation will be implemented.
As previously stated, the Division is currently pursuing the use of a standardized, nationally-recognized
foster and adoptive parent training curricula for statewide use. Within the next thirty
days, the Division anticipates reviewing two nationally-recognized training packages.
With foster parent input, a workgroup will be formed to incorporate Arizona-specific licensing
requirements, Arizona-specific policy and procedures, and training requests from foster parents into
the curricula purchased.
Recommendation 5:
The Division should enhance an existing survey mechanism or implement a new one to solicit more
comprehensive input from foster parents.
DES Response:
The finding of the Auditor General is agreed to and the recommendation will be implemented.
The Division is currently reviewing the results of a “recruitment-focused” survey. The input
provided from 126 surveys is being reviewed, and additional responses will be reviewed and
analyzed as completed surveys are received. The Division will also begin receiving copies of foster
parent surveys that are now required by the home recruitment, study, and supervision contacts.
Since the survey questions are not standardized for all contract agencies, a wide variety of
information can be obtained from these semi-annual surveys.
The Division will also explore other methods of receiving input from foster parents and other
caregivers, including the possible use of a Web site-based feedback tool.
Recommendation 6:
The Division should ensure that all foster parents in Arizona have an opportunity to participate in
support groups, mentoring, and respite care systems by organizing foster homes into clusters, or
developing another method.
DES Response:
The finding of the Auditor General is agreed to and the recommendation will be implemented.
The Division will explore methods of offering these services to foster parents through existing
resources and future modifications to foster home agency contracts.
7
In addition, foster parents, contract agencies, and the Division are discussing the feasibility of having
a statewide foster and adoptive parent association. An association of this type will provide a new
forum and voice for foster and adoptive parents to elevate their needs, concerns, issues, complaints,
questions, and wishes. As previously stated, an initial organization meeting of the foster parent
community is scheduled for late August 2003. The primary purpose of this meeting is to discuss
options for creating a statewide foster and adoptive parent association. Contact information for
foster and adoptive parents who have expressed an interest in becoming more actively involved in
recruitment, retention, and training activities will be shared with the leaders of this effort.
Recommendation 7:
The Division should update its Web site to include information that would be useful to Arizona
foster parents such as links to pertinent portions of the Division’s policy manual, state statutes,
administrative rules, and information about foster parent support groups and training classes.
DES Response:
The finding of the Auditor General is agreed to and the recommendation will be implemented.
The Division will actively work with the Department’s Public Information Office in an effort to fully
utilize the Web site as an effective way for disseminating information to the community. The
Division will also discuss the use of automated links to existing resources through the Web site.
The Division will report progress on the implementation of the recommendations at six month
intervals.
_____________________________________
02-01 Arizona Works
02-02 Arizona State Lottery
Commission
02-03 Department of Economic
Security Kinship Foster Care
and Kinship Care Pilot
Program
02-04 State Parks Board 
Heritage Fund
02-05 Arizona Health Care Cost
Containment System 
Member Services Division
02-06 Arizona Health Care Cost
Containment System Rate
Setting Processes
02-07 Arizona Health Care Cost
Containment System Medical
Services Contracting
02-08 Arizona Health Care Cost
Containment System 
Quality of Care
02-09 Arizona Health Care Cost
Containment System 
Sunset Factors
02-10 Department of Economic
Security Division of Children,
Youth and Families, Child
Protective Services
02-11 Department of Health
Services Health Start
Program
02-12 HB2003 Children s Behavioral
Health Services Monies
02-13 Department of Health
Services Office of Long Term
Care
03-L1 Competitive Electric Metering,
Meter Reading, and Billing
and Collections
03-01 Government Information
Technology Agency 
State-wide Technology
Contracting Issues
03-02 Registrar of Contractors
03-03 Water Infrastructure Finance
Authority
03-04 State Board of Funeral
Directors and Embalmers
Performance Audit Division reports issued within the last 12 months
Future Performance Audit Division reports
Board of Appraisal
State Board for Charter Schools