Performance audit, Department of Economic Security, Division of Children, Youth and Families, Child Protective Services - Congregate Care

              Debra K. Davenport
Auditor General
Performance Audit
Department of
Economic Security—
Division of Children, Youth and Families—Child
Protective Services—Congregate Care
Performance Audit Division
JUNE • 2009
REPORT NO. CPS-0901
A REPORT
TO THE
ARIZONA LEGISLATURE
The 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 services
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
Audit Staff
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.azauditor.gov
Senator Thayer Verschoor, Chair Representative Judy Burges, Vice Chair
Senator Pamela Gorman Representative Tom Boone
Senator John Huppenthal Representative Cloves Campbell, Jr.
Senator Richard Miranda Representative Rich Crandall
Senator Rebecca Rios Representative Kyrsten Sinema
Senator Bob Burns (ex efficio) Representative Kirk Adams (ex efficio)
Melanie M. Chesney, Director
Catherine Dahlquist, Manager and Contact Person
Pamela Niesl, Team Leader
Marc Owen
2910 NORTH 44th STREET • SUITE 410 • PHOENIX, ARIZONA 85018 • (602) 553-0333 • FAX (602) 553-0051
WILLIAM THOMSON
DEPUTY AUDITOR GENERAL
DEBRA K. DAVENPORT, CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
June 25, 2009
Members of the Arizona Legislature
The Honorable Janice K. Brewer, Governor
Mr. Neal Young, Director
Department of Economic Security
Transmitted herewith is a report of the Auditor General, a Performance Audit of the Department
of Economic Security, Division of Children, Youth and Families—Child Protective Services—
Congregate Care. This report was prepared pursuant to and under the authority vested in the
Auditor General by Arizona Revised Statutes §41-1966.
As outlined in its response, the Department of Economic Security agrees with the findings and
plans to implement 5 of 6 recommendations as outlined. It will handle one of the
recommendations in a different manner.
My staff and I will be pleased to discuss or clarify items in the report.
This report will be released to the public on June 26, 2009.
Sincerely,
Debbie Davenport
Auditor General
Attachment
Congregate Care
The Division can take steps
to better ensure the safety
and well-being of children
living in group settings
known as congregate care
including shelters, group
homes, and residential
treatment centers (RTCs).
Specifically, the Division
should improve the time-liness
of its investigations of
CPS reports alleging abuse
and neglect of children in
group homes and shelters
so that threats are miti-gated
promptly. The Divi-sion
should also seek a
statutory amendment that
would clarify that CPS has
authority to investigate
allegations of abuse and
neglect in RTCs. This will
ensure information on
substantiated instances of
abuse is entered into the
State’s central registry and
is considered when
conducting background
checks of prospective
congregate care
employees having direct
contact with children.
Finally, the Division should
implement changes to in-crease
the effectiveness of
outcome monitoring as a
means to help ensure
quality congregate care
services.
The Department agrees
with the findings and will
implement 5 of the 6
recommendations as
outlined. It will handle one
of the recommendations in
a different manner.
This audit was conducted
under the authority vested
in the Auditor General by
Arizona Revised Statutes
§41-1966.
The Department of Economic Security’s (Department) Division of Children, Youth
and Families (Division) oversees Arizona’s Child Protective Services (CPS)
program. The CPS program is designed to protect children alleged to have been
abused or neglected by their parents, guardians, or custodians.
Sometimes, to protect a child from abuse and neglect, CPS staff will remove the
child from his/her home, and the court will order that the child be placed
temporarily in out-of-home care. In accordance with child welfare best practices,
federal law requires that when a child is removed from his/her home, the child
must be placed in the least-restrictive setting available consistent with his/her
best interests and needs.1 In some cases, this may be with a relative or licensed
foster family. However, some children have needs that require the structure and
services provided in a group setting, referred to as congregate care.
In Arizona, there are three types of congregate care settings available for
children who have been removed from their homes by CPS: group homes,
shelters, and residential treatment centers (RTCs). All congregate care facilities
are licensed and paid staff provide 24-hour care and supervision of the children.
Further, all congregate care is provided through contracted service providers.
Although the need for congregate care remains, the Division continues to reduce
its use and expenditures for this type of care.
Improvements needed in congregate care
investigations (see pages 5 through 13)
The Division can better ensure the safety of children living in group homes and
shelters by promptly investigating CPS reports alleging abuse and neglect of the
children by facility staff. Prompt investigations facilitate the Division’s ability to
quickly mitigate threats and provide needed services to the children, but auditors
found that many of the investigations involving children in these facilities were not
being completed, documented, and closed in a timely manner.
The Division can also help protect children in congregate care by seeking a
statutory amendment clarifying that CPS has authority to investigate reports
alleging abuse and neglect of children in RTCs by facility staff. CPS investigates
allegations of child abuse and neglect in group homes providing behavioral
health services that are licensed by the Arizona Department of Health Services,
Office of the Auditor General
page i
Agency Comments
SUMMARY
Our Conclusion
1 42 U.S.C. 675(5)(A)
State of Arizona
which also investigates these allegations as part of its licensing responsibilities.
However, CPS does not investigate allegations of child abuse and neglect within
RTCs because the Division does not believe that it has authority to do so. CPS can
only investigate allegations of abuse and neglect involving children’s parents,
guardians, or custodians, and the Division does not believe that RTC staff have a
custodial relationship with the children. Rather, only the Department of Health
Services investigates these allegations as part of its licensing responsibilities and it
uses different procedures and standards than are required for CPS investigations.
Statute and department policy require that staff providing direct care to children in
contracted congregate care facilities undergo both criminal and central registry
background checks. The central registry is an automated repository of information on
CPS-substantiated reports of child abuse and neglect committed by parents,
guardians, and custodians. However, only CPS-substantiated reports may be
included in the central registry. Therefore, vital information regarding allegations of
abuse and neglect in RTCs is not available for the central registry background
checks.
To address these issues, the Division should:
 Implement the Division’s action plan to improve the timeliness of investigations
of alleged abuse and neglect in congregate care settings by more effectively
tracking investigation activity, updating investigators on upcoming investigation
completion dates, and increasing supervisor communication with investigators
about ongoing investigations.
 Review and prioritize the responsibilities of the specialized investigation unit that
investigates reports of alleged abuse and neglect in family foster homes, group
homes, and shelters to ensure tasks critical for ensuring child safety, such as
completing investigations within 21 days, are performed.
 Monitor and ensure that the Division’s policy that requires staff to document
case activity within 10 days of its occurrence is met in order to improve the
availability of investigative information for management’s use in monitoring
investigation thoroughness, workload, and productivity.
 Seek a statutory amendment that would clarify that CPS has authority to
investigate allegations of abuse and neglect in RTCs to improve the
completeness of the central registry information used to conduct congregate
care employee background checks.
page ii
Division should improve congregate care outcome
monitoring (see pages 15 through 18)
Monitoring congregate care providers’ performance using outcome measures helps
ensure that children are well served and tax dollars are effectively spent. The
Department’s contracts with the congregate providers each include several outcome
measures for assessing provider performance. Both the providers and the Division
share responsibility for gathering and reporting data on the various outcomes.
However, the Division has not been enforcing the reporting requirement, nor using
the outcome data to assess providers’ performance. Further, some of the outcome
measures are inadequate. Division officials reported that limited staffing hinders its
ability to evaluate the outcome data and use it to monitor the providers’ performance.
The Division should review and revise the outcome measures within its congregate
care contracts according to established criteria, enforce the requirement that
outcome data be gathered and reported to the Division, and use the information to
monitor providers’ performance, including using the data as additional criteria for
yearly contract renewal and as the basis for helping providers identify problems and
correct deficiencies.
page iii
Office of the Auditor General
State of Arizona
page iv
Congregate care used to meet children’s specific
needs
page 1
Federal law requires
that a child removed
from home is placed
in the least-restrictive
setting, meaning one
that is most like a
family, consistent with
the child’s best
interests and needs.
Some children have
needs that require the
structure and services
provided in group
settings, referred to as
congregate care.
Congregate care
includes group
homes, shelters, and
residential treatment
centers. The Division
is moving toward its
goal of reducing the
number of children in
congregate care, and
related costs.
BACKGROUND
Office of the Auditor General
The Department of Economic Security’s (Department) Division of Children,
Youth and Families (Division) oversees the State’s Child Protective Services
(CPS) program, which is designed to protect children alleged to have been
abused and neglected. In some instances, to protect a child from further abuse
and neglect, CPS staff will remove the child from his/her home, and the court
will order that the child be placed temporarily in out-of-home care. In
accordance with child welfare best practices, federal law requires that when this
occurs, the child be placed in the least-restrictive setting available consistent
with his/her best interests and needs, such as with a relative or licensed foster
family. However, some children have needs or circumstances that require the
structure and services provided in a group setting, referred to as congregate
care.
Three types of congregate care settings available to CPS—Three
types of congregate care settings are available for children who are removed
from their homes by CPS—group homes, shelters, and residential treatment
centers.1 Although all of the settings are licensed and paid staff provide 24-hour
care and supervision of children, they still vary in a number of ways.2
Specifically:
 Group homes tend to be smaller than other types of congregate care
settings, typically capable of housing between five and ten children of a
specific gender and age group. Group homes are considered staff-secured
as opposed to being a locked facility, and the children typically
attend local schools. Additionally, some group homes provide behavioral
health treatment services. According to a 2008 study, children placed in
group home settings are typically older, more likely to be male, and a
minority, and experience a range of socio-emotional and behavioral
problems as compared with children living in family foster homes.3 Division
personnel indicated that group homes may also be used to keep siblings
together when no family foster home is available to take them. Division
management reported that as of May 2009, the daily cost for group home
care ranged from $54 to $185 per child depending on the level of care
provided.
1 In addition to caring for children referred through the child welfare system, these facilities may care for children
referred through the Arizona juvenile court system, the Arizona Department of Juvenile Corrections, and the state
behavioral health system.
2 Division officials reported that in addition to paid staff, some of the larger shelter facilities may also use volunteer
staff.
3 Ryan, J.P., Marshall, T.M., Herz, D., & Hernandez, P.M. (2008). Juvenile delinquency in child welfare: Investigating
group home effects. Children and Youth Services Review, 30(a), 1088-1099, doi:10.1016/j.childyouth.2008.02.004
 Shelters differ from group homes in that they are used on an emergency or
temporary basis. For example, a child may be placed in a shelter temporarily if
a family foster placement is not available when the child is removed from his/her
home. Shelters vary significantly in the number of children they are capable of
housing, ranging from as few as 2 to more than 40, and may serve both boys
and girls of different ages. Children in shelters are enrolled in school. Although
children in all congregate care settings may be transported to medical and
dental appointments, some shelters have on-site medical and developmental
services for children who require special care. Division management reported
that the daily cost for shelter care ranged between $79 and $130 per bed.
 Residential treatment centers (RTCs) are generally larger than group homes and
shelters, housing between 20 and 87 children, and may serve both boys and
girls of different ages. RTCs can be locked or staff-secured facilities and on-site
schooling is usually provided. The major difference between RTCs and group
homes and shelters is that RTCs provide intensive care, supervision, and
psychiatric oversight of children who have moderate to severe emotional,
behavioral, and/or substance abuse problems. Services include individual,
group, and family therapy; schooling; recreation; and living skills training. The
severity of a child’s behavioral or mental health problems is the primary factor in
determining whether to place the child in an RTC instead of a group home that
provides behavioral health services. Division management reported that the
daily cost for RTC care ranged between $235 and $265 per child.
As of April 2009, the Department contracted with 200 congregate care facilities to
care for children removed from their homes by CPS (see Table 1 on page 3). The
majority of facilities are located in District I (Maricopa County) and District II (Pima
County), the two most populated of the CPS program’s six geographical districts. If
a district does not have a facility within its boundaries that meets a child’s needs, CPS
may place the child in a facility in a nearby district.
Division’s use of congregate care decreasing—In keeping with its efforts
to place children in the least-restrictive setting possible consistent with their needs,
the Division has been working to reduce the number of children it places in
congregate care. As illustrated in Figure 1 (see page 3), the percentage of children
removed from their homes by CPS who were living in a congregate care setting on
June 30, 2005, 2006, 2007, and 2008 declined from 22 percent to 15 percent. The
Division attributes this trend to reasons such as its increased success in placing
children with relatives and licensed foster families and greater availability of and
attention to placement data, which has improved staffs’ ability to monitor children’s
progress toward a less-restrictive setting.
Although the number of children living in group homes and shelters is decreasing, as
shown in Table 2 (see page 4), the number of children in RTCs has increased since
fiscal year 2006. Typically, if a child is placed in an RTC, it is because the court has
page 2
State of Arizona
page 3
District (County)
Group
Homes Shelters
Residential
Treatment
Centers Total
1 Maricopa 83 24 6 113
2 Pima 53 5 0 58
3 Apache, Coconino,
Navajo, Yavapai 8 3 1 12
4 La Paz, Mohave, Yuma 2 1 0 3
5 Gila, Pinal 6 1 1 8
6 Cochise, Graham,
Greenlee, Santa Cruz 3 2 1 6
State-wide 155 36 9 200
Table 1: Number of Congregate Care Facilities Contracted for
Placement of Children Removed by CPS by District
As of April 2009
Source: Auditor General staff summary of a division-prepared spreadsheet of contracted congregate
care facilities as of April 2009.
Office of the Auditor General
ordered the placement and/or the Regional Behavioral Health Authority (RBHA) has
approved the placement based on a documented need.1 According to division
officials, staff and the RBHA in District I initiated a joint evaluation process in 2006 that
allowed some children to be placed in less-restrictive settings, such as group homes,
with additional community supports. Although the joint evaluation process ended in
less than a year when the Arizona Department of Health Services contracted with a
new RBHA, District I staff are working with the current RBHA to reinstate it.
0
5
10
15
20
25
2005 2006 2007 2008
Percent
Figure 1: Percentage of Children in Out-of-home Care
Living in a Congregate Care Setting
As of June 30, 2005, 2006, 2007, and 2008
Source: Auditor General staff analysis of division placement data on children
removed from their homes by CPS and living in out-of-home care on June
30, 2005, 2006, 2007, and 2008.
1 RBHAs are state-contracted, managed-care organizations that contract with service providers to provide behavioral
health services in specific geographic areas.
page 4
Congregate care expenditures also decreasing—As shown in Figure 2,
in line with the reductions in congregate care use, the Division’s congregate care
expenditures have also steadily decreased between fiscal years 2005 and 2008.
Specifically, in fiscal year 2008, the Division spent approximately $50 million for
contracted congregate care, which was 25 percent less than it spent in fiscal year
2005. Both State General Fund and federal monies such as Title IV-E (Foster Care
and Adoption Assistance) and Title IV-A (Temporary Assistance for Needy Families)
monies are used to fund congregate care. In addition to funding provided through
the Division, other sources were used to pay for
congregate care expenditures. For example,
division management estimated that in
December 2008, approximately 80 percent of
the children removed from their homes by CPS
and placed in RTCs and group homes licensed
by the Arizona Department of Health Services
were funded through the RBHAs using federal
Title XIX (Medical Assistance Programs) monies.
The Division pays the allowances for all the
children, and room and board for children not
eligible under Title XIX. In some instances, non-
Title XIX placements for youth adjudicated both
dependent and delinquent are cost shared with
the Arizona Department of Juvenile Corrections
or county juvenile probation agencies.
State of Arizona
Fiscal Year
Facility Type 2005 2006 2007 2008
Group homes 3,925 3,675 3,284 2,788
Shelters 3,151 2,705 2,662 2,313
Residential treatment centers 311 271 319 367
Table 2: Number of Children in Congregate Care by Setting1
Fiscal Years 2005 through 2008
1 A child may be counted in more than one facility type within the fiscal year if he/she was moved from
one type of congregate care setting to another.
Source: Auditor General staff analysis of division congregate care placement data on children removed
from their homes by CPS and living in a group home, shelter, or RTC at any point during the
year for fiscal years 2005 through 2008.
$66.9
$59.3
$54.6
$49.8
0
10
20
30
40
50
60
70
80
In Millions
2005 2006 2007 2008
Figure 2: Annual Congregate Care Expenditures
Fiscal Years 2005 through 2008
Source: Auditor General staff analysis of division-prepared data on congregate care
expenditures for fiscal years 2005 through 2008 obtained from the Division’s
Child Information Library and Data Source.
page 5
Improvements needed in congregate care
investigations
Investigations help to ensure child safety
A vital part of Child Protective Services’ (CPS’) responsibility to promote the
safety and protection of children is achieved by promptly investigating CPS
reports alleging abuse and neglect. Timely investigation is critical because a
delay may jeopardize a child’s immediate safety and long-term well-being by
failing to mitigate threats to the child and/or provide needed services.
Further, timely investigations also help ensure that congregate care staff
members who have abused children do not continue to work in congregate care
settings. During an investigation, an alleged perpetrator may still work for a
congregate care provider, resign, or be terminated by the provider, but then be
hired by another provider. However, statute requires that once the abuse or
neglect allegation is substantiated, it must be recorded in the central registry.1
The Department uses this automated system to record information on the
perpetrators of substantiated incidents of child abuse and neglect committed by
parents, guardians, and custodians.The information in the central registry is
used to conduct background checks on prospective department employees
and employees of their contracted service providers. If a job applicant is listed in
the central registry because CPS determined that he/she was responsible for
high- or moderate-risk abuse and neglect or the death of a child, he/she is not
eligible for employment in a position having direct contact with children, thereby
helping prevent abusive staff from moving to different congregate care facilities.
It is also important that CPS investigators document their actions in a timely
manner in the Division’s automated CPS case management system known as
CHILDS (Children’s Information Library and Data Source). This ensures that the
information can be factored into the safety assessment and decision-making
process if a subsequent report is received involving the same child, alleged
perpetrator, or facility. The information is also available for management’s use in
monitoring investigation thoroughness, workload, and productivity. Additionally,
CPS staff’s delay in documenting their actions may negatively affect the
accuracy of that information.
Timely investigation of
reports of alleged
child abuse and
neglect within
congregate care is
important to help
ensure child safety
and well-being.
Oftentimes the
Division has not met
statutory and division
timeliness
requirements for
investigating these
reports, determining a
finding, and closing
the case. In addition,
the Division has not
documented
investigation activities
in a timely manner,
which may impact
accuracy and impacts
management’s ability
to monitor workload
and productivity.
Therefore, to better
ensure the safety and
well-being of children
in congregate care,
the Division needs to
improve congregate
care investigation and
documentation
timeliness. The
Division should also
seek a statutory
amendment clarifying
CPS' authority to
investigate allegations
of abuse and neglect
in RTCs to improve
the completeness of
the central registry
information used to
conduct congregate
care employee
background checks.
Office of the Auditor General
FINDING 1
1 Before a person’s name can be entered into the central registry, the individual must be afforded due process. If
the outcome of due process is that probable cause exists to sustain the Department's substantiation finding, then
the person's name will be entered into the central registry.
Division should improve timeliness of congregate care
investigations and documentation
Although the Division is required to conduct and record investigations promptly,
many CPS investigations of alleged child abuse and neglect in congregate care are
not being completed, documented, and closed within statutory and/or division policy
time frames. A.R.S. §8-802 and division policy require that CPS investigators enter a
decision, or finding, into CHILDS for each allegation of abuse and neglect in a CPS
report within 21 days of receiving the report. Entry of the finding(s) in CHILDS signifies
that the investigation has been completed. Division policy requires that investigation
documentation be completed and the investigation closed within 45 days of the unit’s
being assigned the report. These requirements apply to all CPS reports, not just
those involving children in congregate care.
A specialized CPS investigation unit in District I conducts the investigations of reports
alleging child abuse and neglect within group homes and shelters for the entire State.
In addition, the unit investigates reports alleging abuse and neglect in family foster
homes within Maricopa County. The unit consists of a supervisor and three
investigators. It is the unit’s responsibility to determine if there is evidence to
substantiate or unsubstantiate that the alleged abuse and neglect occurred.
According to auditors’ review of CPS reports assigned to the unit, the unit conducted
74 investigations of alleged abuse and neglect in congregate care in calendar year
2007, and 73 investigations in calendar year 2008.1
Many congregate care investigations not completed in a timely
manner—Although the Division is statutorily
required to complete investigations within 21
days of report receipt, few of the congregate care
investigations met the time frame. Promptly
conducting investigations helps ensure children’s
safety and well-being by mitigating threats and/or
providing needed services in a timely manner.
However, auditors’ analysis found that only 3
percent, or 4 of 147, of the investigation unit’s
2007 and 2008 congregate care investigations
had findings entered into CHILDS within 21 days
(see Figure 3). Further, 11 percent, or 16 of 147,
exceeded the time frame by more than 6 months.
Auditors conducted additional assessment to
determine if it was only the documentation of the
findings or the actual investigation activities, such
as interviewing the alleged child victims and
perpetrators and reviewing police and medical
page 6
1 In addition to the 74 investigations of alleged child abuse and neglect in congregate care in calendar year 2007, and the
73 investigations in calendar year 2008, the unit was assigned to investigate 194 CPS reports in non-congregate care
settings in calendar year 2007 and 184 CPS reports in calendar year 2008.
State of Arizona
Figure 3: Compliance with Entering Investigation Findings
Within 21 Days of Report Receipt
Reports Received in Calendar Years 2007 and 2008
Source: Auditor General staff analysis of division data for 147 CPS congregate
care investigations conducted in calendar years 2007 and 2008 from the
Department’s data warehouse.
Not entered
13% (20)
Exceeded by
over 1 year
1% (1)
Exceeded by
6 to 12 months
10% (15)
Met standard
3% (4)
Exceeded by
1 to 30 days
20% (29)
Exceeded by
1 to 6 months
53% (78)
reports, which were untimely. Specifically, auditors reviewed the documentation for
23 investigations conducted by the unit during the first half of 2008 that did not have
investigation findings entered into CHILDS within 21 days. Seventeen of the 23
investigations had investigation activities that occurred beyond the 21-day time
frame. For example, in 14 of the investigations, the investigator was still interviewing
the alleged child victim, other children in the facility, or facility staff more than 21 days
after being assigned the report and in three investigations, the investigator was still
interviewing more than 3 months after being assigned the report.
Many congregate care investigations not documented and closed in
a timely manner—Although division policy requires that the investigative unit
document and close investigations within 45 days of a report’s receipt, few
congregate care investigations met the time frame.1 It is important that investigations
be documented in a timely manner because this ensures that the investigative
information can be factored into the safety assessment and decision-making
process if a subsequent report is received involving the same child, alleged
perpetrator, or facility. It is also important to close investigations in a timely manner to
facilitate management’s ability to monitor and manage investigator workload and
productivity by providing an accurate picture of the number of active investigations.
However, auditors’ analysis found that only 10 percent, or 15 of 147, of the
investigations conducted in calendar years 2007 and 2008 were closed within the
required time frame (see Figure 4). Additionally, for 20 of the 23 investigations
auditors reviewed that were conducted in the first half of 2008, the investigators did
not even begin documenting the case in CHILDS until after the 45-day time frame
expired. For 15 of the 23 investigations, investigators did not begin documenting the
case in CHILDS until more than 3 months after the start of the investigation.
page 7
Office of the Auditor General
1 The investigator’s supervisor may close the congregate care investigation after ensuring that the investigator took
appropriate actions to address the alleged child victim’s continued safety and well-being and reviewing the investigative
documentation to ensure that it is complete, thorough, and accurate.
Figure 4: Compliance with Closing Investigations Cases
Within 45 Days of Report Receipt
Reports Received in Calendar Years 2007 and 2008
Source: Auditor General staff analysis of division data for 147 CPS congregate
care investigations conducted in calendar years 2007 and 2008 from the
Department’s data warehouse.
Not entered
19% (28)
Exceeded by
over 1 year
1% (1)
Exceeded by
6 to 12 months
12% (18)
Met standard
10% (15)
Exceeded by
1 to 30 days
12% (17)
Exceeded by
1 to 6 months
46% (68)
page 8
Several reasons cited for untimely congregate care investigations—
Division management provided several reasons to help explain the specialized
investigation unit’s lack of investigation and documentation timeliness. First, at times
the unit experienced delays in receiving police and medical reports and delays in
gaining access to those involved in the case, such as alleged perpetrators, which
contributed to some investigations remaining open for extended periods. Second,
the unit assisted with some District I investigations, thus hampering its ability to
complete its own investigations in a timely manner.1 Finally, management indicated
that changes the Division made to its comprehensive tool for assessing child safety
and family strengths and risks in February and November 2007 required that
investigators relearn how to navigate the automated system.
Despite the delays in completing and documenting congregate care investigations,
unit staff maintain that child safety is ensured because often the child is removed,
and/or the alleged perpetrator is put on leave or terminated when the unit notifies the
group home or shelter that there will be an investigation. However, removing the child
does not guarantee the safety of the remaining children in the group home or shelter,
and terminating the alleged perpetrator does not guarantee the safety of children in
other group homes or shelters. In one case reviewed by auditors, a child in a group
home alleged that a staff person abused him prior to the group home terminating that
person for an undisclosed reason. Investigation revealed that the terminated staff
person went on to work at another group home and was under CPS investigation for
allegedly abusing a child there. During that investigation, which was eventually
substantiated, the staff person went on to work at a third group home.
Division should take actions to resolve untimely congregate care
investigations, but may be limited by budget issues—To help ensure
child safety and well-being in congregate care facilities, it is important that unit
investigators adhere to statutory and policy time frames for completing,
documenting, and closing investigation cases. Division officials indicated that in
March 2009 an action plan was developed to address investigation and
documentation timeliness issues in the investigative unit. The plan requires the unit
supervisor to revise the unit’s procedures to more effectively use manual and online
systems to track investigation activity, to provide weekly updates to investigators on
finding due dates, and to increase the frequency of supervisor contact with
investigators to discuss the progress of ongoing investigations. Additionally, the
Division can help facilitate staff compliance with the investigative time frames by
ensuring that the unit remains adequately staffed and by not routinely using the unit
to assist with other investigative units’ workloads. Further, the unit supervisor should
monitor and ensure that the division policy requiring staff to document case activity
within 10 days of its occurrence is met.
Although division management agrees that maintaining adequate staffing and not
assigning congregate care investigative staff to assist other investigation units would
help with investigation and documentation timeliness, it cautions that this may not be
1 Investigation of alleged abuse by parents is the responsibility of district CPS specialists, but according to division
management, staff shortages in District I have caused it to use the unit’s investigators for this purpose. In 2008, the
specialized investigation unit conducted 15 investigations for District I.
State of Arizona
page 9
feasible right now because of the impact of recent budget cuts on staffing. However,
the Division is planning to mitigate some of the impact of the reduced staffing by not
investigating some of its potential risk CPS reports, meaning those reports where the
alleged abuse and neglect are based on the potential to occur rather than actual
occurrence, and by temporarily re-assigning non-investigative CPS specialists to the
investigative function. Additionally, it should review and prioritize the specialized
investigation unit’s responsibilities to ensure that critical tasks affecting child safety
are accomplished, such as completing investigations within 21 days.
Division should seek statutory amendment clarifying CPS’
authority to investigate allegations of child abuse and
neglect in RTCs
To help ensure the safety of children placed in congregate care settings, the Division
should seek a statutory amendment that would clarify that CPS has authority to
investigate allegations of abuse and neglect in RTCs. As indicated earlier, a
specialized CPS investigation unit in District I conducts investigations of all reports
alleging child abuse and neglect within group homes and shelters for the entire State,
including group homes licensed by the Arizona Department of Health Services.
However, CPS does not investigate or substantiate allegations of child abuse and
neglect within RTCs because the Division does not believe that it has the authority to
do so. Instead, the Division forwards these reports to law enforcement, if appropriate,
and to the Arizona Department of Health Services’ Office of Behavioral Health
Licensing, which investigates these reports as potential licensing violations.
Although the Arizona Department of Health Services investigates these reports as
part of its licensing responsibilities, it uses different procedures and standards than
those required for CPS investigations.1 Further, because only CPS-substantiated
reports may be included in the central registry, vital information is not available for the
central registry background check that all staff providing direct care to children in
congregate care facilities must undergo. This gap potentially leaves children at risk
for abuse and neglect.2
1 Before an allegation of abuse or neglect can be substantiated, CPS must show probable cause, meaning facts that
provide reasonable grounds to believe that abuse or neglect occurred. Additionally, the investigation must undergo
review by an entity external to CPS to verify that the standard of evidence was met. Once this has been confirmed, the
identified perpetrator must be informed that the allegation(s) will be substantiated and entered into the central registry,
and offered an opportunity to provide additional information to refute the substantiation. Although the Arizona Department
of Health Services’ investigations of complaints alleging abuse or neglect of children in RTCs adhere to defined
investigation standards, they are not required to show probable cause and the process for reviewing the investigation
results and providing an opportunity for appeal differ from CPS’ statutory requirements.
2 A.R.S. §8-804 requires the Department to maintain a central registry of substantiated child abuse and neglect reports.
The central registry information is used for specific purposes, including conducting background checks, as one factor to
determine qualifications for persons applying for employment with the State in positions that provide direct service to
children or vulnerable adults and persons applying for contracts with the State and their employees who will provide direct
service to children or vulnerable adults.
Office of the Auditor General
Criminal and child abuse and neglect information used in
congregate care employee background checks—Arizona statute
and department policy require that employees who work for the Department’s
contracted congregate care facilities in direct contact with children undergo
both criminal and child abuse background checks to ensure that they do not
pose a threat to the children in the facilities. The Arizona Department of Public
Safety conducts the criminal background check using the employee’s
fingerprints. As long as the employee is not awaiting trial on, or been convicted
of, certain criminal offenses (see textbox for examples) he/she will receive a
fingerprint clearance card. If the person is declined a fingerprint clearance card
for certain crimes, he/she may appeal the decision to the Arizona Board of
Fingerprinting. Staff in congregate care facilities who do not have a valid
fingerprint clearance card may not work directly with children.
In addition to the criminal background check, statute and department policy
require the Department to review the central registry to see if the employee is
identified as a perpetrator in a substantiated CPS report. The information
contained in the central registry is used as one factor to determine
qualifications for persons applying for positions that provide direct services to
children. A person is disqualified from providing services to children in a direct
service position if he or she is identified as the subject of a substantiated report
involving the death of a child, high-risk physical abuse, sexual abuse or
neglect, moderate-risk physical abuse, sexual abuse or neglect, and
moderate-risk emotional abuse. Table 3 on page 11 provides examples of high
and moderate abuse and neglect.
Children may be vulnerable to staff abuse because CPS does not
investigate child abuse and neglect reports in RTCs—Although CPS
investigates allegations of child abuse and neglect in group homes that provide
behavioral health services and are licensed by the Arizona Department of Health
Services, and it coordinates with the Arizona Department of Health Services, which
also considers these same complaints as part of its licensing responsibilities, CPS
does not investigate allegations of abuse and neglect in RTCs. Rather, only the
Arizona Department of Health Services investigates these complaints as part of its
licensing responsibilities. Because statute only allows information on child abuse and
neglect reports substantiated by CPS to be entered into the central registry,
information on similar complaints in RTCs investigated by the Department of Health
Services as licensing violations is excluded from the central registry. This situation
may potentially allow staff that abuse and neglect children in RTCs to be hired later
at a different congregate care facility. Further, allegations of abuse and neglect
investigated by the Arizona Department of Health Services may not rise to the level
of criminal activity or be pursued for prosecution, and therefore may not appear in a
criminal background check. This potential gap in reviewing staff qualifications
underscores the importance of including reports of abuse and neglect in all
congregate care facilities in the central registry.
page 10
Examples of Criminal
Offenses Precluding
Receipt of a Fingerprint
Clearance Card
• Sexual conduct, abuse, or
exploitation of a minor
• Manslaughter or murder
• Kidnapping
• Arson
• Sexual assault
• Contributing to the delinquency of
a minor
• Felony drug distribution offense
• Burglary or robbery
• Dangerous crimes against
children as defined in A.R.S. §13-
705
• Child abuse or molestation
• Aggravated assault
Source: A.R.S. §41-1758.03
State of Arizona
page 11
-
Abuse
Type High Risk Moderate Risk
Physical
abuse
Severe or life-threatening injuries requiring
emergency medical treatment and/or parent
presents immediate, severe physical harm to a
child.
Physical abuse by a parent, guardian, or
custodian who has a prior substantiated high-risk
report.
Serious or multiple injuries which may require
medical treatment and/or a child at risk for
serious physical abuse if no intervention is
received.
Neglect Severe or life-threatening situations requiring
emergency intervention due to the absence of a
parent, or a parent who is either unable due to
physical or mental limitations or is unwilling to
provide minimally adequate care.
Child 6 to 9 years of age is alone for 3 hours or
longer or unknown when parent, guardian, or
custodian will return.
Imminent harm to child due to health or safety
hazards in living environment which may include
exposure to the elements.
Serious/non-life-threatening situations requiring
intervention due to the absence of a parent, or a
parent who is unable due to physical or mental
limitations or is unwilling to provide minimally
adequate care.
Inadequate supervision or encouragement by
parent, guardian, or custodian, sexual conduct or
physical injury occurs between children. This
includes a licensed or certified DES facility or a
licensed DHS Level I, II, or III Behavioral Health
Treatment facility (e.g. Residential Treatment
Center or Behavioral Health Group Home).
Sexual
abuse
Physical evidence of sexual abuse reported by a
medical doctor or child reporting sexual abuse
within the past seven (7) days.
Sexual behavior or attempted sexual behavior
occurring 8 days or up to 1 year ago and/or child
is exhibiting indicators consistent with sexual
abuse.
Emotional
abuse
Not applicable. Child diagnosed by qualified mental health
professional as exhibiting severe anxiety,
depression, withdrawal, or untoward aggressive
behavior which could be due to serious emotional
damage by parent, guardian, or custodian.
Table 3: Examples of High- and Moderate-Risk Child Abuse and Neglect
Source: Auditor General staff summary of examples of high- and moderate-risk child abuse and neglect obtained from the
Arizona Child Abuse Hotline Procedural Manual.
Office of the Auditor General
page 12
State of Arizona
Division management, in consultation with their Assistant Attorney General
representative, believe there is no clear authority in state law for CPS to investigate
allegations of abuse and neglect in RTCs. CPS can only investigate allegations of
abuse and neglect involving children's parents, guardians, or custodians, and the
Division does not believe that RTC staff have a custodial relationship with the
children. Although the Division does not believe it has the authority to conduct
investigations alleging abuse and neglect in RTCs, auditors found cases where CPS
had investigated such allegations in years past with results demonstrating the
importance of such investigations.1 For example, auditors found a case showing that
CPS investigated and substantiated an allegation of continued sexual abuse inflicted
by an RTC staff person on a child in 1998. The allegation and subsequent
investigation resulted in the staff person being terminated from the facility.
In addition to the concern regarding CPS’ authority to investigate child abuse and
neglect reports in RTCs, division management indicated that conducting
investigations in RTCs may place an excessive burden on CPS’ investigative
resources. Although the Arizona Department of Health Services does not specifically
track the number of reports alleging abuse or neglect of children in RTCs referred to
them from other sources, such as the Division or an RTC itself, Arizona Department
of Health Services staff indicated that they believe the incidence of child abuse and
neglect in RTCs is low.
Division should seek statutory amendment that clarifies CPS'
authority to investigate in RTCs—To help ensure the safety of children and
that vital information is available from all congregate care settings for child abuse and
neglect background checks, the Division should seek a statutory amendment that
would clarify that CPS has authority to investigate allegations of abuse and neglect
in RTCs. By clarifying CPS' investigative authority, the Division would then be able to
investigate allegations of abuse and neglect in RTCs and help to ensure that
individuals who pose a threat are disqualified from providing direct care to children.
Once the investigative authority is clarified, the Division should then coordinate its
RTC investigations with the Arizona Department of Health Services, as it does for
investigations of alleged abuse and neglect in other facilities licensed by the Arizona
Department of Health Services.
Recommendations:
1.1. To help facilitate the timeliness of congregate care investigations, the Division
should:
a. Implement the Division’s action plan for the specialized investigative unit
requiring the unit supervisor to revise the unit’s procedures to more
effectively use manual and online systems to track investigation activity, to
update investigators weekly on upcoming investigation completion dates,
1 Division management indicated that the investigations in RTCs found by auditors may have resulted from the Division’s
central intake unit, which receives reports alleging child abuse and neglect from across the State and forwards them to
the appropriate entity for investigation, incorrectly forwarding the reports to CPS investigation units.
page 13
and to increase contact with investigators to discuss ongoing investigations;
and
b. Ensure the specialized investigative unit remains adequately staffed and do
not routinely use the unit’s investigative staff to assist with other investigative
units’ workloads. If this is not possible due to staffing cuts, the Division
should review and prioritize the specialized investigation unit’s
responsibilities to ensure tasks critical for ensuring child safety are
performed; for example, completing investigations within 21 days.
1.2. To help ensure that information is available for management use in monitoring
investigations’ thoroughness, workload, and productivity, the supervisor of the
specialized investigative unit should enforce division policy requiring staff to
document case activity within 10 days of its occurrence.
1.3. To help ensure child safety by making certain complete information is available
for conducting child abuse background checks on congregate care employees,
the Division should seek a statutory amendment clarifying that CPS has authority
to investigate allegations of abuse and neglect in RTCs.
Office of the Auditor General
page 14
State of Arizona
page 15
Division should improve congregate care outcome
monitoring
Monitoring congregate
care providers’
performance using
outcome measures
helps ensure that
children are well
served and tax dollars
are effectively spent.
The Department’s
contracts with the
congregate providers
each include several
outcome measures for
assessing provider
performance. Both the
providers and the
Division share
responsibility for
gathering and
reporting data on the
various outcomes.
However, the Division
has not been
enforcing the reporting
requirement, nor using
the outcome data to
assess providers’
performance. Further,
some of the outcome
measures are
inadequate. Therefore,
the Division should
review and revise the
outcome measures
within its congregate
care contracts
according to
established criteria,
enforce the
requirement that
outcome data be
gathered and reported
to the Division, and
use the information to
monitor providers’
performance.
FINDING 2
Outcome monitoring helps ensure child well-being
and effective use of state resources
Monitoring congregate care providers’ performance using outcome measures
helps ensure that children are well served and tax dollars are effectively spent.
Outcome monitoring is used to assess whether children benefited from the
services they received. For example, the Division uses outcome monitoring to
determine the extent to which services provided to children by behavioral health
group home providers result in the children moving to and remaining in a less-restrictive
environment, such as with a relative or licensed foster family.
Additionally, monitoring outcomes enables
the Division to ensure that the millions of
dollars allocated annually for congregate
care is directed to those providers meeting
service expectations. Finally, monitoring
outcomes enables the Division to identify
providers that may be having performance
problems. When this occurs, the Division
can help the providers identify problems
and correct deficiencies. Alternately, if the
providers’ performance fails to improve or
worsens, the Division may choose not to
renew the contract.
Division needs to address several deficiencies
affecting outcome monitoring
Despite the importance of outcome monitoring for assessing the quality and
effectiveness of congregate care providers’ performance, several issues hinder
the Division’s ability to adequately implement outcome monitoring. The
Department's contracts with the congregate providers each include between
four and six specific outcome measures. For most of the measures, the provider
is responsible for obtaining the outcome data and reporting it to the Division. For
the remaining measures, the Division is responsible for obtaining the outcome
Outcome measures focus on
the results of services that
the contractor provides, as
well as intermediate
indicators of success.
Source: U.S. Department of Health and
Human Services. (2008). Ensuring
quality in contracted child welfare
services. Retrieved on April 24, 2009
from http://aspe.hhs.gov/hsp/07/CW
PI/quality/report.pdf
Office of the Auditor General
page 16
data.1 However, regardless of which entity collects and reports the outcome data,
there are problems with its quality, availability, and use. Specifically,
• Outcomes unclear—Literature on contract administration indicates that to help
ensure quality contractor performance, the outcomes required of the contractor
should be clear, and that the contracting entity should determine measurable
factors to indicate the degree to which the provider is meeting expectations.2
Auditors’ review of the outcomes required in the Division’s contracts with
congregate care providers found that 5 of the15 required outcomes do not meet
one or both of these criteria. For example, an outcome in the group home
service provider contract regarding the children in the provider’s care requires
that “80% of the children will have improved community citizenship (e.g.
significantly reduced rates of arrest, detention, incarceration and/or recidivism;
increased positive measure of school, work attendance, and/or achievement).”
This outcome does not clearly and specifically define how the provider should
measure improved community citizenship using the indicators listed, including
the degree of reduction or increase necessary to indicate the child’s
improvement.
• Performance targets not established—Contracting literature indicates that
performance goals or targets should be established.3 However, auditors
determined that 6 of the congregate care providers’ 15 required outcomes failed
to meet this standard. For example, an outcome measure in the group home
service provider contract requires submission of the “Number of youth admitted
and number of youth successfully transitioned to live with their families, including
foster families. Successfully transitioned means in stable placement for up to at
least 3 months.” This outcome measure does not have a specific target number
that the provider should attain to achieve adequate performance.
• Outcome data seldom available or used—Contracting literature indicates that
outcome data should be available to assess the degree to which contractors are
achieving expected outcomes. However, the Division does not enforce outcome
data submission by the providers, and as a result, some providers either
infrequently submit the data or do not submit the data at all. For example,
auditors’ review of contract files for four congregate care providers found that
two of the providers had not submitted any outcome data and one had
submitted data only twice during its 5-year contract with the Department. The
Division also does not obtain and/or compile data on some of the congregate
care outcomes that the Division is responsible for tracking. For example, the
1 Although contracts with congregate care providers are issued by the Department’s Office of Procurement, the Division
develops the contract, including the outcome requirements.
2 Planning and Learning Technologies, Inc., & The University of Kentucky. (2006). Literature review on performance-based
contracting and quality assurance. Retrieved August 8, 2008 from http://www.uky.edu/SocialWork/qicpcw/documents/Q
ICPCWPBCLiteratureReview.pdf
3 McCullough, C. (2004). Financing and contracting practices in child welfare initiatives and Medicaid managed care.
Retrieved April 1, 2009 from https://www.cwla.org/programs/bhd/mhpubfinancing.htm
State of Arizona
page 17
group home service provider contract includes an outcome stating that “90% of
case managers will express satisfaction with the contractor’s service delivery
based on a semi-annual survey conducted by the Division.” However, the
Division does not conduct the survey. Finally, the Division does not review or use
the outcome data that it does receive in any meaningful way, such as to help
providers identify and correct deficiencies, or as additional criteria when
renewing providers’ contracts.
Division management reported that staff hours are not available to evaluate outcome
data and use it to monitor provider performance. Management indicated that as of
May 2009, the Division had 3 contract manager positions and 13 contract
administrator positions to develop and/or manage more than 2,800 family foster
agreements, procurement contracts, purchase orders, and requests for
developmental disabilities contracts.
Division should revise required outcomes and consider
them in contract renewals
To help ensure effective, quality performance by congregate care providers, the
Division should review and revise the outcomes required within the congregate care
contracts to ensure they are clear and include measurable indicators of performance,
and that they contain specific performance targets. The Division should also enforce
the requirement that outcome data be gathered and reported, and compile the data
it is responsible for tracking. Finally, as part of its ongoing efforts to reprioritize its
responsibilities in response to budget cuts, the Division should determine the
importance of using the outcome data to monitor provider performance, including
using it as additional criteria for yearly contract renewal and as the basis for helping
providers to identify problems and correct deficiencies, and assign staff accordingly.
Recommendations:
2.1. The Division should review and revise the outcomes within its congregate care
contracts to ensure that they meet established criteria: they are clear, include
measurable indicators of performance, and contain specific performance
targets.
2.2. The Divisions should enforce the requirement that congregate care providers
submit required outcome data to the Division. Additionally, the Division should
ensure that it compiles the necessary outcome data for those congregate care
outcomes it is responsible for tracking.
Office of the Auditor General
2.3. As part of its ongoing efforts to reprioritize its responsibilities in response to
budget cuts, the Division should determine the importance of using outcome
data to monitor congregate care provider performance, including using the data
as additional criteria for yearly contract renewal and as the basis for helping
providers identify problems and correct deficiencies, and assign staff
accordingly.
page 18
State of Arizona
AGENCY RESPONSE
AGENCY RESPONSE
Office of the Auditor General
CPS Reports Issued
-0 CHILDS Data
Integrity Process
-0 Timeliness and
Thoroughness of
Investigations
-0 On-the-Job Training and
Continuing Education
-0 Prevention Programs
-0 Complaint Management
Process
-0 DES’ Federal Title IV-E
Waiver Demonstration
Project Proposal
-0 Family Foster Homes
and Placements
-0 Revenue Maximization
-0 In-Home Services
Program
-0 Federal Deficit Reduction
Act of 2005
-0 Federal Grant Monies
-0 Child Removal Process
-0 Client Characteristics
Future CPS Reports
-0 Substance-Exposed
Newborns
-0 Child Abuse Hotline
-0 Confidentiality of CPS
Information
-0 Licensed Family Foster
Homes
-0 Child and Family
Advocacy Centers
-0 Processes for Evaluating
and Addressing CPS
Employee Performance
and Behavior
Relative Placement
Adoption Program