1. Iowa Child and Family Service Reviews DRAFT Final Report
Statewide IA-CFSR Summary
Eight Reviews Conducted:
April 2008 to November 2008
Report Date: January 2009
Submitted by:
Krystine L. Lange
CFSR State Coordinator
Child and Family Services
IA Department of Human Services

2. Introduction

3. Introduction Brief History
Our first federal Child and Family Service Review [CFSR] review was conducted in May 2003
Our Program Improvement Plan [PIP] was completed in August 2005
Our next CFSR review is in 2010
Information from our state IA-CFSR reviews, will be utilized to inform our Child and Family Service Plan and the CFSR Statewide Assessment reports to our federal partners.

4. Introduction The federal CFSRs process includes: Statewide Assessment
Case-level onsite reviews conducted by a team of Federal and State reviewers
Interviews with key State and local stakeholders
State data from AFCARS and NCANDS

5. Introduction The Federal Child and Family Service Reviews:
Are a collaborative effort between the Federal and State Government.
Promote continuous quality improvement in child welfare systems nationwide.
Evaluate State performance relative to the State Child and Family Services Plan.
Identify both the strengths and areas needing improvement in State Child Welfare programs.
In the CFSR the federal government reviews the whole Child Welfare System, not just the public agency [DHS]

6. Introduction IA-CFSR Reviews Conducted:
Between April and November 2008, Iowa DHS conducted eight IA-CFSR reviews in the following counties [one in each service area]:
Polk County
Scott County
Tama County
Pottawattamie County
Winneshiek County
Dickinson County
Cerro Gordo County

7. Introduction
The review included a in-depth review of 32 cases (4 per site); and included interviews with children, family members, foster parents, and service providers.
In addition, in each county, 8 focus groups were conducted with:
DHS/JCO Administrators
Legal Representatives:
GALs, Parents Attorneys,
CASA, FCRB, Assistant
County Attorney
Foster Parent
Providers
DHS & JCO workers
Juvenile Court Judge
QA Staff
Youth

8. Introduction Quality Assurance
This review process is expected to be continued as an ongoing QA mechanism to:
Determine how we perform compared to federal standards
Make system improvements and continue to enhance practice before and after our federal review in 2010
Efforts are underway to integrate the Judicial Branch Children’s Justice Reviews and IA-CFSR,
An integrated review process will engage child welfare partners and stakeholders as reviewers and provide a more holistic system review and report.

9. Introduction Child and Family Services Review:
The CFSRs analyze strengths and areas needing improvement with respect to seven safety, permanency, and well-being outcomes and seven systemic factors.
The outcomes, which concern safety include:
Safety Outcome 1: Children are, first and foremost, protected from abuse and neglect.
Safety Outcome 2: Children are safely maintained in their homes whenever possible and appropriate.

10. Introduction Child and Family Service Reviews
The outcomes for permanency include:
Permanency Outcome 1: Children have permanency and stability in their living situation.
Permanency Outcome 2: The continuity of family relationships and connections is preserved for children.

11. Introduction The outcomes for well-being include:
Well-Being Outcome 1: Families have enhanced capacity to provide for their children’s needs.
Well-Being Outcome 2: Children receive appropriate services to meet their educational needs.
Well-Being Outcome 3: Children receive adequate services to meet their physical and mental health needs.

12. Introduction The systemic factors include:
Statewide Information System
Case Review System
Quality Assurance System
Staff and Provider Training
Service Array
Agency Responsiveness to the Community
Foster and Adoptive Parent Licensing, Recruitment, and Retention

13. Findings: “It’s a different department now.”
The general perception is that DHS is doing better than ever. There is recognition of efforts to:
improve practice;
engage families, the community, and stakeholders;
develop services that are targeted at the specific needs of children and families.
“It’s a different department now.”
At the same time, there is variation and a dramatic range of practice and performance for the department, as well as the court, in different geographic areas. Consistency of practice and performance is a goal for which to strive.

14. Findings:
Service Areas are monitoring performance with federal requirements and have created processes that promote safety, permanency and well-being outcomes. In two service areas, performance is consistently near to federal requirements.
Examples of these structures:
Dubuque’s post placement staffings set up concurrent goals, monitor ICWA compliance, etc.
Des Moines pre-placement FTMs assures that the individual needs of children are met as they transition to foster care.
Davenport completes a permanency staffing at 30 and 60 days that documents federal standards.

15. Findings:
The Court, Juvenile Court Officers, and Community Partners have also established structures to promote safety, permanency and well-being outcomes. For example:
Juvenile Judges inquire about the frequency and quality of visits between the parents and children in foster care.
Des Moines home/health nurses attend pre-placement FTMs assure that the individual medical needs of children are met as they transition to foster care.
Juvenile Court Services has implemented case reading by supervisor.
Decat and Empowerment committees take on the responsibility to address gaps in the community service array.

16. Overarching Trends and Patterns

17. Overarching Trends & Patterns
DHS and JCS staff are respected and appreciated by child welfare and community partners.
Communities work well together and generally have good relationships through empowerment, Decat, and Community Partnership for Protecting Children [CPPC].
In most communities, the leadership role of the Judge sets expectations for good outcomes, children involved in court, and permanency for children.
Family Team Meetings contribute to strong practice improvement by engaging parents in partnership for planning and improve outcomes.

18. Overarching Trends and Patterns
Transportation limitations are consistently identified in all areas of the state as the number one practice barrier.
Limitations in available mental health services for children result in use of the Juvenile Justice system as the avenue to access mental health services, when it may not be the most appropriate response to the family and child’s needs.
Complexity of the case plan makes it “incomprehensible” to both professionals and families, creating confusion.

19. Overarching Issues
Changes in the contract services over the last year resulted in challenges and transition issues for the child welfare system. [system changes: Foster Care Licensing and Recruitment, Remedial Service Provider Services, FSRP Services and Safety Services]
Communication and cooperative work towards resolution of problems appears productive.

20. Promising Practices
Family team meetings are used to engage families and give them ownership of the plan developed for family change. Service Areas are creative in improving access to facilitation for family team meetings. [Statewide]
Value and belief in mediation; use of mediation to maintain family connections and achieve permanency for children. [Cerro Gordo]
“Elevate” youth support programs. [Polk, Scott, Linn]

21. Promising Practices
Non-custodial parent search and diligent efforts to engage fathers. [Scott, Polk]
Strong partnership with foster parents to bring about change; examples of foster parents mentoring birth parents.[Council Bluffs; Winneshiek]
Parent Partners programs provide support to new parents in the system. [Dickinson]
Concurrent planning and placement conferences within 30 days of placement. [Winneshiek, Scott]
Tribal partnership to conduct child abuse investigations. [Tama]

22. Promising Practices
Visiting nurses program and partnership with public health nurses. [Polk]
Engagement and commitment of community partners to address disproportionality within the child welfare system: fostering an improved understanding and approach to cultural competency. [Linn]
JCS community liaison working with African American families prior to formal interviews with JCS. [Linn]
Disproportionality Projects are being expanded in the state and cultural competency training is provided across child welfare disciplines and the court.

23. Promising Practices
Family Interaction Pilot: focusing on frequent and meaningful family interaction when a child is in foster care.
Utilization of quality assurance and review processes to improve practice; e.g. supervisory reviews or staffings. [Statewide]
Motivational interviewing and assessment tools enhance JCS practice.
Pre-placement conferences ease the transition of children to foster care and assure their needs are met at placement. [Polk] ‘…since Polk County DHS initiated pre and post removal conferences we have seen major changes that present opportunities for us to improve on a child's placement--both for reunification purposes and as a concurrent plan.  These opportunities include: more active outreach to family members and kin as potential placements;  the development of support services for those placements;  the use of assessment tools to identify placements much earlier on that may be appropriate concurrent plans; and the general encouragement of the good social work that can be done outside of the emergency context.’ [Judge Egly]

24. Promising Practice: Court Leadership
Court leadership has focused expectations on improving outcomes for children in juvenile court. [Statewide]
The court sets expectations for hearing content and attendance. In many areas of the state, children are encouraged to attend and participate in court hearings.
The court has focused on the achievement of permanency to the benefit of children; some judges set hearings at 1-3 month intervals to monitor and track progress to permanency.
The court has initiated the Drug Court model and schedules hearings with the family based on their needs.
Statewide practice and court process improvement embraced by the court: Pottawattamie County “Kids First” committee actively partners with the agency to address child welfare issues.
Children’s Justice Initiative promotes and supports good outcomes for children through child welfare partnerships and court practice improvement.

25. Systemic Factor Patterns and Themes
Statewide Information System

26. Statewide Information System
Strengths
FACS, DHS child welfare information system, is available statewide and has the capacity to maintain and track required information in the system: legal status, demographic characteristics, location, and goals for the placement of every child in foster care.
JCS utilized Data Warehouse reports for management.
Data reports are effectively used by management and supervisors as one tool to measure performance and improve practice.
There is no child under the care of the department for whom information on there whereabouts is not in the information system.

27. Statewide Information System
Concerns:
ICIS [used by Juvenile Court and JCS] and FACS [used by DHS] are separate systems that currently do not communicate. JCS has to do duplicative documentation for FACS, and DHS staff have to enter JCS information in many areas.
FACS, ICIS, and Data Warehouse are not always user friendly and a skilled specialist must be used to access information.
Data reports are a look backwards, whereas current information would allow the use of data as a planning tool. Some data has to be hand-tallied by supervisors because it is not available in the system.
Repetitive entry of data in the system takes valuable worker time.
Some critical information to determine performance is not readily available in the system: e.g. we can not identify number of families in the system and which family has FSRP services.

28. Systemic Factor Patterns and Themes
Case Review

29. Case Review Strengths:
There are written case plans for children, which are timely and updated regularly. Supplemental information is provided through court reports.
Family Team Meetings [FTM], which involve the parent and children, with formal and informal support systems are utilized to develop a plan. FTMs are an accepted part of practice. FTMs incorporate the family’s self-identified needs.
Review, permanency, and TPR hearings are timely.
When foster parents attend court, they have an opportunity to be heard and are asked questions from the bench.
Foster Care Review Board and the Juvenile Court conduct at least 6 month reviews.

30. Case Review
Concerns:
When FTMs are not used, it is difficult to identify who routinely participates in developing the case plans and the family’s self-identified needs are less likely to be included. Case plans are not always provided to all parties in time for court preparation. JCS does not always involve parents in case planning.
Parent’s attorneys and GALs do not always know or meet with clients until the hearing.
Some focus groups indicated that court reviews may be conducted without hearings and findings based only on a paper review. Families are not always allowed to participate in hearings.
Compelling reasons not to TPR are not always identified and in the file. There are still some areas where the court is reluctant to terminate because an adoptive family is not identified.
The notification process for foster parents, pre-adoptive parents, and relative caregivers is not standardized in the state and notification is not always given and documented.
Post-permanency responsibility is not clear for GALs or service providers.

31. Systemic Factor Patterns and Themes
Quality Assurance

32. Quality Assurance Strengths:
The state has developed and implemented standards to ensure that children in foster care are provided quality services that protect the safety and health of children.
There is a wide range of activities directed at improving practice: supervisory case reading, focus on supervisory role in clinical consultation, management use and review of data, QA practice reviews, e.g. review of group home or shelter placements, QA concurrent planning staffings, QA review and consultation for repeat maltreatment and cases with special circumstances.
Data and administrative reports are provided to administrators, supervisors, and workers.
JCS supervisors are reviewing cases with staff to assure quality, and supervisory case reading has been initiated around the state.

33. Quality Assurance Strengths:
There is a feedback loop between QA, practice improvement, policy, and training. QA staff have an influence on policy and practice statewide; e.g. physical form revision; case worker visits; worker/parent visit flag. QA evaluates the quality of services, identifies strengths and needs of the service delivery system, provide relevant reports, and evaluates implemented program improvement measures.
Contractors and providers are becoming more engaged in QA activities in the Service Areas; local surveys and partnership meetings are providing valuable information from providers about quality.
Child welfare stakeholders are engaged in quality assurance activities -- service providers, parents, youth, foster parents, group caregivers, relatives, tribes, court personnel, and others participate in IA-CFSRs.

34. Quality Assurance Concerns:
JCS does not have funding for QA activities and their QA is less developed than DHS.
Providers, parents, youth, foster parents, group caregivers, relatives, tribes, court personnel are generally not directly involved in QA activities in local or service areas. Improvement could be made in educating and involving stakeholders in additional QA processes; e.g. as reviewers in the IA-CFSR.
Data reports are a look back. Easily accessible and current data information would allow for better planning and response to areas of concern. More data is needed to evaluate the effectiveness of strategies for program improvement.

35. Systemic Factor Patterns and Themes
Training

36. Training
Strengths:
Requirements for pre-service training prior to case assignment are in place for DHS. Staff are getting initial training prior to full case load assignments and it is a good orientation to DHS and practice.
Monthly initial training includes progressive modules with classroom and on-the-job training. Basic skills and knowledge are provided to prepare staff to begin social work practice when supervisor mentoring is provided. Initial and ongoing training is tracked and monitored; records are available for staff.
Service area and local training supplements state training.
More advanced training, e.g. psychological evaluations, has been seen as quality training that is very beneficial.
Cross training with DHS and provider staff is seen as a positive.
Pre-service PS-MAPP is seen as quality training for foster parents. There is a variety of ongoing training available for foster parents.
Licensed relative caregivers are required to have pre-service PS-MAPP.

37. Training
Strengths:
JCS considers their new worker training as valuable.
There has been excellent JCS on-going training including Iowa delinquency assessment; functional family therapy, motivational interviewing, and aggression replacement therapy.
Training is provided in a variety of ways, including classroom, web-based online training, interactive cable network training, and interactive distance learning through webinars. Training has moved from centralized training to training in Service Areas around the state, making it more convenient and accessible.
Ample training on process and procedure changes over the last few years.
Specialized training is provided for specialized job responsibilities or caseloads.
State licensed child caring facilities are required to have adequate staff training as a condition of licensure.
Training needs are identified by field staff, a representative training committee reviews curriculum and training plans.
There is a feedback loop for training with QA.

38. Training
Concerns:
Minimum standards have not been set for ongoing training requirements for staff per year.
Trainers need to include practice experts that are actually doing the job.
Some DHS training is too basic and there is some repetitious information/skills presented in required training.
Three service areas of the state did not find that initial training adequately prepared staff for job duties or practice orientation.
More training needs to be developed in partnership with the field to improve practical applicability.
JCS staff are assigned case loads prior to training, although mentoring and supervision mitigates the lack of availability of pre-service training.

39. Training
Concerns:
Advanced training for proficient social workers is needed.
Advanced training for experienced foster parents is needed. Foster parents may repeat training they have already attended to meet their hour requirement. Foster parents identified some need for advanced training in complex behavioral needs and special needs issues.
Distance and lack of availability of child care make it difficult for some foster parents to attend training.
Youth do not feel foster parent training adequately prepares foster parents for working with adolescents and youth with behavioral needs.
Youth would like foster parents to have training in “de-escalation and anger management” to help their own anger and to deal with youth when they are angry.

40. Systemic Factor Patterns and Themes
Service Array

41. Service Array Strengths:
The service array is effective in meeting the needs of the children and families, including in-home and foster care cases. Recent changes are seen as benefiting the individual needs of children by providing focused but flexible services.
An adequate array of accessible services is contracted for and provided to protect children in their own homes and prevent removal.
An adequate array of services to promote timely adoptions is provided and accessible in all areas of the state.
An adequate array of accessible services to youth in foster care to prepare them for independent living and to make the transition from foster care to adulthood are available in all areas of the state. DHS support of Elevate to provide peer support has expanded to 8 chapters, one in each service area. .
The array of services are accessible to families and children in all political jurisdictions covered in the State’s Child and Family Services Plan.
Social workers do what needs to be done for families, despite gaps in services.

42. Service Array Strengths:
Family team meetings are empowering and result in individual needs being identified and addressed by both formal and informal supports.
A rich array of community services exists in the more urban areas of the State.
There has been an increased emphasis on meeting the needs of minority families.
Experienced foster parents know how to access services to meet the needs of individual children.
Community partnerships are aware of gaps in services and work collaboratively and creatively to address gaps.
JCS has a range of services to utilize for children with delinquent behaviors; Functional Family Therapy, tracking, weekend offender programs, day treatment programs, residential care, etc.
Drug partnership grant for substance abuse is seen as a positive addition to the service array.
Youth see Transition Services, PALS, and Elevate as positive resources.

43. Service Array Concern:
Gaps in Services: inpatient substance abuse treatment for adolescents, inpatient and outpatient mental health services for children and parents, parent training, education and skill building; services for co-occurring conditions of children and parents; aftercare substance abuse treatment.
Transportation barriers impact access to drug testing, family interaction, etc.
A range of preventative or early intervention services are not always available, e.g. truancy issues, police shelter placement.
CINA assessments delay implementation of needed services for some families.
Lack of availability of parental skill development impacts progress and permanency.
The transition to the new service array was perceived as negatively impacting timely reunification of children in foster care with their families.
Spanish services and interpreters are not always available.

44. Service Array Concern:
RURAL – RURAL – RURAL impacts accessibility of services.
Families don’t know how to access mental health services for their children with mental/behavioral health needs. Some youth with mental health needs are ending up in the delinquency system by default.
There is a need for services for children with high end needs within the State.
Services to support adoptive families and prevent disruption after placement and finalization have been initiated in the State but needs to expand to meet the post-adoption needs of families.
Skill level, education background, and turnover are affecting the quality of contracted services and impacting safety, permanency, and well-being.
Independent living skill development is not always accessible in rural areas.

45. Service Array Concern:
Dental and orthodontia services are not always available for children on Title XIX.
Services for non-title XIX eligible parents and children are not available.
Supports for non-licensed relatives need to be strengthened; relatives don’t know how to access services to meet their needs and the children’s needs.

46. Systemic Factor Patterns and Themes
Responsiveness to the Community

47. Responsiveness to the Community
Strengths:
In implementing the provisions of the Child and Family Services Plan, the State engages in ongoing consultation with tribal representatives, consumers, service providers, foster care providers, the Juvenile Court, and other public and private child- and family-serving agencies and includes the major concerns of these representatives in the goals and objectives of the Child and Family Services Plan.
Child Welfare Stakeholder Panel
Child Welfare Advisory Committee
Service Area quality assurance committees
Community Partnership for the Protection of Children committees
De-categorization committees
Initiative specific collaboration: e.g. disproportionality; Service Array planning

48. Responsiveness to the Community
Strengths:
The State’s services under the Child and Family Services Plan are coordinated with services or benefits of other federal or federally assisted programs serving the same population.
School based programs: Area Education Agency; Early Access
Public Health: public health nurses; substance abuse treatment; visiting nurses program
TANF: economic support programs
Corrections: Prisons
Mental Health: mental health centers, children’s mental health waiver
Domestic Violence: CPPC and DV training programs
Tribes: Meskwaki MOA; Sioux City Tribal community
Strong JCS, DECAT, DHS, Foster Parent, Court, and community services partnerships work effectively to meet family and children needs at the local level.

49. Responsiveness to the Community
Concerns:
Tribal partnership on the Child and Family Service Plan could be strengthened.
Formal protocols to address Tribal concerns on individual cases as well as systemic issues are needed to build partnership and credibility with Tribes.
Tribal Memorandum of Agreements, Iowa Code 232B, and tribal court provisions are not known by all staff and impact working with Iowa’s tribes.
Continued efforts need to be made to engage education in communities to assure youth in foster care succeed in school.

50. Systemic Factor Patterns and Themes
Licensing and Recruitment

51. Licensing and Recruitment
Strengths:
There are licensing standards for foster family homes and child care institutions that ensure the safety and health of children in foster care.
Licensing standards are applied to all licensed foster family homes and child caring institutions receiving title IV-E or IV-B funds. Standards are applied equally. Relatives have the same licensing standards as non-relative foster parents. Relatives are provided with encouragement to be licensed to access adequate resources and supports. Exceptions can be made only on a case by case basis.
Federal requirements are in place for criminal background clearances as related to licensing foster care and adoptive placements. Thorough and effective child abuse and criminal background clearances on prospective foster and adoptive parents are completed prior to licensing.
Re-licensing and inspection of foster homes and facilities are timely and ensure continued conformity with licensing standards.

52. Licensing and Recruitment
Strengths:
Full licensure is required for use of any IV-E funds for a child’s placement.
There is a unified home study process for foster and adoptive parents to avoid foster parents who later adopt having to meet additional criteria.
The case planning process includes provisions for addressing the safety of foster care and adoptive placements for children.
Recruitment activities are in place; bulletin boards, RR meetings, silent auction, concert, etc. Contracting for recruitment services is consistent with federal requirements.
Targeted recruitment plans are in place for each service area for diligent recruitment of potential foster and adoptive families who reflect the ethnic and racial diversity of children in the State for whom foster and adoptive homes are needed.
There are active IFAPA foster parent support groups and foster parent liaisons to improve foster parent retention.

53. Licensing and Recruitment
Concerns:
General lack of adequate numbers of foster parents; especially for adolescents, delinquent youth, African Americans, Hispanic, Native Americans, sibling groups.
Lack of adequate number of foster homes in rural areas impacts proximity, siblings placed together, and family child interaction.
Workers are very concerned about matching children's needs with the skills of foster parents.
Support for foster parents could be strengthened.
Recruitment efforts and plans need to be more visible; community members were not of aware of “Recruitment and Retention Advisory Teams”

54. Licensing and Recruitment
Concerns:
New foster parents are sometime overwhelmed by a number of providers coming into their home.
Retention is a critical issue; e.g. placing children with challenging behaviors in new foster homes; non-fost/adopt homes are not getting called; new foster parents don’t always know what is available or what they may need.
Foster parents feel they do not get adequate information about children being placed in their homes.
Foster parents feel they are not given adequate time to respond to requests for placement of children.
ICPC is perceived as a barrier to placing children across state lines and a concern. ICPC needs to be more customer oriented.

55. Case Review Patterns and Themes

56. STRIVING FOR % FOR KIDS .

57. Case Review Patterns and Themes
Safety Outcome 1
Item 1: Timeliness of Investigations
Item 2: Repeat Maltreatment

58. Timeliness of Investigations
Intake and response actions work well together to assure timely initiation and response to reports of maltreatment.
Supervisory determination of the correct priority response and appropriate approval for delay in initiating investigations could be strengthened.

59. Repeat Maltreatment
Good engagement and strong assessments provide a foundation for intervention with the family in cases where there was no repeat maltreatment.
Effective and targeted interventions resolved the underlying issues and resulted in family change.
Practice focus and quality assurance reviews have contributed to lowering repeat maltreatment.

60. Case Review Patterns and Themes
Safety Outcome 2
Item 3: Preventing Removal and Safely Maintaining at Home
Item 4: Preventing Risk of Harm

61. Preventing Removal and Safely Maintaining Children at Home
Initiation of safety services to keep children safely at home was seen as a strength.
Safety constructs are seen as benefiting decision making around safety and preventing removal.
Family Team meetings address preventing removal and maintain children safely in their homes.

62. Risk of Harm
Risk and safety are evaluated formally and informally on an ongoing basis by workers. Frequency of visiting children has positively impacted assessment of safety in the home or while in foster care.
FTMs and attention to formal and informal supports contributed to keeping kids safe. FTMs assess risk/safety and are used to develop safety plans.
Supervised visitation and closely monitoring substance abuse issues keep children safe during parent/child interaction [visits between children and parents].
Providers and contractors in some areas of the state were not well engaged, communicating well, or were not aware of safety and risk issues; leading to problems in supporting the overall case goals and safety plans.
When safety constructs are not used, safety issues may not be recognized, documented or addressed and safety can be jeopardized.

63. Case Review Patterns and Themes
Permanency Outcome One
Item 5: Re-entry into Foster Care
Item 6: Stability
Item : Permanency Goals

64. Re-entry into Foster Care
Strengths:
Transition planning from placement to return home contributes to preventing re-entry.
Appropriate supports and services to the family contributes to prevent foster care re-entry.[e.g. FSRP services, mental health therapy, mediation services, and LPHA assessment]

65. Stability
Strengths:
Relatives’ and foster parent’s needs were assessed and addressed to assure stability of the placement. Relatives’ and foster parents’ commitment to individual children contributes to the stability of the placement.
Strong child assessment and attention to the children's ongoing needs contributed to stability. Improved frequency of worker visits with children contributed to stability.
Attention to connections with family contributed to stability.
Longevity and expertise of staff contribute to long-term relationships with foster parents, which contributes to support of foster parents, then to stability.
IFAPA support groups and support help meets the needs of foster parents and promotes stability of placements.

66. Stability
Concerns
Better matching of children needing placement with foster parent strengths is needed to improve stability of placements for children.
Ongoing assessment and response to risk of disruption is needed to improve stability for children.
Underlying issues expressed by focus groups:
Transition to KidsNet resulted in changes in procedures
Still an inadequate number of foster homes
Foster parents indicated they do not get complete information at placement, including medical and behavioral health needs
When the first placement is an emergency short-term placement, it leads to additional placements, e.g., shelter care placements
Children placed far from home move back to the parent’s community when a foster home becomes available which results in a placement move which could have been prevented if a foster home were available in the parent’s community.

67. Permanency Goals Strengths
Good child assessment and providing effective services contributes to achieving permanency; including good matching with caregivers and meeting their needs.
Stability of placements contributes to achieving timely permanence.
Concurrent planning, when it is used, contributes to timely achievement of permanency.
Court leadership expectations for meaningful review and permanency hearings contribute to timely permanency for children.
FTMs, Transition Staffings, and Circles of Support contribute to establishing and achieving appropriate and timely permanency goals.
Placing children in close proximity to their parents, stability of placements, foster parents engaging and supporting the birth parents, and arranging early and frequent family interaction contributes to reunification.

68. Permanency Goals Concerns
Another Planned Permanency Living Arrangement (APPLA) is used inappropriately for young children and consideration of alternative goals is not documented.
Compelling reasons for not pursuing termination of parental rights (TPR) or using APPLA as a goal are not well understood by staff or well documented.
Children and parents are not always engaged or involved in permanency decisions.
ICWA requirements are not always followed for permanency goal decisions and placement preferences.
Permanency goals are not always established formally, documented, and known by all parties. Lack of formalized goals negatively impacts timely permanency and case strategies.
Urgency in achieving permanency goals for children needs to be a priority; use of safe case closure criteria could help establish a sense of urgency.
Services to help children understand permanency are not utilized.

69. Case Review Patterns and Themes
Permanency Outcome 2
Item 11: Proximity
Item 12: Siblings Placed Together
Item 13: Visits with Parent and Siblings
Item 14: Maintaining Connections
Item 15: Identifying Relatives
Item 16: Maintaining Parent/Child Relationship

70. Proximity
Local relationships are positively impacting placement recommendations and matching for children and foster parents; keeping children in the community.
Focus groups indicate that the lack of services for delinquents, lack of services for inpatient, adolescent substance abuse treatment and lack of availability of foster homes in the area result in children being placed far from home.
“Child specific” recruitment contributes to maintaining children in close proximity to their parents.
Delays in reunification were attributed to lack of proximity of children in foster care.

71. Placement with Siblings
When a strength, concerted efforts were made to place siblings together and it was a practice expectation.
Lack of adequate numbers of foster homes and lack of initial matching to a foster family that could meet the needs of all the siblings was seen as negatively impacting placement of siblings together, or resulted in later separation.
Active ongoing efforts were not seen to reunify siblings once they had been separated.
Youth indicate that they have lost contact with siblings who were placed separately.

72. Visits between Parents and Siblings in Foster Care
When a strength, DHS workers and contractors work closely and diligently to maintain at least weekly interaction between the child and custodial parents. Family informal supports were seen as contributing to making arrangement and supervising family interaction.
More than once a week family interaction was arranged for young or infant children.
Placement with relatives promotes informal, more frequent visits in more natural settings.
Non-custodial parents were not engaged in interaction with children in foster care.
Some youth indicate that they do not have visits with and in some case have entirely lost contact with their siblings.
Transportation presents barriers for family interaction.

73. Preserving Connections
Custodial parents are consistently engaged and considered in preserving connections for children.
When a strength, proximity contributed to maintaining the same school, friends, therapist and connections with extended family.
Family team meetings and thoughtful planning helps to assess, plan for, and honor ongoing connections.
Concurrent Planning form [DAV] and Placement Staffings within 30 days [DUB] contribute to ICWA compliance.
Non-custodial parents and their extended families were not always engaged.
Relative placements contribute to preserving connections for children.
Consistent inquiry and follow-up with ICWA notification and placement preference was seen as a need.
Lack of placement proximity impacts connections negatively.

74. Identifying Relatives
In cases that had concerted efforts to place the child with relatives, diligent efforts were made to identify and document both maternal and paternal relatives and consider them as a placement options.
Inappropriate placement options were well screened and documented – e.g. home studies on a number of relatives at the same time, exclusion for criminal or child abuse history and incarceration.
All potential relatives, especially extended family of non-custodial parents were not considered.

75. Maintaining Parent/Child Relationship
Encouragement of involvement of parents in the daily lives and activities of children. Flexible scheduling accommodates working parents.
Relative placements increased informal opportunities for maintaining parent/child relations.
Foster parents are encouraged to mentor birth parents which increases opportunities and promotes improved relationships of parents with children in foster care.
Therapeutic visits and treatment were used to maintain or repair relationships.
Custodial parents relationships are well supported and maintained.
Non-custodial parent relationships were not as well supported or maintained with children in foster care as were custodial parent relationships.

76. Case Review Patterns and Themes
Case Work Practice
Item 17: Assessment and services to meet the needs of children, parents, and foster parents
Item 18: Involving parents and children in case planning
Item 19: Visits with Children
Item 20: Visits with Parents

77. Assessment and meeting the needs of children, parents, and foster parents
In many cases, assessments and engagement efforts were made with custodial parents and children and services were provided to meet the needs. There was good use of collateral assessments, e.g. mental health evaluation. Monitoring and tracking were used well to adjust strategies to meet ongoing needs.
Family team meetings enhance understanding and improve addressing the individual needs of families and children.
There was good use of informal assessments of progress and safety during visits.
Non- custodial parents’ and foster parents’ needs were not always assessed and addressed.
Services could be better matched to the individual needs of children, parents, and foster parents.

78. Involving parents and children in case planning
Engagement as a practice strength contributes to involving parents in case planning.
Family team meetings contribute to involving parents and children in case planning.
Youth indicate that they are not always involved in case decisions or in permanency decisions.
Non-custodial parents are not always involved in case planning activities.

79. Visits with Children
This is the area of greatest improvement since the 2003 CFSR. Our performance during that review was 10% and has increased to 75%. In one service area the frequency and quality of visits were 100%.
In many cases the quality, duration, location, privacy, and discussion of safety and critical case issues were a strength. Documentation of visits could be strengthened to reflect the good practice workers are doing. In some cases, frequency of visits increased due to the needs of the child.
In cases needing improvement, quality of visits needed to be improved and visits needed to include time interviewing the child alone.

80. Visits with Parents
Workers are more consistently visiting with custodial parents than non-custodial parents. Frequency and quality of visits are an issue of concern. Often lack of engagement of non-custodial parents resulted in this item being rated as an area needing improvement.
Lack of adequate frequency and quality of visits with parents can have a significant delay on timely permanency and reasonable efforts to achieve reunification.

81. Case Review Patterns and Themes
Item 21: Education

82. Education
Case plans address educational needs. JCS and DHS cases had educational documentation in the file.
Referrals are being made for Early Access.
Assessment, planning and follow through was consistent to meet educational needs.

83. Case Review Patterns and Themes
Item 22: Health and Dental

84. Health and Dental
Good assessment contributed to meeting the medical needs.
Family team meetings cover well-being needs.
Monitoring and tracking of medical needs and consistent follow-through contributed to the medical needs of children being met.
Documentation for medical and dental services and addressing dental needs drive the areas needing improvement in this item.
Especially in rural areas, families must drive a distance to meet the dental health care needs of the children. In other areas, access to physicians and dentists who take Title XIX is limited.

85. Case Review Patterns and Themes
Item 23: Mental Health

86. Mental Health Needs
Strengths:
MH needs are addressed in the case plan.
Individual and unique needs of children are being met.
Good assessment and planning contributed to meeting the mental health needs.
Family team meetings cover well-being needs.
Monitoring and tracking of mental health needs and consistent follow through.

87. Child and Family Service Reviews
24 Iowa youth, age 13 – 21 years, were interviewed for the IA-CFSRs in seven of eight service areas around the State
All youth interviewed were in foster care or had been in foster care
Less than half the youth were members of Elevate
Youth were asked about:
Their experience in foster care;
Safety, permanency, and well-being;
Whether their needs were or are being met;
Their voice in planning;
Connections with family;
Experience with court; and
Their recommendations as to how to improve the child welfare system.

88. What youth told us: The youth who were interviewed told us about:
Connections: Their need to stay connected to their families and the importance of staying connected to siblings.
Coping: Strategies that helped them while they were in foster care.
Permanency and Stability: Having many foster care placements and the challenges/rewards of permanency.
Court: The voice that many have been given by the Juvenile Judge during Child in Need of Assistance hearings.
Voice: How they want to be involved in planning and the decision making regarding their life.
Foster Parents: The importance of having a safe place to live with caring adults.
Social Workers: The importance of their relationship with social workers and advice to improve.
Services: Helpful services for them.
Worries and Fears: The concerns they have had and may still have; especially about their siblings.

89. What our Tribal Partners said:
Seven staff from Meskwaki Family Services were interviewed as a focus group for the Tama County Review. They said, “There is better communication and working together…” Relations between the tribe, the court, and the department have improved but there are still issues to resolve.

90. A tribal partner said: I want you to share my concerns:
We have a lack of resources for our children and families.
The Tribal State Agreement is not always honored in interactions around our children. [by DHS and the Juvenile Court]
The recent State Supreme Court decision is being interpreted as the court determining whether a child is Indian. We are learning of Meskwaki children in other parts of the state who are in foster care and we have not received notice. The decision has fostered a power struggle with attorneys between the tribe and the juvenile court system.

91. A tribal partner said: I want you to share my concern: [continues]
4E language for court orders does not fit our culture. The judge and the family determine what court orders say, not 4E.
We have our own procedures and they do not mirror DHS procedures, they are consistent with our culture…. our values and beliefs. [TPR]
Other counties in Iowa are not providing legal notice to the tribe … it is one of our greatest concerns.
[These concerns were articulated by one focus group member but validated by all focus group members.]

92. Key Strengths, Needs, and Overarching Issues:
Family Team Meetings are seen as positively impacting family engagement and ownership, developing individualized plans, promoting teamwork between professionals and improving a shared understanding of the family's needs.
Collaboration is seen as a strength around the state -- local areas have initiated Promising Practices and very innovative solutions to persistent problems.
Consistent recognition by child welfare partners of the ability of Juvenile Court Officers (JCOs) and DHS social work staff and their practice.
There is a focus on the frequent visits with children in foster care.
Court leadership and oversight contribute to good outcomes for children; many juvenile court judges promote a focus on permanency; and demonstrate a commitment to children.
Children's educational and mental health needs are met.
Youth see Preparation for Adult Living (PAL) program as beneficial to transition to adulthood.
Quality Assurance in the state is a real strength.  

93. Key Strengths, Needs, and Overarching Issues:
Quality and frequency of visits with parents is a strength in only 30% of cases reviewed and may impact time to reunification and overall effectiveness.
We need to complete quality assessments and match services with the needs of the family. Improving this area contributes to better outcomes, increased effectiveness with families, and promotes progress to safe case closure.
Lack of engaging non-custodial parents impacts the greatest number of non-compliance areas.
Documentation or provision of medical care for children needs to improve; access to dental care in rural areas need to improve.
We need to improve ICWA inquiry and compliance.

94. Key Strengths, Needs, and Overarching Issues:
Caseworkers are committed to doing what needs to be done to address the needs of the families.
Transportation barriers.
Rural Practice barriers.
Transition to child welfare changes have resulted in challenges and transition issues for the child welfare system. [system changes: Foster Care Licensing and Recruitment, Remedial Service Provider Services]

95. Closing:
Service Areas are monitoring performance with federal requirements and have created processes that promote safety, permanency and well-being. In two service areas, performance is consistently near to federal standards.
It is heartening to find that practice has so dramatically improved over the last 5 years and that there are counties in our state where solutions have been found for some of the most intractable child welfare system problems. For every performance area found to need improvement, there is a solution. There are places in Iowa where the social work practice and child welfare system supports practice strengths. The service areas have been able to successfully resolve the barriers to good outcomes for children and families.
We do need to continue to improve until we reach 100% for Kids, …..but we have demonstrated we are on the right track.