Invitation To Comment on Proposed Data Composites and Potential Performance Areas and Measures for the Child and Family Services Review, 67479-67489 [05-22095]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Administration for Children and Families
• Children and Families Administration

[Federal Register Volume 70, Number 214 (Monday, November 7, 2005)]
[Notices]
[Pages 67479-67489]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-22095]



[[Page 67479]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families


Invitation To Comment on Proposed Data Composites and Potential 
Performance Areas and Measures for the Child and Family Services Review

AGENCY: Children's Bureau (CB), Administration on Children, Youth and 
Families (ACYF), Administration for Children and Families (ACF), 
Department of Health and Human Services.

ACTION: Invitation to comment on proposed data composites and potential 
performance areas and measures for the Federal Child and Family 
Services Review (CFSR).

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SUMMARY: This notice is to advise the public of ACF's plan to replace 
the six national data measures used for the CFSR with six data 
composites addressing the child welfare domains of maltreatment 
recurrence, maltreatment in foster care, timeliness of adoptions, 
timeliness of reunifications, placement stability, and permanency for 
children. The plan to develop data composites is a response to a 
recommendation made by a consultant under contract with ACF to study 
the CFSR process. The recommendation is based on input from a CFSR 
workgroup convened by the consultant at the end of the first round of 
CFSRs to assist in identifying areas needing improvement.
    ACF expects that each data composite will incorporate multiple 
performance areas and measures relevant to a specific domain. ACF plans 
to use State performance on the data composites as part of its 
evaluation of a State's substantial conformity with specific outcomes 
assessed through the CFSR. National standards will be developed for 
each of the domains represented by the six data composites.
    ACF's plan to replace existing measures with data composites is 
consistent with the final CFSR regulation at 45 CFR 1355.34(b)(4) and 
(5), which authorizes the Secretary of HHS to add, amend, or suspend 
any of the statewide data indicators when appropriate, and to adjust 
the national standards when appropriate. The proposed plan also 
complies with the requirements of section 1123A of the Social Security 
Act (the Act) for ACF to assess State child welfare agencies' 
compliance with titles IV-B and IV-E of the Act as implemented in 45 
CFR 1355.31 through 1355.37.
    We invite the public to comment on the data composites, performance 
areas, and measures proposed in this announcement.

DATES: Written comments must be submitted to the office listed in the 
address section below either by mail or e-mail on or before (30 days).

ADDRESSES: Mail Address: Children's Bureau, 370 L'Enfant Promenade SW., 
Washington, DC 20447. E-mail address: cfsrmeasures@acf.hhs.gov.

FOR FURTHER INFORMATION CONTACT: John Hargrove, 202-205-8634.

SUPPLEMENTARY INFORMATION:

CFSR and Existing Outcome Measures

    The CFSR is ACF's results-oriented comprehensive monitoring system 
designed to promote continuous improvement in the outcomes experienced 
by children and families who come into contact with State public child 
welfare agencies. ACF developed the CFSR in response to a mandate in 
the Social Security Amendments of 1994 (see section 1123A of the Social 
Security Act) for the Department of Health and Human Services to 
promulgate regulations for reviews of State child and family services 
programs under titles IV-B and IV-E of the Social Security Act. ACF's 
final regulations on the CFSR process, issued in 2000, can be found at 
45 CFR 1355.31 through 1355.37. Between fiscal years (FY) 2001 and 
2004, ACF conducted a CFSR of every State, the District of Columbia, 
and Puerto Rico.
    The CFSR assesses State performance on seven outcomes, seven 
systemic factors, and six national data measures that ACF adapted from 
measures originally developed for the Report to Congress on Child 
Welfare Outcomes (see attachment A for the report to Congress measures 
and the CFSR Outcomes). Data for the six national data measures come 
from the Adoption and Foster Care Analysis and Reporting System 
(AFCARS) and the National Child Abuse and Neglect Data System (NCANDS). 
AFCARS is a federally mandated data system established for the 
collection of foster care and adoption data. NCANDS is a voluntary data 
collection system that is the primary source of national information on 
abused and neglected children who are known to State agencies providing 
child protective services.
    ACF established national standards for each of the six data 
measures and used the standards as part of the assessment of a State's 
substantial conformity with particular outcomes. ACF described these 
six data measures in the preamble to the final CFSR regulation, 
published in the Federal Register (65 FR 4024-4025). This same citation 
provides information on how ACF calculated the national standards 
associated with each of the six data measures. Subsequently, ACF issued 
information memoranda on the specific national standards that would be 
used in the initial CFSR implementation (see ACYF-CB-IM-00-11 and ACYF-
CB-IM-01-07).
    The following performance measures and national standards were used 
during the first round of CFSRs as part of the assessment of a State's 
substantial conformity with CFSR Safety Outcome 1--Children are, first 
and foremost, protected from abuse and neglect:
     Repeat maltreatment--Of all children who were victims of 
substantiated or indicated child abuse and/or neglect during the first 
6 months of the reporting period, 6.1 percent or less had another 
substantiated or indicated report within a 6-month period.
     Maltreatment of children in foster care--Of all children 
who were in foster care during the reporting period, 0.57 percent or 
less were the subject of substantiated or indicated maltreatment by a 
foster parent or facility staff member.
    The following performance measures and national standards were used 
as part of the assessment of a State's substantial conformity with CFSR 
Permanency Outcome 1--Children will have permanency and stability in 
their living situations:
     Timeliness of reunification--Of all children who were 
reunified with their parents or caretakers at the time of discharge 
from foster care, 76.2 percent or more were reunified in less than 12 
months from the time of the latest removal from home.
     Re-entry into foster care--Of all children who entered 
foster care during the reporting period, 8.6 percent or less were re-
entering foster care within 12 months of a prior foster care episode.
     Timeliness to adoption--Of all children who exited foster 
care to a finalized adoption, 32 percent or more exited foster care in 
less than 24 months from the time of the latest removal from home.
     Placement stability--Of all children who have been in 
foster care for less than 12 months from the time of the latest removal 
from home, 86.7 percent or more have had no more than 2 placement 
settings.

Recommendation To Develop Data Composites

    ACF views the CFSR as a dynamic process and has made ongoing 
improvements in the process in response to lessons learned in the field

[[Page 67480]]

and to recommendations from State child welfare agency administrators. 
After completion of the first round of CFSRs in FY 2004, ACF contracted 
with a consultant to study the CFSR and make further recommendations 
regarding strategies for improvement. To assist them in this task, the 
consultant convened a CFSR workgroup of State child welfare agency 
administrators and child welfare researchers and, based on input from 
this workgroup, produced a set of recommendations for ACF. One 
recommendation was to replace the existing CFSR single data measures 
for which national standards were established with data composites that 
incorporate a wider range of performance areas relevant to a particular 
child welfare domain. ACF proposes to implement this recommendation for 
the following reasons:
     The recommendation is consistent with our observations 
during the first round of the CFSR that expanding the scope of data 
pertaining to a particular child welfare domain will provide a more 
effective assessment of State performance. For example, expanding the 
scope of data pertaining to the timeliness of reunification will 
address various performance areas relevant to this domain, including 
the permanency of the reunification.
     Data composites will provide a more holistic view of State 
performance in a particular domain than a single data measure can 
achieve. For example, the current CFSR measure of timeliness of 
adoption considers the percentage of children adopted within 24 months 
of entering foster care, but not children's experiences with regard to 
the timeframes between key points in the adoption process, such as the 
time from termination of parental rights (TPR) to a finalized adoption.
     Data composites will ensure that the data component of a 
State's performance with regard to a particular domain will not depend 
on one measure. For example, a State's performance regarding the data 
composite for the domain of timeliness to adoption may be uneven, with 
performance higher in one area than in another. However, overall 
performance on the composite may be high relative to other States. 
Thus, the data composite will account for both the strengths and 
weaknesses that a State exhibits within a particular domain.
     Data composites will allow the development of national 
standards that account for variation in State practices and policies. 
For example, there are differences in State policies and practices 
regarding reunification. In some States, children are physically 
reunified with families several months before legal custody is 
transferred to parents or guardians. States indicate that this practice 
allows them to ensure that the families receive the services and 
monitoring necessary to support the reunification process. In contrast, 
in other States, legal custody and physical custody are transferred 
simultaneously. Using data composites for the domain of timeliness of 
reunification will enhance ACF's ability to account for these 
variations in practice.
     Data composites are being successfully used by the Federal 
government to assess other programs. For example, composite measures 
are being developed and used for the No Child Left Behind initiative. 
In addition, composite measures have been used to evaluate the 
performance of hospitals in various health-related domains.
    Although the methodology for calculating the scores for the data 
composites has not been finalized, the following describes the approach 
that is under consideration:
    Possible composite methodology: Six data composites are under 
consideration (these are described in the section below), with each 
composite pertaining to a different domain of child welfare practice 
(i.e., recurrence of maltreatment, maltreatment of children in foster 
care, timeliness of reunifications, timeliness of adoptions, placement 
stability, and achieving permanency). It is expected that each 
composite will incorporate two or more performance areas, with a 
specific measure developed for each performance area. The final 
performance areas to be included in each data composite will depend 
upon the following: (1) Input from the field in response to this 
announcement, and (2) the results of principle components analyses 
regarding the viability of inclusion of specific performance areas in a 
particular domain. The principle components analyses also will permit a 
determination of the relative contribution of each performance area to 
the overall domain represented by the data composite. Once the 
performance areas and measures are identified, a score will be 
calculated for each State for each data composite based on the 
appropriate weighting (as determined from the analyses) of a State's 
performance in each of the performance areas.
    For each data composite, ACF is considering using the distribution 
of scores across States to establish a national standard (the 
methodology to be used to set the standard has not yet been 
determined). This will result in six separate standards, one for each 
domain. Because the primary purpose of a data composite is to capture 
overall performance in a particular domain, ACF will not establish a 
national standard for the individual performance areas incorporated in 
the composites. Therefore, States will not be expected to meet a 
standard for any individual performance area but to achieve an overall 
performance level in a particular domain related to safety or 
permanency. However, ACF will provide States with information regarding 
each performance area with regard to the mean, median, and range of 
scores across States to enable a State to identify the performance 
areas within a composite where improvements may be needed.
    ACF proposes to use the national standards developed for the data 
composites as part of the assessment of State performance in the second 
round of CFSRs. These will be used in conjunction with findings from 
the CFSR onsite case reviews in the overall determination of a State's 
substantial conformity with specific outcomes.

Proposed Data Composites and Performance Areas

    A table providing a comparison of the existing CFSR data measures 
and the proposed data composites and performance areas is provided in 
attachment B. Additional information regarding the data composites and 
performance areas is presented below. The criteria for selection of 
measures for each performance area are the following: (1) They must be 
measurable using data available from AFCARS and NCANDS, and (2) they 
must be measurable within the CFSR timeframes for assessing State 
improvement in performance.

CFSR Safety Outcome 1: Children are First and Foremost Protected From 
Abuse and Neglect

Safety Composite 1: Recurrence of Maltreatment

    Performance on Safety Composite 1--Recurrence of maltreatment--will 
be part of the assessment of a State's substantial conformity with CFSR 
Safety Outcome 1--Children are, first and foremost, protected from 
abuse and neglect. Safety Composite 1 reflects the responsibility of a 
State child welfare system to ensure the ongoing safety of children who 
come into contact with the system through a maltreatment allegation.
    The following performance areas are under consideration for this 
data composite:
     Recurrence of substantiated or indicated maltreatment 
reports.

[[Page 67481]]

     Multiple unsubstantiated maltreatment reports.
     Timeliness of initiating investigations of child 
maltreatment reports.
     Timeliness of dispositions of maltreatment reports.
Safety Composite 1--Performance Area 1: Recurrence of Substantiated or 
Indicated Maltreatment Reports
    Justification for inclusion: This performance area provides an 
assessment of a child welfare agency's effectiveness in responding to 
the safety of children who are found to be victims of abuse or 
neglect.\1\ It addresses the question of whether the agency took the 
necessary actions to ensure that the children do not experience abuse 
or neglect again.
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    \1\ InChild Maltreatment 2003, a child victim is defined as a 
child for whom an incident of abuse or neglect has been 
substantiated or indicated by an investigation or assessment.
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    Possible measure: Of all children who were victims of substantiated 
or indicated child abuse and/or neglect during the first 6 months of 
the reporting period, what percentage had another substantiated or 
indicated report within a 6-month period? This is the measure that was 
used during the first round of CFSRs to assess maltreatment recurrence.
    Relevant issues: This measure focuses on recurrence within a 6-
month period because it is not possible to link children reported to 
the NCANDS Child File across years. In support of the measure, research 
findings suggest that the incidence of occurrence of a substantiated 
maltreatment report within 12 months of a prior substantiated report is 
not significantly greater than the incidence of recurrence within 6 
months.\2\
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    \2\ Fluke, J. et al. (1999). Recurrence of maltreatment: An 
application of the National Child Abuse and Neglect Data System. 
Child Abuse and Neglect, 23 (7), 633-650. DePanfilis, D., and 
Zuravin, S. (1998). Rates, patterns, and frequency of child 
maltreatment recurrences among families known to CPS. Child 
Maltreatment, 3 (1), 27-42.
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    Some CFSR workgroup participants recommended that the CFSR include 
measures designed to identify the types of maltreatment that recur and 
the characteristics (such as age and race/ethnicity) of children who 
are the victims of maltreatment recurrence. ACF determined that, 
although these measures address important research questions about 
maltreatment recurrence and are appropriate for a research initiative, 
they are beyond the scope of the CFSR, which is intended to provide a 
general assessment of State performance in particular domains. However, 
ACF encourages States to examine their own data to identify the factors 
associated with maltreatment recurrence.
Safety Composite 1--Performance Area 2: Multiple Unsubstantiated 
Maltreatment Reports
    Justification for inclusion: ACF is seeking input from the field 
regarding the feasibility of capturing as part of Safety Composite 1 
the child safety issues relevant to multiple ``unsubstantiated'' 
maltreatment reports. (The term ``unsubstantiated report'' does not 
include maltreatment allegations that are not accepted for 
investigation [i.e., are ``screened out], those that are investigated 
and found to be ``intentionally false,'' or those that are ``closed 
without a finding.\3\'') Research findings indicate the following: (1) 
Children who are the subject of unsubstantiated maltreatment reports 
are highly likely to have experienced abuse or neglect, (2) there is 
extensive variation across States regarding the criteria used to make a 
substantiation determination, and (3) the decision as to whether a 
maltreatment report is substantiated or unsubstantiated often is not 
based on consistent criteria even within a State.\4\ In addition, a 
recent finding of the federally funded study entitled Longitudinal 
Studies of Child Abuse and Neglect, found no differences in the 
behavioral and developmental outcomes of 8-year-old children with 
unsubstantiated and substantiated maltreatment reports filed when the 
children were between the ages of 4 and 8.\5\
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    \3\ The major NCANDS disposition categories are defined in Child 
Maltreatment, 2002, U.S. Department of Health and Human Services, 
Administration on Children, Youth and Families.
    \4\ Drake, B. (1996). Unraveling ``unsubstantiated.'' Child 
Maltreatment, 1 (3), 261-271. English et al. (2002). Causes and 
consequences of the substantiation decision in Washington State 
Child Protective Services. Children and Youth Services Review, 24 
(11), 817-851. Leiter et al. (1994). Substantiated and 
unsubstantiated cases of child maltreatment: Do their consequences 
differ? Social Work Research, 18 (2), 67-82.
    \5\ Hussey, J. et al. (2005). Defining maltreatment according to 
substantiation: Distinction without a difference? Presentation at 
the 15th National Conference on Child Abuse and Neglect, Boston, MA: 
April, 2005.
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    Possible measure: ACF welcomes comments from the field regarding 
possible measures for this performance area. Although research findings 
suggest that a child who is the subject of multiple unsubstantiated 
maltreatment reports is likely to be experiencing maltreatment 
recurrence, ACF is concerned that a measure developed for this 
performance area may result in unintended consequences. For example, 
States that have a practice of monitoring families in which a child is 
the subject of an unsubstantiated report or of providing services to 
these families may be discouraged from implementing these practices if 
the ongoing surveillance of the family increases the likelihood that a 
subsequent maltreatment allegation (either substantiated or 
unsubstantiated) may occur. ACF also wants to ensure that the measure 
will, for the most part, exclude maltreatment allegations that are 
without merit.
    Relevant issues: Although several participants in the CFSR 
workgroup recommended that a measure of recurrence of unsubstantiated 
reports should be incorporated into the CFSR safety assessment, a few 
were not in accord with this recommendation. Those that were opposed to 
the recommendation expressed the concerns identified above.
Safety Outcome 1--Performance Area 3: Timeliness of Initiating 
Investigations of Child Maltreatment Reports
    Justification for inclusion: NCANDS defines the initial 
investigation as beginning when the child protective services (CPS) 
agency has face-to-face contact with, or attempts to have face-to-face 
contact with, the alleged victim. If face-to-face contact with the 
alleged victim is not possible, the initial investigation is considered 
as beginning when CPS first contacts any party who can provide 
information essential to the investigation or assessment. ACF's 
proposal to include timeliness of initiating investigations as a 
performance area for Safety Composite 1 is based on the following 
assumptions:
     The continued risk of harm to a child who is the subject 
of a maltreatment report is best assessed through face-to-face contact 
with the child, and
     Protection of the child is enhanced when this face-to-face 
contact occurs quickly after a maltreatment report is received by the 
agency.
    Possible measures: Two measures of this performance area are under 
consideration and are provided for review and comment.
     During the reporting year, of all children who were the 
subject of an investigation conducted in response to a report alleging 
maltreatment, what was the mean (or median) length of time between 
receipt of the report and the initiation of the investigation?
     During the reporting year, of all children who were the 
subject of an investigation conducted in response to a report alleging 
maltreatment, what percent had investigations that were initiated in 
the following timeframes:

[[Page 67482]]

    Within 1 day (24 hours)?--This timeframe is conceptualized as a 
``timely response.''
    After 7 days?--This timeframe is conceptualized as one that did not 
adequately address the safety of the child.
    Relevant issues: Because ACF believes that the ongoing risk of harm 
to a child is most effectively assessed through face-to-face contact 
with the child and family, and that this contact should take place 
quickly after a report is received, the proposed measures do not 
address variation across States with regard to required timeframes for 
responding to a maltreatment report, which range from a few hours to a 
few weeks (with a few States having no time requirements). The measures 
also do not take into account the ``priority'' systems established by 
many States that result in assigning different timeframes to different 
reports based on perceived risk of harm to the child. These timeframes 
also range from a few hours to a few weeks.
    Some States have established an ``alternative response'' (also 
called a differential response) to maltreatment reports. Under this 
approach, a maltreatment report may be referred for an assessment of 
the family rather than for an investigation to determine whether child 
maltreatment did or did not occur. Usually, reports are referred for an 
assessment when a CPS agency determines that the risk of harm to the 
child is low. ACF has not yet decided whether the timeliness of 
initiating alternative response assessments will be included in the 
proposed measure. A concern is that not all States that implement an 
alternative response approach report these activities to the NCANDS 
Child File. ACF welcomes comment and suggestions from the field 
regarding this issue.
Safety Composite 1--Performance Area 4: Timeliness of Dispositions of 
Child Maltreatment Reports
    Justification for inclusion: This performance area is included in 
Safety Composite 1 for the following reasons.
     Until an investigation is completed and the risk of harm 
to a child is fully assessed, States may not be in a position to 
identify the needs of the child and family accurately and to match 
services to the needs. This could affect the possibility of future 
maltreatment.
     When a disposition is not made in a timely manner and the 
agency receives a subsequent report of alleged maltreatment of the 
child, the lack of a disposition may affect the agency's ability to 
accurately evaluate the subsequent report since it may not have full 
information pertaining to the earlier investigation.
     It is not until the disposition that an agency's plan is 
sanctioned by the court. The court sanctioning ensures that the agency 
and the parents are aware that they are required to carry out the 
actions detailed in the plan.
    Possible measures: The following two measures are under 
consideration.
     During the reporting year, of all children who were the 
subject of investigations conducted in response to reports alleging 
maltreatment, what was the mean (or median) length of time between 
receipt of the report and the disposition?
     During the reporting year, of all children who were the 
subject of investigations conducted in response to maltreatment 
reports, what percent had investigations that reached a disposition in 
various timeframes (e.g., 60 days from the time of receipt of the 
report, between 60 and 90 days, longer than 90 days).
    ACF welcomes comments on the decision to begin the ``disposition 
timeframe'' with the receipt of the maltreatment report rather than 
with the initiation of the investigation.
    Relevant issues: The proposed measures do not include information 
pertaining to assessments made as a result of an alternative response. 
Many States that implement an alternative response do not reach a 
disposition in these situations, even when the decision is made to open 
a case for services. Although the NCANDS Child File includes 
disposition categories of ``Alternative Response Victim'' and 
``Alternative Response Nonvictim,'' only three States report 
Alternative Response Victims, and only nine report Alternative Response 
Nonvictims.

CFSR Safety Outcome 2: Children Are Safely Maintained in Their Homes 
Whenever Possible and Approrpriate

Safety Composite 2: Maltreatment of Children in Foster Care
    Performance on Safety Composite 2 will be part of the assessment of 
a State's substantial conformity with CFSR Safety Outcome 2--Children 
are safely maintained in their own homes whenever possible and 
appropriate. Although the wording of CFSR Safety Outcome 2 specifies 
the safety of children maintained in their own homes, the outcome also 
applies to maintaining children safely while they are in the ``homes'' 
in which they are placed by the child welfare agency, including 
licensed foster family homes, relative homes, group homes, or 
institutions. The composite reflects the primary responsibility of a 
child welfare system to ensure that children are not victims of 
maltreatment while they are under the care and placement responsibility 
of the State.
    The following two performance areas are under consideration for 
this composite:
     Maltreatment of children in foster care by a foster parent 
or facility staff member.
     Maltreatment of children in foster care by their parents.
Safety Composite 2--Performance Area 1: Maltreatment of Children in 
Foster Care by a Foster Parent or Facility Staff Member
    Justification for inclusion: ACF, and the public in general, expect 
State child welfare agencies to ensure that State-appointed caregivers 
of children in foster care do not abuse or neglect the children placed 
in their care.
    Possible measure: Of all children who were in foster care during 
the reporting period, what percent was the subject of substantiated or 
indicated maltreatment by a foster parent or facility staff member?
    Relevant issues: This measure was used to assess maltreatment of 
children in foster care during the first round of CFSRs. Some concern 
was expressed by the field that the measure inadvertently includes 
children who were maltreated by foster care providers or facility staff 
members but who were not in foster care with the State child welfare 
system at the time of the maltreatment (i.e., the children were in 
another system or they were in private foster or facility care). A 
recent requirement that all children in an NCANDS Child File have an 
AFCARS identification number will permit an identification of these 
children so that they can be excluded from the measure.
    Some CFSR workgroup participants recommended that there be separate 
measures for maltreatment of children in foster care by a foster 
parents and maltreatment by a facility staff member. However, a review 
of the data found that the incidence of maltreatment by these 
``perpetrator types'' taken separately is too small to constitute 
meaningful measures.
    Some CFSR workgroup participants also recommended that ACF develop 
a measure that identifies the extent of maltreatment of children who 
are placed by the State with relatives as foster caregivers, including 
relatives who are licensed foster parents and relatives who are not 
licensed foster parents. At present, the NCANDS Child File does not 
allow for this level of detail regarding relative perpetrators.

[[Page 67483]]

Although a relative may be identified in NCANDS as a perpetrator, it is 
not possible to determine whether the relative also was the child's 
State-appointed caretaker. Similarly, a licensed foster parent may be 
identified as the perpetrator, but it is not possible to determine 
whether the licensed foster parent also is a relative.
Safety Outcome 2--Performance Area 2: Maltreatment of Children in 
Foster Care by Their Parents
    Justification for inclusion: State child welfare agencies are 
responsible for ensuring that any safety concerns regarding parental 
contacts with a child in foster care are appropriately addressed. An 
analysis of NCANDS Child File data using matching AFCARS identification 
numbers found that in FY 2003, a substantial number of children who 
were the victims of maltreatment by a parent were in foster care for at 
least 30 days before the date of the maltreatment report. In most 
States, the number of these children was considerably larger than the 
number of children who were victims of maltreatment by foster parents 
or facility staff.
    Possible measure: Of all children who were in foster care for 
longer than 30 days during the reporting year, what percent were the 
subject of a substantiated or indicated maltreatment report in which 
the perpetrator was the parent and the report was received after the 
child had been in foster care for at least 30 days?
    Relevant issues: The proposed measure uses the maltreatment report 
date as a ``proxy'' for the date of the maltreatment itself. Because 
children entering foster care sometimes report maltreatment events that 
occurred prior to entry, the measure excludes maltreatment reports 
involving parent perpetrators that were received during the first 30 
days that the child was in foster care. The 30-day ``exclusion'' is 
based on analysis of NCANDS data demonstrating a substantial decline in 
the number of children in foster care reported as being maltreated by a 
parent after the first 7 days the child is in foster care, a more 
moderate decline in this number from 8 to 30 days after entry into 
foster care, and then a leveling off after 30 days.
    Although the most recent version of the NCANDS Child File includes 
a data element pertaining to the date of the maltreatment incident, 
States are not yet consistently reporting this new data element. When 
States report information pertaining to the maltreatment incident date 
in a consistent manner, the measure of maltreatment of children in 
foster care by their parents can be revised to incorporate the incident 
date and it will no longer be necessary to incorporate a 30-day 
exclusion.

CFSR Permanency Outcome 1: Children Have Permanency and Stability in 
Their Living Situations

Permanency Composite 1: Timeliness and Permanency of Reunifications

    Performance on Permanency Composite 1 will be part of the 
determination of a State's substantial conformity with CFSR Permanency 
Outcome 1--Children will have permanency and stability in their living 
situations. The composite addresses State child welfare system's 
performance with regard to promoting a safe, timely, and permanent 
family reunification by assisting families to resolve the problems that 
resulted in the children being removed from the home. The performance 
areas under consideration for the composite are the following:
     Timeliness of reunifications of children exiting foster 
care in a given fiscal year.
     Timeliness of reunifications of children entering foster 
care in a given fiscal year.
     Permanency of reunifications.
Permanency Composite 1--Performance Area 1: Timeliness of 
Reunifications of Children Exiting Foster Care
    Justification for inclusion: Exits from foster care represent the 
outcomes experienced by children in foster care, and exits to 
reunification reflect an agency's success with regard to its function 
of promoting the reintegration of the family. A primary goal of ACF and 
the Adoption and Safe Families Act of 1997 (ASFA) is to ensure that 
children do not remain in foster care any longer than is necessary to 
achieve permanency. Information about the timeliness of children 
exiting foster care to reunification provides a basis for assessing 
State performance in achieving this goal.
    Possible measures: A number of measures are under consideration for 
this performance area, with each addressing a particular variation in 
State practices and policies pertaining to reunification. For each 
measure, we are proposing two possible approaches to assessing 
timeliness to reunification. One approach that was used in the first 
round of the CFSR reflects an expectation that 12 months is a 
sufficient amount of time to bring about a reunification for most 
children. The second approach examines timeliness to reunification as a 
function of a State's median length of stay in foster care for all 
children exiting foster care to reunification, with the expectation 
that the distribution of these median across States would be used to 
set a performance expectation. Both approaches are included in each of 
the following measures and ACF welcomes input from the field regarding 
these approaches.
     During the reporting year, of all children reunified with 
their parents or caretakers at the time of discharge from foster care, 
(1) what percent were reunified in less than 12 months from the time of 
the latest removal from home? OR, (2) what was the median length of 
stay in foster care (in months) of all children exiting to 
reunification? A frequent criticism of this measure is that it does not 
account for variations in State practices and policies that impact the 
time between entry into foster care and exit to reunification. The 
following measures are designed to address these concerns.
     During the reporting year, of all children reunified with 
their parents or caretakers at the time of discharge from foster care 
who were in foster care for more than 7 days (at least 8 days), (1) 
what percent were reunified in less than 12 months from the time of the 
latest removal from home? OR, (2) what was the median length of stay in 
foster care (in months) for these children? This measure is intended to 
address variations among States with regard to the practice of removing 
a child from his or her home at the onset of a maltreatment 
investigation until an initial court hearing is held to determine 
whether the child should be returned home or remain in foster care.
     During the reporting year, of all children reunified with 
their parents or caretakers at the time of discharge from foster care 
who were in foster care for more than 30 days (at least 31 days), (1) 
what percent were reunified in less than 12 months from the time of the 
latest removal from home? OR (2) what was the median length of stay in 
foster care (in months) for these children? This measure addresses 
another type of variation among States. Some States tend to remove a 
child from his or her home while providing very short-term services to 
the family in response to a family crisis. In contrast, other States, 
in a similar situation, tend to provide services to resolve the crisis 
while the child remains in the home, if it is safe to do so. This 
measure is designed to assess timeliness of reunifications for children 
and families who may need more than very short-term services to resolve 
the issues leading to removal.

[[Page 67484]]

An analyses of the data found that when performance on this measure is 
compared to performance on the existing CFSR measure of reunification, 
five States drop out of the top quartile with regard to the percent of 
reunifications occurring within 12 months of a child's entry into 
foster care.
     During the reporting year, of all children reunified with 
their parents or caretakers at the time of discharge from foster care, 
(1) what percent either were reunified in less than 12 months from the 
time of the latest removal from home or were placed in a trial home 
visit within 11 months of removal and whose last placement setting 
prior to discharge was a Trial Home Visit, OR (2) what was the median 
length of stay in foster care (in months) of children exiting to 
reunification or of children whose placement was a Trial Home Visit at 
least 30 days prior to reunification. Under the AFCARS definitions, a 
child can be reported as discharged from foster care to reunification 
only after the court discharges the agency's responsibility for the 
child (or 6 months after the child's return in certain circumstances). 
However, some States maintain placement and care responsibility of 
children for a period of time after physical reunification, usually 
ranging from 3 to 6 months, in order to provide services and ongoing 
monitoring. ACF has instructed States to report these children to 
AFCARS as being in a Trial Home Visit placement setting. This measure 
is designed to assess timeliness to reunification in a manner that 
accounts for this difference in State practice. An analysis of the data 
found that when this measure was used to assess timeliness to 
reunifications, 13 States exhibited substantial improvements in 
performance, while no State exhibited a decline in performance.
    Relevant issues: Although the measures are presented separately for 
review and comment, ACF is considering the possibility of combining 
some of the variables of concern into one measure. For example, the 
measure incorporating children in a trial home visit also could include 
a requirement that the child be in foster care for more than 30 days.
Permanency Composite 1--Performance Area 2: Timeliness of 
Reunifications for Children Entering Foster Care in a Given Fiscal Year
    Justification for inclusion: Assessment of the timeliness of 
reunifications of children who enter foster care in a given timeframe 
(i.e., an entry cohort) will allow ACF to capture the success of 
recently implemented State efforts to reunify children in a timely 
manner.
    Possible measures: Two measures are under consideration. Neither 
one include an approach involving the assessment of median length of 
stay in foster care because it may be several years before all, or even 
a substantial percentage, of the children in a particular cohort will 
have exited foster care.
     Of all children entering foster care for the first time in 
the first 6 months of the reporting year, what percent exited foster 
care to reunification within 12 months of entry into foster care?
     Of all children entering foster care for the first time in 
the first 6 months of the reporting year, what percent exited foster 
care to reunification after having been in foster care for at least 30 
days but less than 12 months?
    Relevant issues: ACF believes that the assessment of timeliness to 
reunification of children entering foster care in a given year is an 
important component of assessing State performance in this domain. 
However, because not all children in a given entry cohort are destined 
to be reunified with their families, the denominator for the entry 
cohort measure often includes children for whom reunification is not 
the outcome. Because the percentage of those children will vary across 
States and over time, the measure must be interpreted with caution and 
should be used in conjunction with an assessment of timeliness to 
reunification of an exit cohort.
Permanency Composite 1--Performance Area 3: Permanency of 
Reunifications
    Justification for inclusion: The permanency of reunifications may 
be assessed by the extent of a State's re-entries into foster care. A 
reunification, even if it occurs in a timely manner, cannot be 
considered as ``permanent'' if the child re-enters foster care within a 
12-month period after the reunification. A consistent finding over the 
years, as reported in the Report to Congress on Child Welfare Outcomes, 
is that States with a relatively high percentage of children reunified 
within 12 months also tend to have a relatively high percentage of 
children re-entering foster care within 12 months of a prior episode, 
although this is not the case for all States.
    Possible measure: Of all children who exit foster care to 
reunification (including living with a relative) in a fiscal year, what 
percent re-enter foster care within 12 months of the time of exit?
    Relevant issues: This measure is a revision of the one used to 
assess foster care re-entry during the first round of the CFSR. At the 
time the original measure was developed, it was not feasible through 
AFCARS to consistently and reliably link children across years for 
every State. Consequently the existing re-entry measure focused on the 
percentage of children entering foster care who were reported to be re-
entering foster care and whose re-entry occurred within 12 months of a 
prior episode. Because it is now possible to link children across years 
in AFCARS and to capture children re-entering foster care by an AFCARS 
identification number, the measure has been changed to one that is 
conceptually more meaningful.

Permanency Composite 2: Timeliness of Adoptions

    Performance on Permanency Composite 2 will be a part of the 
determination of a State's substantial conformity with CFSR Permanency 
Outcome 1--Children will have permanency and stability in their living 
situations. The composite reflects ACF's emphasis on promoting timely 
adoptions for those children in foster care who cannot be reunified 
with their families. The composite also reflects the requirement of 
ASFA that States pursue TPR for children who have been in foster care 
for 15 of the most recent 22 months, unless the child is placed with 
relatives, the State agency has not provided necessary services, or 
there are documented compelling reasons for not seeking TPR.
    The following performance areas are under consideration for 
Permanency Composite 2:
     Timeliness of finalized adoptions of children discharged 
from foster care.
     Timeliness of finalized adoptions of children who are in 
foster care for 17 months or more at the start of a fiscal year.
     Timeliness of finalized adoptions of children for whom a 
TPR has been granted.
     Timeliness of achieving TPR for children who have been in 
foster care for 17 months or more at the start of a fiscal year.
    Although CFSR workgroup participants recommended that ACF assess 
timeliness to adoption using an entry cohort (i.e., children who enter 
foster care in a particular time period), the results of our analyses 
indicated that an entry cohort approach to assessing the timeliness of 
adoptions is not feasible for the CFSR. The key results were the 
following:
     An extensive timeframe was required to a cohort of 
children from entry into foster care to a finalized

[[Page 67485]]

adoption and the timeframe is not consistent with the CFSR timeframes. 
For example, in following a cohort of children entering foster care in 
FY 2001, meaningful data pertaining to adoptions did not emerge until 3 
years after the entry year.
     Because not all children entering foster care will be 
adopted, and because the number of children waiting to be adopted 
changes each year, it is not possible to establish a stable denominator 
for a cohort measure. In following the FY 2001 cohort, we found that 
the denominator for the measure of timeliness to adoption kept changing 
on an ongoing basis as children in the original cohort were reunified 
or exited foster care for other reasons.
    Some researchers in the field using an entry cohort to assess a 
State's performance with regard to the timeliness of adoptions have 
addressed the problems noted above by employing statistical methods to 
estimate the ``likelihood'' of children who enter foster care in a 
given year being adopted within particular timeframes. ACF determined 
that because the CFSR is a monitoring system and not a research 
initiative, the use of estimates is not appropriate. A monitoring 
system, particularly one that has financial penalties associated with 
it, should be based on actual performance rather than on estimates of 
the likelihood of particular events occurring within a particular 
timeframe.
    Although we have decided that an entry cohort analysis is not 
appropriate for Permanency Composite 2, some of the performance areas 
proposed for this composite involve longitudinal assessments of 
progress toward adoption of a group of children that may be considered 
a cohort (i.e., all children who have been in foster care for 17 months 
or longer at the end of a fiscal year; or all children whose TPR occurs 
during a given fiscal year).
Permanency Composite 2--Performance Area 1: Timeliness of Adoptions of 
Children Discharged From Foster Care to a Finalized Adoption
    Justification for inclusion: Exits to adoption reflect the success 
of a child welfare agency in achieving permanency for those children 
who cannot be returned to their families. A primary goal of ACF is to 
ensure that children who are adopted do not remain in foster care any 
longer than is necessary to achieve a finalized adoption. Information 
about the percentage of children exiting foster care to a finalized 
adoption who exit in a timely manner as well as about the percentage of 
children who are adopted, but not in a timely manner, provides a means 
of assessing State performance with regard to achieving this goal.
    Possible measures: The following three measures are under 
consideration for this performance area:
     Of all children who exited foster care to a finalized 
adoption during the reporting period, what percent exited foster care 
in less than 24 months from the time of the latest removal from home? 
This measure was used to assess timeliness of adoption during the first 
CFSR round.
     Of all children who exited foster care to a finalized 
adoption during the reporting period, what percent was in foster care 
for 48 months or more before exiting to adoption?
     Of all children who exited foster care to a finalized 
adoption during the reporting period, what was the median length of 
stay in foster care (in months)?
    Relevant issues: Some CFSR workgroup participants recommended that 
the CFSR assessment include measures that examine timeliness of 
adoptions for children of different age groups and different races/
ethnicities. Although ACF has determined that this level of analysis is 
beyond the scope of the CFSR, States are encouraged to examine their 
own adoption data in order to understand the relationships between 
these factors and adoption timeliness. States vary considerably with 
regard to the distribution of ages and races/ethnicity among their 
foster care populations, and therefore the relationships between these 
factors and adoption timeliness also may vary.
Permanency Composite 2--Performance Area 2: Timeliness of Adoptions of 
Children Who Are in Foster Care for 17 Months or Longer at the Start of 
a Fiscal Year
    Justification for inclusion: This performance area assesses 
progress toward adoption of a cohort of children who have been in 
foster care for 17 months or longer. ASFA requires State child welfare 
agencies to pursue adoption as a permanency goal for a child who has 
been in foster care for 15 of the most recent 22 months, except in 
limited circumstances. A 17-month rather than a 15-month timeframe was 
chosen for the performance area because, in accordance with ASFA, a 
child is considered to have ``entered foster care'' (for purposes of 
starting the clock for 15 of 22 months) on the earlier of:
    (1) The first judicial finding that the child has been subjected to 
abuse and neglect, or
    (2) The date that is 60 days after the date on which the child is 
removed from home.
    The 17 months in the performance area reflects the latter timeframe 
for defining entry into foster care because AFCARS does not collect 
information pertaining to the date of the first judicial finding.
    Possible measure: Of all children in foster care on the first day 
of a given fiscal year who were in foster care for 17 continuous months 
or longer, what percent were adopted before the end of the fiscal year.
    Relevant issues: The proposed measure is based on the assumption 
that children who have been in foster care for 17 months or longer 
represent a somewhat stable denominator. (However, even after 17 months 
in foster care the denominator is not entirely stable because many 
children in the cohort will exit to reunification.) Although it would 
be preferable to include in the measure only those children in foster 
care for 17 months or longer who have a case goal of adoption, States 
do not consistently report case goal information to AFCARS and AFCARS 
does not have a data element pertaining to the date that a case goal is 
established. Also, in some States, the goal of adoption is not formally 
established until TPR has been achieved although adoption may be the 
goal that the agency is working toward.
Permanency Composite 1--Performance Area 3: Timeliness of Adoptions of 
Children for Whom Parental Rights Have Been Terminated
    Justification for inclusion: The two timeframes that are critical 
to the timeliness of adoptions are (1) the timeframe between entry into 
foster care and TPR, and (2) the timeframe between TPR and adoption 
finalization. This performance area addresses the latter timeframe and 
reflects ACF's expectation that a finalized adoption should occur 
quickly after TPR is granted. An analysis of AFCARS data indicated 
that, nationally, from FY 1998 to FY 2003, the average time from TPR to 
adoption has remained consistent at about 16 months.
    Possible measure: Of all children for whom a TPR was granted during 
a given fiscal year, what percent were adopted within 12 months of the 
TPR?
    Relevant issues: An analysis of existing data relevant to this 
measure resulted in the identification of the following data issues: 
(1) In their submissions to the AFCARS Foster Care File, some States 
are reporting a substantial number of TPR dates after the reporting 
period in which they

[[Page 67486]]

actually occurred, and (2) in FY 2003, States did not provide TPR dates 
in their AFCARS Foster Care File submissions for over one-fifth of the 
children whose discharge reason was adoption. Although these data 
problems do not appear in the data submitted to the AFCARS Adoption 
File, because the AFCARS Foster Care File will be used to calculate the 
measure for this performance area, it is important that States are more 
diligent, timely, and consistent in their reporting of the AFCARS 
Foster Care File data elements pertaining to TPR.
Permanency Composite 2--Performance Area 4: Timeliness of TPR for 
Children Who Have Been in Foster Care for 17 Months or Longer at the 
Start of a Fiscal Year
    Justification for inclusion: This performance area pertains to the 
timeframe required to achieve a TPR for children in foster care for 17 
months or longer. The performance area is consistent with the ASFA 
requirement that TPR should be sought for children who have been in 
foster care for 15 of the most recent 22 months, except in limited 
circumstances.
    Possible measure: Of all children in foster care for 17 months or 
longer on the first day of the fiscal year who did not have a TPR, what 
percentage of those who remained in foster care for the next 6 months 
had a TPR within that timeframe?
    Relevant issues: National data regarding time to adoption indicates 
that the time span between the time of entry into foster care and the 
finalization of a TPR petition has decreased from FY 1998 to FY 2003 by 
an average of 10 months. Inclusion of this performance area in 
Permanency Composite 2 will permit an assessment of an individual 
State's performance with regard to this timeframe.

Permanency Composite 3: Placement Stability

    Performance on Permanency Composite 3 will be one component of the 
determination of a State's substantial conformity with CFSR Permanency 
Outcome 1--Children will have permanency and stability in their living 
situations. The composite reflects the obligation of a State child 
welfare system to ensure that children who are removed from their homes 
by the State experience stable placements during their time in foster 
care. The following performance areas are under consideration for 
Permanency Composite 3:
     Stability of children's placement experience during the 
first year in foster care
     Stability of children's placement experience for children 
in care for longer than 12 months
Proposed Stability Performance Area 1: Stability of Children's 
Placement Experience During the First Year in Foster Care
    Justification for inclusion: This performance area addresses the 
issue of achieving placement stability for children as quickly as 
possible after entry into foster care.
    Possible measure: During the reporting period, of all children who 
have been in foster care for less than 12 months from the time of the 
latest removal from home, what percent have had no more than 2 
placement settings?
    Relevant issues: Some CFSR workgroup participants suggested that 
this measure does not take into account variations in time in care 
within the 12-month period or consider some States' practices of 
routinely placing children in foster care for short periods of time. To 
address this concern, ACF examined the data for this measure in the 
following ways: (1) Excluding children who had been in foster care for 
only 1 month, and (2) excluding children who had been in care for only 
3 months. The correlations between State performance on the measure of 
placement stability within 12 months, and performance on this measure 
using the 1-month and 3-month exclusion exceeded +0.95, indicating 
little variation among the measures. As a result, ACF decided that the 
existing measure was adequate to reflect variation in State performance 
regarding placement stability during the first 12 months in foster 
care.
Permanency Composite 3--Performance Area 2: Stability of Children's 
Placement Experience for Children in Care for Longer Than 12 Months
    Justification for inclusion: ACF believes that children should 
experience placement stability throughout their stay in foster care. 
However, analyses of the AFCARS data indicated that in most States, the 
percentage of children who experience no more than 2 placement settings 
declines considerably (in some States by half) when children have been 
in foster care for at least 12 months but less than 24 months, and 
continues to exhibit a substantial decline for those children in foster 
care for 24 months or longer.
    Possible measure: Two measures are under consideration for this 
performance area.
     During the reporting period, of all children who have been 
in foster care for at least 12 months but less than 24 months, what 
percent have had no more than 2 placement settings?
     During the reporting period, of all children who have been 
in foster care for 24 months or longer, what percent have had no more 
than 2 placement settings?

Permanency Composite 4: Achieving Permanency for Children

    Performance on Permanency Composite 4 will be part of the 
determination of a State's substantial conformity with CFSR Permanency 
Outcome 1--Children will have permanency and stability in their living 
situations. The composite reflects the responsibility of the State 
child welfare systems to engage in concerted efforts to find permanent 
homes for children so that extended stays in foster care are avoided 
and children do not ``age out'' of the system. The following 
performance areas are under consideration for Permanency Composite 4:
     The extent to which children are ``growing up'' in foster 
care.
     Timeliness of establishing permanency goals.
     The extent to which children with TPR exit foster care to 
a permanent family.
Permanency Composite 4--Performance Area 1: Children Growing Up in 
Foster Care
    Justification for inclusion: This performance area addresses the 
question of State effectiveness with regard to ensuring that children 
do not ``languish'' in foster care--i.e., entering foster care at a 
relatively young age and exiting foster care only when they have 
reached the age at which the State will not longer provide for their 
care.
    Possible measure: Of all children who were emancipated from foster 
care prior to age 18 or who reached their 18th birthday while in foster 
care, what percent entered foster care when they were age 12 or younger 
and remained in foster care continuously since that entry?
    Relevant issues: This measure is a modification of a measure that 
is part of the Report to Congress on Child Welfare Outcomes. The 
modification adds to the measure children who reached their 18th 
birthday while in foster care. The modification was established because 
Several States currently allow children to remain in foster care beyond 
age 18, often to complete school or college. The modification will 
ensure that these children are included in the measure if

[[Page 67487]]

they entered foster care when they were age 12 or younger even if they 
have not yet exited foster care.
Permanency Composite 4--Performance Area 2: Timeliness of Establishing 
Permanency Goals
    Justification for inclusion: A key factor in moving a child toward 
permanency is the establishment of a permanency goal. The permanency 
goal is the basis for developing a case plan delineating the services 
to be provided and the objectives to be achieved to reach the goal. A 
Federal requirement is that a case plan be established for every child 
who is in foster care for longer than 60 days and that the case plan 
includes the agency's plan for achieving permanency for the child.
    Possible measure: Of all children in foster care for longer than 12 
months, what percentage is reported to AFCARS as ``Not Yet Determined'' 
with regard to the case goal?
    Relevant issues: An analysis of data relevant to this measure 
indicated that there are a number of States that have a relatively high 
percentage of children for whom the data element regarding case goal is 
reported as ``not yet determined.''
Permanency Composite 4--Permanency Area 3: Exits to Families of 
Children With TPR
    Justification for inclusion: This performance area is an important 
component of Permanency Composite 4 because it addresses the issue of 
whether seeking TPR for children results in children becoming ``legal 
orphans'' (i.e., children with TPR who are not placed for adoption or 
guardianship or placed with relatives and eventually emancipate from 
foster care). TPR is a costly process, both financially and, for the 
child, emotionally. To engage in that process with the end result that 
a child does not exit foster care to a family would be contrary to the 
best interests of the child in most situations.
    Possible measure: Of all children exiting foster care with a TPR, 
what percentage exited to a permanent family? (A permanent family 
includes living with a parent, relative, guardian, or adoptive 
parents.)
    Relevant issues: Although in most States, the vast majority of 
children with TPR exit foster care to a permanent family, there are 
several States in which 15 to 20 percent of these children do not exit 
to a family. This suggests that the child welfare agency in those 
States may not be making sufficient efforts to ensure that children 
with TPR achieve permanency.

    Dated: October 31, 2005.
Joan E. Ohl,
Commissioner, Administration on Children, Youth and Families.

Attachment A: Outcomes and Measures Developed for the Annual Report to 
Congress on Child Welfare Outcomes and the Outcomes and Items Assessed 
by the Child and Family Services Review

    The outcomes and measures presented in the report to Congress are 
the following:

Child Welfare Outcome 1

Reduce Recurrence of Child Abuse and/or Neglect
    Measure 1.1: Of all children who were victims of substantiated or 
indicated child abuse and/or neglect during the first 6 months of the 
reporting period, what percentage had another substantiated or 
indicated report within a 6-month period?

Child Welfare Outcome 2

Reduce the Incidence of Child Abuse and/or Neglect in Foster Care
    Measure 2.1: Of all children who were in foster care during the 
reporting period, what percentage was the subject of substantiated or 
indicated maltreatment by a foster parent or facility staff?

Child Welfare Outcome 3

Increase Permanency for Children in Foster Care
    Measure 3.1: For all children who exited foster care, what 
percentage left either to reunification, adoption, or legal 
guardianship?
    Measure 3.2: For children who exited foster care and were 
identified as having a diagnosed disability, what percentage left 
either to reunification, adoption, or legal guardianship?
    Measure 3.3: For children who exited foster care and were older 
than age 12 at the time of their most recent entry into care, what 
percentage left either to reunification, adoption, or legal 
guardianship?
    Measure 3.4: Of all children exiting foster care to emancipation, 
what percentage was age 12 or younger at the time of entry into care?
    Measure 3.5: For all children who exited foster care, what 
percentage by racial/ethnic category left either to reunification, 
adoption, or legal guardianship?

Child Welfare Outcome 4

Reduce Time in Foster Care to Reunification Without Increasing Re-entry
    Measure 4.1: Of all children who were reunified with their parents 
or caretakers at the time of discharge from foster care, what 
percentage was reunified in the following time periods?
    (1) Less than 12 months from the time of latest removal from home
    (2) At least 12 months, but less than 24 months
    (3) At least 24 months, but less than 36 months
    (4) At least 36 months, but less than 48 months
    (5) 48 or more months
    Measure 4.2: Of all children who entered foster care during the 
reporting period, what percentage re-entered care:
    (1) Within 12 months of a prior foster care episode?
    (2) More than 12 months after a prior foster care episode?

Child Welfare Outcome 5

Reduce Time in Foster Care to Adoption
    Measure 5.1: Of all children