Existing law requires the department to establish the California Child and Family Service Review System, in order to review all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living. Existing law requires the California Health and Human Services Agency to convene a workgroup, as prescribed, to establish a work plan by which child and family service reviews shall be conducted. Existing law requires the workgroup to consider, among other things, measurable outcome indicators, which shall be consistent with specified federal measures and standards.

This bill, subject to an appropriation by the Legislature in the annual Budget Act or another statute for these purposes, would require the California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool, and would also authorize it to include other behavioral health data that is readily available to the department and determined by the department to be relevant. The bill would authorize the department to consider feedback from specified stakeholders in determining which additional relevant data to include.

Existing law requires the department to establish the California Child and Family Service Review System, in order to review all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living. Existing law requires the California Health and Human Services Agency to convene a workgroup, as prescribed, to establish a work plan by which child and family service reviews shall be conducted. Existing law requires the workgroup to consider, among other things, measurable outcome indicators, which shall be consistent with specified federal measures and standards.

This bill, subject to an appropriation by the Legislature in the annual Budget Act or another statute for these purposes, would require the California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool, and would also authorize it to include other behavioral health data that is readily available to the department and determined by the department to be relevant. The bill would authorize the department to consider feedback from specified stakeholders in determining which additional relevant data to include.

Existing law requires the department to establish the California Child and Family Service Review System, in order to review all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living. Existing law requires the California Health and Human Services Agency to convene a workgroup, as prescribed, to establish a work plan by which child and family service reviews shall be conducted. Existing law requires the workgroup to consider, among other things, measurable outcome indicators, which shall be consistent with specified federal measures and standards.

This bill bill, subject to an appropriation by the Legislature in the annual Budget Act or another statute for these purposes, would require the California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool. tool, and would also authorize it to include other behavioral health data that is readily available to the department and determined by the department to be relevant. The bill would authorize the department to consider feedback from specified stakeholders in determining which additional relevant data to include.

Existing law requires the department to establish the California Child and Family Service Review System, in order to review all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living. Existing law requires the California Health and Human Services Agency to convene a workgroup, as prescribed, to establish a work plan by which child and family service reviews shall be conducted. Existing law requires the workgroup to consider, among other things, measurable outcome indicators, which shall be consistent with specified federal measures and standards.

This bill would require the outcome indicators California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool.

Existing law requires the department to establish the California Child and Family Service Review System, in order to review all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living. Existing law requires the California Health and Human Services Agency to convene a workgroup, as prescribed, to establish a work plan by which child and family service reviews shall be conducted. Existing law requires the workgroup to consider, among other things, measurable outcome indicators, which shall be consistent with specified federal measures and standards.

This bill would require the outcome indicators to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1907

Author:(Pellerin)

As Amended Ver:August 15, 2024

Majority vote

SUMMARY

Requires, subject to an appropriation, the California Child and Family Services Review (C-CFSR) System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool.

Senate Amendments

1. Make provisions of this bill subject to an appropriation.
2. Allow the C-CFSR to include other behavioral health data that is readily available, and determined to be relevant by the California Department of Social Services (CDSS).
3. Permit CDSS to consider feedback from relevant stakeholders including researchers, county representatives, advocates, and individuals with lived experience, in determining which additional relevant data to include.

COMMENTS

Background: Child and Family Services Reviews (CFSRs). The Children's Bureau, within the federal Department of Health and Human Services (HHS), administers CFSRs. Beginning in 1994, HHS was authorized to review all state's child and family service programs to ensure conformity with the requirements in titles IV-B and IV-E of the Social Security Act. Then, in 2000, the Children's Bureau published a final rule to establish a process for monitoring state child welfare programs. Under the rule, states are assessed for substantial conformity with federal requirements for child welfare services. All states are assessed in the areas of child protection, foster care, adoption, family connections, and independent living services.

More specifically, the purpose of CFSRs is threefold:

1) Ensure Conformity: CFSRs ensure that states comply with federal child welfare requirements.

2) Assess Real Outcomes: They evaluate the actual impact on children and families engaged in child welfare services.

3) Support Positive Outcomes: CFSRs assist states in achieving positive outcomes related to safety, permanency, and well-being for children and families.

According to a Children's Bureau fact sheet, all 50 states, the District of Columbia, and Puerto Rico completed their first review by 2004 and their second review by 2010, and no state was found to be in substantial conformity in all of the seven outcome areas and seven systemic factors. States developed and implemented Program Improvement Plans after each review to correct those areas not found in substantial conformity. The third round of reviews ran from 2015 to 2018. According to the 2020 HHS report entitled Systemic Factors—Results from the CFSRs, "Each state's unique child welfare system and accompanying process for data collection and analysis provide for a wide array of information included in statewide assessments and stakeholder interview notes. Thus, the information used to inform this report was not consistent in its quantity and quality across states and data source."

The CFSR is conducted in two parts: a Statewide Assessment and an Onsite Review. California's review, which was state-led as opposed to Children's Bureau-led, was conducted from October 1, 2023, through March 31, 2024. Round 4 of CFSRs is currently underway and scheduled to run through the federal fiscal year 2026.

Child Welfare System Improvement and Accountability Act. As directed by the Children's Bureau, the C-CFSR System was established when the Child Welfare System Improvement and Accountability Act was enacted through AB 636, (Steinberg), Chapter 678, Statutes of 2001, and was modeled after the federal CFSR. The C-CFSR was designed to improve outcomes for children in the child welfare system while holding county and state agencies accountable for the outcomes achieved. This statewide accountability system includes the completion of a County Self-Assessment which is comprised of a peer review, the development of a five-year System Improvement Plan (SIP), the submission of annual SIP Progress Reports, and quarterly monitoring of SIP strategies and the effects on child welfare outcomes.

Also as part of AB 636, beginning in the 2003-04 fiscal year, CDSS is required to report to the Legislature annually, on progress in meeting the outcome measures developed by the California Health and Human Services Agency. As a result of a partnership with the University of California, Berkeley and CDSS, California Child Welfare Indicators Project (CCWIP) was created to fulfill the requirements of AB 636 to track outcome measures including child maltreatment, allegation, investigation, and substantiation rates along with entry and in-care rates and also provides a point-in-time look at the number of youth in care that can be sorted according to age, race, ethnicity, and length of placement. CCWIP also provides the public with this valuable information. Currently, CCWIP does not include behavioral data that is currently being collected as part of the CANS assessment.

The Child and Adolescent Needs and Strengths tool evaluates behaviors and academic performance, underscores individual strengths, and assesses caregiver resources. The CANS tool takes a comprehensive approach to facilitate personalized care planning for each child's unique needs. Children and youth involved in the child welfare system have complex mental health needs, due in part to their experiences with trauma and often experience inadequate access to appropriate services. As a result, several programs and initiatives have been developed to address the unique needs of youth with child welfare involvement. Children and youth in foster care who receive federal Social Security Act Title IV-E payments are categorically eligible for Medicaid in every state, and specifically for Medi-Cal in California. In California, children and youth are enrolled into foster care-linked Medi-Cal subject to the court's custody determination. There are several programs and initiatives designed to assist the behavioral needs of foster youth that are provided as a Medi-Cal benefit.

According to a report jointly issued by CDSS and the California Department of Health Care Services entitled Children and Youth in Foster Care: Background and Current Landscape August 2020, "Pursuant to AB 403 [(Stone), Chapter 773, Statutes of 2015] and Continuum of Care Reform (CCR), CDSS selected the CANS as the functional assessment tool to be used with the CFT [child and family team] process to guide case planning and placement decisions. . . The CANS is a multi-purpose assessment tool developed to assess well-being, identify a range of social and behavioral healthcare needs, support care coordination and collaborative decision-making, and monitor outcomes of individuals, providers, and systems. . . The CANS assessment results must be shared, discussed, and used within the CFT process to support case planning and care coordination."

The CANS assessment is required to be completed prior to the completion of the family case plan, and the CANS results are intended to inform the CFT in several key areas, including but not limited to:

1. Determining if the youth has unmet behavioral health or substance use needs;
2. Making placement decisions;
3. Informing the Level of Care protocol; and,
4. Determining educational needs.

Foster youth undergo CANS assessments at specific intervals to evaluate their needs and strengths assessment and typically occur at the following frequencies:

Initial Assessment: Within 30 days of a youth entering foster care, a provider completes the CANS assessment. This initial assessment helps establish a baseline for understanding the child's well-being.

Annual Updates: Annually thereafter, foster youth are eligible for a CANS update to track changes in the child's behavior, functioning, and overall well-being over time.

This bill would additionally include behavioral health data from CANS as part of the data collected for the C-CFSR and would allow the C-CFSR to include other behavioral health data that is readily available, and determined to be relevant by CDSS.

Equity Implications: The provisions of this bill aim to improve the outcomes of those impacted by the child welfare system, the majority of whom have experienced high rates of adverse childhood experiences that negatively impact their long-term mental health. The Author and Sponsors contend that having access to data that can provide a comprehensive understanding of the behavioral health needs of youth in foster care will allow state leaders, policymakers, and child welfare agencies to better assess the effectiveness of current services and policies. Having access to this data on a statewide level could potentially help identify gaps, track progress, and shape targeted interventions to improve the mental health and well-being of children and youth in foster care.

According to the Author

"Children and adolescents involved in the child welfare system often grapple with behavioral and social-emotional challenges at rates far higher than their peers outside the system. Moreover, trauma exposure among these vulnerable youth is alarmingly prevalent, as foster care youth bear a heightened risk of experiencing abuse and neglect, further exacerbating their already precarious situations.

"Integrating behavioral health data into the Child Welfare Indicators Project is paramount in elevating outcomes for the children and youth navigating our child welfare system. By integrating behavioral health data into the Child Welfare Indicators Project, [this bill] will provide invaluable insights into the unique needs and challenges faced by children and youth in the child welfare system and empower policymakers, state leaders, and child welfare agencies to craft targeted interventions and policies aimed at improving their well-being. [This bill] will ensure that every child, regardless of their circumstances, has access to the care, support, and resources they need to survive and thrive."

Arguments in Support

According to the sponsor, The Steinberg Institute, "Research indicates that up to 80% of children in the child welfare system have significant mental health issues, compared to approximately 18-22% of the general population, underscoring the urgent need for the comprehensive behavioral insights the CANS tool offers."

Arguments in Opposition

No opposition on file.

FISCAL COMMENTS

According to the Senate Appropriations Committee on August 15, 2024:

1. Ongoing local assistance costs, likely low millions (General Fund and federal funds), for the addition of data.
2. Ongoing state administration costs, likely low hundreds of thousands (General Fund), for the California Department of Social Services (CDSS).

VOTES:

ASM HUMAN SERVICES: 6-0-1

YES: Lee, Essayli, Calderon, Gipson, Jackson, Ortega

ABS, ABST OR NV: Mathis

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

ASSEMBLY FLOOR: 73-0-7

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

ABS, ABST OR NV: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Luz Rivas

UPDATED

VERSION: August 15, 2024

CONSULTANT: Jessica Langtry / HUM. S. / (916) 319-2089 FN: 0004707

 THIRD READING  

Bill No: AB 1907

Author: Pellerin (D), et al.

Amended: 8/15/24 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 7/1/24

AYES: Alvarado-Gil, Ochoa Bogh, Blakespear, Limón, Menjivar

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/15/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

ASSEMBLY FLOOR: 73-0, 5/21/24 - See last page for vote

SUBJECT: California Child and Family Service Review System: Child and Adolescent Needs and Strengths (CANS) assessment

SOURCE: Steinberg Institute

DIGEST:

This bill requires the California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool and other relevant behavioral health data sources.

ANALYSIS:

Existing law:

1. Creates the California Child and Family Service Review System to review the child protective services, foster care, adoption, family preservation, family support, and independent living in every county. (WIC 10601.2)
2. Requires the California Health and Human Services Agency to convene a workgroup comprised of representatives of the Judicial Council, the State Department of Social Services (CDSS), the State Department of Health Care Services, the State Department of Education, the State Department of Justice, any other state departments or agencies the California Health and Human Services Agency deems necessary, the County Welfare Directors Association of California, the California State Association of Counties, the Chief Probation Officers of California, the California Youth Connection, and representatives of California tribes, interested child advocacy organizations, researchers, and foster parent organizations. The workgroup is required to establish a work plan by which child and family service reviews shall be conducted. The work plan should consider any existing federal program improvement plans entered into by the state pursuant to federal regulations, the outcome indicators to be measured, compliance thresholds for each indicator, timelines for implementation, county review cycles, uniform processes, procedures and review instruments to be used, a corrective action process, and any funding or staffing increases needed (WIC 10601.2 (c))
3. Requires CDSS to provide information to the Assembly and Senate Budget Committees and appropriate legislative policy committees annually, beginning with the 2002–03 fiscal year on the following:
   1. The CDSS’s progress in planning for the federal child and family service review and the findings of that review.
   2. The CDSS’s progress in implementing the California child and family service reviews, including, but not limited to, the timelines for implementation, the process to be used, and any funding or staffing increases needed at the state or local level to implement the requirements of the program
   3. The findings and recommendations for child welfare system improvements identified in county self-assessments and county system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements, any recommendations to overcome those barriers, and, as applicable, information regarding the allocation and use of the moneys provided to counties. (WIC 10601.2 (f))
4. Requires specified entities to update the legislature on the implementation of Continuum of Care Reform, including a status update on the use of Child and Family Teams (CFT) and CANS. Specifically, disaggregated by county, the number and percentage of children in foster care receiving CFT meetings and CANS assessments; average frequency of meetings and assessments, and the overall CANS scoring outcomes and trends over time; number of CANS assessments and who conducted the assessments; and the percentage of CANS assessments that are conducted at the required timeline. (WIC 16523.55)
5. Requires specific entities to report on automation changes to the Child Welfare Services/Case Management System (CWS/CMS) and licensing system needed to implement Continuum of Care Reform which includes support for CANS, the Resource family approval process, level of care protocol, and other programmatic elements. (WIC 16523.58)
6. Requires an assessment of the strengths and needs of the child or nonminor dependent, using an age-appropriate, evidence-based, validated, functional assessment tool and methodology approved by CDSS and the State Department of Health Care Services for placement in a short-term therapeutic residential program or a community treatment facility. (WIC 4096(g)(3)(b))

This Bill:

1. Requires the California Child and Family Service Review System to include data from the CANS assessment tool and allows other behavioral health data readily available to the CDSS to be included if deemed relevant by the department.
2. Allows CDSS to consider feedback from stakeholders about additional relevant data to include in the California Child and Family Service Review System.
3. Makes these changes subject to an appropriation by the legislature.

Comments

According to the author, “Children and adolescents involved in the child welfare system often grapple with behavioral and social-emotional challenges at rates far higher than their peers outside the system. Moreover, trauma exposure among these vulnerable youth is alarmingly prevalent, as foster care youth bear a heightened risk of experiencing abuse and neglect, further exacerbating their already precarious situations.

Integrating behavioral health data into the Child Welfare Indicators Project is paramount in elevating outcomes for the children and youth navigating our child welfare system. By integrating behavioral health data into the Child Welfare Indicators Project, AB 1907 will provide invaluable insights into the unique needs and challenges faced by children and youth in the child welfare system and empower policymakers, state leaders, and child welfare agencies to craft targeted interventions and policies aimed at improving their well-being. AB 1907 will ensure that every child, regardless of their circumstances, has access to the care, support, and resources they need to survive and thrive.”

Child Welfare Services (CWS). California’s CWS system is an essential component of the state’s safety net. Social workers in each county receive reports of abuse or neglect, investigate and resolve those reports. Abused and neglected children who have been removed from their homes fall under the jurisdiction of the County’s juvenile dependency court. The dependency court holds legal jurisdiction over the child, while the child is served by the CWS system social worker. This system seeks to ensure the safety and protection of these children, and where possible, preserve and strengthen families through visitation and family reunification. The CWS system provides multiple opportunities for the custody of the child, or the child’s placement outside of the home, to be evaluated, reviewed and determined by the judicial system, in consultation with the child’s social worker to help provide the best possible services to the child. It is the state’s goal to reunify a foster child or youth with their biological family whenever possible. In instances where reunification is not possible, it is the state’s goal to provide a permanent placement alternative, such as adoption or guardianship, with the second highest placement priority of the CWS system being to unite children with other relatives or nonrelative extended family members. In 2023, the state’s child welfare agencies received 433,571 reports of abuse or neglect and 18,147 children were removed from their homes and placed into foster care via the CWS system. As of January 1, 2024, there were 43,633 children in the CWS system in California.

Continuum of Care Reform. The use of CANS was introduced to through the CWS system as a part of Continuum of Care Reform, initiated by AB 403 (Stone, Chapter 773, Statutes of 2015). Continuum of Care Reform is intended to reduce the numbers of foster children placed in congregate settings by improving assessments of children and families, emphasizing home-based family placements of foster children, and changing the goals of congregate care placements. Major changes made by Continuum of Care Reform are:

• Increased use of child and family teams with CANS assessments
• Creation of an Emergency Caregiver program
• Creating rate-equity for children placed in a relative’s home
• Establishing a new home-based family care rate structure that is tied to the child’s assessed level of care needs
• Expansion of the Intensive Services Foster Care program
• More funding for foster care family recruitment
• New requirements for congregate care providers to ensure they are providing appropriate supports

A child and family team is convened by the child welfare placing agency with the goal of including members that are invested in the family’s success. Instead of relying on a single social worker to assess, plan and coordinate care, team members are tasked with identifying the strengths and needs of the child or youth and their family. Team members include the youth, the youth’s family and extended family members, current caregiver, placing agency social worker and other individuals who are identified by the family as being important. This may include coaches, teachers, tribal members, behavioral health staff and others who have relationships with the child and can help with case planning, and placement decisions that are made to best support the family’s success.^[1]

AB 403 required child and family teams to create a child and family team plan that is “strengths-based, needs-driven, and culturally relevant.” The teams are required by CDSS to use CANS to evaluate the child’s and family’s needs. According to CDSS, “The CANS must be informed by CFT members, including the youth and family. The CANS assessment results must be shared, discussed, and used within the CFT process to support case planning and care coordination.”

CANS Assessment Tool. The CANS Assessment was developed by John Lyons to better evaluate the needs of minors. It was created specifically for providers of children’s services to support decision making and monitor the outcomes of services provided based on those decisions. There are several versions of the tool that can adapt to the provider or work across multiple systems. According to the Praed Foundation, CANS assessments are being used in 50 states by “child welfare, mental health, juvenile justice, and early intervention applications.” The foundation also said the assessment “facilitate[s] the linkage between the assessment process and the design of individualized service plans.” The goal of these assessments are to allow better communication between the child, their family and the service providers about the needs of the child. The assessment standardizes the way those needs are communicated among the various service providers in the system to make deciding which services to provide and assessing improvement easier, which ultimately should make decision making for families and providers easier.

Both CDSS and the Department of Health Care Services require counties to use CANS for their respective programs (the Department of Health Care Services requires it to be used for Early and Periodic Screening, Diagnosis, and Treatment mental health services). CDSS has chosen the CANS Early Childhood as the state-approved child welfare assessment tool for children ages birth to five years old and CANS Core 50 for youth five years old to 21 years old. However, counties can modify it to accommodate their local needs. This bill proposes to report out the disaggregated behavioral health data collected through CANS in the California Child Welfare Indicators Project by including it in the California Child and Family Service Review System.

California Child and Family Service Review System and California Child Welfare Indicators Project. The California Child and Family Service Review System was created by AB 636 (Steinberg, Chapter 768, Statutes 2001) to require CDSS to establish a new system to review all county child welfare systems, and to ensure compliance with federal regulations for the receipt of federal foster care funds. The system replaced the former oversight mechanism and created a continuous quality improvement model that requires review of all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living facilities and is managed by county child welfare departments. County probation departments, Native American tribes, service recipients, and other relevant county departments are also expected to contribute to the review. Other relevant government entities and non-profit providers are allowed to participate.

AB 636 also required CDSS to provide annual data updates to the Assembly and Senate Budget Committees. The California Child Welfare Indicators Project was created out of that requirement. The project is a collaborative efforts between CDSS and the University of California at Berkley and is housed in the School of Social Welfare. According to CDSS, the website reports the child outcomes of Safety, Permanency and Well-being as well as numerous other important longitudinal systemic outcome measures. The website also provides counties the opportunity to analyze data and to identify areas that are either performing well or need improvement. It provides data on outcomes for foster youth, placement rates, documented mistreatment and many of the other points of data counties track. However it does not track behavioral health data specifically.

While the Quarterly Data Reports are static and provide a point in time view, the California Child Welfare Indicators Project is dynamic and changes over time.. The California Child and Family Service Review System Quarterly Data Reports and the California Child Welfare Indicators Project draw from the same qualitative data sources and report on similar metrics. This bill would add CANS as a new data source for the California Child and Family Service Review System.

Related/Prior Legislation

AB 636 (Steinberg, Chapter 678, Statutes of 2001) required CDSS to establish, by July 1, 2003, a Child and Family Service (CFS) Review System in order to review all county child welfare systems, and to ensure compliance with federal regulations for the receipt of federal foster care funds.

AB 403 (Stone, Chapter 773, Statutes of 2015), initiated continuum of care reform and created Child and Family Teams.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee:

• Ongoing local assistance costs, likely low millions (General Fund and federal funds), for the addition of data.

• Ongoing state administration costs, likely low hundreds of thousands (General Fund), for the California Department of Social Services (CDSS).

SUPPORT: (Verified 8/15/24)

California Academy of Child and Adolescent Psychiatry
Children Now
Steinberg Institute

OPPOSITION: (Verified 8/15/24)

None received

ASSEMBLY FLOOR: 73-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Luz Rivas

Prepared by: Naima Ford Antal / HUMAN S. / (916) 651-1524

8/19/24 10:47:16

**** END ****

1. All County Letter NO. 16-84, California Department of Social Services (October 7, 2016). ↑

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 1907 (Pellerin) - California Child and Family Service Review System: Child and Adolescent Needs and Strengths (CANS) assessment

Bill Summary:

AB 1907 would require the California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 15, 2024

Fiscal Impact:

• Ongoing local assistance costs, likely low millions (General Fund and federal funds), for the addition of data.

• Ongoing state administration costs, likely low hundreds of thousands (General Fund), for the California Department of Social Services (CDSS).

Author Amendments:

Make the provisions subject to an appropriation by the Legislature; allow the California Child and Family Service Review System to include other behavioral health data that is readily available to the CDSS and determined by the department to be relevant; and allow CDSS to consider feedback from relevant stakeholders, as specified, in determining which additional relevant data to include.

-- END --

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 1907 (Pellerin) - California Child and Family Service Review System: Child and Adolescent Needs and Strengths (CANS) assessment

Bill Summary:

AB 1907 would require the California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool.

Fiscal Impact:

The California Department of Social Services (CDSS) estimates the following:

• Local assistance costs of $1.3 million ($943,000 General Fund and $357,000 federal funds) in 2024-25 and $2.6 million ($1.9 million General Fund and $700,000 federal funds) ongoing thereafter for the addition of the CANS assessment tool data.
• State administration costs of $362,000 in 2024-25 and $352,000 ongoing thereafter (General Fund).

Background:

Current law requires the CDSS to establish the California Child and Family Service Review System to review all county child welfare systems, and to ensure compliance with federal regulations for the receipt of federal foster care funds. The system is based on a continuous quality improvement model that requires review of all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living facilities and is managed by county child welfare departments. County probation departments, Native American tribes, service recipients, and other relevant county departments are also expected to contribute to the review. Other relevant government entities and non-profit providers are allowed to participate. The California Child and Family Service Review System consists of five components: County Self-Assessment; Peer Review; System Improvement Plan; Annual System Improvement Plan Progress Report; and Quarterly Data Reports.

The CANS assessment tool was developed to allow better communication between the child, their family and the service providers about the needs of the child. The assessment tool standardizes the way those needs are communicated among the various service providers in the system to make deciding which services to provide and assessing improvement easier. The CDSS requires counties to use the CANS assessment tool in the child welfare services programs.

Proposed Law:

AB 1907 would require the California Child and Family Service Review System to include data from the CANS assessment tool.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: California Child and Family Service Review System: Child and Adolescent Needs and Strengths (CANS) assessment

SUMMARY

This bill requires the California Child and Family Service Review System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool.

ABSTRACT

Existing Law:

1. Creates the California Child and Family Service Review System to review the child protective services, foster care, adoption, family preservation, family support, and independent living in every county. (WIC 10601.2)
2. Requires the California Health and Human Services Agency to convene a workgroup comprised of representatives of the Judicial Council, the State Department of Social Services (CDSS), the State Department of Health Care Services, the State Department of Education, the State Department of Justice, any other state departments or agencies the California Health and Human Services Agency deems necessary, the County Welfare Directors Association of California, the California State Association of Counties, the Chief Probation Officers of California, the California Youth Connection, and representatives of California tribes, interested child advocacy organizations, researchers, and foster parent organizations. The workgroup is required to establish a work plan by which child and family service reviews shall be conducted. The work plan should consider any existing federal program improvement plans entered into by the state pursuant to federal regulations, the outcome indicators to be measured, compliance thresholds for each indicator, timelines for implementation, county review cycles, uniform processes, procedures and review instruments to be used, a corrective action process, and any funding or staffing increases needed (WIC 10601.2 (c))
3. Requires CDSS to provide information to the Assembly and Senate Budget Committees and appropriate legislative policy committees annually, beginning with the 2002–03 fiscal year on the following:
   1. The CDSS’s progress in planning for the federal child and family service review and the findings of that review.
   2. The CDSS’s progress in implementing the California child and family service reviews, including, but not limited to, the timelines for implementation, the process to be used, and any funding or staffing increases needed at the state or local level to implement the requirements of the program
   3. The findings and recommendations for child welfare system improvements identified in county self-assessments and county system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements, any recommendations to overcome those barriers, and, as applicable, information regarding the allocation and use of the moneys provided to counties. (WIC 10601.2 (f))
4. Requires specified entities to update the legislature on the implementation of Continuum of Care Reform, including a status update on the use of Child and Family Teams (CFT) and CANS. Specifically, disaggregated by county, the number and percentage of children in foster care receiving CFT meetings and CANS assessments; average frequency of meetings and assessments, and the overall CANS scoring outcomes and trends over time; number of CANS assessments and who conducted the assessments; and the percentage of CANS assessments that are conducted at the required timeline. (WIC 16523.55)
5. Requires specific entities to report on automation changes to the Child Welfare Services/Case Management System (CWS/CMS) and licensing system needed to implement Continuum of Care Reform which includes support for CANS, the Resource family approval process, level of care protocol, and other programmatic elements. (WIC 16523.58)
6. Requires an assessment of the strengths and needs of the child or nonminor dependent, using an age-appropriate, evidence-based, validated, functional assessment tool and methodology approved by CDSS and the State Department of Health Care Services for placement in a short-term therapeutic residential program or a community treatment facility. (WIC 4096(g)(3)(b))

This Bill:

1. Requires the California Child and Family Service Review System to include data from the CANS assessment tool.

FISCAL IMPACT

According to the Assembly Appropriations Committee, “CDSS estimates ongoing General Fund costs of approximately $300,000 annually for two staff positions to support integration of new data into C-CFSR system and to provide contract oversight with the California Child Welfare Indicators Project (CCWIP) at the University of California (UC) Berkeley. In addition, staff would develop methodology for the CANS reports on the CCWIP website, support counties with analysis and interpretation of data and partner with the California Automation Response and Engagement System (CWS-CARES) team to ensure consistent data methodology and supports. CDSS notes potential additional costs of an unknown amount to update CWS-CARES.”

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “Children and adolescents involved in the child welfare system often grapple with behavioral and social-emotional challenges at rates far higher than their peers outside the system. Moreover, trauma exposure among these vulnerable youth is alarmingly prevalent, as foster care youth bear a heightened risk of experiencing abuse and neglect, further exacerbating their already precarious situations.

Integrating behavioral health data into the Child Welfare Indicators Project is paramount in elevating outcomes for the children and youth navigating our child welfare system. By integrating behavioral health data into the Child Welfare Indicators Project, AB 1907 will provide invaluable insights into the unique needs and challenges faced by children and youth in the child welfare system and empower policymakers, state leaders, and child welfare agencies to craft targeted interventions and policies aimed at improving their well-being. AB 1907 will ensure that every child, regardless of their circumstances, has access to the care, support, and resources they need to survive and thrive.”

Child Welfare Services (CWS)

California’s CWS system is an essential component of the state’s safety net. Social workers in each county receive reports of abuse or neglect, investigate and resolve those reports. Abused and neglected children who have been removed from their homes fall under the jurisdiction of the County’s juvenile dependency court. The dependency court holds legal jurisdiction over the child, while the child is served by the CWS system social worker. This system seeks to ensure the safety and protection of these children, and where possible, preserve and strengthen families through visitation and family reunification. The CWS system provides multiple opportunities for the custody of the child, or the child’s placement outside of the home, to be evaluated, reviewed and determined by the judicial system, in consultation with the child’s social worker to help provide the best possible services to the child. It is the state’s goal to reunify a foster child or youth with their biological family whenever possible. In instances where reunification is not possible, it is the state’s goal to provide a permanent placement alternative, such as adoption or guardianship, with the second highest placement priority of the CWS system being to unite children with other relatives or nonrelative extended family members. In 2023, the state’s child welfare agencies received 433,571 reports of abuse or neglect and 18,147 children were removed from their homes and placed into foster care via the CWS system. As of January 1, 2024, there were 43,633 children in the CWS system in California.

Continuum of Care Reform

The use of CANS was introduced to through the CWS system as a part of Continuum of Care Reform, initiated by AB 403 (Chapter 773, Statutes of 2015). Continuum of Care Reform is intended to reduce the numbers of foster children placed in congregate settings by improving assessments of children and families, emphasizing home-based family placements of foster children, and changing the goals of congregate care placements. Major changes made by Continuum of Care Reform are:

• Increased use of child and family teams with CANS assessments
• Creation of an Emergency Caregiver program
• Creating rate-equity for children placed in a relative’s home
• Establishing a new home-based family care rate structure that is tied to the child’s assessed level of care needs
• Expansion of the Intensive Services Foster Care program
• More funding for foster care family recruitment
• New requirements for congregate care providers to ensure they are providing appropriate supports

A child and family team is convened by the child welfare placing agency with the goal of including members that are invested in the family’s success. Instead of relying on a single social worker to assess, plan and coordinate care, team members are tasked with identifying the strengths and needs of the child or youth and their family. Team members include the youth, the youth’s family and extended family members, current caregiver, placing agency social worker and other individuals who are identified by the family as being important. This may include coaches, teachers, tribal members, behavioral health staff and others who have relationships with the child and can help with case planning, and placement decisions that are made to best support the family’s success.^[1]

AB 403 requires child and family teams to create a child and family team plan that is “strengths-based, needs-driven, and culturally relevant.” The teams are required by CDSS to use CANS to evaluate the child’s and family’s needs. According to CDSS, “The CANS must be informed by CFT members, including the youth and family. The CANS assessment results must be shared, discussed, and used within the CFT process to support case planning and care coordination.” Specifically it is intended to inform the following areas:

• Determining if the child, youth, or Non-Minor Dependent has unmet behavioral health or substance use needs;
• Making placement decisions;
• Informing the Level of Care protocol;
• Determining educational needs
• Identifying any immediate support needs of the family or care provider, such as coaching or respite care; and/or
• Developing a comprehensive plan to support safety, permanency, and wellbeing^[2]

CANS Assessment Tool

The CANS Assessment was developed by John Lyons to better evaluate the needs of minors. It was created specifically for providers of children’s services to support decision making and monitor the outcomes of services provided based on those decisions. There are several versions of the tool that can adapt to the provider or work across multiple systems. According to the Praed Foundation, CANS assessments are being used in 50 states by “child welfare, mental health, juvenile justice, and early intervention applications.” The foundation also said the assessment “facilitate[s] the linkage between the assessment process and the design of individualized service plans.” The goal of these assessments are to allow better communication between the child, their family and the service providers about the needs of the child. The assessment standardizes the way those needs are communicated among the various service providers in the system to make deciding which services to provide and assessing improvement easier, which ultimately should make decision making for families and providers easier.

Both CDSS and the Department of Health Care Services require counties to use CANS for their respective programs (the Department of Health Care Services requires it to be used for Early and Periodic Screening, Diagnosis, and Treatment mental health services). CDSS has chosen the CANS Early Childhood as the state-approved child welfare assessment tool for children ages birth to five years old and CANS Core 50 for youth five years old to 21 years old. However, counties can modify it to accommodate their local needs. This bill proposes to report out the disaggregated behavioral health data collected through CANS in the California Child Welfare Indicators Project by including it in the California Child and Family Service Review System.

California Child and Family Service Review System and California Child Welfare Indicators Project

The California Child and Family Service Review System was created by AB 636 (Chapter 92, Statues 2001) to require CDSS to establish a new system to review all county child welfare systems, and to ensure compliance with federal regulations for the receipt of federal foster care funds. The system replaced the former oversight mechanism and created a continuous quality improvement model that requires review of all county child welfare systems, including child protective services, foster care, adoption, family preservation, family support, and independent living facilities and is managed by county child welfare departments. County probation departments, Native American tribes, service recipients, and other relevant county departments are also expected to contribute to the review. Other relevant government entities and non-profit providers are allowed to participate.

The California Child and Family Service Review System consists of five components.

• County Self-Assessment- an assessment completed every five years by the county in coordination with their local community partners to “determine effectiveness of current practice, programs and resources across the continuum of child welfare and probation placement services and identifies areas for targeted system improvement.”
• Peer Review- allows counties to share qualitative feedback about their programs and share best practices.
• System Improvement Plan- an agreement between the county and state created every five years about improvements they will make.
• Annual System Improvement Plan Progress Report- a progress report created by county child welfare departments and their stakeholders about the effectiveness of strategies agreed to in the System Improvement Plan
• Quarterly Data Reports- Outcome-based data reports created by CDSS quarterly focused on core safety, permanency and well-being measures. The data is extracted from the Child Welfare Services/Case Management System (CWS/CMS) and provides qualitative data that helps inform the other reports that are a part of the entire review system.

AB 636 also required CDSS to provide annual data updates to the Assembly and Senate Budget Committees. The California Child Welfare Indicators Project was created out of that requirement. The project is a collaborative efforts between CDSS and the University of California at Berkley and is housed in the School of Social Welfare. According to CDSS, the website reports the child outcomes of Safety, Permanency and Well-being as well as numerous other important longitudinal systemic outcome measures. The website also provides counties the opportunity to analyze data and to identify areas that are either performing well or need improvement. It provides data on outcomes for foster youth, placement rates, documented mistreatment and many of the other points of data counties track. However it does not track behavioral health data specifically.

While the Quarterly Data Reports are static and provide a point in time view, the California Child Welfare Indicators Project is dynamic and changes over time.. The California Child and Family Service Review System Quarterly Data Reports and the California Child Welfare Indicators Project draw from the same qualitative data sources and report on similar metrics. This bill would add CANS as a new data source for the California Child and Family Service Review System.

Related/Prior Legislation:

AB 636 (Steinberg, Chapter 678, Statutes of 2001) requires CDSS to establish, by July 1, 2003, a Child and Family Service (CFS) Review System in order to review all county child welfare systems, and to ensure compliance with federal regulations for the receipt of federal foster care funds.

AB 403 (Stone, Chapter 773, Statutes of 2015), initiated continuum of care reform and created Child and Family Teams.

COMMENTS

This bill makes the CANS assessment tool a required part of the California Child and Family Service Review System and its data posted regularly on the California Child Welfare Indicators Project website. The California Child Welfare Indicators Project website provides valuable data about foster youth that lawmakers, policy advocates, and researchers consult to learn about that population. It provides that data in easy to understand ways including using charts and graphics. This bill would require CDSS to use CANS as a data source to extract important information about the behavioral health needs youth in the child welfare system that are not being reported from other data sources on the California Child Welfare Indicators Project website.

PRIOR VOTES

POSITIONS

Support:

Steinberg Institute (Sponsor)

California Academy of Child and Adolescent Psychiatry
Children Now

Oppose:

None

-- END --

1. All County Letter NO. 16-84, California Department of Social Services (October 7, 2016). ↑

2. All County Letter NO. 18-09, California Department of Social Services (January 25, 2018). ↑

ASSEMBLY THIRD READING

ATR Bill Id:AB 1907

Author:(Pellerin)

As Amended Ver:April 8, 2024

Majority vote

SUMMARY

Requires the California Child and Family Services Review (C-CFSR) System to include data from the CANS assessment tool.

Major Provisions

COMMENTS

Background: Child and Family Services Reviews (CFSRs). The Children's Bureau, within the federal Department of Health and Human Services (HHS), administers CFSRs. Beginning in 1994, HHS was authorized to review all state's child and family service programs to ensure conformity with the requirements in titles IV-B and IV-E of the Social Security Act. Then, in 2000, the Children's Bureau published a final rule to establish a process for monitoring state child welfare programs. Under the rule, states are assessed for substantial conformity with federal requirements for child welfare services. All states are assessed in the areas of child protection, foster care, adoption, family connections, and independent living services.

More specifically, the purpose of CFSRs is threefold:

1. Ensure Conformity: CFSRs ensure that states comply with federal child welfare requirements.
2. Assess Real Outcomes: They evaluate the actual impact on children and families engaged in child welfare services.
3. Support Positive Outcomes: CFSRs assist states in achieving positive outcomes related to safety, permanency, and well-being for children and families.

According to a Children's Bureau fact sheet, all 50 states, the District of Columbia, and Puerto Rico completed their first review by 2004 and their second review by 2010, and no state was found to be in substantial conformity in all of the seven outcome areas and seven systemic factors. States developed and implemented Program Improvement Plans after each review to correct those areas not found in substantial conformity. The third round of reviews ran from 2015 to 2018.

According to the 2020 HHS report entitled Systemic Factors—Results from the CFSRs, "Each state's unique child welfare system and accompanying process for data collection and analysis provide for a wide array of information included in statewide assessments and stakeholder interview notes. Thus, the information used to inform this report was not consistent in its quantity and quality across states and data source."

Round four of CFSRs is currently underway and scheduled to run through the federal fiscal year 2026.

The CFSR is conducted in two parts: a Statewide Assessment and an Onsite Review. California's review, which was state-led as opposed to Children's Bureau-led, was conducted from October 1, 2023, through March 31, 2024.

Child Welfare System Improvement and Accountability Act. As directed by the Children's Bureau, the California Child and Family Services Review (C-CFSR) System was established when the Child Welfare System Improvement and Accountability Act was enacted through

AB 636, (Steinberg), Chapter 678, Statutes of 2001, and was modeled after the federal CFSR. The C-CFSR was designed to improve outcomes for children in the child welfare system while holding county and state agencies accountable for the outcomes achieved. This statewide accountability system includes the completion of a County Self-Assessment which is comprised of a peer review, the development of a five-year System Improvement Plan (SIP), the submission of annual SIP Progress Reports, and quarterly monitoring of SIP strategies and the effects on child welfare outcomes.

Also as part of AB 636, beginning in the 2003-04 fiscal year, CDSS is required to report to the Legislature annually, on progress in meeting the outcome measures developed by the California Health and Human Services Agency. As a result of a partnership with the University of California, Berkeley and California Department of Social Services (CDSS), California Child Welfare Indicators Project (CCWIP) was created to fulfill the requirements of AB 636 to track outcome measures including child maltreatment, allegation, investigation, and substantiation rates along with entry and in-care rates and also provides a point-in-time look at the number of youth in care that can be sorted according to age, race, ethnicity, and length of placement. CCWIP also provides the public with this valuable information.

Currently, CCWIP does not include behavioral data that is currently being collected as part of the Child and Adolescent Needs and Strengths (CANS) tool. This bill would additionally include behavioral health data as part of the data collected for the C-CFRS.

The Child and Adolescent Needs and Strengths tool evaluates behaviors and academic performance, underscores individual strengths, and assesses caregiver resources. The CANS tool takes a comprehensive approach to facilitate personalized care planning for each child's unique needs.

Children and youth involved in child welfare have complex mental health needs, due in part to their experiences with trauma and often experience inadequate access to appropriate services. As a result, several programs and initiatives have been developed to address the unique needs of youth with child welfare involvement. Children and youth in foster care who receive federal Social Security Act Title IV-E payments are categorically eligible for Medicaid in every state, and specifically for Medi-Cal in California. In California, children and youth are enrolled into foster care-linked Medi-Cal subject to the court's custody determination. There are several programs and initiatives designed to assist the behavioral needs of foster youth that are provided as a Medi-Cal benefit.

According to a report jointly issued by CDSS and the Department of Health Care Services (DHCS) entitled Children and Youth in Foster Care: Background and Current Landscape August 2020, "Pursuant to AB 403 and Continuum of Care Reform (CCR), CDSS selected the CANS as the functional assessment tool to be used with the CFT [child and family team] process to guide case planning and placement decisions. . . The CANS is a multi-purpose assessment tool developed to assess well-being, identify a range of social and behavioral healthcare needs, support care coordination and collaborative decision-making, and monitor outcomes of individuals, providers, and systems. . . The CANS assessment results must be shared, discussed, and used within the CFT process to support case planning and care coordination."

The CANS is required to be completed prior to the completion of the family case plan, and the CANS results are intended to inform the CFT in several key areas, including but not limited to:

1. Determining if the youth has unmet behavioral health or substance use needs;
2. Making placement decisions;
3. Informing the Level of Care protocol; and,
4. Determining educational needs.

Foster youth undergo CANS assessments at specific intervals to evaluate their needs and strengths assessment and typically occur at the following frequencies:

Initial Assessment: Within 30 days of a youth entering foster care, a provider completes the CANS assessment. This initial assessment helps establish a baseline for understanding the child's well-being.

Annual Updates: Annually thereafter, foster youth are eligible for a CANS update to track changes in the child's behavior, functioning, and overall well-being over time.

Concerns with CANS Data. Counties have reported that not all counties are using the same version of CANS and there are variations in how that data is being input, as well as variations in the frequency that the CANS is being administered, resulting in inconsistent tracking of this data that is sometimes inaccessible and therefore providing an incomplete picture of the needs of California's foster youth.

Underscoring the need for uniformity in the frequency and content of this assessment is the proposal for CANS to be used in CDSS' forthcoming rate reform as the basis for determining the appropriate foster care payment for each youth entering care.

Equity Implications: The provisions of this bill aim to improve the outcomes of those impacted by the child welfare system, the majority of whom have experienced high rates of adverse childhood experiences that negatively impact their long-term mental health. The Author and sponsors contend that having access to data that can provide a comprehensive understanding of the behavioral health needs of youth in foster care will allow state leaders, policymakers, and child welfare agencies to better assess the effectiveness of current services and policies. Having access to this data on a statewide level could potentially help identify gaps, track progress, and shape targeted interventions to improve the mental health and well-being of children and youth in foster care.

According to the Author

"Children and adolescents involved in the child welfare system often grapple with behavioral and social-emotional challenges at rates far higher than their peers outside the system. Moreover, trauma exposure among these vulnerable youth is alarmingly prevalent, as foster care youth bear a heightened risk of experiencing abuse and neglect, further exacerbating their already precarious situations.

"Integrating behavioral health data into the Child Welfare Indicators Project is paramount in elevating outcomes for the children and youth navigating our child welfare system. By integrating behavioral health data into the Child Welfare Indicators Project, [this bill] will provide invaluable insights into the unique needs and challenges faced by children and youth in the child welfare system and empower policymakers, state leaders, and child welfare agencies to craft targeted interventions and policies aimed at improving their well-being. [This bill] will ensure that every child, regardless of their circumstances, has access to the care, support, and resources they need to survive and thrive."

Arguments in Support

According to the sponsor, The Steinberg Institute, "Research indicates that up to 80% of children in the child welfare system have significant mental health issues, compared to approximately 18-22% of the general population, underscoring the urgent need for the comprehensive behavioral insights the CANS tool offers."

Arguments in Opposition

No opposition on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee on May 14, 2024, "The California Department of Social Services (CDSS) estimates ongoing General Fund costs of approximately $300,000 annually for two staff positions to support integration of new data into C-CFSR system and to provide contract oversight with the California Child Welfare Indicators Project (CCWIP) at the University of California (UC) Berkeley. In addition, staff would develop methodology for the CANS reports on the CCWIP website, support counties with analysis and interpretation of data and partner with the California Automation Response and Engagement System (CWS-CARES) team to ensure consistent data methodology and supports. CDSS notes potential additional costs of an unknown amount to update CWS-CARES.
According to the Legislative Analyst's Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years."

VOTES

ASM HUMAN SERVICES: 6-0-1

YES: Lee, Essayli, Calderon, Gipson, Jackson, Ortega

ABS, ABST OR NV: Mathis

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

UPDATED

VERSION: April 8, 2024

CONSULTANT: Jessica Langtry / HUM. S. / (916) 319-2089 FN: 0003216

Date of Hearing: May 15, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 1907

Author:(Pellerin) – As Amended Ver:April 8, 2024

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Child and Family Services Review (C-CFSR) System to include data from the Child and Adolescent Needs and Strengths (CANS) assessment tool.

FISCAL EFFECT:

The California Department of Social Services (CDSS) estimates ongoing General Fund costs of approximately $300,000 annually for two staff positions to support integration of new data into C-CFSR system and to provide contract oversight with the California Child Welfare Indicators Project (CCWIP) at the University of California (UC) Berkeley. In addition, staff would develop methodology for the CANS reports on the CCWIP website, support counties with analysis and interpretation of data and partner with the California Automation Response and Engagement System (CWS-CARES) team to ensure consistent data methodology and supports. CDSS notes potential additional costs of an unknown amount to update CWS-CARES.

According to the Legislative Analyst’s Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years. 

COMMENTS:

1. Purpose. According to the author:

Children and adolescents involved in the child welfare system often grapple with behavioral and social-emotional challenges at rates far higher than their peers outside the system. Moreover, trauma exposure among these vulnerable youth is alarmingly prevalent, as foster care youth bear a heightened risk of experiencing abuse and neglect, further exacerbating their already precarious situations.

Integrating behavioral health data into the CCWIP is paramount in elevating outcomes for the children and youth navigating our child welfare system. By integrating behavioral health data into the CWIP, [this bill] will provide invaluable insights into the unique needs and challenges faced by children and youth in the child welfare system and empower policymakers, state leaders, and child welfare agencies to craft targeted interventions and policies aimed at improving their well-being.

1. Background. Beginning in 1994, the federal Department of Health and Human Services (HHS) was authorized to review every state’s child and family service programs to ensure conformity with certain federal requirements. In 2000, the Children’s Bureau, within HHS, published a final rule to establish a process for monitoring state child welfare programs. Under the rule, states are assessed for substantial conformity with federal requirements for child welfare services, including in the areas of child protection, foster care, adoption, family connections, and independent living services.

The Child Welfare System Improvement and Accountability Act, enacted through AB 636, (Steinberg), Chapter 678, Statutes of 2001, established the C-CFSR System modeled after the federal CFSR. The C-CFSR system is designed to improve outcomes for children in the child welfare system while holding county and state agencies accountable for the outcomes achieved. Also as part of AB 636, CDSS is required to report to the Legislature annually on progress in meeting the outcome measures. As a result of a partnership with UC Berkeley and CDSS, the CCWIP was created to fulfill the requirements of AB 636 to track outcome measures, including child maltreatment, allegation, investigation, and substantiation rates along with entry and in-care rates. The data also provides a point-in-time look at the number of youth in care.

The CANS is a multi-purpose assessment tool developed to assess well-being, identify a range of social and behavioral healthcare needs, support care coordination and collaborative decision-making, and monitor outcomes of individuals, providers, and systems.

CCWIP does not include behavioral data collected as part of the CANS tool. This bill additionally includes behavioral health data as part of the data collected for the C-CFSR system..

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 23, 2024

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

ABPCA Bill Id:AB 1907 (

Author:Pellerin) – As Amended Ver:April 8, 2024

SUBJECT: California Child and Family Service Review System: Child and Adolescent Needs and Strengths (CANS) assessment

SUMMARY: Requires the California Child and Family Services Review (C-CFSR) System to include data from the CANS assessment tool.

EXISTING LAW:

State law:

1. Required the California Department of Social Services (CDSS) to establish, by April 1, 2003, the C-CFSR System, in order to review all county child welfare systems to cover child protective services, foster care, adoption, family preservation, family support, and independent living. (Welfare and Institutions Code [WIC] § 10601.2(a))
2. Requires the California Health and Human Services Agency (CalHHS) to convene a workgroup comprised of representatives of the Judicial Council, CDSS, the California Department of Health Care Services (DHCS), the California Department of Education, the California Department of Justice, any other state departments or agencies CalHHS deemed necessary, the County Welfare Directors Association of California,  the California State Association of Counties, the Chief Probation Officers of California, the California Youth Connection, and representatives of California tribes, interested child advocacy organizations, researchers, and foster parent organizations to establish a work plan by which child and family service reviews would be conducted, including a process for qualitative peer reviews of case information. (WIC § 10601.2(c)(1)) 
3. Requires the C-CFSR System outcome indicators to be consistent with the federal child and family service review (F-CFSR) measures and standards for child and family outcomes and system factors authorized by federal law. (WIC § 10601.2(d)(1)) 
4. Required, during the first review cycle, each county to be reviewed according to the outcome indicators established for the C-CFSR System and for subsequent reviews, requires the workgroup to consider whether to establish additional outcome indicators that support the federal outcomes and any program improvement plan, and promote good health, mental health, behavioral, educational, and other relevant outcomes for children and families in California’s child welfare services system. (WIC § 10601.2(d)(3)) 
5. Requires, at a minimum, in establishing the work plan, the workgroup to consider any existing federal program improvement plans entered into by the state pursuant to federal regulations, the outcome indicators to be measured, compliance thresholds for each indicator, timelines for implementation, county review cycles, uniform processes, procedures and review instruments to be used, a corrective action process, and any funding or staffing increases needed to implement the requirements of this section. Further requires CalHHS to broadly consider collaboration with all entities to allow the adequate exchange of information and coordination of efforts to improve outcomes for foster youth and families. (WIC § 10601.2(c)(2)) 
6. Requires counties to continue to be responsible for and accountable to CDSS for child welfare program performance measures, as specified. (WIC § 10601.2(j))

Federal law:

1. Established the federal CFSR in 1994 to conduct reviews of states for compliance with federal child welfare requirements to be conducted by the Children’s Bureau, within the federal Department of Health and Human Services (HHS). (Code of Federal Regulations [CFR] Title 45, §§ 421 and 470)
2. Requires the C-CFSR outcome indicators to be consistent with the federal child and family service review measures and standards for child and family outcomes and system factors authorized by Title IV of the federal Social Security Act and the regulations adopted pursuant to those provisions. (CFR
3. , Title 45, §§ 1355 to 1357)

FISCAL EFFECT: Unknown, this bill has not been analyzed by a fiscal committee.

COMMENTS:

Background: Child Welfare Services. California’s child welfare services system was established with the goal of protecting youth from abuse and neglect and is designed to provide safety, health, and overall well-being of children. When a child is identified as being at risk of abuse or neglect, reports can be made to either law enforcement or a county child welfare agency. Often, these reports are submitted by mandated reporters who are legally required to report suspicion of child abuse or neglect due to their profession, such as a teacher or healthcare provider. When a mandated reporter submits a report to either law enforcement or the county child welfare agency, a social worker determines whether the allegation is of suspected abuse, neglect, or exploitation, and creates a case plan which includes the provision of relevant services. The child's social worker and the court collaborate to evaluate and review the circumstances of each case, seeking either reunification or placement outside of the home as a way for the child to achieve permanency.

California's child welfare services programs are administered by the 58 individual counties with each county organizing and operating its own program of child protection based on local needs while adhering to state and federal regulations. When a child welfare case is open, counties are the primary governmental entity interacting with children and families when addressing issues of child abuse and neglect and are responsible, either directly or through providers, for obtaining or providing the interventions and relevant services to protect children and assist families with issues related to child abuse and neglect.

The California Department of Social Services (CDSS) secures federal funding to support child welfare services programs, provides statewide best practices training for social workers, and conducts program regulatory oversight and administration, and is responsible for the development of policy while also providing direct services such as adoption placements.

As of January 1, 2024, there are 43,633 youth between birth and 20 years of age in foster care in California.

Child and Family Services Reviews (CFSRs). The Children’s Bureau, within HHS, administers CFSRs. Beginning in 1994, HHS was authorized to review all state’s child and family service programs to ensure conformity with the requirements in titles IV-B and IV-E of the Social Security Act. Then, in 2000, the Children’s Bureau published a final rule to establish a process for monitoring state child welfare programs. Under the rule, states are assessed for substantial conformity with federal requirements for child welfare services. All states are assessed in the areas of child protection, foster care, adoption, family connections, and independent living services.

More specifically, the purpose of CFSRs is threefold:

1. Ensure Conformity: CFSRs ensure that states comply with federal child welfare requirements.
2. Assess Real Outcomes: They evaluate the actual impact on children and families engaged in child welfare services.
3. Support Positive Outcomes: CFSRs assist states in achieving positive outcomes related to safety, permanency, and well-being for children and families.

According to a Children’s Bureau fact sheet, all 50 states, the District of Columbia, and Puerto Rico completed their first review by 2004 and their second review by 2010, and no state was found to be in substantial conformity in all of the seven outcome areas and seven systemic factors. States developed and implemented Program Improvement Plans after each review to correct those areas not found in substantial conformity. The third round of reviews ran from 2015 to 2018.

According to the 2020 HHS report entitled Systemic Factors—Results from the CFSRs, “Each state’s unique child welfare system and accompanying process for data collection and analysis provide for a wide array of information included in statewide assessments and stakeholder interview notes. Thus, the information used to inform this report was not consistent in its quantity and quality across states and data source.” The systemic factors that were evaluated in round three were:

• Statewide Information System
• Case Review System
• Quality Assurance System
• Staff and Provider Training
• Service Array and Resource Development
• Agency Responsiveness to the Community
• Foster and Adoptive Parent Licensing, Recruitment, and Retention

Round 4 of CFSRs is currently underway and scheduled to run through the federal fiscal year 2026.

The CFSR is conducted in two parts: a Statewide Assessment and an Onsite Review. California’s review, which was state-led as opposed to Children’s Bureau-led, was conducted from October 1, 2023, through March 31, 2024.

While the Systemic Factors—Results from the CFSRs report did not include state-specific data, it did note the following related to challenges affecting systemic factor functioning, “States struggled with the collection and analysis of evidence to show that the array of required services is available and meets the needs of children and families statewide. States lacked specific types of services to address family needs (e.g., housing, parent-child-sibling visitation, quality mental health and substance use disorder treatment, trauma-informed services, domestic violence services, employment assistance, childcare). There was a lack of services in rural areas of the state. Access to services was limited due to lack of transportation, provider capacity, or service availability during times convenient for families. Service availability was limited due to a lack of funding. Waitlists existed for various services across the state or within specific areas of the state.”

Additionally, the report noted, that the Children’s Bureau, “encouraged states to determine whether there was evidence readily available within the child welfare agency or from agency partners to be used in combination with other information to help demonstrate routine systemic factor functioning statewide. Examples of available data included: Data from federal, state, and local databases (e.g., Statewide Automated Child Welfare Information System, Comprehensive Child Welfare Information System, Supplemental Nutritional Assistance Program, Temporary Assistance for Needy Families, Medicaid, Geographic Information Systems, Adoption and Foster Care Analysis and Reporting System, National Child Abuse and Neglect Data System.”

Child Welfare System Improvement and Accountability Act. As directed by the Children’s Bureau, the California Child and Family Services Review (C-CFSR) System was established when the Child Welfare System Improvement and Accountability Act was enacted through
AB 636, (Steinberg), Chapter 678, Statutes of 2001, and was modeled after the federal CFSR. The C-CFSR was designed to improve outcomes for children in the child welfare system while holding county and state agencies accountable for the outcomes achieved. This statewide accountability system includes the completion of a County Self-Assessment which is comprised of a peer review, the development of a five-year System Improvement Plan (SIP), the submission of annual SIP Progress Reports, and quarterly monitoring of SIP strategies and the effects on child welfare outcomes.

Also as part of AB 636, beginning in the 2003-04 fiscal year, CDSS is required to report to the Legislature annually, on progress in meeting the outcome measures developed by CalHHS. As a result of a partnership with the University of California, Berkeley and CDSS, California Child Welfare Indicators Project (CCWIP) was created to fulfill the requirements of AB 636 to track outcome measures including child maltreatment, allegation, investigation, and substantiation rates along with entry and in-care rates and also provides a point-in-time look at the number of youth in care that can be sorted according to age, race, ethnicity, and length of placement. CCWIP also provides the public with this valuable information.

Currently, CCWIP does not include behavioral data that is currently being collected as part of the Child and Adolescent Needs and Strengths (CANS) tool. This bill would additionally include behavioral health data as part of the data collected for the C-CFRS.

The Child and Adolescent Needs and Strengths tool evaluates behaviors and academic performance, underscores individual strengths, and assesses caregiver resources. The CANS tool takes a comprehensive approach to facilitate personalized care planning for each child's unique needs.

Children and youth involved in child welfare have complex mental health needs, due in part to their experiences with trauma and often experience inadequate access to appropriate services. As a result, several programs and initiatives have been developed to address the unique needs of youth with child welfare involvement. Children and youth in foster care who receive federal Social Security Act Title IV-E payments are categorically eligible for Medicaid in every state, and specifically for Medi-Cal in California. In California, children and youth are enrolled into foster care-linked Medi-Cal subject to the court’s custody determination. There are several programs and initiatives designed to assist the behavioral needs of foster youth that are provided as a Medi-Cal benefit.

According to a report jointly issued by CDSS and DHCS entitled Children and Youth in Foster Care: Background and Current Landscape August 2020, “Pursuant to AB 403 and Continuum of Care Reform (CCR), CDSS selected the CANS as the functional assessment tool to be used with the CFT [child and family team] process to guide case planning and placement decisions. . . The CANS is a multi-purpose assessment tool developed to assess well-being, identify a range of social and behavioral healthcare needs, support care coordination and collaborative decision-making, and monitor outcomes of individuals, providers, and systems. . . The CANS assessment results must be shared, discussed, and used within the CFT process to support case planning and care coordination.”

The CANS is required to be completed prior to the completion of the family case plan, and the CANS results are intended to inform the CFT in several key areas, including but not limited to:

• Determining if the youth has unmet behavioral health or substance use needs;
  
• Making placement decisions;
  
• Informing the Level of Care protocol; and,
  
• Determining educational needs.

Foster youth undergo CANS assessments at specific intervals to evaluate their needs and strengths assessment and typically occur at the following frequencies:

Initial Assessment: Within 30 days of a youth entering foster care, a provider completes the CANS assessment. This initial assessment helps establish a baseline for understanding the child’s well-being.

Annual Updates: Annually thereafter, foster youth are eligible for a CANS update to track changes in the child’s behavior, functioning, and overall well-being over time.

The sponsors of this bill provided a comparison with the state of Washington, which utilizes aggregated CANS data to inform their behavioral health services. The state data from Washington can be viewed at: https://fortress.wa.gov/hca/wisebhasreports/QuarterlyWISeReport.html

Concerns CANS Data. Counties have reported that not all counties are using the same version of CANS and there are variations in how that data is being input, as well as variations in the frequency that the CANS is being administered, resulting in inconsistent tracking of this data that is sometimes inaccessible and therefore providing an incomplete picture of the needs of California’s foster youth.

Underscoring the need for uniformity in the frequency and content of this assessment is the proposal for CANS to be used in CDSS’ forthcoming rate reform as the basis for determining the appropriate foster care payment for each youth entering care.

Author’s Statement: According to the Author, “Children and adolescents involved in the child welfare system often grapple with behavioral and social-emotional challenges at rates far higher than their peers outside the system. Moreover, trauma exposure among these vulnerable youth is alarmingly prevalent, as foster care youth bear a heightened risk of experiencing abuse and neglect, further exacerbating their already precarious situations.

“Integrating behavioral health data into the Child Welfare Indicators Project is paramount in elevating outcomes for the children and youth navigating our child welfare system. By integrating behavioral health data into the Child Welfare Indicators Project, [this bill] will provide invaluable insights into the unique needs and challenges faced by children and youth in the child welfare system and empower policymakers, state leaders, and child welfare agencies to craft targeted interventions and policies aimed at improving their well-being. [This bill] will ensure that every child, regardless of their circumstances, has access to the care, support, and resources they need to survive and thrive.”

Equity Implications: The provisions of this bill aim to improve the outcomes of those impacted by the child welfare system, the majority of whom have experienced high rates of adverse childhood experiences that negatively impact their long-term mental health. The Author and sponsors contend that having access to data that can provide a comprehensive understanding of the behavioral health needs of youth in foster care will allow state leaders, policymakers, and child welfare agencies to better assess the effectiveness of current services and policies. Having access to this data on a statewide level could potentially help identify gaps, track progress, and shape targeted interventions to improve the mental health and well-being of children and youth in foster care.

RELATED AND PRIOR LEGISLATION:

SB 625 (Beall), of 2013, would have required counties to include in self assessments and improvement plans, data and information about efforts to eliminate racial and ethnic disproportionality in services and supports provided in the child welfare system, as specified, among other requirements. SB 625 was set to be heard by the Senate Human Services Committee but the hearing was cancelled at the request of the author.

AB 363 (Chu), Chapter 296, Statutes of 2005, required CDSS to establish a process for allocating funds appropriated in the Budget Act to counties to implement approaches to improve performance on outcome indicators established through the C-CFSR.

AB 636 (Steinberg), Chapter 678, Statutes of 2001, see comments above.

REGISTERED SUPPORT / OPPOSITION:

Support

Steinberg Institute (Sponsor)

California Youth Connection (CYC)

Children Now

John Burton Advocates for Youth

Opposition

None on file.

Analysis Prepared by: Jessica Langtry / HUM. S. / (916) 319-2089