Child and Family Services Review On-Site Review

Title IV-E Foster Care Eligibility Reviews, Child and Family Services Reviews

Onsite Review Instrument (OSRI) 4.3.24_exp. XX-XX-XXXX

Child and Family Services Review On-Site Review

OMB: 0970-0214

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Child and Family
Services Reviews
Onsite Review Instrument and
Instructions
June 2022

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104−13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to review state
child welfare systems’ performance related to child protective services, foster care, adoption, family preservation and independent living as well as their conformity
to required child and family outcomes. Public reporting burden for this collection of information is estimated to average 1,186 hours per grantee, including the time
for reviewing instructions, gathering and maintaining the data needed, and preparation for and conducting the case reviews and interviews as well as conducting
the review itself, and reviewing the collection of information. This is a mandatory collection of information (45 CFR 1355.33(c)). An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it
displays a currently valid OMB control number. The OMB # is 0970−0214 and the expiration date is XX/XX/XXXX. If you have any comments on this collection of
information, please contact the Children's Bureau at Danielle.McConaga@acf.hhs.gov

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Table of Contents
Face Sheet ...................................................................................................................................................... 3
SAFETY OUTCOME 1: CHILDREN ARE, FIRST AND FOREMOST, PROTECTED FROM ABUSE
AND NEGLECT ....................................................................................................................................... 10
Item 1: Timeliness of Initiating Investigations of Reports of Child Maltreatment ............................................ 10
SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES WHENEVER
POSSIBLE AND APPROPRIATE ........................................................................................................... 15
Item 2: Services to Family to Protect Child(ren) in the Home and Prevent Removal or Re-Entry Into
Foster Care .............................................................................................................................................. 15
Item 3: Risk and Safety Assessment and Management ................................................................................ 19
PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY IN THEIR
LIVING SITUATIONS ............................................................................................................................... 26
Item 4: Stability of Foster Care Placement .................................................................................................... 26
Item 5: Permanency Goal for Child ................................................................................................................ 30
Item 6: Achieving Reunification, Guardianship, Adoption, or Another Planned Permanent Living
Arrangement ............................................................................................................................................. 36
PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN ............................................................................... 42
Item 7: Placement With Siblings .................................................................................................................... 42
Item 8: Visiting With Parents and Siblings in Foster Care ............................................................................. 44
Item 9: Preserving Connections ..................................................................................................................... 49
Item 10: Relative Placement .......................................................................................................................... 51
Item 11: Relationship of Child in Care With Parents ...................................................................................... 54
WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE FOR THEIR
CHILDREN’S NEEDS .............................................................................................................................. 59
Item 12: Needs and Services of Child, Parents, and Foster Parents ............................................................. 59
Item 13: Child and Family Involvement in Case Planning .............................................................................. 69
Item 14: Caseworker Visits With Child ........................................................................................................... 73
Item 15: Caseworker Visits With Parents ....................................................................................................... 76
WELL-BEING OUTCOME 2: CHILDREN RECEIVE APPROPRIATE SERVICES TO MEET THEIR
EDUCATIONAL NEEDS .......................................................................................................................... 81
Item 16: Educational Needs of the Child ........................................................................................................ 81
WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES TO MEET THEIR
PHYSICAL AND MENTAL HEALTH NEEDS.......................................................................................... 85
Item 17: Physical Health of the Child ............................................................................................................. 85
Item 18: Mental/Behavioral Health of the Child .............................................................................................. 90

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OMB Control Number: 0970-0214
Expiration Date: XX/XX/XXXX

Children's Bureau
Child and Family Services Reviews
Onsite Review Instrument and Instructions
GENERAL INSTRUCTIONS
The Onsite Review Instrument and Instructions (OSRI) is used to review both foster care and
in-home services cases during the onsite review component of the Child and Family Services
Reviews (CFSRs). In completing the instrument, reviewers conduct case file reviews and
case-related interviews with children, parents, foster parents, caseworkers, and other
professionals involved with the child.
The instrument is organized into a Face Sheet and three sections. On the Face Sheet,
reviewers document general information about a case, such as the type of case. The three
sections focus on the outcome domains that form the basis of the CFSRs: safety, permanency,
and child and family well-being. For each outcome, reviewers collect information on “items”
related to that outcome.
Although reviewers use the instrument to review both foster care and in-home services cases,
they should complete the permanency section only if the case under review is a foster care
case. If reviewing an in-home services case, reviewers should select Not Applicable as the
rating for the permanency items.
For children in foster care, reviewers should consider the safety items (1 through 3) for all
children in the family, but complete the permanency items (4 through 11) and the child and
family well-being items (12 through 18) only as they apply to the specific child whose case is
under review (referred to as the target child). For children receiving in-home services,
reviewers should consider the safety items (1 through 3) for all children in the family home and
complete the well-being items (12 through 18) for all children in the family unless reviewers
determine that only specific children should be receiving services and, based on case
circumstances, the other children in the family home do not need to be considered in these
items.

Reviewing the Case
Reviewers must respond to all the questions for each applicable item. Reviewers should use
their professional judgment to determine how best to gather all the relevant information
needed to respond to questions. The instrument provides some instructions on where to find
information, such as the case record or court orders. Information gathered through caserelated interviews should be considered when responding to questions.
Reviewers must consider all agency services and actions on all accepted maltreatment reports
and cases from the start of the period under review (PUR) until the case review is complete.
The PUR begins with the sampling period start date and ends with the date the case review is
completed or the case is closed, whichever comes first.

CFSR Onsite Review Instrument and Instructions

Reviewers must indicate the case participants included in the assessment of certain items to
identify which children in an in-home services case are included in the assessment of various
items and to determine who is being considered as “mother” and “father” in various items.
Participants should be selected from the case participants listed in the child and case
participant tables in the Face Sheet.
Further instructions for answering the questions relating to the individual items, along with
definitions for key terms, are provided below the relevant question. Reviewers should read all
instructions and definitions carefully before responding to questions.

CFSR Onsite Review Instrument and Instructions

Face Sheet

CHILD AND FAMILY SERVICES REVIEWS ONSITE REVIEW INSTRUMENT
Face Sheet
Case Information
Definition and Instructions for Questions A Through E Below:
•

For the site, use the name of the location that is used by the state for the review. This may be an
office, district, region, county, or multiple counties.

•

Enter the case name that is the official name on the case file.

A. Name of state and site: _____________________________
B. Case name: _____________________________
C. Period under review begins on: _____________________________
D. Reviewer name(s): _____________________________
Initial QA completed by (name): _____________________________
Second Level QA completed by (name): _____________________________
Secondary Oversight completed by (name): _____________________________

E. Date case review was completed: ------/-------/---------------F. What is the type of case reviewed? Select one type only:
Foster Care 

In-Home Services 

In-Home Services—Differential/Alternative Response 

Question F Instructions:
•

The case is a foster care case if the target child was in foster care at any time during the PUR.
Foster care means 24-hour substitute care for children placed away from their parents or
guardians and for whom the title IV-E agency has placement and care responsibility. This includes
a child who is placed by the agency with relatives or in other kin-type placements, and for whom
the agency maintains placement and care responsibility. It does not include a child who is living
with relatives (or caregivers other than parents) and who is not under the placement and care
responsibility of the agency.

•

The case is an in-home services case if no child in the family was in foster care at any time during
the PUR, and the case was open for at least 45 days.

•

The case is an in-home services differential/alternative response case if the state has some form
of differential/alternative response program during the PUR and the in-home services case was
served through that program.

CFSR Onsite Review Instrument and Instructions

Face Sheet

G1. Child Table
Target
Child

Child’s Name

Race(s)

Ethnicity

Date of Birth
(MM/DD/YYYY)

Gender

Interviewed
(Yes/No)

Table G1 Instructions:
•

For both foster care cases and in-home services cases, enter the first and last names (first name
first) of all children in the family as identified in the case file. If the case is a foster care case,
indicate “Yes” in the first column of the table next to the name of the target child. It is essential that
the target child be clearly identified for all foster care cases.

•

Enter the race and ethnicity information as provided in the case file. If the child is of two or more
races, list all that are provided in the case file (for example, White and Asian, or White and
American Indian). If you learn during the interviews that a child is of a different race or ethnicity
than is noted in the file or is of two or more races and only one is noted in the file (for example,
Non-Hispanic instead of Hispanic, or both White and American Indian), please change the race or
ethnicity identification information presented to reflect the accurate information.

•

Select from the following options for ethnicity: “Hispanic,” “Non-Hispanic,” “Unknown,” and “Unable
to Determine.”

•

Select from the following options for race:

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Unknown or Unable to Determine

•

Provide the date of birth for every child in the family, even if this is a foster care case.

•

If the child is abandoned or the date of birth is otherwise unknown, enter an approximate date of
birth. Use the 15th as the day of birth.

CFSR Onsite Review Instrument and Instructions

Face Sheet

G2. Case Participant Table
Name

Role

Relationship to Child

Interviewed (Yes/No)

Table G2 Instructions:
•

Participants include biological parents even if their identity is unknown, they are deceased, or their
parental rights have been terminated; caregivers; adults in the home if they are involved with the
child; foster parents; and interview subjects including caseworkers, supervisors, and key service
providers.

•

In the Name column, for both foster care and in-home services cases, enter the first and last
names (first name first) of the key case participants whose participation in this case will be
assessed in the instrument and other persons who were interviewed to provide relevant
information. If the identity of a parent is unknown, indicate “unknown” in the Name column.

•

In the Role column, list one of the following options for each participant listed: Mother, Father,
Caregiver, Foster Parent, Caseworker, Caseworker’s Supervisor, Other. The same role may be
indicated for more than one person (for example, a biological father may have the role of Father,
and a stepfather may have the role of Father).

•

In the Relationship to Child column, indicate how the person is involved in the case and/or related
to the child. Indicate whether the person is/was living with the child and/or in a caregiving role. If
there is more than one child, identify the child or children with whom the person is connected by
assigning each child a number that corresponds to their line on the table. For example: significant
other of (child number 1)’s mother, lives in the home; biological mother of (child(ren) numbers 1
and 2) not living in the home, not a caregiver; legal father of (child number 3), not living in the
home; biological mother termination of parental rights (TPR) (date); biological father deceased
(date).

•

In the Interviewed column, note whether the person has been interviewed regarding the case.

H. Was this case opened for reasons other than child abuse and neglect?
Yes 

No 

Question H Instruction:
Examples of cases opened for reasons other than child abuse or neglect include: (1) cases opened
because of the child’s behavior, including juvenile delinquency, substance abuse, or “child in need of
supervision,” and there were no maltreatment concerns in the family; or (2) cases opened because
parents requested mental/behavioral health services for their child(ren).

CFSR Onsite Review Instrument and Instructions

Face Sheet

I. Why was/were the case(s) opened for services?
 Physical abuse
 Sexual abuse
 Emotional maltreatment
 Neglect (not including medical
neglect)
 Medical neglect

 Abandonment
 Mental/physical health of parent
 Mental/physical health of child
 Substance abuse by parent(s)
 Child’s behavior
 Substance abuse by child

 Domestic violence in child’s
home
 Child in juvenile justice system
 Other (specify):

Question I Instructions:
Indicate the reason(s) for case opening(s) by selecting all that apply. Consider all cases open during
the PUR. The reason for case opening should be based on whatever information is available in the
case record and from interviews that identifies why the agency opened the case. This would include
the maltreatment type that was substantiated or resulted in case opening, and it could also include
other information that informed the agency’s decision to open the case. If “other” was checked as a
reason the case was opened for services, the circumstances and reason must be very clearly
documented in the narrative.

J. What is the date of the first case opening, of the cases open for services during the PUR?
------/-------/---------------Question J Definition:
Typically, a case is considered “open for services” when the case was opened for case management
and/or service provision.

Question J Instructions:
•

Using the MM/DD/YYYY format, enter the date on which the case was actually opened within
the agency. Consider all cases that were open for services during the PUR, if there were
multiple case openings. If the first case that was open during the PUR was opened before the
PUR began, include it as the first case opening date for the period.

•

If a child was on a trial home visit and returned to a foster care placement, the return to foster
care is not considered a “case opening” unless the trial home visit was longer than 6 months
and there was no court order extending the trial home visit beyond 6 months.

•

If the family received in-home services before the removal of a child and placement of the
child in foster care, and the case was not closed before placement, enter the date on which
the case was opened for in-home services. The date of the child’s removal from home will be
captured in the next question.

K. What is the date of the child’s latest removal?
------/-------/----------------

Not Applicable 

CFSR Onsite Review Instrument and Instructions

Face Sheet
Question K Definition:
The date of latest removal refers to a child’s removal from his or her normal place of residence and
placement in a substitute care setting under the placement and care responsibility of the state or local
title IV-B/IV-E agency. Children are considered to have been removed if the child has been in substitute
care for 24 hours or more.

Question K Instructions:
•

Using the MM/DD/YYYY format, enter the date of the child’s latest removal from his or her
normal place of residence.

•

If a child was on a trial home visit and returned to a foster care placement, the return is not
considered the latest removal unless the trial home visit was longer than 6 months and there
was no court order extending the trial home visit beyond 6 months.

•

If the case is an in-home services case, K is Not Applicable.

L. What is the date of the child’s most recent entry into foster care?
------/-------/----------------

Not Applicable 

Question L Definition:
“Entry into foster care” refers to either the date of a judicial finding that the child had been subjected to
child abuse or neglect (often the adjudicatory hearing), or 60 days after the date on which the child was
removed from the home, whichever is earlier.

Question L Instructions:
• Using the MM/DD/YYYY format, enter the date of the child’s most recent entry into foster care.
• If a child was on a trial home visit and returned to a foster care placement, the return is not
considered an entry into foster care unless the trial home visit was longer than 6 months and
there was no court order extending the trial home visit beyond 6 months.
• If the case is an in-home services case, L is Not Applicable.

M. What is the date the target child was physically returned from a foster care placement to live with his or
her parent(s) or legal guardian?
------/-------/----------------

Not Applicable 

CFSR Onsite Review Instrument and Instructions

Face Sheet
Question M Instructions
• Using the MM/DD/YYYY format, enter the date the child was physically returned home.
• The date the target child was physically returned home may be different from the date that
legal custody of the child is returned to the parent or legal guardian and the child is considered
fully discharged from foster care.
• The state or local child welfare agency may retain legal custody of the child, with the plan that
legal custody will be returned to the parent or guardian after a period of time in the home
(designated by the court or child welfare agency), if that trial period is successful.
• If the child is physically returned home multiple times during the PUR, reviewers should use
the date of the most recent physical return home.
• If the target child did not physically return home during the PUR or this is an in-home services
case, M is Not Applicable.

N. What is the date of discharge from foster care for the most recent foster care episode?
------/-------/----------------

Not Applicable 

Not Yet Discharged 

Question N Definition:
“Discharge from foster care” is defined as the point when the child is no longer in foster care under the
placement and care responsibility or supervision of the agency.

Question N Instructions:
• Using the MM/DD/YYYY format, enter the date of discharge from foster care for the most recent
foster care episode.
• If a child returns home on a trial home visit and the agency retains responsibility or supervision
of the child, the child should be considered discharged from foster care only if the trial home
visit was longer than 6 months, and there was no court order extending the trial home visit
beyond 6 months.
• If the child is in foster care but has not yet been discharged, select Not Yet Discharged.
• If the case is an in-home services case, N is Not Applicable.

O. What is the date of the most recent case closure during the PUR? ------/-------/---------------Case not closed by time of review 

CFSR Onsite Review Instrument and Instructions

Face Sheet
Question O Instructions:
• Using the MM/DD/YYYY format, enter the date on which the agency officially closed the case.
For foster care cases, this may or may not be the same as the discharge date.
• If there were multiple case openings and closures during the PUR, indicate the date of the last
case closure that occurred during the period.
• The date entered is the date on which the agency completed all case closure activities
required by the state’s policy.
• If the case is still open at the time of review, select “Case not closed by time of review.”
Case Summary (optional) (Do not use proper names):

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 1

SECTION I: SAFETY
SAFETY OUTCOME 1: CHILDREN ARE, FIRST AND FOREMOST, PROTECTED FROM ABUSE
AND NEGLECT.
Item 1: Timeliness of Initiating Investigations of Reports of Child Maltreatment
Purpose of Assessment: To determine whether responses to all accepted child maltreatment reports
received during the PUR were initiated, and face-to-face contact with the child(ren) made, within the
timeframes established by agency policies or state statutes.

Item 1 Applicable Cases:
•

Cases are applicable for an assessment of this item if an accepted child maltreatment report on
any child in the family was received during the PUR. “Accepted” means that the report was
assigned to the agency to conduct an assessment or investigation. This includes reports
assigned for an “alternative response” assessment. Reports that are screened out are not
considered “accepted.” “Alternative response” refers to an agency’s approach to addressing child
maltreatment reports that meet agency criteria for acceptance but at the initial screening do not
meet the agency’s requirements for a mandated investigation. For example, the agency’s policy
may be that reports that appear to present low to moderate risk to the child may be referred for a
family assessment, rather than an investigation. Under such a response, no determination of
child maltreatment is made. The alternative response may include an assessment to determine
the safety of the child(ren), the risk of maltreatment, and the family’s strengths and needs. The
assessment may lead the state agency to provide services to eliminate or lessen the safety
concerns and maltreatment risks.

•

Cases are not applicable for an assessment of this item if, during the PUR, there were no child
maltreatment reports on any child in the family, or if a report was received on a child in the family
but it was “screened out”; that is, not referred for an assessment or investigation.

Is this case applicable?
Select the appropriate response below. If the response is No, rate the case as Not Applicable in the ratings
section and continue to Item 2.
Yes 

No 

Optional: Provide comments in the narrative field below:

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 1

A1. Reports Table
Report
Date

Name of
Child

Allegation Priority Level, Assessment Date Assigned
If Applicable
or
for an
Investigation Investigation or
Assessment

Date
Date of FaceInvestigation or
to-Face
Assessment
Contact With
Initiated
Child

Relationship Disposition
of Alleged
Perpetrator to
Child

Table 1A1 Instructions:
• Complete the table for all accepted reports received during the PUR.
• List reports by date, per child, and per allegation (for each perpetrator). If the same child had multiple allegations that resulted in
separate dispositions, each allegation should be indicated in a separate row in the table so the disposition can be noted for each
allegation. If multiple allegations received the same disposition, all allegations may be indicated in the same row.
• If the state has policies outlining different priority levels for reports, indicate the priority level that was assigned.
• Indicate whether the report was assigned for an investigation or referred for an assessment.
• The date assigned for an investigation or assessment is the date the report is assigned to a specific worker to conduct the
investigation or assessment. If the report was not assigned, document the date assigned as “Did not occur.”
•

The date the investigation or assessment was initiated is the date on which the agency made the first attempt to contact the family.
Include the date on which the investigation/assessment was initiated per state policy, or if no state policy exists, include the date
when contact with the family was first attempted. If the investigation or assessment was not initiated or face-to-face contact with the
child did not occur, document these dates as “Did not occur.”

•

In the last column, report the disposition of the case. If the case was investigated, indicate whether the report was “Substantiated” or
“Not Substantiated” (this may be documented in the record as “founded” or “unfounded,” or “indicated” or “not indicated”). If the
investigation has not been completed as of the time of review, indicate “Investigation Pending.” If the case was referred for an
assessment, indicate whether it was “opened for services” or “not opened for services.” If the assessment has not yet been
completed, indicate “Assessment Still Pending.”

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 1
Question 1A and B Instructions:
•

When tallying the number of reports in responding to questions A and B, do not count each
allegation or child as a separate report, but rather consider the date of the report as a distinct
report made to the agency.

•

Requirements refer to any provisions, beyond timeframes, that are noted in state policies or
statutes related to initial face-to-face contact with the children in accepted maltreatment reports.

•

Concerns that delays to initiation or face-to-face contact affected risk/safety should be
considered in Item 3.

A. In how many of the reports listed in the table was the investigation or assessment NOT initiated in
accordance with the state’s timeframes and requirements for a report of that priority?

B. In how many of the reports in the table was face-to-face contact with the child(ren) who is (are) the
subject of the report NOT made in accordance with the state’s timeframes and requirements for a
report of that priority?

C. For all reports identified in A and B, were the reasons for the delays due to circumstances beyond
the control of the agency?
Yes 

No 

Not Applicable 

Explain the reason for any delays related to reports identified in A and B in the narrative field below:

Question 1C Instructions:
• If the answers to both questions A and B are zero, the answer to question C should be Not
Applicable.
• Delays in services provided by organizations or agencies under contract with the agency
would not be considered as beyond the control of the agency. However, where services are
provided by another public state or local agency, such as law enforcement, the actions of
these agencies may be beyond the control of the child welfare agency.

Item 1 Rating Criteria:
Item 1 should be rated as a Strength if either of the following applies:
• The answers to A and B are zero.
• The answers to A or B are greater than zero, but the answer to C is Yes.

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 1
Item 1 should be rated as an Area Needing Improvement if the following applies:
• The answer to A or B is greater than zero, and the answer to C is No.
Item 1 should be rated as Not Applicable if the response to the question of applicability is No.
Item 1 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 
Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 1

RATING SAFETY OUTCOME 1
SAFETY OUTCOME 1: CHILDREN ARE, FIRST AND FOREMOST, PROTECTED FROM ABUSE
AND NEGLECT.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the rating for Item 1?

Instructions:
Safety Outcome 1 should be rated as Substantially Achieved if the following applies:
• Item 1 is rated as a Strength.
Safety Outcome 1 should be rated as Not Achieved if the following applies:
• Item 1 is rated as an Area Needing Improvement.
Safety Outcome 1 should be rated as Not Applicable if the following applies:
• Item 1 is rated as Not Applicable.
Select the appropriate response:
Substantially Achieved 

Not Achieved 

CFSR Onsite Review Instrument and Instructions

Not Applicable 

Section I: Safety Outcome 2

SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES WHENEVER
POSSIBLE AND APPROPRIATE.
Item 2: Services to Family to Protect Child(ren) in the Home and Prevent Removal or Re-Entry
Into Foster Care
Purpose of Assessment: To determine whether, during the PUR, the agency made concerted efforts to
provide services to the family to prevent children’s entry into foster care or re-entry after a reunification.
In the list of criteria below, check Yes for any that apply and No for any that do not apply. A case is applicable
for an assessment of this item if it meets at least one of the following criteria:
It is an in-home services case and during the PUR:
•

Services were needed to address concerns for safety and/or risk of abuse/neglect of any child to
prevent foster care placement and ensure that the child(ren) would be able to remain safely in the
home or with an alternative caregiver or to return home safely from a temporary alternative
caregiver arrangement. Yes  No 

It is a foster care case and during the PUR:
•

The target child entered foster care due to reasons associated with child safety and/or risk of child
abuse/neglect. Yes  No 

•

The target child was reunified (or was returned home on a trial basis), and services were needed to
support reunification and prevent foster care re-entry. Yes  No 

•

The target child was in foster care during the PUR and there are concerns regarding the safety and/or risk
of child abuse or neglect for any child(ren) remaining in the home.
Yes 

No 

Is this case applicable?

Select the appropriate response below. If the response is No, rate the case as Not Applicable in the ratings
section and continue to Item 3.

Yes 

No 

Optional: Provide comments in the narrative field below:

A. During the PUR, did the agency make concerted efforts to provide or arrange for services for the family
(including any services for alternative caregivers) to protect the children and prevent their entry into foster
care or re-entry into foster care after a reunification? (Be sure to assess the entire PUR.)

Yes 

No 

If No, explain circumstances in the narrative field below:

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2
Question 2A Definitions:
• “Appropriate Services,” for the purposes of Item 2, are those that are provided to, or arranged for,
the family (including any services for alternative caregivers) with the explicit goal of (1) addressing
the case-specific safety concerns for the child(ren) and/or risk of child abuse/neglect, and (2)
doing so within a timeframe needed to prevent a child’s entry into foster care and/or re-entry after
a reunification.
•

The following are examples of services that may be appropriate for preventing removal and/or
foster care re-entry depending on case-specific circumstances and assessed needs:
-

Intensive in-home services
Child care services
Substance abuse/mental health treatment services
Concrete services (e.g., financial assistance to prevent immediate eviction or ensure utilities
remain connected in the context of safety and/or imminent risk of child abuse/neglect)

•

“Concerted efforts,” for the purposes of Item 2, refers to facilitating a family’s access to
appropriate services within a timeframe aimed at preventing a child’s entry into foster care
and/or re-entry after a reunification.

•

“Safety plan” refers to a plan that describes strategies developed by the agency and family to
ensure that the child(ren) is (are) safe. Safety plans may address (1) safety threats and how
those will be managed and addressed by the caregiver, (2) caregiver capacity to implement the
plan and report safety issues to the agency, and (3) family or other support system involvement
in implementation of the plan. Safety plans may be separate from or integrated into the case
plan.

•

“Alternative Caregiver Arrangement” refers to an arrangement in which children are placed
temporarily with alternate caregivers to ensure their safety. For example, within in-home services
cases, an alternative caregiver arrangement is evident when children are living with extended
family members or other family friends via voluntary agreements with the parent(s), conditional
custody orders, or other court orders that do NOT place the child under the care and placement
responsibility of the agency. In some states these arrangements may be considered placement
with safety resources or out-of-home safety plans. An alternative caregiver arrangement is not
considered a safety service.

•

Safety refers to a current condition within a home or family and considers whether there is an
immediate threat of danger to a child.

•

Risk refers to the likelihood, chance, potential, or probability of child abuse and/or neglect
occurring in the future.

Question 2A Instructions:
•

In answering question A, focus only on whether the agency made concerted efforts to provide
appropriate services to the family to address the safety and/or risk issues in the family so the
child(ren) could remain safely in the home or would not re-enter foster care after reunification.

•

Whether services are considered appropriate must be informed by the context of case-specific
circumstances and the assessment of family, caregiver, and child needs. As such, in answering
question A, it is important that the identified services be clearly linked to case-specific
circumstances related to the prevention of foster care entry/re-entry and/or supporting
reunification.

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2
•

It is important for the reviewer to distinguish services for which timely provision is explicitly aimed at
preventing foster care entry or re-entry after reunification, and/or supporting a safety plan from
other types of services to address child and family needs more appropriately captured under OSRI
Items 12 or 16−18. The explicit aim of the service, rather than the type of service, is important to
consider when distinguishing services that are captured under OSRI Item 2 versus other areas of
the OSRI.

•

For in-home services and foster care cases, consider an alternative caregiver arrangement as a
safety plan (not a safety service), and determine whether appropriate services were provided to the
birth/legal parents to address concerns for safety and/or risk of child abuse or neglect to prevent the
child’s entry and/or re-entry into foster care. Determine whether appropriate services were provided
to the alternative caregiver in an effort to support, implement, maintain, or supplement a safety plan
in order to ensure the safety of a child and prevent the removal or re-entry into foster care. Any
safety plan in place during the PUR will be assessed in Item 3.

•

If the agency removed the child from the home without making concerted efforts to provide
appropriate services, the answer to question A should be No, even if the agency determined that it
was necessary to remove the child for safety concerns and/or reasons associated with the risk of
child abuse/neglect. This issue will be addressed in question B.

B. If, during the PUR, any child was removed from the home without providing or arranging for appropriate

services, was this action necessary?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 2B Instructions:
• If the answer to question A is Yes, but, after making efforts to provide appropriate services, the child
was removed from the home during the PUR due to unmanageable safety concerns or risk of
abuse/neglect, the answer to question B should be Not Applicable.
• If the child was not removed from the home during the PUR, the answer to question B should be Not
Applicable.
• Focus on whether the circumstances of the case and of the removal suggest that appropriate services
would not have been sufficient to ensure the child’s safety and protection if the child remained in the
home. If the information indicates that it was necessary to remove the child immediately to ensure the
child’s safety and protection, the answer to question B should be Yes. If the information indicates that
services could have been provided to prevent removal but the child was removed without providing
appropriate services, this question should be answered No.
• If services should have been offered to protect the child but were not offered because those services
were not available in the community, the answer to question B should be No.

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2

Item 2 Rating Criteria:
Item 2 should be rated as a Strength if either of the following applies:
• The answer to question A is Yes, and the answer to question B is Not Applicable.
• The answer to question A is No, and the answer to question B is Yes.
Item 2 should be rated as an Area Needing Improvement if either of the following applies:
• The answer to question A is No, and the answer to question B is No.
• The answer to question A is No, and the answer to question B is Not Applicable.
Item 2 should be rated as Not Applicable if the response to the question of applicability is No.
Item 2 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2

SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES
WHENEVER POSSIBLE AND APPROPRIATE.
Item 3: Risk and Safety Assessment and Management
Purpose of Assessment: To determine whether, during the PUR, the agency made concerted efforts to
assess and address the risk and safety concerns relating to the child(ren) in their own homes or while in
foster care.
Item 3 Applicable Cases: All cases are applicable for an assessment of this item.

A1. Did any of the following concerns exist during the PUR?
•

There were maltreatment allegations about the family, but they were never formally reported or
formally investigated/assessed. Yes  No 

•

There were maltreatment allegations that were not substantiated despite evidence that would
support substantiation. Yes  No 

A. If the case was opened during the PUR, did the agency conduct an initial assessment that accurately
assessed all risk and safety concerns for the target child in foster care and/or any child(ren) in the family
remaining in the home?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Questions 3A and 3B Definitions:
•

“Risk” refers to the likelihood, chance, probability, or potential of child abuse and/or neglect
occurring in the future.

•

“Safety” refers to a current condition within a home or family and considers whether there is an
immediate threat of danger to a child.

•

An assessment of safety is made to determine whether a child is in a safe environment. A safe
environment is one in which there are no threats that pose a danger or, if there are threats, there
is a responsible adult in a caregiving role who demonstrates sufficient capacity to protect the
child.

Questions 3A and 3B Instructions:
•

For foster care cases, questions A and B should be answered for the target child in foster care
and any children remaining in the home.

•

For in-home services cases, questions A and B should be answered for all children in the home.

•

In responding to questions A and B, consider any concerns selected in 3A1.

•

Question A should be answered Not Applicable if the case was opened before the PUR, unless
the initial assessment related to the case opening was pending or completed during the PUR.

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2

B. During the PUR, did the agency conduct ongoing assessments that accurately assessed all of the risk
and safety concerns for the target child in foster care and/or any child(ren) in the family remaining in the
home?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 3B Instructions:
•

In responding to question B, determine whether ongoing assessments (formal or informal) were
conducted during the PUR. If the agency conducted an initial assessment of risk and safety at the
onset of the case, but did not assess for risk and safety concerns on an ongoing basis and at critical
times in the case (for example, when there were new allegations of abuse or neglect, changing
family conditions, new people coming into the family home or having access to the children, or
changes to visitation, upon reunification or at case closure) then the answer to question B should be
No.

•

Note that in some cases that were opened during the PUR, the issue of ongoing assessments may
not be relevant because the case was opened for a very short period of time (for example, if the
case was opened shortly before the end of the PUR and, during the initial assessment, the agency
determined that there were no risk or safety concerns, it may be reasonable to conclude that the
agency would not have conducted a second risk and safety assessment during the PUR). If the
case was opened during the PUR and you believe that ongoing assessments were not necessary
given the timeframe and circumstances of the case, question B may be answered Not Applicable.

•

If a case was closed during the PUR, determine whether the agency conducted a risk and safety
assessment before closing the case. If not, the answer to question B should be No.

C. During the PUR, if safety concerns were present, did the agency: (1) develop an appropriate safety
plan with the family and (2) continually monitor and update the safety plan as needed?

Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 3C Definition:
“Safety plan” refers to a plan that describes strategies developed by the agency and family to ensure
that the child(ren) is (are) safe. Safety plans may address (1) safety threats and how those will be
managed and addressed by the caregiver, (2) caregiver capacity to implement the plan and report
safety issues to the agency, and (3) family or other support system involvement in implementation of
the plan. Safety plans may be separate from or integrated into the case plan and may be evidenced
by the articulation of the elements of the plan in case-related interviews.

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2
Question 3C Instructions:
• Question C is applicable to all in-home services cases and to foster care cases in which there are
other children remaining in the family home and/or the target child in foster care returned home
during the PUR. For in-home cases in which children are placed temporarily with alternative
caregivers to ensure safety, consider that as a safety plan to be assessed in question C.
•

Appropriate services needed to support a safety plan should be addressed in Item 2.

•

Question C should be answered Not Applicable if you determine that during the PUR there were
no apparent safety concerns for any child in the family home.

D1. Indicate whether any safety-related incidents occurred during the PUR. Select all that apply:
 Recurring maltreatment: There was at least one substantiated or indicated maltreatment report on
any child in the family during the PUR AND there was another substantiated report within a 6-month
period before or after that report that involved the same or similar circumstances. In
determining the similarity of the circumstances, consider the perpetrator of the maltreatment and
other individuals involved in the incident.
 Recurring safety concerns: There was at least one maltreatment report involving any child in the
family during the PUR that was handled by an alternative response and resulted in opening the
case for services to address safety concerns (this decision may have been made by the agency or
by a private provider under contract with the agency) AND there was at least one additional
maltreatment report within a 6-month period before or after that report that was handled by an
alternative response and resulted in a decision to open the case for services to address the same
or similar safety concerns (the case may have been opened for services by the agency or by a
private provider under contract with the agency). In determining the similarity of the concerns,
consider the perpetrator of the maltreatment, other individuals involved in the incident, and the type
of safety issues that existed.
 The case was closed while significant safety concerns that were not adequately addressed still
existed in the home.
 Other (describe any other safety-related incidents that were not adequately addressed by the
agency): _______________________________________________
 Not Applicable (no safety issues were present during the PUR).
 No safety-related incidents occurred that were not adequately addressed by the agency.

D. During the PUR, were there safety concerns pertaining to the target child in foster care and/or any

child(ren) in the family remaining in the home that were not adequately or appropriately addressed by the
agency?
Yes 

No 

Not Applicable 

Question 3D Instructions:
•
•
•
•

Question D is applicable to all cases.
Answer Yes if any safety-related incidents in D1 are selected.
Answer No if no safety-related incidents occurred that were not adequately addressed by the agency.
Answer Not Applicable if no safety issues were present during the PUR.

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2

E1. For foster care cases only, indicate whether any safety concerns related to visitation were present
during the PUR. Select all that apply:
 Not Applicable (this is an in-home services case, or the target child did not have any visitation).
 No safety concerns existed for the target child related to visitation that were not adequately
addressed.
 Sufficient monitoring of visitation by parents/caregivers or other family members was not ensured.
 Unsupervised visitation was allowed when it was not appropriate.
 Visitation was court-ordered despite safety concerns that could not be controlled with supervision.
 Other (describe the safety concerns that existed with visitation):

_____________________________________________

E. During the PUR, were there any safety concerns related to the target child in foster care during

visitation with parents/caregivers or other family members that were not adequately or appropriately
addressed by the agency?
Yes 

No 

Not Applicable 

Question 3E Instructions:
•

Select Not Applicable if this is not a foster care case.

•

Answer Yes if any safety concerns in E1 are selected.

•

If no safety concerns were identified in E1, answer No.

•

If a child or youth’s behavior affects his or her own safety during visitation, select "other" in E1 and
describe the concern. Concerns related to the safety of others due to the youth's behavior during
visitation should be captured in Item 8 when responding to questions about the quality of visitation.

•

If the child does not have visits with parents/caregivers or with other family members, select Not
Applicable.

F1. For foster care cases only, indicate whether any concerns existed for the child in at least one foster care
placement during the PUR. Select all that apply:
 Not Applicable (this is an in-home services case).
 No safety concerns existed for the target child while in foster care placement that were not
adequately addressed.
 There was a substantiated allegation of maltreatment of the child by a foster parent (including a
relative foster parent) or facility staff member that could have been prevented if the agency had
taken appropriate actions.
 There was a critical incident report or other major issue relevant to noncompliance by foster parents
or facility staff that could potentially make the child unsafe, and the agency could have prevented it
or did not provide an adequate response after it occurred.
 The child’s placement during the PUR presented other risks to the child that are not being
addressed, even though no allegation was made and no critical incident reports were filed.
CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2
 The reviewer discovers that there are safety concerns related to the child in the foster home of
which the agency is unaware because of inadequate monitoring.
 Other (describe any other safety concerns that existed with the child’s foster placement):
_____________________________________________________________________________
Questions 3F1 and 3F Definition:
Foster parents are defined as related or non-related caregivers who have been given responsibility for
care of the child by the agency while the child is under the placement and care responsibility and
supervision of the agency. This includes pre-adoptive parents if the adoption has not been finalized.

F. For foster care cases only, during the PUR, were there any concerns for the target child’s safety related
to the foster parents, members of the foster parents’ family, other children in the foster home or facility, or
facility staff members, that were not adequately or appropriately addressed by the agency?
Yes 

No 

Not Applicable 

Question 3F Instructions:
•

Answer Not Applicable if this is not a foster care case.

•

Answer No if no unaddressed concerns were noted in F1.

•

Answer Yes if you determine that, during the PUR, the child was in at least one foster care
placement in which he or she was unsafe, and appropriate action was not taken (such as
providing closer monitoring of the placement, placing fewer children in the home, providing
services to address potential problems or existing problems, or finding a more appropriate
placement). This includes any safety concerns when a child is staying temporarily in a hotel,
agency office, or other setting.

•

If any concerns are selected in F1, question F should be answered Yes.

Item 3 Rating Criteria:
Item 3 should be rated as a Strength if the following applies:
• Questions A and B are both answered Yes, or
• The answer to either A or B is Yes and the other is Not Applicable, and
• The answer to question C is either Yes or Not Applicable, and
• The answers to questions D, E, and F are either No or Not Applicable.
Item 3 should be rated as an Area Needing Improvement if the following applies:
• The answer to any one of questions A, B, or C is No, and/or
• The answer to any one of questions D, E, or F is Yes.
There are no circumstances under which Item 3 could be rated as Not Applicable.
Item 3 Rating (select one):
Strength 

Area Needing Improvement 

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2
Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 
Area Needing Improvement 
Override reason:

CFSR Onsite Review Instrument and Instructions

Section I: Safety Outcome 2

RATING SAFETY OUTCOME 2
SAFETY OUTCOME 2: CHILDREN ARE SAFELY MAINTAINED IN THEIR HOMES WHENEVER
POSSIBLE AND APPROPRIATE.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for Items 2 and 3?

Instructions:
Safety Outcome 2 should be rated as Substantially Achieved if either of the following applies:
•

Items 2 and 3 are rated as Strengths.

•

Item 2 is rated as Not Applicable and Item 3 is rated as a Strength.

Safety Outcome 2 should be rated as Partially Achieved if the following applies:
•

One of the two items is rated as a Strength and the other as an Area Needing Improvement.

Safety Outcome 2 should be rated as Not Achieved if either of the following applies:
•

Items 2 and 3 are rated as Areas Needing Improvement.

•

Item 2 is rated as Not Applicable and Item 3 is rated as an Area Needing Improvement.

Select the appropriate response:
Substantially Achieved 

Partially Achieved 

CFSR Onsite Review Instrument and Instructions

Not Achieved 

Section II: Permanency Outcome 1

SECTION II: PERMANENCY
PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY IN THEIR
LIVING SITUATIONS.
Item 4: Stability of Foster Care Placement
Purpose of Assessment: To determine whether the child in foster care is in a stable placement at the time
of the onsite review and that any changes in placement that occurred during the PUR were in the best
interests of the child and consistent with achieving the child’s permanency goal(s).
Item 4 Applicable Cases: All foster care cases are applicable for an assessment of this item.

A1. Placement Table
Placement
Date

Placement Type

Reason for Change in Placement Setting

Table 4A1 Definitions and Instructions:
Complete the placement table. Begin with the child’s placement setting at the onset of the PUR, or if the
child was removed during the PUR, begin with the first placement setting upon removal. If there was only
one placement setting, complete only the first two columns of the first row.
Select from the following options for placement type. Definitions for each placement type are provided:
• Pre-Adoptive Home—A home in which the family intends to adopt the child. The family may or
may not be receiving a foster care payment or an adoption subsidy on behalf of the child.
• Foster Family Home (Relative)—A licensed or unlicensed home of the child's relatives regarded
by the title IV-E agency as a foster care living arrangement for the child.

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 1
• Foster Family Home (Non-Relative)—A licensed foster family home regarded by the title IV-E
agency as a foster care living arrangement.
• Group Home—A licensed or approved home providing 24-hour care for children in a small group
setting that generally has from 7 to 12 children.
• Institution—A child care facility operated by a public or private agency and providing 24-hour care
and/or treatment for children who require separation from their own homes and group living
experience. These facilities may include child care institutions, residential treatment facilities,
maternity homes, etc.
• Supervised Independent Living—An alternative transitional living arrangement where the child is
under the supervision of the agency but without 24-hour adult supervision, is receiving financial
support from the child welfare agency, and is in a setting that provides the opportunity for
increased responsibility for self-care.
• Other—A licensed or unlicensed placement setting that is not included in the list of placement
types considered for this item AND is not one of the placement settings that should not be counted
as a placement per Table 4A1 Instructions, such as runaway or respite care. Examples include a
child’s placement in a hotel or agency office.
Select from the following options for reason for change in placement setting:










Not Applicable. This is the current or most recent placement.
Move to an adoptive or permanent guardian’s home.
Move from a more restrictive to a less restrictive placement.
Move from a less restrictive to a more restrictive placement.
Move to a relative placement.
Move that brings the child closer to family or other important connections.
Move to a temporary placement while awaiting a more appropriate placement.
Move due to foster parent’s request.
Other (describe): _______________________________________________________________

A. How many placement settings did the child experience during the PUR? _____________________
Question 4A Definitions:
• “Placement setting” refers to a physical setting in which a child resides while in foster care under the
placement and care responsibility of the agency. A new placement setting would result, for example,
when a child moves from one foster family home to another or to a group home or institution. If,
however, a foster family with whom a child is placed moves and the child moves with them, this does
not constitute a change in placement.
• “Date of latest removal” refers to a child’s removal from his or her normal place of residence and
placement in a substitute care setting under the placement and care responsibility of the state or
local title IV-B/IV-E agency. Children are considered to have entered foster care if the child has been
in substitute care for 24 hours or more.
• “Current episode of foster care” refers to a child’s current stay in foster care based on the most
recent removal of the child from his or her normal place of residence, resulting in his or her
placement in a foster care setting and ending upon the child’s discharge from foster care.

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 1
Question 4A Instructions:
•

If there were multiple episodes of foster care during the PUR, add up the placement settings within each
episode. If there is a re-entry into foster care and the child is placed in a different placement setting at
the time of re-entry, this would count as a new placement setting. If the child returns to the placement
setting he or she was in before the return home, this would not count as a new placement setting.

•

Do not consider the following as placement settings: (1) a trial home visit; (2) a runaway episode; (3)
temporary absences from the child’s ongoing foster care placement, including visitation with a sibling,
relative, or other caregiver (for example, pre-placement visits with a subsequent foster care provider or
pre-adoptive parents); (4) hospitalization for medical treatment, acute psychiatric episodes, or diagnosis;
(5) respite care; (6) day or summer camps; and (7) locked facilities (for example, when a youth is held in
detention).

B. Were all placement changes during the PUR planned by the agency in an effort to achieve the child’s
case goals or to meet the needs of the child?
Yes 

No 

Not Applicable 

Question 4B Instructions:
• If the response to question A is one (1), the response to question B should be Not Applicable. If the
single placement is not stable, that information will be collected in question C.
•

Placement changes that reflect agency efforts to achieve case goals include moves from a foster
home to an adoptive home, moves from a more restrictive to a less restrictive placement, moves
from non-relative foster care to relative foster care, and moves that bring the child closer to family or
community.

•

Placement changes that do not reflect agency efforts to achieve case goals include moves due to
unexpected and undesired placement disruptions; moves due to placing the child in an
inappropriate placement (that is, moves based on mere availability rather than on appropriateness);
moves to more restrictive placements when this is not essential to achieving a child’s permanency
goal or meeting a child’s needs; temporary placements while awaiting a more appropriate
placement; and practices of routinely placing children in a particular placement type, such as shelter
care, upon removal regardless of individual needs.

•

If ALL placement changes during the PUR reflect planned agency efforts to achieve the child’s case
goals or to meet the needs of the child, the answer to question B should be Yes.

•

If any single placement change that occurred during the PUR was for a reason other than agency
efforts to achieve case goals or to meet the child’s needs, the answer to question B should be No.

•

Placement changes that result from unexpected circumstances that are out of the control of the
agency (such as the death of a foster parent, or foster parents moving to another state) can be
considered similar to those that reflect agency efforts to achieve case goals for purposes of
question B.

C1. Indicate whether any of the circumstances below apply to the child’s current or most recent placement.
Select all that apply:

 None apply, placement is or was stable.
 The child’s current placement is in a temporary shelter or other temporary setting.
CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 1
 There is information indicating that the child’s current substitute care provider may not be able to
continue to care for the child.
 There are problems in the current placement threatening its stability that the agency is not addressing.
 The child has run away from this placement more than once in the past or is in runaway status at the
time of the review.
 Other (describe reasons why the current placement is not stable):

C. Is the child’s current placement setting (or most recent placement if the child is no longer in foster care)
stable?

Yes 

No 

Question 4C Instruction:
If any of the circumstances in C1 apply to the child’s current placement, the answer to question C should be
No.

Item 4 Rating Criteria:
Item 4 should be rated as a Strength if either of the following applies:
•

The answer to question A is one (1), the answer to question B is Not Applicable, and the
answer to question C is Yes.

•

The answer to question A is greater than one (1), but the answers to questions B and C are
Yes.

Item 4 should be rated as an Area Needing Improvement if either of the following applies:
•

The answer to question A is one (1), but the answer to question C is No.

•

The answer to question A is greater than one (1), and the answer to question B and/or C is
No.

Item 4 Rating (select one):
Strength 

Area Needing Improvement 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 
Area Needing Improvement 
Override reason:

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 1

PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY IN THEIR
LIVING SITUATIONS.
Item 5: Permanency Goal for Child
Purpose of Assessment: To determine whether appropriate permanency goals were established for the
child in a timely manner.
Item 5 Applicable Cases: All foster care cases are applicable for assessment of this item, unless the child has
been in foster care for less than 60 days, and a permanency goal has not been established.

Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the rating section
and continue to Item 6.
Yes 

No 

Optional: Provide comments in the narrative field below:

A1. Permanency Goal Table
Permanency Goal

Date
Established

Time in
Foster Care
Before Goal
Established

CFSR Onsite Review Instrument and Instructions

Date Goal
Changed

Reason for Goal Change

Section II: Permanency Outcome 1
Table 5A1 Definitions:
Permanency goals are defined as follows:
•

A goal of reunification is defined as a plan for the child to be discharged from foster care to his or her
parents or primary caregiver.

•

A goal of guardianship is defined as a plan for the child to be discharged from foster care to a legally
established custody arrangement with an individual that is intended to be permanent. This could
include permanent placement with a relative.

•

A goal of adoption is defined as a plan for the child to be discharged from foster care to the care and
custody of adoptive parents through a legal adoption.

•

A goal of another planned permanent living arrangement refers to a situation in which the agency
maintains placement and care responsibility for, and supervision of, the child, and places the child in a
setting in which the child is expected to remain until adulthood. Examples of these “permanent” living
arrangements include situations where foster parents have made a formal commitment to care for the
child until adulthood, the child is with relatives who plan to care for the child until adulthood, the child is
in a long-term care facility to meet special needs and will be transferred to an adult facility at the
appropriate time, the child is an older adolescent in a stable group home and both the group home
directors and the child have agreed that it will be the child’s placement until adulthood, or the child is in
agency-supervised transitional living.

Table 5A1 Instructions:
•

Complete the table for each of the permanency goals in place during the PUR. Begin with the child’s
first permanency goal in place during the PUR, and end with the current or latest permanency goal or
goals. If no permanency goal is specified in the case file, but the caseworker indicates that a
permanency goal has been established, consider that goal. If two concurrent permanency goals
have been established and are identified in the case plan, identify both goals in the table.

•

When concurrent goals are established and one goal is subsequently dropped, use the date the
remaining goal was first established in the table.

A2. What is (are) the child’s current permanency goal(s)? (If concurrent permanency goals have been
established in the case plan, identify both goals.) Or, if the case was closed during the PUR, what was the
permanency goal(s) before the case was closed?
Permanency Goal 1:
Permanency Goal 2 (if applicable):

A3. Is (are) the child’s permanency goal(s) specified in the case file?
Yes 

No 

Not Applicable 

Question 5A3 Instructions:
• If the child has been in foster care less than 60 days and the goal is not specified in the case file, A3
should be answered Not Applicable.
• If the permanency goal(s) is (are) not specified anywhere in the case file, such as in the case plan or in
a court order, the answer to question A3 should be No.

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Section II: Permanency Outcome 1

B. Were all the permanency goals that were in effect during the PUR established in a timely manner?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 5B Instructions:
• If the child has been in foster care less than 60 days, question B should be answered Not Applicable.
• Answer this question based on your professional judgment regarding the timeliness of establishing the
goal, particularly with regard to changing a goal. For children who recently entered care, expect the
first permanency goal to have been established no later than 60 days from the date of the child’s
removal from the home, consistent with the federal requirement. For children whose goal was
changed from reunification to adoption, consider the guidelines established by the federal Adoption
and Safe Families Act regarding seeking TPR, which might affect the timeliness of changing a goal
from reunification to adoption.
• Answer this question for all permanency goals in effect during the PUR. If there are concurrent goals,
the answer should apply to both goals. For example, if there are concurrent goals of reunification and
adoption, and you believe that the reunification goal was established in a timely manner but the
adoption goal was not, the answer to question B should be No.

C. Were all permanency goals in effect during the PUR appropriate to the child’s needs for permanency and
to the circumstances of the case?

Yes 

No 

If No, explain any concerns in the narrative field below:

Question 5C Instructions:
•

Answer this question based on your professional judgment regarding the appropriateness of the
permanency goal(s).

•

Consider the factors that the agency considered in deciding on the permanency goal(s) and whether
all of the relevant factors were evaluated.

•

If one of the goals is another planned permanent living arrangement and the reviewer determines
that the goal was established without a thorough consideration of other permanency goals, the
answer to question C should be No.

D. Has the child been in foster care for at least 15 of the most recent 22 months?
Yes 

No 

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Section II: Permanency Outcome 1
Question 5D Instructions:
•

In answering question D, begin by determining the child’s most recent date of entry into foster care,
defined as either the date of a judicial finding that the child had been subjected to child abuse or
neglect (often the adjudicatory hearing), or 60 days after the date on which the child was removed
from the home, whichever is earlier. This date should be the same as the date provided in response
to question L on the Face Sheet.

•

Next, determine if the child had multiple dates of entry into foster care over the past 22 months from
the current foster care entry date.

•

If the child did not have multiple foster care episodes during the past 22 months, calculate how long
the child has been in care by starting with the most recent date of entry into foster care.

•

If the child had multiple foster care episodes during the past 22 months from the current foster care
entry date, start the cumulative count with the earliest entry into foster care that occurred during this
22-month period.

•

If the most recent entry date is more than 22 months after the child entered foster care during the
prior episode, begin a new count of 15 of 22 months using the most recent foster care entry date.

•

Do not include trial home visits or runaway episodes in calculating 15 out of 22 months in foster care.

•

Question 5D applies to all children in foster care regardless of adjudication type.

E. Does the child meet other Adoption and Safe Families Act criteria for TPR?
Yes 

No 

Not Applicable 

Question 5E Definitions:
The Adoption and Safe Families Act requires an agency to seek TPR when the child has been in care for at
least 15 of the most recent 22 months, or a court of competent jurisdiction has determined that:
• The child is an abandoned infant, or
• The child’s parents have been convicted of one of the felonies designated in Section 475(5)(E) of the
Social Security Act: (1) committed murder of another child of the parent; (2) committed voluntary
manslaughter of another child of the parent; (3) aided or abetted, attempted, conspired, or solicited to
commit such a murder or such a voluntary manslaughter; or (4) committed a felony assault that
resulted in serious bodily injury to the child or another child of the parent.
Question 5E Instructions:
• If the answer to question D is Yes, the answer to question E should be Not Applicable.
• Question E must be answered if the answer to question D is No.
• If any of the conditions noted above apply to the case under review, question E should be answered
Yes.

F. Did the agency file or join a TPR petition before the PUR or in a timely manner during the PUR?
Yes 

No 

Not Applicable 

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Section II: Permanency Outcome 1
Question 5F Instructions:
• This question determines whether a TPR petition was filed at any point prior to the PUR or if it was
filed in a timely manner during the PUR if the child reached his or her 15th month in foster care during
the PUR.
• If the answers to both questions D and E are No, the answer to question F should be Not Applicable.
• Answer 5F as Yes if:
− The child reached his or her 15th month in foster care during the PUR and a TPR petition was
filed in a timely manner; or
− A TPR petition was filed prior to the PUR. Timeliness is not considered because it occurred
outside the PUR.
• Answer 5F as No if:
− The child reached his or her 15th month in foster care during the PUR but the TPR petition filed
during the PUR was not filed timely; or
− The child has already been in foster care for 15 out of 22 months prior to the start of the PUR
and the agency DID NOT file a petition to TPR prior to the PUR.
• Review the case file for evidence of petitioning for TPR. If there is no evidence of this in the file, ask
the caseworker for documentation regarding petitioning for TPR. If there is no evidence in the file or
other documentation, question F should be answered No.
• Answer 5F as Not Applicable if both parents were either deceased or relinquished parental rights prior
to the 15/22-month timeframe.

G1. Indicate whether any of the following exceptions to the TPR requirement applies.
Not Applicable 
(1) At the option of the state, the child is being cared for by a relative at the 15/22-month timeframe.
Yes 

No

(2) The agency documented in the case plan a compelling reason for determining that TPR would not be in
the best interests of the child.
Yes 

No

(3) The state has not provided to the family the services that the state deemed necessary for the safe
return of the child to the child’s home.
Yes 

No

Question 5G1 Instructions:
•

If the answer to question F is Yes or Not Applicable, question G1 should be answered Not
Applicable.

•

Documentation of exception (1) above is not required.

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Section II: Permanency Outcome 1

G. Did an exception to the requirement to file or join a TPR petition exist?
Yes 

No 

Not Applicable 

Question 5G Instructions:
•

If the answer to question F is Yes or Not Applicable, question G should be answered Not Applicable.

•

If any answers to G1 are yes, question G should be answered Yes.

•

If, during an interview, the caseworker provides a compelling reason for not seeking TPR but cannot
provide any documentation, question G should be answered No.

Item 5 Rating Criteria:
Item 5 should be rated as a Strength if any one of the following criteria applies:
•

The answers to questions A3, B, and C are Yes or Not Applicable, and the answers to questions D
and E are No.

•

The answers to questions A3, B, and C are Yes or Not Applicable, and D and F are Yes.

•

The answers to questions A3, B, and C are Yes or Not Applicable, the answer to question D is No,
and the answers to questions E and F are Yes.

•

The answers to questions A3, B, and C are Yes or Not Applicable, the answer to question D or E is
Yes, the answer to question F is No, and the answer to question G is Yes.

Item 5 should be rated as an Area Needing Improvement if any of the following apply:
•

The answer to question A3, B, or C is No.

•

The answers to questions A3, B, and C are Yes or Not Applicable, but the answer to question D or E
is Yes, and the answers to questions F and G are No.

Item 5 should be rated as Not Applicable if the response to the question of applicability is No.
Item 5 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 
Area Needing Improvement 

Not Applicable 

Override reason:

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Section II: Permanency Outcome 1

PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY IN THEIR
LIVING SITUATIONS.
Item 6: Achieving Reunification, Guardianship, Adoption, or Another Planned Permanent
Living Arrangement
Purpose of Assessment: To determine whether concerted efforts were made, or are being made, during the
PUR to achieve reunification, guardianship, adoption, or another planned permanent living arrangement.
Item 6 Applicable Cases: All foster care cases are applicable for this item.

A1. What is the date of the child’s latest removal?
------/-------/---------------Question 6A1 Definition:
“Latest removal” refers to a child’s removal from his or her normal place of residence and placement
in a substitute care setting under the placement and care responsibility of the state or local title IVB/IV-E agency. Children are considered to have been removed if the child has been in substitute care
for 24 hours or more.
Question 6A1 Instruction:
Using the MM/DD/YYYY format, enter the date of the child’s latest removal. This date should be the
same as the date provided in question K on the Face Sheet.

A2. What is the time in care (in months) at the time of the onsite review?
Question 6A2 Instructions:
•

Enter the number of months that the child was in foster care, from the date of the latest removal to
(1) the date the case is being reviewed, (2) the date of discharge, or (3) the date of the most recent
physical return home.

•

Do not include time in trial home visits and runaway episodes in the calculation.

A3. What is the date the child discharged from foster care? ------/-------/---------------

Not Applicable
Question 6A3 Definition:
“Discharge from foster care” is defined as the point when the child is no longer in foster care under the
placement and care responsibility or supervision of the agency. If a child returns home on a trial home
visit and the agency retains responsibility or supervision of the child, the child is not considered
discharged from foster care unless the trial home visit is longer than 6 months and there was no court
order extending the trial home visit beyond 6 months.

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Section II: Permanency Outcome 1
Question 6A3 Instruction:
Using the MM/DD/YYYY format, enter the date the child discharged from foster care. This date should be
the same as the date provided in question N on the Face Sheet. If the child was not discharged, select Not
Applicable.

A4. What is (are) the child’s current permanency goal(s)? (If concurrent permanency goals have been
established in the case plan, identify both goals.) Or, if the case was closed during the PUR, what was the
permanency goal before the case was closed?
Reunification 

Guardianship 

Adoption 

Another planned permanent living arrangement 

Question 6A4 Instruction:
If Item 5 was completed, select the same goal or goals identified in question 5A2. If Item 5 was not
applicable, refer to the definitions and instructions provided for Table 5A1 in order to determine the child’s
permanency goal(s). For cases in which the child has been in foster care less than 60 days and no goal is
documented, ask the caseworker what the goal is (in most cases it should be reunification).

B. During the PUR, did the agency and court make concerted efforts to achieve permanency in a timely

manner?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 6B Instructions:
• If the current or most recent goal for the child during the PUR was another planned permanent living
arrangement, and no other concurrent goals were in place, select Not Applicable.
• In determining a response to question B, consider the time the child has been in foster care as well
as agency and court efforts. The following timeframes for achievement should be considered for
each goal:
−
−
−

Reunification: 12 months
Guardianship: 18 months
Adoption: 24 months

• If the child has been in foster care for more than the suggested timeframe (12, 18, or 24 months,
depending on the goal) and the goal has not yet been achieved, the answer to question B should be
No, unless there are particular circumstances that justify the delay. For example:
−

The permanency goal of reunification has been in place for longer than 12 months, but the child
was physically returned to the parents during or before the 12th month and remained at home on
a trial home visit beyond the 12th month. If you determine that the length of time the child spent
in out-of-home care and on the trial home visit was reasonable given the child and family

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Section II: Permanency Outcome 1
circumstances, the item may be rated as a Strength even though the child was not
discharged from foster care until after the 12th month.
−

The permanency goal of adoption has been in place for longer than 24 months, but there is
evidence that the agency has made reasonable efforts to find an adoptive home for a child
with special needs although an appropriate family has not yet been found, or a pre-adoptive
placement disrupted despite reasonable efforts on the part of the agency to support it.

• If you determine that the agency and court could have achieved the permanency goal before the
suggested timeframe, but there was a delay due to lack of concerted efforts on the part of the
agency or court during the PUR, the answer to question B should be No even if the child achieved
the goal within the suggested timeframe.

Questions 6B and 6C Instructions:
•

If concurrent goals are in place and one of the goals has been, or will likely be, achieved in a timely
manner, answer question B OR C based on the goal that has been or will be achieved.

•

If concurrent goals are in place (neither of which is another planned permanent living arrangement)
but permanency will not be achieved in a timely manner, answer question B No and indicate in the
documentation specific barriers to implementing concurrent planning.

•

If concurrent goals are in place and one of the goals is another planned permanent living arrangement
and the child is or will be placed in a living arrangement that can be considered permanent until
discharge from foster care, answer question B Not Applicable and question C accordingly.

•

If concurrent goals are in place and one of the goals is another planned permanent living arrangement
but neither goal will be achieved in a timely manner, answer questions B and C No and indicate in the
documentation specific barriers to implementing concurrent planning.

C1. If the child’s current (or most recent) permanency goal is (was) another planned permanent living
arrangement, what is (was) the child’s permanent living arrangement?
 Not Applicable
 Placement with a non-relative foster parent until age of majority or extended age
 Placement with a specified relative in foster care until age of majority or extended age
 Placement in a longer-term facility until transition to an adult care facility
 Placement in an independent living program/supervised independent living until the age of majority or
extended age
 Other:
Question 6C1 Instructions:
• If the child’s current (or most recent) permanency goal was not another planned permanent living
arrangement, select Not Applicable.
• If the child’s current (or most recent) permanency plan is another planned permanent living
arrangement, select the response that describes the permanent living arrangement for the child.
• If the child does not have a permanent living arrangement specified, indicate that in “Other.”
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Section II: Permanency Outcome 1
• If the child has an arrangement that does not fit any of the options noted in C1, describe it in “Other.”
• If the goal for the child is noted as “emancipation/independent living” without a permanent placement
specified, indicate that in “Other.”

C2. For a child with a goal of another planned permanent living arrangement during the PUR, what is the
date of documentation regarding “permanency” of the child’s living arrangements? ------/-------/---------------Not Applicable 

No Date 

Question 6C2 Definition:
The date of documentation regarding “permanency” is the date on which there was a court order, signed
agreement, or other method to formalize that the caregiver or a particular facility would provide care for
this child until the child reaches adulthood.
Question 6C2 Instructions:
• If the child’s permanency goal is not another planned permanent living arrangement, select Not
Applicable.
• If there is no documentation regarding “permanency” of the child’s living arrangement, select “No
Date.”
• Using the MM/DD/YYYY format, enter the date of documentation regarding “permanency.”

C. For a child with a goal of another planned permanent living arrangement during the PUR, did the agency
and court make concerted efforts to place the child in a living arrangement that can be considered
permanent until discharge from foster care?

Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 6C Instructions:
• If the child’s only goal during the PUR was reunification, guardianship, or adoption, select Not
Applicable.
• Consider the child’s current living arrangement and whether formal steps were completed to make this
arrangement permanent.
• This might include the agency asking foster parents or relatives to agree to and sign a long-term care
commitment, or ensuring that a child who is in a long-term care facility to meet special needs will be
transferred to an adult facility at the appropriate time.
• If the child is no longer in foster care, the answer to question C should be based on the child’s last
placement before leaving foster care.

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Section II: Permanency Outcome 1

Item 6 Rating Criteria:
Item 6 should be rated as a Strength if the answer to either question B or C is Yes.
Item 6 should be rated as an Area Needing Improvement if the answer to question B and/or C is No.
Item 6 Rating (select one):
Strength 

Area Needing Improvement 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 1

RATING PERMANENCY OUTCOME 1
PERMANENCY OUTCOME 1: CHILDREN HAVE PERMANENCY AND STABILITY IN THEIR
LIVING SITUATIONS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or
has been achieved, based on the ratings for Items 4, 5, and 6?

Instructions:
Permanency Outcome 1 should be rated as Substantially Achieved if either of the following applies:
•

Items 4, 5, and 6 are rated as Strengths.

•

Items 4 and 6 are rated as Strengths and Item 5 is rated as Not Applicable.

Permanency Outcome 1 should be rated as Partially Achieved if the following applies:
•

At least one of Items 4, 5, or 6 is rated as a Strength.

Permanency Outcome 1 should be rated as Not Achieved if either of the following applies:
•

All of Items 4, 5, and 6 are rated as Areas Needing Improvement.

•

Items 4 and 6 are rated as Areas Needing Improvement and Item 5 is rated as Not Applicable.

Select the appropriate response:
Substantially Achieved 

Partially Achieved 

CFSR Onsite Review Instrument and Instructions

Not Achieved 

Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 7: Placement With Siblings
Purpose of Assessment: To determine whether, during the PUR, concerted efforts were made to ensure that
siblings in foster care are placed together unless a separation was necessary to meet the needs of one of the
siblings.
Item 7 Applicable Cases: Cases applicable for an assessment of this item include all foster care cases in
which the child has one or more siblings who are (or were) also in foster care during the PUR. If the child has
no siblings in foster care during the PUR, the case is Not Applicable for an assessment of this item. For
example, if the child in foster care has an older sibling who was in foster care at one time, but not during the
PUR, this case would be Not Applicable.

Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the ratings section
and continue to Item 8.
Yes 

No 

Optional: Provide comments in the narrative field below:

A. During the entire PUR, was the child placed with all siblings who also were in foster care?
Yes 

No 

Question 7A Definition:
Siblings are children who have one or more parents in common either biologically, through adoption, or
through the marriage of their parents, and with whom the child lived before his or her foster care
placement, or with whom the child would be expected to live if the child were not in foster care.
Question 7A Instructions:
In answering question A, consider only the location of each of the siblings, not the reason for their
location. If the child was placed with siblings for a portion of the PUR, or if the child was placed with
one but not all siblings during the PUR, answer question A No.

B. If the answer to question A is No, was there a valid reason for the child’s separation from the siblings?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

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Section II: Permanency Outcome 2
Question 7B Instructions:
•

If question A was answered Yes, question B is Not Applicable.

•

Consider the circumstances of the placement of siblings, focusing on whether separation was
necessary to meet the child’s needs. For example, were siblings separated temporarily because
one sibling needed a specialized treatment or to be in a treatment foster home, or because one
sibling was abusive to the other, or because siblings with different biological parents were placed
with different relatives?

•

If the separation of siblings is attributed by the agency to a lack of foster homes willing to take
sibling groups, question B should be answered No.

•

In cases of large sibling groups, determine if concerted efforts were made to place the child with
any of his or her siblings who were also in foster care, even if he or she was not placed with all
siblings. If, for example, the agency was able to split a large sibling group into two placements so
that the target child was in fact placed with some of his or her siblings, it could be determined that
the agency made concerted efforts to place siblings together, and that would be reflected in the
response to question B.

•

If siblings were separated for a valid reason, consider the entire PUR and determine whether that
valid reason existed during the whole period of separation. For example, the siblings were separated
because one sibling needed temporary treatment services. However, during the PUR, the sibling’s
treatment services ended. In this situation, determine whether concerted efforts were made to
reunite the siblings after the treatment service was completed. If the need for separation no longer
existed and no efforts were made to reunite the siblings, the answer to question B should be No.

Item 7 Rating Criteria:
Item 7 should be rated as a Strength if either of the following applies:
•

The answer to question A is Yes.

•

The answer to question A is No, but the answer to question B is Yes.

Item 7 should be rated as an Area Needing Improvement if the answers to questions A and B are No.
Item 7 should be rated as Not Applicable if the response to the question of applicability is No.
Item 7 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 8: Visiting With Parents and Siblings in Foster Care
Purpose of Assessment: To determine whether, during the PUR, concerted efforts were made to ensure that
visitation between a child in foster care and his or her mother, father, and siblings is of sufficient frequency and
quality to promote continuity in the child’s relationship with these close family members.
Definitions:
•

“Mother” and “Father” in Items 8 and 11 are typically defined as the parents/caregivers from whom the
child was removed and with whom the agency is working toward reunification.

•

“Mother” and “Father” in Items 8 and 11 also include parents/caregivers from whom the child was NOT
removed, but with whom the child had a relationship prior to the child’s entry into foster care and with
whom the agency is working toward reunification.

•

Because the focus of Item 8 is to promote continuity in the child’s relationships, do not include in this
item a parent who did not have a relationship with the child prior to the child’s entry in foster care, even
if the goal is to reunify with that parent. Visitation for a parent in that circumstance may be assessed as
a service need in Item 12 (see Item 12 instructions).

•

"Relationship" in Items 8 and 11 is defined as a meaningful connection between the child and the
parent.

Item 8 Applicable Cases:
Cases are applicable for an assessment of this item if the following applies:
• The child has at least one sibling in foster care who is in a different placement setting. Yes 

No 

Cases are Not Applicable for assessment if the child has no siblings placed separately in foster care, AND if one
or more conditions applies to each of the parents, as defined for this item. (check Yes for any that apply and No
for any that do not apply):
•

During the entire PUR, it was documented in the case file that contact between the child and the
No 
parent is not in the child’s best interests. Yes 

•

Child was abandoned and both parents’ identities were unknown during the entire PUR despite
documented concerted agency efforts to identify the parents. Yes  No 

•

Parent’s whereabouts were unknown during the entire PUR despite documented concerted agency
efforts to locate the parent. Yes 
No 

•

Parent was deceased during the entire PUR. Yes 

•

Parental rights remained terminated during the entire PUR. Yes 

•

Parent(s) being assessed in this item do(es) not meet the definition of Mother/Father for this item.
Yes 
No 

No 
No 

Is this case applicable?
Select the appropriate response. If the response is No, rate the case as Not Applicable in the ratings section,
indicate the reason(s) in the second text box below, and continue to Item 9.
Yes 

No 

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Section II: Permanency Outcome 2
In the text box below, indicate the case participants who are included in this item as Mother and Father:

If the case participants who are included in this item as Mother and/or Father are not applicable, identify which
condition applies to the parent:

A1. What was the usual frequency of visits between the mother and the child during the PUR? Select the box
next to the statement that best describes the typical frequency of visits during the PUR.








Not Applicable
More than once a week
Once a week
Less than once a week, but at least twice a month
Less than twice a month, but at least once a month
Less than once a month
Never

A. During the PUR, were concerted efforts made to ensure that visitation (or other forms of contact if visitation
was not possible) between the child and his or her mother was of sufficient frequency to maintain or promote
the continuity of the relationship?
Yes 

No 

Not Applicable 

Questions 8A1 and 8B1 Instructions:
Answer Not Applicable if (1) contact between the child and the mother or father was not in the child’s best
interests and this was documented in the case file or court order, (2) the identities or the whereabouts of
the mother or father were not known during the entire PUR, despite documented concerted efforts to
identify or locate her or him, (3) the mother’s or father’s parental rights remained terminated during the
entire PUR, or (4) the mother or father was deceased during the entire PUR.

B1. What was the usual frequency of visits between the father and the child during the PUR? Select the box next
to the statement that best describes the typical frequency of visits during the PUR.








Not Applicable
More than once a week
Once a week
Less than once a week, but at least twice a month
Less than twice a month, but at least once a month
Less than once a month
Never

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2

B. During the PUR, were concerted efforts made to ensure that visitation (or other forms of contact if visitation
was not possible) between the child and his or her father was of sufficient frequency to maintain or promote
the continuity of the relationship?
Yes 

No 

Not Applicable 

Questions 8A and 8B Instructions:
•

If A1 is Not Applicable, question A is answered Not Applicable.

•

If B1 is Not Applicable, question B is answered Not Applicable.

•

Determine whether the frequency of visitation during the PUR was sufficient to maintain the continuity of
the relationship between the child and the mother or father, depending on the circumstances of the case.
For example, frequency may need to be greater for infants and young children who are still forming
attachments. Frequency also may need to be greater if reunification is imminent. Visitation should be as
frequent as possible unless safety concerns cannot be appropriately managed with supervision. The
opportunity for visitation should not be used as a consequence or reward for parents or for children.

•

Frequency should be assessed based on the child’s and the family’s needs and the circumstances of the
case and not solely on state policy or resource availability.

•

If, during the PUR, frequent visitation with the mother or father was not possible (for example, due to
incarceration in a facility where visitation is not feasible, or if the parent lives in another state), determine
whether there are documented concerted efforts to promote other forms of contact between the child
and the mother or father, such as telephone calls or letters, in addition to facilitating visits when possible
and appropriate.

C. During the PUR, were concerted efforts made to ensure that the quality of visitation (or other forms of
contact if visitation was not possible) between the child and the mother was sufficient to maintain or promote
the continuity of the relationship?
Yes 

No 

Not Applicable 

Questions 8C and 8D Instructions:
•

If A1 is Not Applicable or Never, question C is answered Not Applicable.

•

If B1 is Not Applicable or Never, question D is answered Not Applicable.

•

Determine whether concerted efforts were made to ensure that the quality of parent-child visitation,
and/or other forms of contact, was sufficient to maintain the continuity of the relationship. For
example, did visits take place in a comfortable atmosphere and were they of an appropriate
length? Did visitation allow for sufficient interaction between the mother or father and child? If
siblings were involved, did visits allow the mother or father to interact with each child individually?
If appropriate, were unsupervised visits and visits in the mother’s or father’s home in preparation
for reunification allowed?

D. During the PUR, were concerted efforts made to ensure that the quality of visitation (or other forms of
contact if visitation was not possible) between the child and the father was sufficient to maintain or promote the
continuity of the relationship?
Yes 

No 

Not Applicable 

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2

E1. What was the usual frequency of visits between the child and his or her siblings during the PUR? Select
the box next to the statement that best describes the usual frequency of visits between the siblings and the
child during the PUR.








Not Applicable
More than once a week
Once a week
Less than once a week, but at least twice a month
Less than twice a month, but at least once a month
Less than once a month
Never

Question 8E1 Instruction:
Answer E1 Not Applicable if the child has no siblings in foster care or if contact with all siblings who are in
foster care was not considered to be in the best interests of the child for the entire PUR (for example, one
sibling is a physical threat to the other sibling or has a history of physical or sexual abuse of the other
sibling and this concern remained throughout the PUR).

E. During the PUR, were concerted efforts made to ensure that visitation (or other forms of contact if visitation

was not possible) between the child and his or her sibling(s) was of sufficient frequency to maintain or promote
the continuity of the relationship?
Yes 

No 

Not Applicable 

Question 8E Instructions:
•

If E1 is Not Applicable, E should be answered Not Applicable.

•

If E1 is Never, E should be answered No.

•

Consider whether the frequency of visits during the PUR was sufficient to maintain the continuity of
the sibling relationships.

•

If, during the PUR, frequent visitation with the sibling(s) was not possible (for example, siblings were
placed far apart), determine whether there were concerted efforts to promote other forms of contact
between the child and sibling(s), such as telephone calls or letters, in addition to facilitating visits
when possible.

•

Frequency should be assessed based on the child’s needs and the circumstances of the case and
not solely on state policy or resource availability.

F. During the PUR, were concerted efforts made to ensure that the quality of visitation (or other forms of

contact if visitation was not possible) between the child and his or her sibling(s) was sufficient to promote the
continuity of their relationships?
Yes 

No 

Not Applicable 

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2
Question 8F Instructions:
•

If E1 is Not Applicable or Never, question F should be answered Not Applicable.

•

Determine whether concerted efforts were made to ensure that the quality of sibling visitation, and/or
other forms of contact, was sufficient to maintain the continuity of the relationship. For example, were
visits long enough to permit quality interaction? Did sibling visits occur only in the context of parent
visitations? Did visits occur in a comfortable atmosphere?

Item 8 Rating Criteria:
Item 8 should be rated as a Strength if at least one of the questions A through F is answered Yes and
the other questions are answered Not Applicable.
Item 8 should be rated as an Area Needing Improvement if any one of the questions A through F is
answered No.
Item 8 should be rated as Not Applicable if the response to the question of applicability is No.
Item 8 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 9: Preserving Connections
Purpose of Assessment: To determine whether, during the PUR, concerted efforts were made to maintain the
child’s connections to his or her neighborhood, community, faith, extended family, kin, Tribe, school, and
friends.
Item 9 Applicable Cases: Almost all foster care cases are applicable for an assessment of this item. A possible
exception may be the situation of an abandoned infant where the agency has no information about the child’s
extended family or connections.

Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the ratings section
and continue to Item 10.
Yes 

No 

Optional: Provide comments in the narrative field below:

A. During the PUR, were concerted efforts made to maintain the child’s important connections (for example,

neighborhood, community, faith, language, extended family members including siblings who are not in foster
care, kin, Tribe, school, and/or friends)?

Yes 

No 

Question 9A Instructions:
• Determine what the important connections were for the child prior to their placement in foster care and
then determine whether concerted efforts were made to maintain those connections during the PUR.
• It is expected that an infant removed from his or her parents at birth would typically have connections to
the birth family that should be preserved.
• For a child enrolled in school, consider whether efforts were made to maintain the child in the same
school the child was in before placement in foster care, if remaining in the same school was in the
child’s best interests.
• Consider whether the child had a connection with a Tribe based on possible or confirmed Tribal
affiliation or cultural self-identification by the family.
• Examples of efforts to maintain a Tribal connection include securing a placement that maintains that
connection, supporting participation in Tribal community events and activities, supporting attendance in
language classes or other types of education to preserve the connection to the Tribe and indigenous
knowledge. Coordination with a Tribe to preserve a connection should also be considered in this item.
Such efforts may include coordination with Tribal courts where available and appropriate and working
with the Tribe to integrate traditional teachings/culture/beliefs in case planning and service delivery.
• Do not rate this item based on connections the child developed after entering foster care. Information
about those connections is captured in Sub-Item 12A.

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2
• Do not rate this item based on connections to parents/caregivers from whom the child was removed
and/or with whom the child will be reunified, or to siblings who are in foster care. Information about
sustaining those connections is captured in other items. However, this item may be rated based on
connections with siblings who are not in foster care and other extended family members, such as
grandparents, uncles, aunts, or cousins.
• Connections to caregivers from whom the child was removed may also be included in this item if the
goal is not to reunify the child with those caregivers and it is in the child’s best interests to preserve
those relationships.
• If, prior to placement in foster care, the child had a relationship with a biological parent who was not the
caregiver from whom the child was removed or with whom the child is being reunified, that connection
may be included in this item if it is in the child’s best interests to preserve that relationship.

Item 9 Rating Criteria:
•

Item 9 should be rated as a Strength if the answer to question A is Yes.

•

Item 9 should be rated as an Area Needing Improvement if question A is No.

•

Item 9 should be rated as Not Applicable if the response to the question of applicability is No.

Item 9 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 10: Relative Placement
Purpose of Assessment: To determine whether, during the PUR, concerted efforts were
made to place the child with relatives when appropriate.
Item 10 Applicable Cases: All foster care cases are applicable for assessment of this item except those in which
(1) the agency determined upon the child’s initial entry into care that his or her needs required a specialized
placement (such as residential treatment services) and that they will continue to require such specialized
treatment the entire time the child is in care and a relative placement would be inappropriate, or (2) situations
such as abandonment in which the identity of both parents and all relatives remains unknown despite
documented concerted efforts to identify them.

Is this case applicable?

Select the appropriate response. If the response is No, rate the case as Not Applicable in the ratings section and
continue to Item 11.
Yes 

No 

Optional: Provide comments in the narrative field below:

A1. During the PUR, was the child’s current or most recent placement with a relative?
Yes 

No 

A2. If the child’s current or most recent placement is with a relative, is (or was) this placement appropriate to
the child’s needs?
Yes 

No 

Not Applicable 

Questions 10A1 and 10A2 Definition:
“Relative” is defined as a person related to the child by blood, marriage, or adoption.

Questions 10A1 and 10A2 Instructions:
• If the answer to question A1 is No, the answer to question A2 should be Not Applicable.
• If the answer to question A2 is Yes, rate the item as a Strength, and answer Not Applicable to the
remaining questions for the item.
• If the answer to question A1 or A2 is No, answer the remaining questions for this item.

B. Did the agency, during the PUR, make concerted efforts to identify, locate, inform, and evaluate maternal

relatives as potential placements for the child, with the result that maternal relatives were ruled out as
placement resources (due to fit, relative’s unwillingness, or child's best interests) during the PUR?
Yes 

No 

Not Applicable 

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2
If No, specify the area in which concerns existed:
Identify 

Locate 

Inform 

Evaluate 

Questions 10B and 10C Instructions:
• The answers to questions B and C are Not Applicable if the answers to both questions A1 and A2 are
Yes.
• If a child entered foster care during the PUR, determine whether the state followed the requirements of
the title IV-E provision that requires states to consider giving preference to placing the child with
relatives, and determine whether the state considered such a placement and how (for example,
identifying, seeking out, and informing and evaluating the child’s relatives).
• If the parent’s whereabouts were not known during the entire PUR despite agency efforts to locate the
parent, and relatives could not be identified as a result, the answer to question B and/or C should be
Not Applicable.
• If a child entered foster care before the PUR and the answer to either question A1 or A2 is No,
determine whether, during the PUR, the agency made concerted efforts to search for and assess
relatives as placement resources, if appropriate. If all maternal and/or paternal relatives had already
been appropriately considered and permanently ruled out before the PUR, the answer to question B
and/or C can be Not Applicable. If you determine that during the PUR, the agency should have
reconsidered relatives who had previously been ruled out and they did not, however, the answer to
question B and/or C should be No.

C. Did the agency, during the PUR, make concerted efforts to identify, locate, inform, and evaluate paternal
relatives as potential placements for the child, with the result that paternal relatives were ruled out as
placement resources (due to fit, relative’s unwillingness, or child's best interests) during the PUR?
Yes 

No 

Not Applicable 

If No, specify the area in which concerns existed:
Identify 

Locate 

Inform 

Evaluate 

Item 10 Rating Criteria:
Item 10 should be rated as a Strength if either of the following applies:
•

The answers to both questions A1 and A2 are Yes.

•

The answer to either question A1 or A2 is No, but the answers to questions B and/or C are Yes or
Not Applicable.

Item 10 should be rated as an Area Needing Improvement if both of the following apply:
•

The answer to either question A1 or A2 is No.

•

The answer to question B and/or C is No.

Item 10 should be rated as Not Applicable if the response to the question of applicability is No.
Item 10 Rating (select one):
Strength 

Area Needing Improvement 

CFSR Onsite Review Instrument and Instructions

Not Applicable 

Section II: Permanency Outcome 2
Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2

PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
Item 11: Relationship of Child in Care With Parents
Purpose of Assessment: To determine whether, during the PUR, concerted efforts were made to promote,
support, and/or maintain positive relationships between the child in foster care and his or her mother and
father or other primary caregiver(s) from whom the child had been removed through activities other than just
arranging for visitation.
Item 11 Definitions:
• “Mother” and “Father” in Items 8 and 11 are typically defined as the parents/caregivers from whom the
child was removed and with whom the agency is working toward reunification.
• “Mother” and “Father” in Items 8 and 11 also include parents/caregivers from whom the child was NOT
removed, but with whom the child had a relationship prior to the child’s entry into foster care and with
whom the agency is working toward reunification.
• Because the focus of Item 11 is to promote, support, and maintain the child’s relationships with the
parents/caregivers from whom the child was removed, do not include in this item a parent who did not
have a relationship with the child prior to the child’s entry into foster care, even if the goal is to reunify
with that parent. Services to support a parent in developing a new relationship with a child may be
assessed as a service need in Item 12 (see Item 12 instructions).
• "Relationship" in Items 8 and 11 is defined as a meaningful connection between the child and the
parent.
Item 11 Applicable Cases: All foster care cases are applicable for assessment of this item unless one (or
more) of the following conditions applies to each person who is defined as a parent for this item (check Yes for
any that apply and No for any that do not apply):
•

During the entire PUR, it was documented in the case file that contact between the child and the parent
is not in the child’s best interests. Yes  No 

•

The child was abandoned and both parents’ identities were unknown during the entire PUR despite
documented concerted agency efforts to identify the parents. Yes  No 

•

Parent’s whereabouts were not known during the entire PUR despite documented concerted agency
efforts to locate the parent. Yes  No 

•

Parent was deceased during the entire PUR. Yes 

•

Parental rights remained terminated during the entire PUR. Yes 

•

Parent(s) being assessed in this item do(es) not meet the definition for Mother/Father for this item.
Yes  No 

No 
No 

Is this case applicable?
Select the appropriate response. If the response is No, rate the item as Not Applicable in the ratings section
for this item, and indicate the reason(s) in the second text box below.
Yes 

No 

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2
Indicate the case participants who are included in this item as Mother and Father:

If the case participants who are included in this item as Mother and/or Father are not applicable, identify which
condition applies to the parent:

A. During the PUR, were concerted efforts made to promote, support, and otherwise maintain a positive and
nurturing relationship between the child in foster care and his or her mother?
Yes 

No 

Not Applicable 

Questions 11A and 11B Instructions:
• Question A or B should be answered Not Applicable if (1) contact between the child and the mother or
father was not in the child’s best interests and this was documented in the case file or court order, (2)
the identities or the whereabouts of the mother or father were not known during the entire PUR,
despite documented concerted efforts to identify or locate her or him, (3) the mother’s or father’s
parental rights remained terminated during the entire PUR, or (4) the mother or father was deceased
during the entire PUR.
• Foster parents’ activities are considered for purposes of this question. For example, if the foster parent
provided transportation so the mother or father could attend the child’s school event or medical
appointment, that would be considered as contributing toward concerted efforts.
• Do not answer this question based on efforts (or lack of efforts) to ensure the frequency or quality of
visitation between the mother or father and the child. That information is captured under Item 8. This
question pertains to additional activities to help support, strengthen, or maintain the parent-child
relationship.

A1. What concerted efforts were made to support or strengthen the mother-child relationship? Select all
that apply if question A is Yes.
 Not Applicable
 Encouraged the mother’s participation in school activities and case conferences, attendance at
doctors’ appointments with the child, or engagement in the child’s after-school or sports activities, or
hobbies?
 Provided or arranged for transportation or provided funds for transportation so the mother could
attend the child’s special activities and doctors’ appointments?
 Provided opportunities for therapeutic situations to help the mother and child strengthen their
relationship?
 Encouraged the foster parents to provide mentoring or serve as role models to the mother to assist
her in appropriate parenting (e.g., helping with homework, sharing meals, participating in bedtime
routine)?
 Encouraged and facilitated contact with a mother not living in close proximity to the child?
 Other (describe other concerted efforts made):
CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2
Question 11A1 Instructions
• Select Not Applicable if the answer to question A is Not Applicable.
• Select Not Applicable if the answer to question A is No.

B. During the PUR, were concerted efforts made to promote, support, and otherwise maintain a positive and

nurturing relationship between the child in foster care and his or her father?
Yes 

No 

Not Applicable 

B1. What concerted efforts were made to support or strengthen the father-child relationship?

Select all that apply if question B is Yes.
 Not Applicable

 Encouraged the father’s participation in school activities and case conferences, attendance at doctors’
appointments with the child, or engagement in the child’s after-school or sports activities, or hobbies?
 Provided or arranged for transportation or provided funds for transportation so that the father could
attend the child’s special activities and doctors’ appointments?
 Provided opportunities for therapeutic situations to help the father and child strengthen their
relationship?
 Encouraged the foster parents to provide mentoring or serve as role models to the father to assist him in
appropriate parenting (e.g., helping with homework, sharing meals, participating in bedtime routine)?
 Encouraged and facilitated contact with a father not living in close proximity to the child?
 Other (describe other concerted efforts made): ____________________
Question 11B1 Instructions:
• Select Not Applicable if the answer to question B is Not Applicable.
• Select Not Applicable if the answer to question B is No.

Item 11 Rating Criteria:
Item 11 should be rated as a Strength if either of the following applies:
•

The answers to both questions A and B are Yes.

•

The answer to either question A or B is Yes and the answer to the other question is Not
Applicable.

Item 11 should be rated as an Area Needing Improvement if the answer to question A and/or B is No.
Item 11 should be rated as Not Applicable if the response to the question of applicability is No.
Item 11 Rating (select one):
Strength 

Area Needing Improvement 

CFSR Onsite Review Instrument and Instructions

Not Applicable 

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section II: Permanency Outcome 2

RATING PERMANENCY OUTCOME 2
PERMANENCY OUTCOME 2: THE CONTINUITY OF FAMILY RELATIONSHIPS AND
CONNECTIONS IS PRESERVED FOR CHILDREN.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for Items 7 through 11?

Instructions:
Permanency Outcome 2 should be rated as Substantially Achieved if both of the following apply:
•

Not more than one of Items 7 through 11 is rated as an Area Needing Improvement.

•

At least one item is rated as a Strength.

Permanency Outcome 2 should be rated as Partially Achieved if both of the following apply:
•

At least two items, but fewer than all five items, are rated as an Area Needing Improvement.

•

At least one item is rated as a Strength.

Permanency Outcome 2 should be rated as Not Achieved if both of the following apply:
•

No item is rated as a Strength.

•

At least one item is rated as an Area Needing Improvement.

Permanency Outcome 2 should be rated as Not Applicable if the following applies:
•

All of Items 7 through 11 are rated as Not Applicable.

Select the appropriate response:
Substantially Achieved 

Partially Achieved 

CFSR Onsite Review Instrument and Instructions

Not Achieved 

Not Applicable 

Section III: Child and Family Well-Being Outcome 1

SECTION III: CHILD AND FAMILY WELL-BEING
WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE FOR THEIR
CHILDREN’S NEEDS.
Item 12: Needs and Services of Child, Parents, and Foster Parents
Item 12 is divided into three Sub-Items: 12A: Needs assessment and services to children, 12B: Needs
assessment and services to parents, and 12C: Needs assessment and services to foster parents.
Purpose of Assessment: To determine whether, during the PUR, the agency made concerted efforts to (1)
assess the needs of children, parents, and foster parents (both initially, if the child entered foster care or the
case was opened during the PUR, and on an ongoing basis) to identify the services necessary to achieve
case goals and adequately address the issues relevant to the agency’s involvement with the family, and (2)
provide the appropriate services.
Item 12 Applicable Cases: Most cases are applicable for an assessment of this item because Sub-Item 12A
is typically applicable to all cases. Sub-Items 12B and 12C may not be applicable to all cases, and
instructions for applicability are provided before each sub-item.

Sub-Item 12A: Needs Assessment and Services to Children
Sub-Item 12A Instructions:
• If the case is a foster care case, determine whether the agency assessed the needs of, and
provided services for, the target child in the case, even if there are other children in the family in
foster care or in the home.
• If the case is an in-home services case, determine whether the agency assessed the needs of, and
provided services for, all children in the family unless you determine that based on case
circumstances, only specific children in the home should be assessed and provided with services.
For in-home services cases, indicate the names of the children who were included in the assessment of SubItem 12A:

A1. During the PUR, did the agency conduct a formal or informal initial and/or ongoing comprehensive
assessment that accurately assessed the children’s needs?
Yes 

No 

If No, explain any concerns in the narrative field below:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 1
Question 12A1 Instructions:
• If the case was opened during the PUR, focus on whether the agency conducted an initial
comprehensive assessment as a basis for developing a case plan, and whether ongoing
assessment was conducted as appropriate.
• If the case was opened before the PUR, focus on whether the agency conducted periodic
comprehensive needs assessments (as appropriate) during the PUR to update information
relevant to ongoing case planning.
• Assessment of needs may take different forms. For example, needs may be assessed through a
formal evaluation conducted by another agency or by a contracted provider, or through a more
informal case planning process involving intensive interviews with the child, family, and service
providers. Answer question A1 based on a determination of whether the agency made concerted
efforts to achieve an in-depth understanding of the needs of the child, regardless of whether the
needs were assessed in a formal or informal manner. Consequently, the evaluation of the
assessment should focus on its adequacy in accurately assessing the child’s needs in addition to
whether one was conducted.
• Answer this question with regard to an assessment of needs other than those related to children’s
education, physical health, and mental/behavioral health (including substance abuse). The
assessment of the child’s needs related to these issues is addressed in later items. Needs that
should be assessed in this item include those related to social/emotional development that are not
connected to other physical health or mental health issues. These may include social
competencies; attachment and caregiver relationships; social relationships and connections,
including kin; social skills; self-esteem; and coping skills.
• Alternative caregivers should have their needs adequately assessed as related to their ability to
meet the identified needs of the children living with them.
• If the case is a foster care case, and the child is an adolescent, determine whether the child’s
needs for independent living services are being assessed on an ongoing basis as part of the
child’s independent living plan. In making this determination, consider:
– Did the agency assess for independent living skills?
– Is there an independent living plan in the file? (This is required for all youth age 16 and older.)

A2. During the PUR, were appropriate services provided to meet the children’s identified needs?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 12A2 Instructions:
• If the answer to question A1 is Yes, but the result of the assessment was that no service needs were
identified other than those related to education, physical health, and mental/behavioral health
(including substance abuse), and therefore no services were provided other than services to address
those needs, the answer to question A2 should be Not Applicable.

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 1
• If the agency did not conduct an initial assessment and A1 is answered No, A2 could be answered
No or Yes. A2 could be answered Yes only if reviewers can determine through clearly documented
evidence in the case file that ALL of the child’s needs were met with appropriate services. If there is
not enough information for the reviewer to ascertain the child’s needs, because an assessment was
not conducted and the needs are not clearly articulated in the case file, A2 should be answered No.
• Focus on the agency’s provision of services during the PUR. If services were provided before the
PUR, and an assessment conducted during the PUR indicated no further service needs, the answer
to question A2 should be Not Applicable.
• Answer this question with regard to provision of services other than those related to education,
physical health, or mental/behavioral health (including substance abuse). The assessment of service
provision related to these issues is addressed in later items.
• Determine whether the services provided matched identified needs. For example, were the services
provided simply because those were the services available, or were they provided because the
assessment revealed a particular need for a particular type of service? Reviewers may also consider
whether the services provided were:

Tailored to the specific needs of the child(ren);
Culturally appropriate, with providers who can speak the language of the child;
Accessible to the child (considering waitlists, transportation, and hours available);
Provided in a setting that is the most effective and responsive to needs; and
Monitored and adjusted, as needed, to ensure that treatment goals are being achieved and
progress is made.

• If the case is a foster care case, independent living services should be provided to all youth age 16
and older and to children of any age with a goal of emancipation/independence or “another planned
permanent living arrangement” who are expected to eventually exit foster care to independence.
Consider whether concerted efforts were made to provide the child with services to adequately
prepare the child for independent living when the child leaves foster care, such as post-high school
planning, life skills classes, employment training, financial planning skills training, and transitional
services.
• Examples of services that are assessed under this item include child care services, mentoring
programs that are not related to the child’s education, recreational services, teen parenting
education, preparation for adoption and other permanency goals, services that address family
relationships that are not mental health in nature (for example, services to assist children in
reestablishing or maintaining family ties), and services to assist the child that are recommended by
a therapist or other provider but are not mental health-related (such as enrollment in an activity to
assist with social skills or to boost self-esteem).

• Alternative caregivers should be provided services necessary to meet the identified needs of the
children living with them.

Sub-Item 12A Rating Criteria:
Sub-Item 12A should be rated as a Strength if either of the following applies:
•

The answers to both questions A1 and A2 are Yes.

•

The answer to question A1 is Yes, and the answer to question A2 is Not Applicable.

Sub-Item 12A should be rated as an Area Needing Improvement if the answer to question A1 and/or A2
is No.
There are no circumstances under which Sub-Item 12A could be rated as Not Applicable.
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Sub-Item 12A Rating (select one):
Strength 

Area Needing Improvement 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

Sub-Item 12B: Needs Assessment and Services to Parents
Sub-Item 12B Definitions:
In-home services cases:
• “Mother” and “Father” in Items 12, 13, and 15 are typically defined as the parents/caregivers with
whom the children were living when the agency became involved with the family and with whom the
children will remain (for example, biological parents, relatives, guardians, adoptive parents).
• If a biological parent does not fall into any of the categories above, determine whether that parent
should be included in this item based on the circumstances of the case. Some things to consider in
this determination are the reason for the agency’s involvement and the identified perpetrators in the
case, the status of the children’s relationship with the parent, the nature of the case (courtsupervised or voluntary) and the length of case opening. If a biological parent indicates a desire
during the PUR to be involved with the child and it is in the child’s best interests to do so, they should
be assessed in this item.
Foster care cases:
• “Mother” and “Father” in Items 12, 13, and 15 are typically defined as the parents/caregivers from
whom the child was removed and with whom the agency is working toward reunification.
• “Mother” and “Father” in Items 12, 13, and 15 include biological parents who were not the parents
from whom the child was removed.
• “Mother” and “Father” include adoptive parents if the adoption has been finalized during the PUR.
Optional: Provide comments in the narrative field below:

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Sub-Item 12B Applicable Cases:
•

Because multiple case participants can be assessed in these questions, consider applicability for all
appropriate case participants before determining that the rating should be Not Applicable.

•

Questions in Sub-Item 12B should be answered Not Applicable for a specific parent if any of the
following applies to that parent (check Yes for any that apply and No for any that do not apply):
– Parental rights remained terminated during the entire PUR. Yes 

No 

– Parent’s identity or whereabouts were not known during the entire PUR despite agency efforts to
identify or locate the parent. Yes 
No 
– Parent was deceased during the entire PUR. Yes 

No 

– During the entire PUR, it was documented in the case file that it was not in the child’s best interests
to involve the parent in case planning. Yes  No 
– During the entire PUR, the parent indicated that he or she did not want to be involved in the child’s
life and this was documented in the case file. Yes 
No 

Is Sub-Item 12B applicable for Mother?
Yes 

No 

If No, answer questions B1 and B3 Not Applicable.

Is Sub-Item 12B applicable for Father?
Yes 

No 

If No, answer questions B2 and B4 Not Applicable.
Indicate the case participants who are included in this sub-item as Mother and Father:

If both parents are not applicable for this item, go to Sub-Item 12B rating criteria, select Not Applicable and
continue to Sub-Item 12C.

B1. During the PUR, did the agency conduct a formal or informal initial and/or ongoing comprehensive
assessment that accurately assessed the mother’s needs?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Questions 12B1 and 12B2 Instructions:
• If the case was opened during the PUR, focus on whether the agency conducted an initial
comprehensive assessment as a basis for developing a case plan, and whether ongoing
assessment was conducted as appropriate.
• If the case was opened before the PUR, focus on whether the agency conducted periodic
comprehensive needs assessments (as appropriate) during the PUR to update information relevant
to ongoing case planning.
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• Determine whether the agency has made concerted efforts to ensure that case planning is based on
an in-depth understanding of the needs of the mother and father, regardless of whether the needs
were assessed in a formal or informal manner. (Assessment of needs may take different forms. For
example, needs may be assessed through a formal psychosocial evaluation conducted by another
agency or by a contracted provider, or through a more informal case planning process involving
intensive interviews with the child, family, and service providers.)
• Assessment of mother’s and father’s needs refers to a determination of what the mother or father
needs to provide appropriate care and supervision and to ensure the well-being of his or her
children. This could include mental and physical health needs (as later items do not address these
concerns for the parents) if those needs affect the parent’s capacity to care for the children. This
could also include an assessment of needs related to supporting a biological parent’s relationship
with the child if they did not have an established relationship prior to the child’s entry into foster care.
• If the agency did not make concerted efforts to identify/locate the mother and/or alleged father,
question B1 and/or B2 should be answered No.

B2. During the PUR, did the agency conduct a formal or informal initial and/or ongoing comprehensive
assessment that accurately assessed the father’s needs?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

B3. During the PUR, did the agency provide appropriate services to the mother to meet identified needs?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 12B3 and 12B4 Instructions:
• If an assessment was conducted but no service needs were identified, this question can be
answered Not Applicable.
• Appropriate services are those that enhance the mother’s or father’s ability to provide care and
supervision and support the well-being of his or her child(ren); for example, substance abuse
treatment, parenting skills classes, or visitation and/or family counseling services for a biological
parent who is establishing a new relationship with the child. Visitation services would only be
included for a biological parent in this item if the parent were not included in Item 8.
• Determine whether the services provided matched identified needs. For example, were the services
provided simply because those were the services available, or were they provided because the
assessment revealed a particular need for a particular type of service? Reviewers may also consider
whether the services provided were:
– Tailored to the specific needs of the parent;
– Culturally appropriate, with providers who can speak the language of the parent;
– Accessible to the parent (considering waitlists, transportation, and hours available);
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– Provided in a setting that is the most effective and responsive to needs; and
– Monitored and adjusted, as needed, to ensure that treatment goals are being achieved and
progress is made.

B4. During the PUR, did the agency provide appropriate services to the father to address identified needs?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Sub-Item 12B Rating Criteria:
Sub-Item 12B should be rated as a Strength if either of the following applies:
•

The answers to B1, B2, B3, and B4 are Yes.

•

The answer to at least one question is Yes, and the answer to the other questions is Not
Applicable.

Sub-Item 12B should be rated as an Area Needing Improvement if the answer to any one of the
questions is No.
Sub-Item 12B should be rated as Not Applicable if the answer to the questions of applicability for both
Mother and Father is No.
Sub-Item 12B Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

Sub-Item 12C: Needs Assessment and Services to Foster Parents
Sub-Item 12C Applicable Cases:
•

In-home services cases are not applicable for an assessment of this sub-item.

•

All foster care cases are applicable for assessment of this sub-item unless, during the entire PUR, the
child was in out-of-home care in a residential facility or similar placement but does not have foster
parents.

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Is Sub-Item 12C applicable?
Yes 

No 

Optional: Provide comments in the narrative field below:

If No, go to Sub-Item 12C rating criteria and select Not Applicable.
Sub-Item 12C Definition:
Foster parents are defined as related or non-related caregivers who have been given responsibility for care
of the child by the agency while the child is under the placement and care responsibility and supervision of
the agency. This includes pre-adoptive parents if the adoption has not been finalized.

C1. During the PUR, did the agency adequately assess the needs of the foster or pre-adoptive parents on
an ongoing basis (with respect to services they need in order to provide appropriate care and supervision to
ensure the safety and well-being of the children in their care)?
Yes 

No 

If No, explain any concerns in the narrative field below:

Question 12C1 Instructions:
• All foster parents who cared for the child during the PUR are included in this assessment.
• Determine whether an assessment was conducted to identify what the foster parents needed to
enhance their capacity to provide appropriate care and supervision to the child in their home,
such as respite care, assistance with transportation, or counseling to address the child’s
behavior problems.
• Determine whether assessment of foster parent needs is done on an ongoing basis. If there is
no evidence in the case file that the agency assessed the needs of the foster parents at any
time during the PUR, and the foster parents (if available for interview) indicate that they have not
been assessed, the answer to question C1 should be No.

C2. During the PUR, were the foster or pre-adoptive parents provided with appropriate services to address
identified needs that pertained to their capacity to provide appropriate care and supervision of the children in
their care?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

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Question 12C2 Instructions:
• The answer to question C2 should be Not Applicable if needs were assessed but no service needs
were identified.
• All foster parents who cared for the child during the PUR are included in this assessment.

Sub-Item 12C Rating Criteria:
Sub-Item 12C should be rated as a Strength if either of the following applies:
•

The answers to both questions C1 and C2 are Yes.

•

The answer to question C1 is Yes, and the answer to question C2 is Not Applicable.

Sub-Item 12C should be rated as an Area Needing Improvement if the answer to question C1 and/or C2
is No.
Sub-Item 12C should be rated as Not Applicable if the response to the question of applicability is No.
Item 12C Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

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Item 12 Rating Criteria:
Item 12 should be rated as a Strength if sections A, B, and C are all rated Strength OR at least one of
the sections is rated as a Strength and the others are Not Applicable.
Item 12 should be rated as an Area Needing Improvement if any one of sections A, B, or C is rated as
an Area Needing Improvement.
Item 12 Rating (select one):
Strength 

Area Needing Improvement 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating?



Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

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WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE FOR THEIR
CHILDREN’S NEEDS.
Item 13: Child and Family Involvement in Case Planning
Purpose of Assessment: To determine whether, during the PUR, concerted efforts were made (or are
being made) to involve parents and children (if developmentally appropriate) in the case planning
process on an ongoing basis.
Item 13 Definitions:
In-home services cases:
• “Mother” and “Father” in Items 12, 13, and 15 are typically defined as the parents/caregivers with
whom the children were living when the agency became involved with the family and with whom the
children will remain (for example, biological parents, relatives, guardians, adoptive parents).
• If a biological parent does not fall into any of the categories above, determine whether that parent
should be included in this item based on the circumstances of the case. Some things to consider in
this determination are the reason for the agency’s involvement and the identified perpetrators in the
case, the status of the children’s relationship with the parent, the nature of the case (court
supervised or voluntary) and the length of case opening. If a biological parent indicates a desire
during the PUR to be involved with the child and it is in the child’s best interests to do so, they
should be assessed in this item.
Foster care cases:
• “Mother” and “Father” in Items 12, 13, and 15 are typically defined as the parents/caregivers from
whom the child was removed and with whom the agency is working toward reunification.
• “Mother” and “Father” in Items 12, 13, and 15 include biological parents who were not the parents
from whom the child was removed.
• “Mother” and “Father” include adoptive parents if the adoption has been finalized during the PUR.

Item 13 Applicable Cases:
Because multiple case participants can be assessed in these questions, consider applicability for all
appropriate case participants before determining that the rating should be Not Applicable. All cases are
applicable for an assessment of this item except as determined below (check Yes for criteria that apply and
No for those that do not).
•

Cases involving children for whom participating in planning is not developmentally appropriate.
Yes 
No 
AND:

•

Cases in which a specific parent being assessed as Mother or Father meet any of these criteria:
–

Parental rights remained terminated during the entire PUR. Yes 

–

Parent’s identity or whereabouts were not known during the entire PUR despite agency efforts to
identify or locate the parent. Yes  No 

–

The reviewer has determined that Item 12B is rated as an Area Needing Improvement due to lack of
concerted efforts to identify or locate applicable parents. Yes  No 

–

Parent was deceased during the entire PUR. Yes 

–

During the entire PUR, it was documented in the case file that it was not in the child’s best interests
to involve the parent in case planning. Yes 
No 

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Section III: Child and Family Well-Being Outcome 1
–
•

During the entire PUR, the parent has indicated he or she does not want to be involved in the child’s
life and this was documented in the case file. Yes 
No 

In-home services cases are applicable even in states that do not require a formal case plan to be
developed for in-home services cases. Therefore, the case is applicable even if there is no state
requirement for a case plan and there is no case plan in the file.

Is this case applicable?
Select the appropriate response. If the response is No, rate the case as Not Applicable in the ratings section
and continue to Item 14.
Yes 

No 

Indicate the case participants who are included in this item as Mother and Father:

Optional: Provide comments in the narrative field below:

A. During the PUR, did the agency make concerted efforts to actively involve the child in the case planning
process?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

For in-home services cases, indicate the names of the children who are included in the assessment of Item
13:

Question 13A Definition:
“Actively involved” means that the agency consulted with the child (as developmentally appropriate)
regarding the child’s goals and services, explained the plan and terms used in the plan in language that
the child can understand, and included the child in periodic case planning meetings, particularly if any
changes are being considered in the plan.
Question 13A Instructions:
• Select Not Applicable if the child is not old enough to participate in case planning or is incapacitated.
Although the capacity to participate actively in case planning will need to be decided on a case-bycase basis, as a guideline, most children who are elementary school-aged or older may be expected to
participate to some extent.
• If the case is a foster care case, Item 13 applies to the target child only. If the case is an in-home
services case, Item 13 applies to all children in the family home unless you determine that based on

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case circumstances only specific children in the home should be engaged in case planning (for
example, only children receiving services from the agency).
• If the case is an in-home services case and there is no case plan in the file (some states require
that an identifiable written case plan be included in the file for in-home services cases), identify the
extent to which the children (if developmentally appropriate) were involved in determining (1) their
strengths and needs, (2) the type and level of services needed, and (3) their goals and progress
toward meeting them. Determine whether this information was documented in the case file in any
way.
• Do not assume that a child’s knowledge about his or her case plan is an indicator of active
involvement.
• If the initial case plan was developed before the PUR, focus on the children’s involvement during
the PUR in the ongoing case planning process, particularly with regard to evaluating progress and
making changes in the type and level of services needed as well as understanding changes made
to their permanency goal (in foster care cases).

B. During the PUR, did the agency make concerted efforts to actively involve the mother in the case planning
process?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Questions 13B and 13C Definition:
“Actively involved” means that the agency involved the mother or father in (1) identifying strengths and
needs, (2) identifying services and service providers, (3) establishing goals in case plans, (4)
evaluating progress toward goals, and (5) discussing the case plan.
Questions 13B and 13C Instructions:
• Select Not Applicable if all case participants being assessed as Mother in 13B or as Father in 13C
meet the criteria for Not Applicable in the Item 13 rating criteria.
• If the initial case plan was developed before the PUR, focus on the mother’s or father’s involvement
during the PUR in the ongoing case planning process, particularly with regard to evaluating
progress and making changes in the plan.
• Select Not Applicable if the agency did not make concerted efforts to identify or locate a mother or
father whose identity or whereabouts were unknown. In Well-Being Outcome 1, concerns about
efforts to identify or locate a parent should only be reflected in Item 12.

C. During the PUR, did the agency make concerted efforts to actively involve the father in the case planning
process?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

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Item 13 Rating Criteria:
Item 13 should be rated as a Strength if either of the following applies:
•

The answers to A, B, and C are Yes.

•

The answer to at least one question is Yes, and the answer to the other questions is Not
Applicable.

Item 13 should be rated as an Area Needing Improvement if the answer to any one of questions A, B, or
C is No.
Item 13 should be rated as Not Applicable if the response to the question of applicability is No.
Item 13 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

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WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE FOR THEIR
CHILDREN’S NEEDS.
Item 14: Caseworker Visits With Child
Purpose of Assessment: To determine whether the frequency and quality of visits between caseworkers
and the child(ren) in the case are sufficient to ensure the safety, permanency, and well-being of the child(ren)
and promote achievement of case goals.
Item 14 Applicable Cases: All cases are applicable for an assessment of this item.

A1. During the PUR, what was the most typical pattern of visitation between the caseworker or other

responsible party and the child(ren) in the case? Select the box that describes the usual pattern of visitation.
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never
Questions 14A1 and 14A Definitions:
• “Other responsible party” refers to contracted service providers who have full responsibility for case
planning and case management (for example, fully or partially privatized child welfare systems
where full case management responsibilities are delegated to contract agencies). It does not refer
to contracted service providers that provide services while the agency maintains decision-making
and case management responsibilities regarding the case or the child.
• A “visit” is defined as a face-to-face contact between the caseworker or other responsible party and
the child.
Question 14A1 Instructions:
• If the case is an in-home services case, question A1 should be answered for all children in the
family home.
• If the case is a foster care case, question A1 should be answered only for the target child in the
case.
• Consider only the pattern of visits during the PUR and not over the life of the case.
• Focus on the visitation frequency of the agency caseworker (or other responsible party) responsible
for the case and not on other service providers who may be visiting the children.
• Determine the most typical pattern of visitation during the PUR because the actual frequency
may vary in specific time periods.

A. During the PUR, was the frequency of the visits between the caseworker (or other responsible party) and
the child(ren) sufficient to address issues pertaining to the safety, permanency, and well-being of the
child(ren) and promote achievement of case goals?
Yes 

No 

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Question 14A Instructions:
• If the answer to A1 is Never, question A is No.
• In responding to question A, consider the frequency of visits selected in question A1.
• Base your determination on the frequency necessary to ensure the child’s safety, permanency, and
well-being and not on compliance with state policy requirements regarding caseworker contacts or
visits with the child. For example, if state policy is that the caseworker should visit the child at least
once a month and they complied with that, but you determine that given the circumstances of the
case (for example, there are safety concerns), the caseworker should visit more frequently, the
answer to question A should be No.
• If the child is in a placement in another state, you should determine whether a caseworker from the
jurisdiction in which the child is placed, or a caseworker from the jurisdiction from which the child
was placed, visits with the child in the placement on a schedule that is consistent with the child’s
needs.
• If the typical pattern of visits is less than once a month, the answer to question A should be No
unless you determine that there is a substantial justification for a Yes answer.
• For an in-home services case, any children in the home who were assessed in Item 12 should be
visited at least monthly unless there is substantial justification for less than monthly visits.
Frequency of visitation with other children in the family home should be determined based on the
circumstances of the case, such as any risk and safety concerns present during the PUR, the age
and vulnerability of the children, or the reason for the agency’s involvement with the family.
• If the case is a foster care case, question A should be answered only for the target child in the
case.

B. During the PUR, was the quality of the visits between the caseworker and the child(ren) sufficient to

address issues pertaining to the safety, permanency, and well-being of the child(ren) and promote
achievement of case goals (for example, did the visits between the caseworker or other responsible party and
the child(ren) focus on issues pertinent to case planning, service delivery, and goal achievement)?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Question 14B Instructions:
• If the answer to A1 is Never, question B is Not Applicable.
• Consider both the length of the visit (for example, was it of sufficient duration to address key issues
with the child, or was it just a brief visit?) and the location of the visit (for example, was it in a place
conducive to open and honest conversation, such as a private home, or was it in a more formal or
public environment, such as a court house or restaurant?).
• Consider whether the caseworker (or other responsible party) saw the child alone or whether the
parent or foster parent was usually present during the caseworker’s visits with the child. If the child
was older than an infant, and the caseworker did not see the child alone for at least part of each
visit, the answer to question B should be No. However, if a child is older than an infant but has not
reached the stage in development where he or she is comfortable being away from the parent or
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foster parent, assess whether visitation is conducted in a way that is sensitive to the child’s needs
but allows the caseworker to determine the safety and well-being of the child.
• Also consider the topics that were discussed during the visits if that information is available in the
case file or through interviews. For the answer to question B to be Yes, there must be some
evidence that the caseworker and the child addressed issues pertaining to the child’s needs,
services, and case goals during the visits.

Item 14 Rating Criteria:
Item 14 should be rated as a Strength if the answers to both questions A and B are Yes.
Item 14 should be rated as an Area Needing Improvement if the answer to question A and/or B is No.
There are no circumstances under which Item 14 could be rated as Not Applicable.
Item 14 Rating (select one):
Strength 

Area Needing Improvement 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Override rating:
Strength 

Area Needing Improvement 

Override reason:

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WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE FOR THEIR
CHILDREN’S NEEDS.
Item 15: Caseworker Visits With Parents
Purpose of Assessment: To determine whether, during the PUR, the frequency and quality of visits between
caseworkers and the mothers and fathers of the child(ren) are sufficient to ensure the safety, permanency,
and well-being of the child(ren) and promote achievement of case goals.
Item 15 Definitions:
In-home services cases:
•

“Mother” and “Father” in Items 12, 13, and 15 are typically defined as the parents/caregivers with
whom the children were living when the agency became involved with the family and with whom the
children will remain (for example, biological parents, relatives, guardians, adoptive parents).

•

If a biological parent does not fall into any of the categories above, determine whether that parent
should be included in this item based on the circumstances of the case. Some things to consider in
this determination are the reason for the agency’s involvement and the identified perpetrators in
the case, the status of the children’s relationship with the parent, the nature of the case (court
supervised or voluntary), and the length of case opening. If a biological parent indicates a desire
during the PUR to be involved with the child and it is in the child’s best interests to do so, they
should be assessed in this item.

Foster care cases:
• “Mother” and “Father” in Items 12, 13, and 15 are typically defined as the parents/caregivers from whom
the child was removed and with whom the agency is working toward reunification.
• “Mother” and “Father” in Items 12, 13, and 15 include biological parents who were not the parents from
whom the child was removed.
• “Mother” and “Father” include adoptive parents if the adoption has been finalized during the PUR.

Item 15 Applicable Cases:
Because multiple case participants can be assessed in these questions, consider applicability for all
appropriate case participants before determining that the rating should be Not Applicable. All cases are
applicable for an assessment of this item except cases in which all parents being assessed as Mother and
Father meet any of the following criteria (check Yes for any that apply and No for those that do not):
•

Parental rights remained terminated during the entire PUR. Yes 

•

Parent’s identity or whereabouts were not known during the entire PUR despite agency efforts to identify
or locate the parent. Yes  No 

•

The reviewer has determined that Item 12B is rated as an Area Needing Improvement due to lack of
concerted efforts to identify or locate applicable parents. Yes  No 

•

Parent was deceased during the entire PUR. Yes 

•

During the entire PUR, it was documented in the case file that it was not in the child’s best interests to
involve the parent in case planning. Yes  No 

•

During the entire PUR, the parent has indicated he or she does not want to be involved in the child’s life
and this was documented in the case file. Yes 
No 

CFSR Onsite Review Instrument and Instructions

No 

Section III: Child and Family Well-Being Outcome 1

Is this case applicable?
Select the appropriate response. If the response is No, select Not Applicable in the ratings section and
continue to Item 16. Yes 
No 
Indicate the case participants who are included in this item as Mother and Father:

Optional: Provide comments in the narrative field below:

A1. During the PUR, what was the most typical pattern of visitation between the caseworker (or other
responsible party) and the mother of the child(ren)? Select the appropriate response:
 Not Applicable
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never
Questions 15A1, 15A2, 15B1, and 15B2 Definitions:
• “Other responsible party” refers to contracted service providers who have full responsibility for
case planning and case management (for example, fully or partially privatized child welfare
systems where full case management responsibilities are delegated to contract agencies). It
does not refer to contracted service providers who provide services while the agency maintains
decision-making and case management responsibilities regarding the case or the child.
• A “visit” is defined as a face-to-face contact between the caseworker or other responsible
party and the parent.
Questions 15A1 and 15B1 Instructions:
• Select Not Applicable if all case participants being assessed as Mother in 15A1 or as Father
in 15B1 meet the criteria for Not Applicable in the Item 15 rating criteria above. Consider only
the pattern of visits during the PUR and not over the life of the case.
• Determine the most typical pattern of visitation during the PUR because the actual frequency
may vary in specific time periods.
• Select Not Applicable for questions A1 and B1 if the agency did not make concerted efforts to
identify or locate a mother or father whose identity or whereabouts were unknown. In WellBeing Outcome 1, concerns about efforts to identify or locate a parent should only be reflected
in Item 12.

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 1

A2. During the PUR, was the frequency of the visits between the caseworker (or other responsible party)

and the mother sufficient to (1) address issues pertaining to the safety, permanency, and well-being of the
child and (2) promote achievement of case goals?
Yes 

No 

Not Applicable 

Questions 15A2 and 15B2 Instructions:
• If the answer to question A1 or B1 is Not Applicable, the answer to question A2 or B2 for that
parent also should be Not Applicable.
• Consider the frequency of visits that is necessary to effectively address: (1) the child’s safety,
permanency, and well-being, and (2) achievement of case goals. Do not answer the question
based on the caseworker visit requirements that may be established by state policy.
• The answers to questions A2 and B2 should be No if the typical pattern of contact is less than
once a month, unless you have a substantial justification for answering either question as Yes.

B1. During the PUR, what was the most typical pattern of visitation between the caseworker (or other

responsible party) and the father of the child(ren)? Select the appropriate response:
 Not Applicable
 More than once a week
 Once a week
 Less than once a week, but at least twice a month
 Less than twice a month, but at least once a month
 Less than once a month
 Never

B2. During the PUR, was the frequency of the visits between the caseworker (or other responsible party) and
the father sufficient to address issues pertaining to the safety, permanency, and well-being of the child and
promote achievement of case goals?
Yes 

No 

Not Applicable 

C. During the PUR, was the quality of the visits between the caseworker (or other responsible party) and the
mother sufficient to address issues pertaining to the safety, permanency, and well-being of the child and
promote achievement of case goals?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 1
Questions 15C and 15D Instructions:
• Consider both the length of the visit (for example, was it of sufficient duration to address key issues
with the mother/father, or was it just a brief visit?) and the location of the visit (for example, was it in a
place conducive to open and honest conversation, such as a private home, or was it in a formal or
public environment that might be uncomfortable for the parent, such as a court house or restaurant?).
• Consider whether the visits between the caseworker or other responsible party and the
father/mother focused on issues pertinent to case planning, service delivery, and goal achievement.
• If the answer to question A1 or B1 is Not Applicable or Never, the answer to the corresponding
question (same parent) C or D should be Not Applicable.

D. During the PUR, was the quality of the visits between the caseworker (or other responsible party) and the
father sufficient to address issues pertaining to the safety, permanency, and well-being of the child and
promote achievement of case goals?
Yes 

No 

Not Applicable 

If No, explain any concerns in the narrative field below:

Item 15 Rating Criteria:
Item 15 should be rated as a Strength if any of the following apply:
•

The answers to A2, B2, C, and D are Yes.

•

The answer to A2 and C is Yes and the answer to B2 and D is Not Applicable.

•

The answer to A2 and C is Not Applicable and the answer to B2 and D is Yes.

Item 15 should be rated as an Area Needing Improvement if the answer to any one of questions A2, B2,
C, or D is No.
Item 15 should be rated as Not Applicable if the response to the question of applicability is No.
Item 15 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 
Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 1

RATING CHILD AND FAMILY WELL-BEING OUTCOME 1
WELL-BEING OUTCOME 1: FAMILIES HAVE ENHANCED CAPACITY TO PROVIDE FOR THEIR
CHILDREN’S NEEDS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or
has been achieved, based on the ratings for Items 12 through 15?

Instructions:
Well-Being Outcome 1 should be rated as Substantially Achieved if both of the following apply:
•

Item 12 is rated as a Strength or Not Applicable; and

•

Only one of Items 13, 14, and 15 is rated as an Area Needing Improvement.

Well-Being Outcome 1 should be rated as Partially Achieved if either of the following applies:
•

Item 12 is rated as an Area Needing Improvement, but at least one other item is rated as a Strength.

•

Item 12 is rated as a Strength or Not Applicable, but at least two of Items 13, 14, and 15 are rated as
Areas Needing Improvement.

Well-Being Outcome 1 should be rated as Not Achieved if the following applies:
•

All applicable items are rated as Areas Needing Improvement.

Select the appropriate response:
Substantially Achieved 

Partially Achieved 

CFSR Onsite Review Instrument and Instructions

Not Achieved 

Section III: Child and Family Well-Being Outcome 2

WELL-BEING OUTCOME 2: CHILDREN RECEIVE APPROPRIATE SERVICES TO MEET THEIR
EDUCATIONAL NEEDS.
Item 16: Educational Needs of the Child
Purpose of Assessment: To assess whether, during the PUR, the agency made concerted efforts to assess
children’s educational needs at the initial contact with the child (if the case was opened during the PUR) or on
an ongoing basis (if the case was opened before the PUR), and whether identified needs were appropriately
addressed in case planning and case management activities.

Item 16 Applicable Cases:
•

All foster care cases involving a school-aged child, including those in pre-school, are applicable for an
assessment of this item. If a child is 2 years old or younger and has been identified as having
developmental delays, the case may be applicable if the developmental delays need to be addressed
through an educational approach rather than through physical therapy or some form of physical health
approach. In these latter cases, the issue of developmental delays would be addressed under Item 17.

•

Foster care cases are Not Applicable if the child is age 2 or younger and there are no apparent
developmental delays.

•

In-home services cases are applicable for an assessment of this item if (1) educational issues are
relevant to the reason for the agency’s involvement with the family, and/or (2) it is reasonable to expect
that the agency would address educational issues given the circumstances of the case. For example, it
is reasonable to expect that the agency would address educational issues in a case in which the child
is the subject of a substantiated maltreatment report and, during the PUR, the maltreatment appeared
to be affecting the child’s school performance.

•

In-home services cases are Not Applicable for an assessment of this item if you determine that, during
the PUR, there is no reason to expect that the agency would address educational issues for any
children in the family, given the reason for agency involvement or the circumstances of the case. This
“non-applicability” applies even if there is evidence in the case file that the agency has learned that the
parent/caregiver has obtained educational services for the children.

Is this case applicable?
Select the appropriate response. If the answer is No, rate the item as Not Applicable in the ratings section and
continue to Item 17.
Yes 

No 

Optional: Provide comments in the narrative field below:

A. During the PUR, did the agency make concerted efforts to accurately assess the children’s educational
needs?
Yes 

No 

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 2
For in-home services cases, indicate the names of the children who are included in the assessment of Item 16:

Question 16A Instructions:
• If the case is a foster care case, question A should be answered only for the target child in foster
care, even if the child was reunified during the PUR and there are other children in the home.
• If the case is an in-home services case, question A should be answered for all children in the home
who meet the case applicability requirements.
• Question A should be answered Yes if there was evidence of an educational assessment in the
case file, such as:
- An educational assessment included in the comprehensive needs assessment.

- A separate educational assessment conducted by the school (and made available to the
agency) or by the agency.
- An informal (and documented) educational assessment conducted by the agency.
• Question A should be answered Yes if the reviewer determines through interviews with key
individuals that the agency assessed the children’s educational needs, even if the case file did not
include the documentation identified above.

A1. Education Table
Educational Needs

Services Provided

Services Needed But Not Provided

Table 16A1 Instructions:
• Document in the table the child(ren)’s educational needs, services provided to meet those needs,
and services needed but not provided. If all needed services were provided, enter “None” in the
column labeled “Services Needed But Not Provided.”
• Services could include ensuring that children received special education classes; making provisions
for children to receive tutoring or educational mentoring; and arranging for children to be enrolled in
early intervention preschool classes such as Head Start. Foster care cases could include advocacy
on the part of foster parents as well as the caseworker.

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 2

B. During the PUR, did the agency engage in concerted efforts to address the children’s educational needs
through appropriate services?
Yes 

No 

Not Applicable 

Question 16B Instructions:
• Question B should be answered Not Applicable if an educational assessment was conducted (i.e.,
question A is answered Yes) but no needs were identified.
• If the case is a foster care case, question B should be answered only for the target child in foster
care, even if the child was reunified during the PUR and there are other children in the home.
• Review any “services needed but not provided” noted in table A1 when responding to question B.
Focus on agency efforts, even if these efforts were not fully successful due to factors beyond the
agency’s control. For example, if the agency made concerted efforts to advocate for special
education classes, but the local school continued to resist, you may answer Yes to question B,
although the child did not receive the needed services. Also consider whether the service need was
recently identified during the PUR and the agency has not had a reasonable amount of time to
arrange for/request the service.
• Reviewers may also consider whether the services provided were:
− Tailored to the specific needs of the child(ren);
− Accessible to the child (considering waitlists, transportation, and hours available); and
− Monitored and adjusted, as needed, to ensure that educational goals are being achieved and
progress is made.

Item 16 Rating Criteria:
Item 16 should be rated as a Strength if either of the following applies:
•

The answers to questions A and B are Yes.

•

The answer to question A is Yes, and the answer to question B is Not Applicable.

Item 16 should be rated as an Area Needing Improvement if the answer to question A and/or B is No.
Item 16 should be rated as Not Applicable if the response to the question of applicability is No.
Item 16 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 
Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 2

RATING CHILD AND FAMILY WELL-BEING OUTCOME 2
WELL-BEING OUTCOME 2: CHILDREN RECEIVE APPROPRIATE SERVICES TO MEET THEIR
EDUCATIONAL NEEDS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or
has been achieved, based on the rating for Item 16?

Instructions:
Well-Being Outcome 2 should be rated as Substantially Achieved if the following applies:
•

Item 16 is rated as a Strength.

Well-Being Outcome 2 should be rated as Partially Achieved if the following applies:
•

Item 16 is rated as an Area Needing Improvement, but question A or B is answered Yes.

Well-Being Outcome 2 should be rated as Not Achieved if the following applies:
•

Item 16 is rated as an Area Needing Improvement and both questions A and B were answered No.

Well-Being Outcome 2 should be rated as Not Applicable if the following applies:
•

Item 16 is rated as Not Applicable.

Select the appropriate response:
Substantially Achieved 

Partially Achieved 

Not Achieved 

Not Applicable 

Partially Achieved 

Not Achieved 

Not Applicable 

Overridden outcome rating:
Substantially Achieved 
Override reason:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3

WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES TO MEET THEIR
PHYSICAL AND MENTAL HEALTH NEEDS.
Item 17: Physical Health of the Child
Purpose of Assessment: To determine whether, during the PUR, the agency addressed the physical
health needs of the children, including dental health needs.

Item 17 Applicable Cases:
•

All foster care cases are applicable for an assessment of this item.

•

If a child has been identified as having developmental delays, the case may be applicable if the
developmental delays need to be addressed through physical therapy or some form of physical health
approach. If the developmental delays need to be addressed through an educational approach, the
issue of developmental delays would be addressed under Item 16.

•

In-home services cases are applicable for an assessment of this item if (1) physical/dental health
issues were relevant to the reason for the agency’s involvement with the family, and/or (2) it is
reasonable to expect that the agency would address physical/dental health issues given the
circumstances of the case. For example, it is reasonable to expect that the agency would address
physical health issues in a case in which a child is the subject of a substantiated maltreatment report
of physical neglect and there is reason to suspect that, during the PUR, the neglect may have affected
the child’s physical health.

•

In-home services cases are Not Applicable for an assessment of this item if you determine that there
is no reason to expect that the agency would address physical and dental health issues for any
children in the family, given the reason for agency involvement or the circumstances of the case. This
“non-applicability” applies even if there is evidence in the case file that the agency has learned that
the parent is effective in taking care of the children’s physical and dental health needs.

Is this case applicable?
Select the appropriate response. If the answer is No, rate the case as Not Applicable in the ratings section
and continue to Item 18.
Yes 

No 

Optional: Provide comments in the narrative field below:

A1. During the PUR, did the agency accurately assess the children’s physical health care needs?
Yes 

No 

Not Applicable 

For in-home services cases, indicate the names of the children who are included in the assessment of Item
17:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3
Questions 17A1 and 17A2 Instructions:
• For in-home services cases, questions A1 and A2 should be answered for all children in the home
who meet the case applicability requirements. A1 or A2 may be Not Applicable if only one of the
issues (physical or dental health) was relevant for assessment in an in-home services case.
• For foster care cases, questions A1 and A2 should be answered only for the target child in foster
care, even if the child was reunified during the PUR and there are other children in the home.
• Determine whether there is evidence that, during the PUR, the agency arranged for assessment of
the child(ren)’s health care needs, including dental care needs, both initially (if the target child
entered foster care during the PUR or if an in-home services case was opened during the PUR), and
on an ongoing basis through periodic health and dental screening services conducted during the
PUR.
• The evidence to consider would include but is not limited to:
- Conducting an initial health care screening, such as Early Periodic Screening, Diagnosis, and
Treatment (EPSDT) or other comprehensive medical examination upon entry into foster care (if
the child entered foster care during the PUR) or when the case first opened (for an in-home
services case that opened during the PUR).
- Ensuring that, during the PUR, the children received recommended ongoing periodic preventive
physical and dental health screenings to identify and avoid potential problems. Preventive health
care refers to initial and periodic age-appropriate physical and dental health examinations. Wellchild examinations should occur according to the guidelines established by agency policies
and/or protocols or, if none exist, the schedule established by the EPSDT, unless otherwise
recommended by the child’s physician.
- Including an assessment of physical and dental health needs in the initial comprehensive needs
assessment (if the child entered foster care during the PUR or if the in-home services case was
opened during the PUR), or in ongoing needs assessments conducted to guide case planning.

A2. During the PUR, did the agency accurately assess the children’s dental health care needs?
Yes 

No 

Not Applicable 

Question 17A2 Instruction:
If the children are too young for a dental examination, question A2 should be answered Not Applicable.

A3. Physical and Dental Health Table
Identified Physical or Dental
Health Needs

Services Provided

CFSR Onsite Review Instrument and Instructions

Services Needed But Not Provided

Section III: Child and Family Well-Being Outcome 3
Table 17A3 Instructions:
• Document in the table each identified physical or dental health need, the services provided to meet
those needs, and the services needed but not provided related to each identified need. If all needed
services were provided, enter “None” in the column labeled “Services Needed But Not Provided.”
• Needed services could include immunizations, treatment services, and dental services, including
orthodontics.

A4. For foster care cases only, determine whether, during the PUR, there was evidence that the following

case-management criteria required by federal statute were met (select each one that was met).
 Not Applicable (this is an in-home services case).
 No evidence found.

 To the extent available and accessible, the child’s health records are up to date and included in the
case file [Social Security Act § 475(1)(C)].
 The case plan addresses the issue of health and dental care needs [Social Security Act § 475(1)(C)].
 To the extent available and accessible, foster parents or foster care providers are provided with the
child’s health records [Social Security Act § 475(5)(D)].
Question 17A4 Definition:
Health records include the names and addresses of the child’s health care providers, a record of the
child’s immunizations, the child’s known medical problems, the child’s medications, and any other
relevant health information.

B1. For foster care cases only, during the PUR, did the agency provide appropriate oversight of prescription
medications for physical health issues?
Yes 

No 

Not Applicable 

Question 17B1 Definition:
“Appropriate oversight” includes but is not limited to:
•

Ensuring that the target child is seen regularly by a physician to monitor the effectiveness of the
medication, assess any side effects and/or health implications, consider any changes needed to
dosage or medication type and determine whether medication is still necessary and/or if other
treatment options would be more appropriate

•

Regularly following up with foster parents/caregivers about administering medications
appropriately and about the target child’s experience with the medication(s), including any side
effects

•

Following any additional state protocols that may be in place related to the appropriate use and
monitoring of medications

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3
Question 17B1 Instructions:
• Select Not Applicable if this is not a foster care case.
• If the target child was not prescribed any medications for physical health issues during the PUR,
select Not Applicable.

B2. During the PUR, did the agency ensure that appropriate services were provided to the children to
address all identified physical health needs?
Yes 

No 

Not Applicable 

Questions 17B2 and 17B3 Instructions:
• For in-home services cases, questions B2 and B3 should be answered for all children in the
home who meet the case applicability requirements.
• For foster care cases, questions B2 and B3 should be answered only for the target child in foster
care, even if the child was reunified during the PUR and there are other children in the home.
• If the answers to question(s) A1 and/or A2 are Yes and no needs for services or treatment were
identified, the corresponding question(s) B2 and/or B3 should be answered Not Applicable. If
question A2 is Not Applicable because of the child’s age, question B3 also should be Not
Applicable.
• If any “services needed but not provided” are noted in the A3 table, question B2 and/or B3
should be No, unless the service was recently identified during the PUR and the agency has not
had a reasonable amount of time to arrange for the service. If services were not provided due to
excessive waitlists, service providers not being available in the community, or delays by the
agency, question B2 and/or B3 should be No.
• Answer No to question B2 or B3 if the case management criteria noted in question A4 were not
met and you determine that had or has a negative impact on the agency’s ability to meet the
child’s health and dental care needs. For example, the foster parents were unable to effectively
address health care needs because they had never seen the child’s health records, or the child’s
health care needs were not being met because there were no health records in the case file and
the worker was unaware of the child’s health care needs.
• Routine exams can include both evaluations and services (e.g., a teeth cleaning). In cases
where initial and/or ongoing assessments were conducted and the child received routine care
but no follow-up services were needed, the answer to 17B2 or 17B3 should be Yes. If either
routine care or any additional services were needed but not provided, the answer to 17B2 or
17B3 should be No.
• Determine whether the services provided matched identified needs. For example, were the
services provided simply because those were the services available, or were they provided
because the assessment revealed a particular need for a particular type of service? Reviewers
may also consider whether the services provided were:
–
–
–
–
–

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3

B3. During the PUR, did the agency ensure that appropriate services were provided to the children to
address all identified dental health needs?
Yes 

No 

Not Applicable 

Item 17 Rating Criteria:
Item 17 should be rated as a Strength if either of the following applies:
•

The answers to questions A1, A2, B1, B2, and B3 are Yes.

•

The answer to at least one of questions A1, A2, B1, B2, or B3 is Yes, and the rest are Not
Applicable.

Item 17 should be rated as an Area Needing Improvement if the answer to any question is No.
Item 17 should be rated as Not Applicable if the response to the question of applicability is No.
Item 17 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 
Area Needing Improvement 
Override reason:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3

WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES TO MEET THEIR
PHYSICAL AND MENTAL HEALTH NEEDS.
Item 18: Mental/Behavioral Health of the Child
Purpose of Assessment: To determine whether, during the PUR, the agency addressed the mental/
behavioral health needs of the children.

Item 18 Applicable Cases:
•

Foster care cases are applicable for an assessment of this item if the reviewer determines that, during
the PUR, the child had existing mental/behavioral health needs, including substance abuse issues. If
the child had mental/behavioral health issues before the PUR that were adequately addressed and
there are no remaining needs during the PUR, the case should be rated as Not Applicable.

•

In-home services cases are applicable for an assessment of this item if (1) mental/behavioral health
issues related to any of the children in the family were relevant to the reason for the agency’s
involvement with the family, and/or (2) it is reasonable to expect that the agency would address mental/
behavioral health issues given the circumstances of the case. For example, it is reasonable to expect
that the agency would address mental health issues in a case in which a child is the subject of a
substantiated maltreatment report and there is reason to suspect that, during the PUR, the
maltreatment may have affected the child’s mental health.

•

In-home services cases are Not Applicable for an assessment of this item if the reviewer determines
that there is no reason to expect that, during the PUR, the agency would address mental/behavioral
health issues for any children in the family, given the reason for agency involvement or the
circumstances of the case. This “non-applicability” applies even if there is evidence in the case file that
the agency has learned that the parent is effective in taking care of the children’s
mental/behavioral health needs.

Is this case applicable?
Select the appropriate response. If the answer is No, rate the case as Not Applicable in the rating section.
Yes 

No 

Optional: Provide comments in the narrative field below:

A. During the PUR, did the agency conduct an accurate assessment of the children’s mental/behavioral

health needs either initially (if the child entered foster care during the PUR or if the in-home services case was
opened during the PUR) and on an ongoing basis to inform case planning decisions?
Yes 

No 

For in-home services cases, indicate the names of the children who are included in the assessment of Item 18:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3
Question 18A Definition:
“Behavioral health needs” includes needs related to behavioral problems that are not always specified
as mental health needs, including substance abuse.
Question 18A Instructions:
• An assessment of mental health should include consideration of any trauma that the children may
have experienced, including exposure to domestic violence.
• Determine whether, during the PUR, the agency conducted a formal or informal mental/behavioral
health assessment on the children initially (if the in-home services case was opened during the
PUR) or at entry into foster care (if the child entered foster care during the PUR), and on an
ongoing basis.
• If the case is an in-home services case, question A should be answered for all children in the home
who meet the case applicability requirements.
• For foster care cases, question A should be answered only for the target child in foster care, even if
the child was reunified during the PUR and there are other children in the home.

A1. Mental/Behavioral Health Table
Identified Mental/
Behavioral Health Needs

Services Provided

Services Needed But Not Provided

Table 18A1 Instructions:
• Identify in the table the identified mental/behavioral health needs, services provided to address
those identified needs, and services needed but not provided. If all needed services were provided,
enter “None” in the column labeled “Services Needed But Not Provided.”
• Services may include outpatient treatment, inpatient mental health treatment, treatment for
substance abuse disorders, individual therapy, group therapy, family therapy, etc.

B. For foster care cases only, during the PUR, did the agency provide appropriate oversight of prescription
medications for mental/behavioral health issues?
Yes 

No 

Not Applicable 

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3
Question 18B Definition:
“Appropriate oversight” includes but is not limited to the following:
• Ensuring that the target child is seen regularly by a physician to monitor the effectiveness of the
medication, assess any side effects and/or health implications, consider any changes needed to
dosage or medication type, and determine whether medication is still necessary and/or whether
other treatment options would be more appropriate
• Regularly following up with foster parents/caregivers about administering medications
appropriately and about the target child’s experience with the medication(s), including any side
effects
• Following any additional state protocols that may be in place related to the appropriate use and
monitoring of medications
Question 18B Instructions:
• Select Not Applicable if this is not a foster care case.
• If the child was not prescribed any medications for mental/behavioral health issues during the
PUR, select Not Applicable.

C. During the PUR, did the agency provide appropriate services to address the children’s mental/behavioral
health needs?
Yes 

No 

Not Applicable 

Question 18C Instructions:
• For in-home services cases, question C should be answered for all children in the home who meet
the case applicability requirements.
• For foster care cases, question C should be answered only for the target child in foster care, even
if the child was reunified during the PUR and there are other children in the home.
• If question A is answered Yes, but no mental/behavioral health service needs were identified, the
answer to question C should be Not Applicable.
• If you noted any “services needed but not provided” in the A1 table, question C should be No,
unless the service was recently identified during the PUR and the agency has not had a
reasonable amount of time to arrange for the service. If services were not provided due to
excessive waitlists, service providers not being available in the community, or delays by the
agency, question C should be answered No.
• Determine whether the services provided matched identified needs. For example, were the
services provided simply because those were the services available, or were they provided
because the assessment revealed a particular need for a particular type of service? Reviewers
may also consider whether the services provided were:
–
–
–
–

Tailored to the specific needs of the child(ren);
Culturally appropriate, with providers who can speak the language of the child(ren);
Accessible to the child(ren) (considering waitlists, transportation, and hours available);
Provided in a setting that is the most effective and responsive to needs; and

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3
– Monitored and adjusted, as needed, to ensure that treatment goals are being achieved and
progress is made.

Item 18 Rating Criteria:
Item 18 should be rated as a Strength if the answer to question A is Yes, the answer to question B is
Yes or Not Applicable, and the answer to question C is Yes or Not Applicable.
Item 18 should be rated as an Area Needing Improvement if the answer to any question is No.
Item 18 should be rated as Not Applicable if the response to the question of applicability is No.
Item 18 Rating (select one):
Strength 

Area Needing Improvement 

Not Applicable 

Provide comments that highlight strengths or challenges related to specific practices, systemic issues, or
resources that affected this item in the narrative field below:

Override this rating? 
Overridden rating:
Strength 

Area Needing Improvement 

Not Applicable 

Override reason:

CFSR Onsite Review Instrument and Instructions

Section III: Child and Family Well-Being Outcome 3

RATING CHILD AND FAMILY WELL-BEING OUTCOME 3
WELL-BEING OUTCOME 3: CHILDREN RECEIVE ADEQUATE SERVICES TO MEET THEIR
PHYSICAL AND MENTAL HEALTH NEEDS.
What is the level of outcome achievement that best describes the extent to which this outcome is being or has
been achieved, based on the ratings for Items 17 and 18?

Instructions:
Well-Being Outcome 3 should be rated as Substantially Achieved if either of the following applies:
• Items 17 and 18 are both rated as Strengths.
• One item is rated as a Strength and the other item is rated as Not Applicable.
Well-Being Outcome 3 should be rated as Partially Achieved if the following applies:
• One of the two items (17 and 18) is rated as a Strength and the other is rated as an Area Needing
Improvement.
Well-Being Outcome 3 should be rated as Not Achieved if either of the following applies:
• Both items are rated as Areas Needing Improvement.
• One item is rated as an Area Needing Improvement and the other item is rated as Not Applicable.
Well-Being Outcome 3 should be rated as Not Applicable if the following applies:
• Items 17 and 18 are both rated as Not Applicable.
Select the appropriate response:
Substantially Achieved 

Partially Achieved 

CFSR Onsite Review Instrument and Instructions

Not Achieved 

Not Applicable 

File Type	application/pdf
File Title	CFSR Onsite Review Instrument and Instructions
Subject	CFSR Onsite Review Instrument and Instructions, OSRI, Round 4 OSRI, Child and Family Services Reviews
Author	HHS/Children's Bureau
File Modified	2024-04-09
File Created	2021-09-19