While child welfare programs are a primary responsibility of state and local governments, the federal government appropriates close to $7 billion annually to support these programs (primarily for foster care and adoption assistance) and states are required to meet certain federal policies in order to receive this funding. Child and Family Services Reviews (CFSRs) gauge state efforts and ability to achieve the primary goals of safety and permanence for children, and well-being for children and their families. The review is intended both to measure state compliance with federal child welfare policy and to strengthen and improve state child welfare programs. The Department of Health and Human Services (HHS) conducted the initial round of onsite reviews between March 2001 and March 2004. No state was found to be in substantial conformity with all of the outcomes and systems assessed. Some critics of the CFSR argue that while the outcomes reviewed are on target, the criteria established to determine state achievement of those outcomes may give misleading information about a state’s performance. Although much attention has focused on states’ uniform inability to meet all of the federal criteria, the reviews also showed certain relative strengths. States showed the greatest ability to ensure that children were not exposed to child abuse and neglect and remained safely in their homes whenever appropriate and possible, and in preserving their family relationships and connections. They had the most difficulty in achieving permanent and stable living arrangements for children, enhancing the capacity of families to meet the needs of their children and in seeing that appropriate mental and physical health services were available to children served. Information regarding ensuring provision of educational services to children was more mixed. In addition to reviewing outcomes, the CFSR assesses state compliance with federal child welfare policy by examining certain federally required systems. States were most likely to be found successful at operating a statewide information system; maintaining foster and adoptive parent licensing, training, recruitment and retention; and responding to community concerns. They were least likely to have a strong service array or case review system in place. Ratings of state quality assurance and training systems were more mixed. To avoid immediate assessment of penalties for failure to comply with federal policy, each state was required to develop a Program Improvement Plan (PIP). A PIP must address each one of the outcomes or systems with which a state was found to be out of substantial conformity and must describe the state’s specific plan for moving toward full conformity with federal policy. A few states have successfully completed their PIPS but most are still in the process of implementing them. The Children’s Bureau has begun planning for a second round of CFSRs and onsite reviews will likely begin in FY2006. This book describes the origins and design of CFSRs before turning to its primary discussion: state performance in the initial round of CFSRs.