Child Welfare
Improved Federal Oversight Could Assist States in Overcoming Key Challenges Gao ID: GAO-04-418T January 28, 2004Title IV-B of the Social Security Act, comprised of two subparts, is the primary source of federal funding for services to help families address problems that lead to child abuse and neglect and to prevent the unnecessary separation of children from their families; however, a number of challenges exist that impair states' ability to deliver and track these services. This testimony is based on findings from three reports issued in 2003 and addresses the following: (1) states' use of Title IV-B funds in providing a wide array of services to prevent the occurrence of abuse, neglect, and unnecessary foster care placements, as well as in providing other child welfare services; (2) factors that hinder states' ability to protect children from abuse and neglect; and (3) the Department of Health and Human Services' (HHS) role in helping states to overcome these challenges. Findings are based on multiple methodologies, including a survey to child welfare directors on states' use of Title IV-B funds; an analysis of nearly 600 exit interview documents completed by staff who severed their employment from 17 state, 40 county, and 19 private child welfare agencies; and a survey of all 50 states and the District of Columbia regarding their experiences in developing and using information systems and their ability to report data to HHS. In each case, GAO also conducted multiple site visits to selected states and interviewed child welfare experts and HHS headquarters and regional officials.
States use of Title IV-B funds to provide a wide variety of services to prevent the occurrence of abuse, neglect, and foster care placements, as well as to provide other child welfare services. According to GAO's Title IV-B survey data for fiscal year 2002, states spent about 60 percent of subpart 1 funds on the salaries of child welfare agency staff, administration and management expenses, and child protective services, while about 10 percent were used to provide family support and family preservation services. In comparison, states spent about 62 percent of their subpart 2 funds on family support and preservation services. Child welfare agencies face a number of challenges related to staffing and data management that impair their ability to protect children from abuse and neglect. Low salaries hinder agencies' ability to attract potential child welfare workers and retain those already in the profession. According to caseworkers GAO interviewed, high turnover rates and staffing shortages leave remaining staff with insufficient time to establish relationships with families and make the necessary decisions to ensure safe and stable permanent placements. States also face challenges developing appropriate information systems needed to track abuse or neglect reports and monitor children in foster care. In addition, several factors affect states' ability to collect and report reliable adoption, foster care, and child abuse and neglect data, including insufficient caseworker training, inaccurate and incomplete data entry, and technical challenges reporting the data. HHS plays a role in helping states overcome some of the challenges they face in operating their child welfare programs, but additional oversight or technical assistance could assist states in meeting the needs of children served by child welfare agencies. HHS's oversight of Title IV-B focuses primarily on states' overall child welfare systems and outcomes, but the agency provides relatively little oversight specific to Title IV-B subpart 1. In addition, HHS plays a limited role in states' workforce activities by offering partial reimbursement for training expenses and managing discretionary grant programs. The agency monitors states' information systems development and data reporting, but despite the availability of technical assistance, states reported ongoing challenges reporting reliable data. In the related reports, GAO made several recommendations to HHS. GAO recommended that HHS provide the necessary guidance to ensure that regional offices monitor states' use of Title IV-B subpart 1 and to consider gathering additional information on its use. GAO also recommended that HHS take actions that may help child welfare agencies address recruitment and retention challenges. Last, GAO recommended that HHS consider ways to enhance the guidance and assistance offered to help states overcome key data challenges. HHS generally agreed with GAO's findings and recommendations, except that it noted that its level of oversight of Title IV-B was commensurate with the program's scope and intent.
GAO-04-418T, Child Welfare: Improved Federal Oversight Could Assist States in Overcoming Key Challenges
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Testimony:
Before the Subcommittee on Human Resources, Committee on Ways and
Means, House of Representatives:
United States General Accounting Office:
GAO:
For Release on Delivery Expected at 10:30 a.m. EST:
Wednesday, January 28, 2004:
CHILD WELFARE:
Improved Federal Oversight Could Assist States in Overcoming Key
Challenges:
Statement of Cornelia M. Ashby, Director Education, Workforce, and
Income Security Issues:
GAO-04-418T:
GAO Highlights:
Highlights of GAO-04-418T, a testimony before the Subcommittee on
Human Resources, Committee on Ways and Means, House of Representatives
Why GAO Did This Study:
Title IV-B of the Social Security Act, comprised of two subparts, is
the primary source of federal funding for services to help families
address problems that lead to child abuse and neglect and to prevent
the unnecessary separation of children from their families; however, a
number of challenges exist that impair states‘ ability to deliver and
track these services. This testimony is based on findings from three
reports issued in 2003 and addresses the following: (1) states‘ use of
Title IV-B funds in providing a wide array of services to prevent the
occurrence of abuse, neglect, and unnecessary foster care placements,
as well as in providing other child welfare services; (2) factors that
hinder states‘ ability to protect children from abuse and neglect; and
(3) the Department of Health and Human Services‘ (HHS) role in helping
states to overcome these challenges. Findings are based on multiple
methodologies, including a survey to child welfare directors on
states‘ use of Title IV-B funds; an analysis of nearly 600 exit
interview documents completed by staff who severed their employment
from 17 state, 40 county, and 19 private child welfare agencies; and a
survey of all 50 states and the District of Columbia regarding their
experiences in developing and using information systems and their
ability to report data to HHS. In each case, GAO also conducted
multiple site visits to selected states and interviewed child welfare
experts and HHS headquarters and regional officials.
What GAO Found:
States use of Title IV-B funds to provide a wide variety of services
to prevent the occurrence of abuse, neglect, and foster care
placements, as well as to provide other child welfare services.
According to GAO‘s Title IV-B survey data for fiscal year 2002, states
spent about 60 percent of subpart 1 funds on the salaries of child
welfare agency staff, administration and management expenses, and
child protective services, while about 10 percent were used to provide
family support and family preservation services. In comparison, states
spent about 62 percent of their subpart 2 funds on family support and
preservation services.
Child welfare agencies face a number of challenges related to staffing
and data management that impair their ability to protect children from
abuse and neglect. Low salaries hinder agencies‘ ability to attract
potential child welfare workers and retain those already in the
profession. According to caseworkers GAO interviewed, high turnover
rates and staffing shortages leave remaining staff with insufficient
time to establish relationships with families and make the necessary
decisions to ensure safe and stable permanent placements. States also
face challenges developing appropriate information systems needed to
track abuse or neglect reports and monitor children in foster care. In
addition, several factors affect states‘ ability to collect and report
reliable adoption, foster care, and child abuse and neglect data,
including insufficient caseworker training, inaccurate and incomplete
data entry, and technical challenges reporting the data.
HHS plays a role in helping states overcome some of the challenges
they face in operating their child welfare programs, but additional
oversight or technical assistance could assist states in meeting the
needs of children served by child welfare agencies. HHS‘s oversight of
Title IV-B focuses primarily on states‘ overall child welfare systems
and outcomes, but the agency provides relatively little oversight
specific to Title IV-B subpart 1. In addition, HHS plays a limited
role in states‘ workforce activities by offering partial reimbursement
for training expenses and managing discretionary grant programs. The
agency monitors states‘ information systems development and data
reporting, but despite the availability of technical assistance,
states reported ongoing challenges reporting reliable data.
In the related reports, GAO made several recommendations to HHS. GAO
recommended that HHS provide the necessary guidance to ensure that
regional offices monitor states‘ use of Title IV-B subpart 1 and to
consider gathering additional information on its use. GAO also
recommended that HHS take actions that may help child welfare agencies
address recruitment and retention challenges. Last, GAO recommended
that HHS consider ways to enhance the guidance and assistance offered
to help states overcome key data challenges. HHS generally agreed with
GAO‘s findings and recommendations, except that it noted that its
level of oversight of Title IV-B was commensurate with the program‘s
scope and intent.
www.gao.gov/cgi-bin/getrpt?GAO-04-418T.
To view the full product, including the scope and methodology, click
on the link above. For more information, contact Cornelia M. Ashby at
(202) 512-8403 or ashbyc@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me here today to discuss several issues related
to the oversight of child welfare programs across the nation. As you
are aware, state child welfare agencies determined that over 900,000
children had been the victims of abuse or neglect by their parents or
other caretakers in 2001. Additionally, more than 800,000 children are
estimated to spend some time in foster care each year, with the federal
government allocating approximately $7 billion each year to investigate
abuse and neglect, provide placements to children outside their homes,
and deliver services to help keep families together. Title IV-B of the
Social Security Act, comprised of two subparts, is the primary source
of federal funding for services to help families address problems that
lead to child abuse and neglect and to prevent the unnecessary
separation of children from their families. Funding under Title IV-E of
the Social Security Act is used primarily to pay for the room and board
of children in foster care. Since 1994, designated federal matching
funds have been available to states to develop and implement
comprehensive case management systems--statewide automated child
welfare information systems (SACWIS)--to manage their child welfare
cases as well as to report child abuse and neglect, foster care, and
adoption information to the federal government.
In addition to this funding, the Department of Health and Human
Services' (HHS) Administration for Children and Families (ACF) monitors
states' compliance with key federal goals, specified in part by the
Adoption and Safe Families Act (ASFA) of 1997, to keep children safe
and ensure their placement in stable and permanent homes. Through its
formal review process, known as the Child and Family Services Review
(CFSR), HHS uses specific assessment measures, such as agencies'
ability to conduct timely abuse and neglect investigations and
regularly visit children in their homes, to assess the performance of
states' child welfare systems.
My testimony today will focus on three key issues: (1) states' use of
Title IV-B funds in providing a wide array of services to prevent the
occurrence of abuse, neglect, and foster care placements, as well as
other child welfare services; (2) factors that hinder states' ability
to protect children from abuse and neglect; and (3) HHS's role in
helping states to overcome the challenges they face in protecting
children from abuse and neglect. My comments are based primarily on the
findings from three reports:[Footnote 1] U.S. General Accounting
Office, Child Welfare: HHS Could Play a Greater Role in Helping Child
Welfare Agencies Recruit and Retain Staff. GAO-03-357. Washington,
D.C.: March 31, 2003; Child Welfare: Most States Are Developing
Statewide Information Systems, but the Reliability of Child Welfare
Data Could Be Improved. GAO-03-809. Washington, D.C.: July 31, 2003;
and Child Welfare: Enhanced Federal Oversight of Title IV-B Could
Provide States Additional Information to Improve Services. GAO-03-956.
Washington, D.C.: September 12, 2003. Those findings were based on
multiple methodologies, including a survey of child welfare directors
on states' use of Title IV-B funds; an analysis of 600 exit interview
documents completed by staff who severed their employment from 17
state, 40 county, and 19 private child welfare agencies; and a survey
of all 50 states and the District of Columbia regarding their
experiences in developing and using information systems and their
ability to report data to HHS. In each case, we supplemented these
surveys and analyses by conducting multiple site visits to selected
states and by interviewing child welfare experts and HHS headquarters
and regional officials.
In summary, we found that states use Title IV-B funds to provide a wide
variety of services to prevent the occurrence of abuse, neglect, and
foster care placements, as well as to provide other child welfare
services. Subpart 1 dollars were most frequently used to fund staff
salaries, with almost half of these funds designated for the salaries
of child protective services (CPS)[Footnote 2] social workers. In
comparison, states spent half of their subpart 2 funds on family
support or prevention programs and another 12 percent on family
preservation services. CFSR results for the past 2 years, however,
indicate that states have not performed strongly in terms of assessing
the services families need and providing those services. Child welfare
agencies face a number of issues related to staffing and data
management that impair their ability to protect children from abuse and
neglect. In particular, low salaries hinder agencies' ability to
attract potential child welfare workers and to retain those already in
the profession. Our analysis of CFSRs in 27 states indicated that large
caseloads and worker turnover delay the timeliness of investigations
and limit the frequency of worker visits with children, hampering
agencies' attainment of some key federal safety and permanency
outcomes. Furthermore, states face challenges developing appropriate
information systems needed to track abuse or neglect reports and
monitor children in foster care, with many states reporting development
delays. In addition, several factors affect the states' ability to
collect and report reliable adoption, foster care, and child abuse and
neglect data, including insufficient caseworker training, inaccurate
and incomplete data entry, and technical challenges reporting the data.
Although HHS plays a role in monitoring child welfare programs,
additional oversight or technical assistance could assist states in
meeting the needs of children served by child welfare agencies. For
example, HHS's oversight of Title IV-B focuses primarily on states'
overall child welfare systems and outcomes, but the agency provides
relatively little oversight specific to the services provided under
Title IV-B subpart 1.[Footnote 3] In addition, HHS plays a limited role
in states' workforce activities by offering partial reimbursement for
training expenses and managing discretionary grant programs. The agency
monitors SACWIS development and data reporting, but despite the
availability of technical assistance, states reported ongoing
challenges reporting reliable data.
Background:
ACF is responsible for the administration and oversight of federal
funding to states for child welfare services under Titles IV-B and IV-
E. HHS headquarters staff are responsible for developing appropriate
policies and procedures for states to follow in terms of obtaining and
using federal child welfare funds, while staff in HHS's 10 regional
offices and 10 national resource centers provide guidance and technical
assistance to improve child welfare services nationwide. HHS compiles
state-reported child welfare data in two databases: the Adoption and
Foster Care Analysis and Reporting System (AFCARS) and the National
Child Abuse and Neglect Data System (NCANDS). HHS relies on the
information available in its databases to analyze and track children's
experiences in the child welfare system, to determine states'
performance on federal child welfare outcome measures, and to report to
Congress on children's well being and child welfare experiences.
However, the monitoring of children served by state child welfare
agencies is the responsibility of the state agencies that provide the
services to these children and their families. Child welfare
caseworkers at the county or local level are the key personnel
responsible for documenting the wide range of services offered to
children and families, such as investigations of abuse and neglect;
treatment services offered to families to keep them intact and prevent
the need for foster care; and arrangements made for permanent or
adoptive placements when children must be removed from their homes.
Most states and counties provide some child welfare services directly
and provide others through contracts with private agencies. National
survey data confirm that both state and private child welfare agencies
are experiencing similar challenges recruiting and retaining qualified
caseworkers. For instance, turnover of child welfare staff has been
estimated at between 30 percent and 40 percent annually nationwide,
with the average tenure for child welfare workers being less than 2
years.
In 2000, HHS established a new federal review system to monitor state
compliance with federal child welfare laws. One component of this
system is the CFSR, which assesses state performance in achieving
safety and permanency for children, along with well-being for children
and families. The CFSR process includes a self-assessment by the state,
an analysis of state performance in meeting national standards
established by HHS, and an on-site review by a joint team of federal
and state officials. Based on the results of this process, HHS
determines whether a state achieved substantial conformity with (1)
outcomes related to safety, permanency, and well-being, such as keeping
children protected from abuse and neglect and achieving permanent and
stable living situations for children and (2) key systemic factors,
such as having an adequate case review system and an adequate array of
services. States are required to develop program improvement plans to
address all areas of nonconformity.
Federal Funding of Child Welfare Services and Programs:
Two titles of the Social Security Act provide federal funding targeted
specifically to foster care and related child welfare
services.[Footnote 4] Title IV-E[Footnote 5] provides an open-ended
individual entitlement for foster care maintenance payments to cover a
portion of the food, housing, and incidental expenses for all foster
children whose parents meet certain federal eligibility
criteria.[Footnote 6] Title IV-E also provides payments to adoptive
parents of eligible foster children with special needs.[Footnote 7] To
qualify for federal IV-E funding for SACWIS, states must prepare and
submit an advance planning document (APD) to ACF's Children's Bureau,
in which they describe the state's plan for managing the design,
development, implementation, and operation of a SACWIS that meets
federal requirements and state needs in an efficient, comprehensive,
and cost-effective manner. Since the administration and structure of
state child welfare agencies vary across the nation, states can design
their SACWIS to meet their state needs, as long as states meet certain
federal requirements.
Title IV-B of the Social Security Act, established in 1935, authorizes
funds to states to provide a wide array of services to prevent the
occurrence of abuse, neglect, and foster care placements.[Footnote 8]
In 1993, the Congress created a new program as subpart 2 of Title IV-B
(now known as Promoting Safe and Stable Families), which funds similar
types of services but is more prescriptive in how states can spend the
funds.[Footnote 9] No federal eligibility criteria apply to the
children and families receiving services funded by Title IV-B.
Title IV-B subpart 1 provides grants to states for child welfare
services, which are broadly defined. Subpart 1 funds are intended for
services that are directed toward the accomplishment of the following
purposes: (1) protect and promote the welfare of all children; (2)
prevent or remedy problems that may result in the abuse or neglect of
children; (3) prevent the unnecessary separation of children from their
families by helping families address problems that can lead to out-of-
home placements; (4) reunite children with their families; (5) place
children in appropriate adoptive homes when reunification is not
possible; and (6) ensure adequate care to children away from their
homes in cases in which the child cannot be returned home or cannot be
placed for adoption.
In 1980, the Congress enacted legislation that limited the total
subpart 1 funds states could use for three categories of services:
foster care maintenance payments, adoption assistance payments, and
child care related to a parent's employment or training.[Footnote 10]
The total of subpart 1 funds used for these purposes cannot exceed a
state's total 1979 subpart 1 expenditures for all types of services.
The intent of this restriction, according to a congressional document,
was to encourage states to devote increases in subpart 1 funding as
much as possible to supportive services that could prevent the need for
out-of-home placements.[Footnote 11] However, this restriction applies
only to the federal portion of subpart 1 expenditures, as the law notes
that states may use any or all of their state matching funds for foster
care maintenance payments.
Subpart 2 authorizes grants to states to provide four categories of
services, which are defined below:
* Family preservation services: Services designed to help families at
risk or in crisis, including services to (1) help reunify children with
their families when safe and appropriate; (2) place children in
permanent homes through adoption, guardianship, or some other permanent
living arrangement; (3) help children at risk of foster care placement
remain safely with their families; (4) provide follow-up assistance to
families when a child has been returned after a foster care placement;
(5) provide temporary respite care; and (6) improve parenting skills.
* Family support services: Community-based services to promote the
safety and well-being of children and families designed to increase the
strength and stability of families, to increase parental competence, to
provide children a safe and supportive family environment, to
strengthen parental relationships, and to enhance child development.
Examples of such services include parenting skills training and home
visiting programs for first time parents of newborns.
* Time-limited family reunification services: Services provided to a
child placed in foster care and to the parents of the child in order to
facilitate the safe reunification of the child within 15 months of
placement. These services include: counseling, substance abuse
treatment services, mental health services, and assistance to address
domestic violence.
* Adoption promotion and support services: Services designed to
encourage more adoptions of children in foster care when adoption is in
the best interest of the child, including services to expedite the
adoption process and support adoptive families.
States Spend IV-B Funds on A Variety of Services, With Subpart 2
Focusing More on Prevention:
In our September 2003 report on Title IV-B, we found that states use
these funds to provide a wide variety of services to prevent the
occurrence of abuse, neglect, and foster care placements, as well as
services to help children in foster care and their parents; however,
relatively few subpart 1 dollars are used to provide family support and
family preservation services, while the majority of subpart 2 funds are
used for these purposes. According to our survey data for fiscal year
2002,[Footnote 12] states spent subpart 1 funds most frequently on the
salaries of child welfare agency staff, administration and management
expenses, CPS services, and foster care maintenance payments. In
comparison, states spent half of their subpart 2 funds on family
support or prevention programs and another 12 percent on family
preservation services. CFSR results for the past 2 years, however,
indicate that states have not performed strongly in terms of assessing
the services families need and providing those services.
States Use Subpart 1 Funds Primarily for Staff Salaries:
Relatively few subpart 1 dollars were used for family support or family
preservation services; instead, they were most frequently used to fund
staff salaries, with almost half of these funds designated for the
salaries of CPS social workers. Another 20 percent of these funds were
used for the salaries of other social workers.[Footnote 13] During a
site visit to the state of Washington for the Title IV-B
report,[Footnote 14] child welfare officials told us that they used
over 50 percent of the state's subpart 1 funds for salaries of staff
providing direct services, including CPS social workers, other types of
social workers, social work supervisors, and clerical support staff.
Administration and management comprised the second largest category of
service, accounting for almost 17 percent of subpart 1 dollars. This
category included rent and utilities for office space, travel expenses
for agency staff, and staff training.[Footnote 15]
CPS represents the third largest category of services that states
funded with subpart 1. States used about 16 percent of their subpart 1
funds to provide a variety of CPS services, such as telephone hotlines
for the public to report instances of child abuse and neglect,
emergency shelters for children who needed to be removed from their
homes, and investigative services. During our site visit to California,
for example, officials reported using about 40 percent of their subpart
1 dollars to fund staff salaries and operating expenses associated with
a variety of shelter care services provided by counties, such as
emergency shelters and foster homes. A child is placed in one of these
shelters when no other placement option is immediately available--for
example, when an investigation in the middle of the night determines
that the child is at immediate risk of harm. States also used nearly 11
percent of their subpart 1 funds to make recurring payments for the
room and board of foster children who are not eligible for
reimbursement through Title IV-E. About 10 percent of subpart 1 dollars
were used to provide family support and family preservation services.
Subpart 2 Most Frequently Funds Family Support and Family Preservation
Services:
In contrast to subpart 1, states used over 80 percent of their subpart
2 dollars to fund services in its four mandated service categories--
family support, family preservation, family reunification, and adoption
promotion and support services (see app. I for additional information
on states' comparative expenditures on subparts 1 and 2). For example,
states reported using half of their subpart 2 dollars to fund family
support and prevention services. These services included mentoring
programs to help pregnant adolescents learn to be self-sufficient;
financial assistance to low-income families to help with rent and
utility payments; and parenting classes, child care, and support groups
provided by a community-based resource center. Washington funded a
network of public health nurses and social service agencies to provide
support services to families that are the subject of a report of abuse
or neglect--these services are provided in lieu of, or following, a
formal investigation when the level of risk to the child is not
considered high.
Family preservation services--designed to keep families together and
prevent the need to place a child in foster care--represented the
second largest service category funded by subpart 2. Washington used
subpart 2 funds for its statewide family preservation program, which
offers counseling and parent training services for up to 6 months to
families with children who are at risk of being placed in foster care.
In addition, states reported using about 11 percent of their subpart 2
funds for adoption support and preservation services. With these funds,
states provided services such as counseling for children who are going
to be adopted, family preservation services to adoptive families, and
respite care[Footnote 16] for adoptive families. Officials in Ohio
reported using almost half of its subpart 2 dollars for adoption
services, including post adoption services and services to recruit
families for children in need of adoptive homes.
Finally, states spent about 9 percent of their subpart 2 dollars on
family reunification services. States funded a diverse array of family
reunification programs, such as supervised visitation centers for
parents to visit with their children and coordinators for alcohol and
drug treatment services for families whose primary barrier to
reunification is substance abuse. New Jersey funded a supervised
visitation program that offers parenting education, counseling,
transportation, and support groups and is located in a private home,
allowing families to visit together in a homelike setting and engage in
more natural interactions.
CFSRs Find States Are Weak in Assessing Families' Service Needs:
While states are using Title IV-B funds to provide this array of
services, CFSR results for the past 2 years indicate that states have
not performed strongly in terms of assessing the services families need
and providing those services. When HHS reviewed case files it
determined that 31of the 32 states that underwent a CFSR in 2001 or
2002 needed improvement in terms of assessing family needs and
providing services to meet those needs. While 21 of the 32 states were
considered to have an appropriate array of services for families, HHS
found that the accessibility of services was a particular weakness in
that many services were either not available statewide or had long
waiting lists or other barriers to accessibility.
Staff and Data Issues Affect States' Ability to Protect Children From
Abuse and Neglect:
Child welfare agencies face a number of issues related to staffing and
data management that impair their ability to protect children from
abuse and neglect. In particular, low salaries hinder agencies' ability
to attract potential child welfare workers and to retain those already
in the profession. Additionally, caseworkers in the four states we
visited for the March 2003 child welfare workforce report[Footnote 17]
cited high caseloads and a lack of supervisory support as issues
impacting their ability to work effectively. According to these
caseworkers, high turnover rates and staffing shortages leave remaining
staff with insufficient time to establish relationships with children
and families and make the necessary decisions to ensure safe and stable
permanent placements. Furthermore, our July 2003 report found that
states face challenges developing appropriate information systems
needed to track abuse or neglect reports and monitor children in foster
care. While 47 states are developing or operating a SACWIS, many
states[Footnote 18] reported that the development of their SACWIS is
delayed. Most states responding to our survey faced challenges to
SACWIS development, such as obtaining state funding and developing a
system that met the child welfare agency's needs statewide. In
addition, several factors affect states' ability to collect and report
reliable adoption, foster care, and child abuse and neglect data,
including insufficient caseworker training, inaccurate and incomplete
data entry, and technical challenges reporting the data.
Recruitment and Retention Challenges May Hamper Agencies' Attainment of
Federal Child Welfare Outcomes:
In our report on the child welfare workforce, we found that public and
private child welfare agencies face a number of challenges recruiting
and retaining qualified caseworkers and supervisors. Low salaries, in
particular, hinder agencies' ability to attract potential staff and to
retain those already in the profession. For example, caseworkers in
each of the four states we visited said that many of their former child
welfare colleagues pursued positions in the education field where they
could not only make more money but also work with children without
risking their own safety. For example, the Bureau of Labor Statistics'
national wages survey[Footnote 19] reports that elementary and middle
school teachers earn, on average, about $42,000 annually while social
workers earn about $33,000.[Footnote 20]
Additionally, high caseloads, administrative burdens, limited
supervision, and insufficient training reduce the appeal of child
welfare work. Caseworkers and supervisors in all four states we visited
cited demanding and complex caseloads and related administrative
requirements, such as casework documentation, as factors affecting
retention. Some of the caseworkers we interviewed handled double the
number of cases recommended by advocacy organizations,[Footnote 21] and
one study found that caseloads for individual child welfare workers
ranged from 10 to 110 children,[Footnote 22] with workers handling an
average of about 24 to 31 children each. Furthermore, some of the
caseworkers we interviewed told us that they spent between 50 and 80
percent of their time completing paperwork, thereby limiting their time
to assist children and families.
Caseworkers told us that their desire to stay in the child welfare
profession was influenced by high-quality supervision and adequate on-
the-job training; however, these elements were often lacking. According
to supervisors in one city we visited, about half of new trainees left
their jobs before completing 1 year, in part, because these newly hired
caseworkers were not sufficiently trained to do their jobs.
Furthermore, some newly promoted supervisors have requested demotions
because they felt unprepared to meet job demands, and the caseworkers
they supervised complained of poor management and insufficient support.
There is some evidence to suggest how recruitment and retention
challenges affect the safety and permanency of children in care, but
the magnitude of this effect is unknown. Caseworkers in the four states
that we visited said that high turnover rates and staffing shortages
leave remaining staff with insufficient time to conduct the types of
home visits necessary to assess children's safety and to make well-
supported decisions to ensure safe and stable permanent placements. For
example, when staff change, caseworkers may have to reestablish
information to update the case record and families may become hesitant
to work with unfamiliar caseworkers, making it difficult to learn the
history of the case. Worker turnover also disrupts the continuity of
services, particularly when newly assigned caseworkers have to conduct
or reevaluate educational, health, and safety assessments due to poor
or insufficient information in case files left behind by others.
Furthermore, caseworkers explained that high caseloads require them to
limit the number and quality of the home visits they conduct, forcing
them to focus only on the most serious circumstances of abuse and
neglect. One caseworker in Texas noted that when she does make a home
visit, the visit is quick and does not enable her to identify subtle or
potential risks to the child's well-being.
Our analysis of federal CFSRs corroborated caseworker
accounts,[Footnote 23] showing that large caseloads and worker turnover
delay the timeliness of investigations and limit the frequency of
worker visits with children, thereby hampering agencies' attainment of
some key federal safety and permanency goals. Although identifying
workforce deficiencies is not an objective of the CFSR process, in all
27 CFSRs we analyzed, HHS explicitly cited workforce deficiencies--high
caseloads, training deficiencies, and staffing shortages--that
affected the attainment of at least one assessment measure. While the
number of affected assessment measures varied by state, we found that
HHS cited these factors for an average of nine assessment measures per
state, with more than half of the 27 states exceeding this average. For
example, in New Mexico's CFSR, reviewers cited staff turnover and
vacancies as impairing workers' ability to investigate child
maltreatment reports, provide appropriate services for families, and
establish timely permanency goals. Furthermore, the District of
Columbia's CFSR describes heavy workloads, high staff turnover, and a
climate in which supervisors often call new workers out of training to
handle ongoing caseload activities.
Delays in SACWIS Completion and Challenges with Data Collection Affect
States' Ability to Ensure Reliable Data on Children's Experiences:
In addition to performing a wide range of services to protect children,
child welfare caseworkers are the key personnel who collect and
document information on children and families served by children
welfare agencies. Case file documentation is generally captured in
state computer systems. In our July 2003 report, HHS reported that 47
states are using targeted federal funds to develop or operate their
child welfare computer systems--known as SACWIS--but many continue to
face challenges completing their systems. In our November 2003
testimony on SACWIS,[Footnote 24] we reported on the costs associated
with developing SACWIS and the associated barriers, such as development
delays and difficulties in receiving state funding approval, creating a
system that reflects child welfare work processes, and securing
contractors knowledgeable about child welfare. Many state officials
said that they recognize the benefit their state will achieve by
developing SACWIS, such as contributing to the timeliness of child
abuse and neglect investigations. In Oklahoma, for example, caseworkers
and state officials noted that they believe their children are safer
since the implementation of SACWIS simply because the information on
the children is easily accessible to the caseworkers and their
supervisors. According to our survey results, automated systems
provided easier access to data and allowed caseworkers to better
monitor children in their care, which may contribute to additional
child welfare and administrative benefits, such as decreased incidences
of child abuse and neglect, shortened length of time to achieve
adoption, timeliness of payments to foster families, and timeliness of
payments to foster facilities.
Some of the data captured in case file records are reported to two HHS
databases that compile child welfare data--AFCARS and NCANDS. We found
that several factors affect states' ability to collect and report
reliable data to HHS on children served by state child welfare
agencies. Almost all of the states responding to our survey[Footnote
25] reported that insufficient caseworker training and inaccurate and
incomplete data entry into their information system affect the quality
of AFCARS and NCANDS data. Although most states reported these as
separate factors, HHS and the states we visited found that insufficient
training and inaccurate and incomplete data entry are often linked.
Caseworkers, supervisors, and managers in the five states that we
visited reported that additional factors, such as difficulties
balancing data entry with the time that they spend with the families
and children, contributed to inaccurate or incomplete data entry.
Supervisors in Iowa explained that since caseworkers are responsible
for ensuring that children and their families receive the services they
need, the caseworkers tend to initially limit data entry to the
information that is necessary to ensure timely payment to foster care
providers, and complete all other data elements when the caseworkers
have time. In addition, caseworkers in Colorado said that they are
between 30 and 60 days behind in their data entry, so the information
in the automated system may not accurately reflect the current
circumstances of children in care.
We also reported in our July 2003 report and November 2003 testimony
that many states experienced technical challenges reporting their data
to HHS. The problems reported by states are typically a result of
challenges associated with data "mapping"--matching state data elements
to the federal data elements. For example, 36 states reported in our
survey that matching their state-defined data to HHS's definitions
affected the quality of the data reported to NCANDS and AFCARS. In
addition to the challenges reported in our survey, HHS reported that
transferring data from older data systems into SACWIS affects the
quality of the data reported to AFCARS and NCANDS.
Improvements in HHS'S Oversight of Child Welfare Programs Could Help
States Overcome Some Challenges:
HHS plays a role in helping states implement their child welfare
programs, but in some cases, additional federal oversight or technical
assistance could help states provide more effective services. In terms
of child welfare funding, HHS focuses its programmatic oversight on the
overall child welfare system in each state and provides relatively
little oversight specific to Title IV-B subpart 1. HHS's role in
assisting states overcome the child welfare workforce challenges is
limited to partial federal reimbursement for training expenses and
management of discretionary grant programs, such as the Child Welfare
Training Program. HHS also monitors SACWIS development and data
reporting and provides assistance to states to address some of the
associated challenges; however, states reported ongoing challenges,
such as the lack of clear and documented guidance on how to report
child welfare data, despite the availability of this assistance.
HHS Focuses Oversight on the Overall Child Welfare System, but Has
Limited Knowledge about States' Use of Subpart 1 Funds:
HHS focuses much of its programmatic oversight on the overall child
welfare system in each state, rather than focusing specifically on
subpart 1 or any other federal funding source. A major component of
HHS's subpart 1 oversight is having the regional offices actively work
with states to develop appropriate goals for their child welfare
systems and ensure that available funds are used to support those
goals. To receive Title IV-B funding, HHS requires states to submit a
Child and Family Services Plan, which covers a 5-year period and
describes the state's goals and objectives toward improving outcomes
related to the safety, permanency, and well-being of children and
families, as well as the services and programs the state will pursue to
achieve these goals. In addition to the 5-year plan, HHS requires
states to submit an update each year to discuss their progress in
meeting the goals outlined in their plans. Some regional officials
noted that states are still struggling to use these documents
appropriately for planning purposes and frequently just describe their
current programs, rather than focusing on outcomes and collecting data
to measure progress toward those outcomes.
The CFSR process is an additional tool HHS uses to ensure that states
conform to federal child welfare requirements and to help states
improve their child welfare services. Staff at one regional office
described the CFSR as a thorough review of the services funded by
different federal programs, such as Title IV-B, providing an
opportunity to determine whether states are providing the services they
report in their planning documents and whether those services are
adequate and appropriate to meet the needs of the state's children and
families. When asked about HHS's role in guiding states' use of subpart
1 funds to address weaknesses identified by the CFSRs, an HHS official
told us that the agency provides technical assistance to states to help
them determine the most effective use of their resources, while giving
states much latitude to determine the most appropriate use of their
subpart 1 funds.
HHS does not require states to provide any data about their use of
subpart 1 funds, such as their subpart 1 expenditures for specific
services.[Footnote 26] As a result, several regional offices noted that
they have no way of knowing how states actually spend their subpart 1
funds. Instead, HHS requires states to submit annual estimates of the
amount of subpart 1, subpart 2, and other federal funds the state plans
to spend in the upcoming year on different categories of services (such
as family support or CPS). However, these estimates may not provide
reliable data as to how states are using subpart 1 funds. HHS officials
explained that states' actual expenditures may vary from these
estimates, as they address unforeseen circumstances. In addition, HHS
requires states to submit their estimates before the final spending
amounts have been appropriated.[Footnote 27]
The descriptions provided by regional office staff of their review of
these estimates indicate that they review them for relatively limited
purposes. As a result, most HHS regional offices do not review the
annual estimates for compliance with the statutory limits. In addition,
HHS's annual program instruction, which details what information states
must include in their estimates and serves as the basis for the
regional offices' review of subpart 1 spending, does not mention the
subpart 1 limits. Five regional offices were unaware that any limits on
the use of subpart 1 funds existed. Four other regional offices were
aware of the limits, but did not ensure that states complied with the
limits.
This lack of review led HHS to approve spending plans for 15 states
that reported fiscal year 2002 planned subpart 1 expenditures for
foster care maintenance and adoption assistance payments that exceeded
the statutory limits.[Footnote 28] The dollar amounts by which the
subpart 1 spending estimates surpassed the limits were small in some
cases, but large in others. For example, Georgia reported that it
planned to spend $1,497,000 of subpart 1 funds for these purposes in
2002, which would exceed its statutory limit by $1,558. At the other
extreme, Florida's estimate indicated that it planned to spend over $9
million, which was more than $7 million over the maximum allowable
spending of $1.9 million. In total, these 15 states submitted planned
subpart 1 spending estimates for foster care maintenance and adoption
assistance payments that would exceed the statutory limits by over $30
million.
Several regional offices said that they are not concerned about a state
planning to spend significant proportions of its subpart 1 funds on
foster care maintenance and adoption assistance payments if they
believed the state had a strong child welfare system with an
appropriate array of services. Regional office staff said that they
would, however, ask a state to reconsider its funding strategy if the
state were performing poorly. However, many of the states with approved
subpart 1 estimates above the statutory ceilings did not achieve strong
outcomes on their CFSR evaluations with regard to providing needed
services and having an appropriate array of services. HHS has conducted
CFSRs on 13 of the 15 states with approved annual estimates over the
subpart 1 spending limits and determined that appropriately assessing
family needs and providing services to address those needs was an area
needing improvement in 12 of the 13 states. In addition, 7 of the 13
states were also determined to need improvement in terms of having an
appropriate array of services to meet the needs of families in the
state.[Footnote 29]
In discussing the current structure of Title IV-B, officials in all of
HHS's regional offices told us that they believe states need some
flexibility to use Title IV-B funds to address state-specific child
welfare needs as is currently the case under subpart 1. At the same
time, officials in 8 of HHS's 10 regional offices also stressed the
importance of subpart 2 to ensure that states use some funds on family
support services and prevention activities to help preserve families
and keep children from entering foster care. Several regional offices
expressed concern that, in the absence of the minimum spending
requirements outlined in subpart 2, states would neglect preventive
services, while using Title IV-B funds for more urgent services, such
as CPS or foster care. State and local child welfare officials in one
state we visited, along with officials at 2 HHS regional offices, said
that states need more federal funds to provide services to prevent
foster care placements, such as an increase in funds available under
Title IV-B or more flexibility to use Title IV-E funds to provide
services. HHS is currently developing a legislative proposal to give
states more flexibility in using Title IV-E foster care funds for such
preventive services.[Footnote 30]
HHS's Involvement with States' Child Welfare Workforce Is Limited:
HHS's primary connection to the child welfare workforce has been
through partial federal reimbursement--75 percent--of states' training
funds to implement educational programs for current child welfare staff
and to enhance the child welfare curriculum of undergraduate and
graduate social work programs to better educate and prepare potential
caseworkers.[Footnote 31] This funding may also be used for curriculum
development, materials and books, support for current workers to obtain
a social work degree, and incentives to induce entry to the child
welfare field. During fiscal year 2002, 49 states received $286 million
in title IV-E training reimbursements.[Footnote 32] These
reimbursements ranged from a low of approximately $10,400 in Alaska to
a high of more than $79 million in California, with the median
reimbursement approximating $2.7 million.
In addition, ACF's Children's Bureau manages six discretionary grant
programs through which it funds various activities related to
improvements in the child welfare system. One of these programs--the
Child Welfare Training Program, authorized by Section 426 of Title IV
of the Social Security Act--awards grants to public and private
nonprofit institutions of higher learning to develop and improve the
education, training, and resources available for child welfare service
providers.[Footnote 33] This is the only program of the six with a
specific emphasis on staff training;[Footnote 34] however, in fiscal
year 2003, it received the second smallest share--8 percent--of the
Children's Bureau's total discretionary funds.
According to HHS officials, HHS has no authority to require states to
address caseload issues in their CFSR-related program improvement plans
or to enforce any caseload standards. Furthermore, HHS officials said
that states have made few requests of HHS's national resource centers
for assistance with child welfare staff recruitment and retention.
Although HHS officials told us that they plan to examine the CFSRs to
better understand the relationship between recruitment and retention
and safety and permanency outcomes across the states, the agency is
still conducting these reviews and is not expected to complete them
until March 2004.
HHS Offers Assistance to Help States Develop SACWIS and Improve Their
Data, but States Report Ongoing Challenges with Some of HHS's Efforts:
In response to some of the challenges states face in developing SACWIS
and collecting and reporting child welfare data, HHS has conducted on-
site reviews of information systems and provided technical assistance
from a variety of sources. For example, at the time of our review, HHS
had conducted on-site reviews in 26 states with operational SACWIS to
ensure that the systems met all federal requirements and to offer
assistance to states that faced challenges completing the development
of their SACWIS. Few systems have been determined complete after an on-
site review because of unresolved issues, such as not being able to
build links to other state information systems or not implementing
certain eligibility determination functions. To help states address
some of these development challenges, the SACWIS review team provides
the state with recommendations for complying with SACWIS requirements
and schedules a conference call with the state officials to walk
through the system's deficiencies and offer guidance on how the state
can move forward. In addition, in an attempt to help states comply with
the reporting standards and address some of the factors that contribute
to data quality problems, HHS performs comprehensive reviews of state
information systems' ability to capture AFCARS data to identify
problems associated with data collection and reporting and to ensure
that the information in the automated system correctly reflects
children's experiences in care.
Other technical assistance is available to states in a variety of
formats. HHS facilitates the sharing of information between states
developing SACWIS through an automated system users' group that allows
state and federal officials to exchange information, ideas, and
concerns. In addition to the users' group, HHS officials sponsor a
Listserv--an electronic mailing list--that allows state officials to
exchange information, a monthly conference call with state information
technology directors,[Footnote 35] an annual technical assistance
meeting, and an NCANDS state advisory group. The National Resource
Center for Information Technology in Child Welfare, which opened in
1999, also provides assistance to states on SACWIS development and data
issues.
HHS has also made available to states the software it uses to examine
states' AFCARS and NCANDS submissions for inconsistencies and invalid
data. Officials in all the states that we visited said that they
regularly use this software, and an HHS official said that nearly every
state has used the software at least once. HHS officials reported that
these tests help them to identify some data quality errors, such as
missing data, and said that they believe that, in general, data have
improved in recent years. However, the officials indicated that the
tests cannot pinpoint the underlying problems contributing to these
errors. Furthermore, one official reported that no specific efforts
have been conducted to track the individual data elements and,
therefore, HHS cannot report on how data quality has changed over time.
Although the states we visited appreciated some of HHS's efforts to
assist with improving state data quality, they and most states
responding to our survey agreed that the assistance is not always
consistent or easily accessible. The primary concerns reported by the
states we visited were delays in receiving clear written guidance on
defining and reporting certain data elements and the lack of state
input in suggesting changes to AFCARS. Despite the written guidance
available to states in the form of regulations and an online policy
manual, states reported that the variation in state policies and
practices makes it difficult to interpret how to apply the general
guidance. As a result, states consult with HHS to ensure they are
applying the regulations appropriately. However, in commenting on a
draft of the July 2003 report, officials in Oklahoma told us that a
common concern among the states is the lack of timely response from HHS
when seeking guidance on how to report data. In commenting on a draft
of the same report, HHS explained that it first refers states to its
Web site for information and believes that the available guidance
addresses states' concerns in most instances. In addition, the states
that have had an AFCARS review experienced delays in obtaining guidance
on how to proceed following the on-site review. An HHS official told us
that since the review process is relatively new, the agency is still
developing a process to respond to the states and recognizes that it
has not been responsive to the states already reviewed. In addition,
HHS is taking steps to gather feedback from states and other users of
AFCARS data to determine how to improve the system to make the data
more accurate and usable. As a part of these efforts, HHS has published
a Federal Register notice soliciting comments and held focus group
meetings at national conferences. The difficulties states face in
receiving federal guidance and assistance, as well as the other
challenges they face in reporting data, may negatively affect the
reliability of the data available in AFCARS and NCANDS.
Concluding Observations:
Despite its relatively small funding level compared to other funding
sources for child welfare services, Title IV-B represents an important
federal commitment to states' efforts to protect children from abuse
and neglect. However, HHS does not provide in-depth oversight specific
to Title IV-B subpart 1. Two key issues further compound states'
ability to prevent abuse and neglect. For example, given the
difficulties that public and private child welfare agencies are
experiencing in hiring, training, and retaining their workforces, these
agencies' ability to provide services to children is threatened. In
addition, states face challenges in completing their SACWIS systems and
in ensuring that caseworkers input complete and accurate case data in a
timely manner.
We recommended in our September 2003 report on Title IV-B that the
Secretary of HHS provide the necessary guidance to ensure that HHS
regional offices monitor states' use of Title IV-B subpart 1 funds for
compliance with statutory restrictions on the use of these funds. We
also recommended that the Secretary consider the feasibility of
collecting basic data on states' use of these funds to facilitate its
oversight of the program and to provide guidance to help states
determine appropriate services to fund. In commenting on a draft of
that report, HHS agreed with our first recommendation but noted that
the statutory limitations on Title IV-B funds no longer serve a useful
purpose and are incompatible with its current proposal to offer states
much more flexibility in using other federal child welfare dollars. HHS
disagreed with our second recommendation, stating that it believes that
its level of oversight is commensurate with the scope and intent of the
program and minimizes states' reporting requirements.
We recommended in our March 2003 report on child welfare worker
recruitment and retention that, because of the reported impact staffing
shortages and high caseloads have on the attainment of federal outcome
measures, that the Secretary of HHS take actions that may help child
welfare agencies address the recruitment and retention challenges they
face. In commenting on a draft of that report, HHS generally agreed
with our findings and concurred with our recommendation, saying that it
has begun to explore the effectiveness of child welfare training
programs, with an emphasis on lessons learned and best practices.
However, HHS stressed that it has no authority to require states to
address caseload issues in their CFSR program improvement plans or to
enforce any caseload standard.
To improve the reliability of state-reported child welfare data, we
recommended in our July 2003 SACWIS report that the Secretary of HHS
consider, in addition to HHS's recent efforts to improve AFCARS data,
ways to enhance the guidance and assistance offered to states to help
them overcome the key challenges in collecting and reporting child
welfare data. HHS generally agreed with our findings and, in response
to our recommendation, noted that the data definitions need to be
updated and revised and said it is currently in the process of revising
the AFCARS regulations to further standardize the information states
are to report. More recently, HHS said that it would be creating policy
guidance that will delineate what will happen if a state fails to
complete its SACWIS within a reasonable time frame.
Mr. Chairman, this concludes my prepared statement. I would be pleased
to respond to any questions that you or other members of the
Subcommittee may have.
GAO Contact and Acknowledgments:
For further information regarding this testimony, please call Cornelia
M. Ashby at (202) 512-8403. Individuals making key contributions to
this testimony include Diana Pietrowiak, Joy Gambino, Sara Schibanoff,
and Michelle St. Pierre.
[End of section]
Appendix I: Subparts 1 and 2 Expenditures:
Table 1: Fiscal Year 2002 Expenditures for Subparts 1 and 2 Service
Categories:
Service category: Staff positions;
Subpart 1: Number of states: 25;
Amount of subpart 1 funding[A]: $70,965,578;
Percentage of subpart 1 funding: 27.6;
Subpart 2: Number of States: 17;
Amount of subpart 2 funding[A]: $6,229,058;
Percentage of subpart 2 funding[B]: 2.4.
Service category: Administration and management;
Subpart 1: Number of states: 16;
Amount of subpart 1 funding[A]: 43,143,097;
Percentage of subpart 1 funding: 16.8;
Subpart 2: Number of States: 18;
Amount of subpart 2 funding[A]: 11,614,667;
Percentage of subpart 2 funding[B]: 4.5.
Service category: Child protective services;
Subpart 1: Number of states: 17;
Amount of subpart 1 funding[A]: 40,543,000;
Percentage of subpart 1 funding: 15.8;
Subpart 2: Number of States: 5;
Amount of subpart 2 funding[A]: 2,248,690;
Percentage of subpart 2 funding[B]: 0.9.
Service category: Foster care maintenance payments;
Subpart 1: Number of states: 17;
Amount of subpart 1 funding[A]: 27,890,783;
Percentage of subpart 1 funding: 10.8;
Subpart 2: Number of States: 2;
Amount of subpart 2 funding[A]: 647,154;
Percentage of subpart 2 funding[B]: 0.3.
Service category: Multiple responses[C];
Subpart 1: Number of states: 8;
Amount of subpart 1 funding[A]: 25,806,347;
Percentage of subpart 1 funding: 10.0;
Subpart 2: Number of States: 4;
Amount of subpart 2 funding[A]: 3,503,585;
Percentage of subpart 2 funding[B]: 1.4.
Service category: Family support/prevention;
Subpart 1: Number of states: 17;
Amount of subpart 1 funding[A]: 19,840,891;
Percentage of subpart 1 funding: 7.7;
Subpart 2: Number of States: 28;
Amount of subpart 2 funding[A]: 127,430,496;
Percentage of subpart 2 funding[B]: 49.8.
Service category: Counseling and mental health services;
Subpart 1: Number of states: 2;
Amount of subpart 1 funding[A]: 8,350,562;
Percentage of subpart 1 funding: 3.2;
Subpart 2: Number of States: 5;
Amount of subpart 2 funding[A]: 1,354,763;
Percentage of subpart 2 funding[B]: 0.5.
Service category: Family preservation;
Subpart 1: Number of states: 7;
Amount of subpart 1 funding[A]: 5,986,045;
Percentage of subpart 1 funding: 2.3;
Subpart 2: Number of States: 23;
Amount of subpart 2 funding[A]: 30,308,896;
Percentage of subpart 2 funding[B]: 11.8.
Service category: Adoption subsidy payments;
Subpart 1: Number of states: 7;
Amount of subpart 1 funding[A]: 4,657,546;
Percentage of subpart 1 funding: 1.8;
Subpart 2: Number of States: 2;
Amount of subpart 2 funding[A]: 737,412;
Percentage of subpart 2 funding[B]: 0.3.
Service category: Family reunification;
Subpart 1: Number of states: 4;
Amount of subpart 1 funding[A]: 2,446,570;
Percentage of subpart 1 funding: 1.0;
Subpart 2: Number of States: 26;
Amount of subpart 2 funding[A]: 23,625,973;
Percentage of subpart 2 funding[B]: 9.2.
Service category: Recruitment and training for foster/adoptive
parents;
Subpart 1: Number of states: 9;
Amount of subpart 1 funding[A]: 2,260,061;
Percentage of subpart 1 funding: 0.9;
Subpart 2: Number of States: 16;
Amount of subpart 2 funding[A]: 6,828,885;
Percentage of subpart 2 funding[B]: 2.7.
Service category: Adoption support and preservation services;
Subpart 1: Number of states: 2;
Amount of subpart 1 funding[A]: 446,877;
Percentage of subpart 1 funding: 0.2;
Subpart 2: Number of States: 27;
Amount of subpart 2 funding[A]: 28,481,585;
Percentage of subpart 2 funding[B]: 11.1.
Service category: Other;
Subpart 1: Number of states: 11;
Amount of subpart 1 funding[A]: 4,817,180;
Percentage of subpart 1 funding: 1.9;
Subpart 2: Number of States: 15;
Amount of subpart 2 funding[A]: 12,795,915;
Percentage of subpart 2 funding[B]: 5.0.
Total[D];
Subpart 1:
Amount of subpart 1 funding[A]: $257,154,537;
Percentage of subpart 1 funding: 100.0;
Subpart 2:
Amount of subpart 2 funding[A]: $255,807,079;
Percentage of subpart 2 funding[B]: 100.0.
Source: GAO survey.
Notes: Percentages do not always total to 100 due to rounding.
Data on subpart 1 expenditures are based on survey responses from 46
states and data on subpart 2 expenditures are based on survey responses
from 44 states. While Pennsylvania responded to our survey, it did not
provide expenditure data for subparts 1 or 2.
[A] When providing data for our survey, states were asked to indicate
the single service category that best described the type of program
funded by subparts 1 and 2. Thus, programs that fall into multiple
service categories may not be fully captured. For example, one state
indicated it funded a family support program, which includes some
family preservation and reunification services. In addition, states may
not have been consistent in categorizing services. For example, several
HHS officials told us that the delineation between family support and
family preservation services is not clear, so that two states providing
the same services to the same types of families may report them in
different categories. Inconsistencies such as these could have an
effect on any measured differences among service categories.
[B] States may spend less than 20 percent of their subpart 2 funds on
any of the required service categories if they have a strong rationale.
Some HHS regional officials said that they approve exceptions to the 20
percent requirement if a state is spending a significant amount of
nonfederal funds on a subpart 2 service category.
[C] Although states were asked to indicate the single service category
that best described the type of program funded by subparts 1 and 2,
several states selected multiple program categories when responding to
our survey. For example, Rhode Island reported that it funded a home
visitation program and indicated that this program includes family
support, health, and family reunification services. Thus, the responses
from states that reported multiple categories for a program are
represented by this category.
[D] The aggregate dollars reported in the service categories do not
match the total allocations for subparts 1 and 2 in fiscal year 2002.
States have 2 years to spend their Title IV-B allocations; as a result,
expenditures in fiscal year 2002 may include dollars from a state's
fiscal year 2001 Title IV-B allocation, as well as its fiscal year 2002
Title IV-B allocation. Similarly, some fiscal year 2002 allocations may
not have been spent until fiscal year 2003.
[End of table]
[End of section]
Related GAO Products:
D.C. Family Court: Progress Has Been Made in Implementing Its
Transition. GAO-04-234. Washington, D.C.: January 6, 2004.
Child Welfare: States Face Challenges in Developing Information Systems
and Reporting Reliable Child Welfare Data. GAO-04-267T. Washington,
D.C.: November 19, 2003.
Child Welfare: Enhanced Federal Oversight of Title IV-B Could Provide
States Additional Information to Improve Services. GAO-03-956.
Washington, D.C.: September 12, 2003.
Child Welfare: Most States Are Developing Statewide Information
Systems, but the Reliability of Child Welfare Data Could be Improved.
GAO-03-809. Washington, D.C.: July 31, 2003.
D.C. Child and Family Services: Key Issues Affecting the Management of
Its Foster Care Cases. GAO-03-758T. Washington, D.C.: May 16, 2003.
Child Welfare and Juvenile Justice: Federal Agencies Could Play a
Stronger Role in Helping States Reduce the Number of Children Placed
Solely to Obtain Mental Health Services. GAO-03-397. Washington, D.C.:
April 21, 2003.
Foster Care: States Focusing on Finding Permanent Homes for Children,
but Long-Standing Barriers Remain. GAO-03-626T. Washington, D.C.: April
8, 2003.
Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare
Agencies Recruit and Retain Staff. GAO-03-357. Washington, D.C.: March
31, 2003.
Foster Care: Recent Legislation Helps States Focus on Finding Permanent
Homes for Children, but Long-Standing Barriers Remain. GAO-02-585.
Washington, D.C.: June 28, 2002.
District of Columbia Child Welfare: Long-Term Challenges to Ensuring
Children's Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000.
Child Welfare: New Financing and Service Strategies Hold Promise, but
Effects Unknown. GAO/T-HEHS-00-158. Washington, D.C.: July 20, 2000.
Foster Care: States' Early Experiences Implementing the Adoption and
Safe Families Act. GAO/HEHS-00-1. Washington, D.C.: December 22, 1999.
Foster Care: HHS Could Better Facilitate the Interjurisdictional
Adoption Process. GAO/HEHS-00-12. Washington, D.C.: November 19, 1999.
Foster Care: Effectiveness of Independent Living Services Unknown. GAO/
HEHS-00-13. Washington, D.C.: November 5, 1999.
Foster Care: Kinship Care Quality and Permanency Issues. GAO/HEHS-99-
32. Washington, D.C.: May 6, 1999.
Juvenile Courts: Reforms Aim to Better Serve Maltreated Children. GAO/
HEHS-99-13. Washington, D.C.: January 11, 1999.
Child Welfare: Early Experiences Implementing a Managed Care Approach.
GAO/HEHS-99-8. Washington, D.C.: October 21, 1998.
Foster Care: Agencies Face Challenges Securing Stable Homes for
Children of Substance Abusers. GAO/HEHS-98-182. Washington, D.C.:
September 30, 1998.
FOOTNOTES
[1] We also recently testified on one of these reports. See U.S.
General Accounting Office, Child Welfare: States Face Challenges in
Developing Information Systems and Reporting Reliable Child Welfare
Data. GAO-04-267T. (Washington, D.C.: Nov. 19, 2003).
[2] Child protective services activities typically include reviewing
reports of alleged child abuse and neglect, investigating those that
meet the state's criteria as a potential incident of abuse or neglect
to determine if the alleged incident occurred, and, in some cases,
referring families to needed services and removing the child from the
home, if necessary.
[3] Our September 2003 report on Title IV-B focused primarily on
subpart 1 because little, if any, research has been conducted on how
subpart 1 funds have been spent on child welfare services. In contrast,
a number of studies have been conducted on the services provided under
subpart 2.
[4] In addition, Title XX provides funds under the social services
block grant that may be used for many purposes, including child
welfare.
[5] In fiscal year 2002, total Title IV-E spending was approximately
$6.1 billion. The state matching rate for these payments is based on a
state's per capita income and ranges from 50 percent to 83 percent.
[6] States are entitled to Title IV-E reimbursement on behalf of
children who would have been eligible for Aid to Families with
Dependent Children (AFDC) (as AFDC existed on July 16, 1996), but for
the fact that they were removed from the home of certain specified
relatives. While the AFDC program was replaced by the Temporary
Assistance for Needy Families Program in 1996, eligibility for Title
IV-E payments remains tied to the income eligibility requirements of
the now defunct AFDC program. In addition, certain judicial findings
must be present, and all other requirements included in section 472 (a)
and (b) of the Social Security Act must be met, in order for the child
to be eligible for Title IV-E foster care maintenance payments.
[7] Special needs are characteristics that can make it difficult for a
child to be adopted and may include emotional, physical, or mental
disabilities, emotional disturbance, age, or being a member of a
minority race. To qualify for an adoption subsidy under Title IV-E, a
state must determine that the child cannot or should not return home; a
state must make a reasonable, but unsuccessful effort to place the
child without the subsidy; and a specific factor or condition must
exist that makes it difficult to place the child without a subsidy.
[8] In fiscal year 2003, the Congress appropriated $292 million for
subpart 1 and $405 million for subpart 2. These federal funds cover 75
percent of states' total Title IV-B expenditures because states must
provide an additional 25 percent using nonfederal dollars.
[9] States must spend a "significant portion" of their subpart 2 funds
on each of the four service categories. HHS program instructions
require states to spend at least 20 percent of their subpart 2 funds on
each of the four service categories, unless a state has a strong
rationale for some other spending pattern.
[10] For our September 2003 report on Title IV-B and in this testimony,
we mention only foster care maintenance and adoption assistance
payments when referring to subpart 1 limits, although we did include
planned spending on child care in our analyses of states' planned
subpart 1 spending.
[11] Staff of the House Committee on Ways and Means, 106th Congress,
Background Material and Data on Programs Within the Jurisdiction of the
Committee on Ways and Means (Comm. Print 2000).
[12] To obtain a breakdown of state spending for subparts 1 and 2 for
the Title IV-B report, we sent a survey to all 50 states and the
District of Columbia and received responses from 47 states.
[13] The survey data reported in this category reflect the salaries of
staff affiliated with the child welfare agency. These figures do not
include the salaries of child welfare agency staff dedicated to a
specific program, which may be embedded within some of the other direct
service categories, such as family support and family preservation. In
addition, a state may use Title IV-B funds to contract with an
organization to provide a particular program, which may include salary
expenses as well as direct service expenditures.
[14] For the Title IV-B report, we conducted site visits in California,
New Jersey, Ohio, and Washington to obtain more in-depth information on
the services provided and the types of children and families served.
These states represent both geographic diversity and diversity in how
states used subpart 1 funds.
[15] This amount may be underestimated, since some states may not have
separately reported administrative expenses associated with a specific
program. For example, officials in one state reported that the total
spending for a family support program included salaries for agency
staff, overhead expenses, and related staff travel.
[16] Respite care refers to the temporary care of children that can
provide a break for the families from the daily demands of caring for
their children or respite during times of emergencies.
[17] For this report, we conducted site visits in California, Illinois,
Kentucky, and Texas to obtain more in-depth information on workforce
issues and their effect on children's safety and permanency outcomes.
Among other factors, these states represent geographic diversity and
diversity in the practices they have implemented to address their
recruitment and retention challenges.
[18] These reports were obtained through both site visit interviews and
survey responses. For the child welfare information systems and data
report, we conducted site visits in Colorado, Iowa, New York, North
Carolina, and Oklahoma to obtain more in-depth information on states'
experiences developing SACWIS and reporting data to HHS. These states
represent both geographic diversity and different stages of SACWIS
implementation. In addition, we surveyed all 50 states and the District
of Columbia regarding their experiences in developing and using
information systems and their ability to report data to HHS. We
received responses from 49 states and the District of Columbia,
although some states did not respond to every question. Forty-six of
these states reported that they are developing or operating a SACWIS.
Nevada, which HHS reported has an operational SACWIS, did not respond
to our survey. Throughout this testimony, references to state survey
responses for our July 2003 report include the District of Columbia.
[19] U.S. Department of Labor, Bureau of Labor Statistics, 2000
National Occupational Employment and Wage Estimates.
[20] This amount is specific to child, family, and school social
workers (the occupation under which caseworkers would likely be
classified).
[21] The Child Welfare League of America suggests a caseload ratio of
12 to 15 children per caseworker, and the Council on Accreditation for
Children and Family Services suggests that caseloads not exceed 18
children per caseworker.
[22] American Public Human Services Association, Report from the Child
Welfare Workforce Survey: State and County Data and Findings, May 2001.
[23] At the time of the original study, CFSR final reports were
available for only 27 states; as of January 28, 2004, HHS had released
reports for an additional 14 states.
[24] See U.S. General Accounting Office, Child Welfare: States Face
Challenges in Developing Information Systems and Reporting Reliable
Child Welfare Data, GAO-04-267T (Washington, D.C.: Nov. 19, 2003).
[25] The analysis of survey responses about reporting data to HHS is
based on responses from 49 states and the District of Columbia. All
states, regardless of SACWIS development, were asked to complete these
questions.
[26] States are required to submit general reports on their total
subpart 1 expenditures, but these provide no data on how the funds are
actually used. Per instructions from the Office of Management and
Budget, agencies must require states receiving federal grants to
complete a financial status report (SF 269), providing general
information on state expenditures. For example, the form might indicate
that a state spent $10 million in subpart 1 funds in a specific fiscal
quarter, but it provides no details on how the $10 million was used.
[27] HHS requires states to submit their annual estimates for the
upcoming fiscal year on a form CFS-101. For example, for fiscal year
2002, the CFS-101 was due by June 30, 2001. Because they are submitted
before final appropriations have been enacted, a state might not
request the full amount of funds to which it is entitled, if the final
appropriation is greater than the state's initial estimate. States must
submit a revised CFS-101 by June 30, 2002, to request any additional
fiscal year 2002 Title IV-B funds that might be available to them once
appropriations are finalized. In addition, states can request
additional Title IV-B funds if other states do not use the total funds
to which they are entitled.
[28] In most cases, we reviewed the final revised CFS-101 approved by
HHS. For 1 state, however, we used the initial CFS-101 approved by HHS
because it included planned subpart 1 expenditures that exceeded the
limits for foster care and adoption assistance payments. Although the
revised CFS-101 did not show that the state planned to exceed the
limit, we used the initial CFS-101 to show that HHS had previously
approved a spending plan that did not comply with the statutory limits.
[29] Ten of the 13 states were also cited as needing improvement in
ensuring that needed services are accessible to families in all areas
of the state and 9 of the 13 states were categorized as needing
improvement in terms of individualizing services to meet the unique
needs of individual families.
[30] Under this new proposal, states could voluntarily choose to
receive a fixed IV-E foster care allocation, which could be used for
any services provided under Titles IV-B and IV-E.
[31] As authorized under Title IV-E of the Social Security Act, the
federal government reimburses 75 percent of states' training
expenditures related to foster care and adoption services. States
providing training for contracted private agency staff can receive 50
percent federal reimbursement for this purpose.
[32] Fiscal year 2002 data are the most recent data available at the
time of this testimony. The District of Columbia, Massachusetts, and
Puerto Rico have not participated in title IV-E reimbursements for the
last three fiscal years.
[33] In fiscal year 2003, among other child welfare training project
activities, HHS awarded grants to eight recipients for developing
models of effective child welfare staff recruitment and retention
training.
[34] Although the other discretionary grant programs fund initiatives
that can involve caseworker training, caseworker training and
development is not their primary focus.
[35] In commenting on a draft of the July 2003 report, HHS indicated
that a Web resource is available to states interested in learning
about other states' efforts to develop human services--child welfare,
food stamps, Temporary Assistance to Needy Families, child care, and
child support enforcement--information systems at
http://www.acf.hhs.gov/nhsitrc.
