Child Welfare
Better Data and Evaluations Could Improve Processes and Programs for Adopting Children with Special Needs Gao ID: GAO-05-292 June 13, 2005On September 30, 2002, the most recent date for which Department of Health and Human Services (HHS) data were available, about 126,000 foster children were waiting to be adopted. Estimates suggest that a significant portion of these children had one or more special needs, such as a medical condition or membership in a minority group, that may discourage or delay their adoption. Federal support in the form of adoption subsidies and incentive payments to states is available to promote special needs adoption. This report (1) identifies the major challenges to placing and keeping special needs children in adoptive homes, (2) examines what states and HHS have done to facilitate special needs adoptions, and (3) assesses how well the Adoption Assistance Program and the Adoption Incentives Program have worked to facilitate special needs adoptions, and determines if changes might be needed.
According to state child welfare officials, limited resources, court processes, and delays in completing interstate placements challenged the adoption of children with special needs by hindering recruitment of adoptive families and delaying the adoption process. In particular, adoptive parents in many states received lower subsidies and fewer services than foster parents. In addition, child welfare officials, court staff, and judges said that the adoption process can take months to complete because hearings to terminate parents' rights are hard to schedule and may involve appeals. Further, officials said that interstate placements are often hampered by delays in completing home studies of prospective families, although no data exist to assess the timeliness of such placements. States and HHS have developed and implemented strategies and programs to promote special needs adoptions, but few evaluations measure their effectiveness. Four of the 5 states we visited sponsored post adoption resource centers. However, only 9 of 49 states responding to a relevant question in our survey indicated that they had evaluated the effectiveness of their services. At the federal level, HHS supported and promoted local innovation, provided technical assistance, and disseminated information, but the agency has done little to assess the effectiveness of the programs it has funded. When HHS has taken steps to have states assess funded projects, the agency has not ensured sufficient rigor to assess effectiveness. The Adoption Assistance and Adoption Incentives Programs have provided support for special needs adoptions, but data are lacking to determine if changes are needed to better facilitate adoption. The former uses an income eligibility threshold that is more restrictive than other cash assistance programs' standards of need and may not include all who might otherwise qualify. Since 1998, the Adoption Incentives Program has provided financial awards to almost all states for increasing adoptions, but does not provide a specific inducement for interstate placements. Data to track and credit states for collaborating on interstate placements are not available.
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Director: Team: Phone:GAO-05-292, Child Welfare: Better Data and Evaluations Could Improve Processes and Programs for Adopting Children with Special Needs
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Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
June 2005:
Child Welfare:
Better Data and Evaluations Could Improve Processes and Programs for
Adopting Children with Special Needs:
GAO-05-292:
GAO Highlights:
Highlights of GAO-05-292, a report to congressional requesters:
Why GAO Did This Study:
On September 30, 2002, the most recent date for which Department of
Health and Human Services (HHS) data were available, about 126,000
foster children were waiting to be adopted. Estimates suggest that a
significant portion of these children had one or more special needs,
such as a medical condition or membership in a minority group, that may
discourage or delay their adoption. Federal support in the form of
adoption subsidies and incentive payments to states is available to
promote special needs adoption. This report (1) identifies the major
challenges to placing and keeping special needs children in adoptive
homes, (2) examines what states and HHS have done to facilitate special
needs adoptions, and (3) assesses how well the Adoption Assistance
Program and the Adoption Incentives Program have worked to facilitate
special needs adoptions, and determines if changes might be needed.
What GAO Found:
According to state child welfare officials, limited resources, court
processes, and delays in completing interstate placements challenged
the adoption of children with special needs by hindering recruitment of
adoptive families and delaying the adoption process. In particular,
adoptive parents in many states received lower subsidies and fewer
services than foster parents. In addition, child welfare officials,
court staff, and judges said that the adoption process can take months
to complete because hearings to terminate parents‘ rights are hard to
schedule and may involve appeals. Further, officials said that
interstate placements are often hampered by delays in completing home
studies of prospective families, although no data exist to assess the
timeliness of such placements.
States and HHS have developed and implemented strategies and programs
to promote special needs adoptions, but few evaluations measure their
effectiveness. Four of the 5 states we visited sponsored post adoption
resource centers. However, only 9 of 49 states responding to a relevant
question in our survey indicated that they had evaluated the
effectiveness of their services. At the federal level, HHS supported
and promoted local innovation, provided technical assistance, and
disseminated information, but the agency has done little to assess the
effectiveness of the programs it has funded. When HHS has taken steps
to have states assess funded projects, the agency has not ensured
sufficient rigor to assess effectiveness.
The Adoption Assistance and Adoption Incentives Programs have provided
support for special needs adoptions, but data are lacking to determine
if changes are needed to better facilitate adoption. The former uses an
income eligibility threshold that is more restrictive than other cash
assistance programs‘ standards of need and may not include all who
might otherwise qualify. Since 1998, the Adoption Incentives Program
has provided financial awards to almost all states for increasing
adoptions, but does not provide a specific inducement for interstate
placements. Data to track and credit states for collaborating on
interstate placements are not available.
Flowchart of a Typical Adoption Process:
[See PDF for image]
[End of figure]
What GAO Recommends:
GAO recommends that HHS improve its data collection and evaluation
efforts. HHS did not explicitly agree or disagree with the
recommendations. It said that changes to address the data collection
recommendations were being considered and that while steps to
strengthen evaluations have been taken, some project results have
sometimes been of limited use because of problems adhering to
evaluation protocols.
www.gao.gov/cgi-bin/getrpt?GAO-05-292.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cornelia Ashby at (202)
512-8403 or ashbyc@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
States Reported That Limited Resources, Court-Related Processes, and
Interstate Placement Delays Impede the Adoption of Special Needs
Children:
States and HHS Have Promoted Special Needs Adoption, but Few
Evaluations Measure Program Effectiveness:
The Adoption Promotion Programs Have Supported Special Needs Adoption,
but Data Are Lacking to Determine if Changes Are Needed:
Conclusions:
Recommendations for Executive Action:
Agency Comments:
Appendix I: Objectives, Scope, and Methodology:
Objectives:
Scope and Methodology:
Survey:
Site Visits:
Interviews and Discussion Groups:
Review of States' Reports, Federal Laws, and HHS Regulations:
Review of Studies and Evaluations:
Appendix II: Comments from the Department of Health and Human Services:
Appendix III: GAO Contact and Acknowledgments:
Related GAO Products:
Tables:
Table 1: Characteristics of Post Adoption Resources Available in Five
States:
Figures:
Figure 1: Flowchart of a Typical Adoption Process:
Figure 2: Types of Support Provided to Families Caring for Children
with Special Needs:
Figure 3: Frequency of States' Attainment of the Adoption Incentive
Award, 1998-2003:
Figure 4: Number of States Claiming Award, by Earning Year:
Figure 5: Illustration of the Difficulty in Claiming an Award under the
Adoption Incentives Program:
Abbreviations:
AFCARS: Adoption and Foster Care Analysis and Reporting System:
AFDC: Aid to Families with Dependent Children:
APHSA: American Public Human Services Association:
ASFA: Adoption and Safe Families Act of 1997:
CFSR: Child and Family Services Review:
HHS: Department of Health and Human Services:
ICPC: Interstate Compact on the Placement of Children:
NCANDS: National Child Abuse and Neglect Data System:
SSBG: Social Services Block Grant:
SSI: Supplemental Security Income:
TANF: Temporary Assistance for Needy Families:
TPR: Termination of Parental Rights:
United States Government Accountability Office:
Washington, DC 20548:
June 13, 2005:
The Honorable Charles E. Grassley:
Chairman:
Committee on Finance:
United States Senate:
The Honorable Hillary R. Clinton:
United States Senate:
On September 30, 2002, the most recent date for which these data were
available, about 126,000 foster children were reported by the
Department of Health and Human Services (HHS) to be waiting for
adoption. These children, on average, were 8 years old, had been in
foster care for nearly half their lives, and 55 percent were living
with an unrelated foster care provider. According to federal program
officials, a significant portion of these children had at least one
special need, such as a medical condition or membership in a minority
group that might make adoptive placements challenging. Further, in some
cases, the most appropriate adoptive families reside in one state while
waiting children reside in another. Therefore, interstate placements,
which require child welfare agencies in both states to work together,
are critical to finalizing their adoption.
In an effort to promote the adoption of children with special needs,
Congress authorized the Adoption Assistance Program in 1980 under Title
IV-E of the Social Security Act. Through this program, the federal
government partially reimburses states for subsidies they provide to
adoptive parents of eligible special needs children to assist them with
related caretaking expenses. The act defines children as having special
needs if the state has determined that the child should not or could
not be returned to the home of his or her parents, and certain factors,
such as age; membership in a sibling unit or minority group; or
emotional, mental, or physical conditions would make finding an
appropriate adoptive home difficult.
In order to qualify for the federal subsidy reimbursement, children
must meet the special needs definition and one of several eligibility
criteria. These criteria include having been removed from the home
pursuant to a judicial determination and being eligible for the Aid to
Families with Dependent Children (AFDC) program, as it existed in 1996.
In each of the fiscal years 2001 through 2003, the federal adoption
assistance subsidy reimbursement, including related administrative and
training expenses, exceeded $1 billion. In fiscal year 2002, the latest
year for which HHS could provide figures, the federal government
partially reimbursed states for adoptive families' subsidies for about
66 percent of foster children adopted.
In addition to the adoption subsidy reimbursement, the Adoption
Incentives Program, created by the Adoption and Safe Families Act of
1997 (ASFA) and amended in 2003, provides rewards for states that
increase the number of foster care adoptions, special needs adoptions,
or adoptions of children age 9 and older. Since the program's inception
through 2003, the most recent year for which data are available, the
federal government has awarded nearly $178 million to states in
adoption incentive payments.
To better understand the issues related to the placement and adoption
of special needs children, we (1) identified the major challenges to
placing and keeping special needs children in adoptive homes, (2)
examined what states and the Department of Health and Human Services
have done to facilitate special needs adoptions, and (3) assessed how
well the Adoption Assistance Program and the Adoption Incentives
Program have worked to facilitate special needs adoptions and what
changes, if any, might be needed to further facilitate adoptions.
To conduct our work, we gathered and analyzed data from several
sources. We developed and conducted a nationwide survey of adoption
directors in all 50 states, as well as those in Washington, D.C., and
Puerto Rico, and we received 50 responses.[Footnote 1] We visited 5
states --Georgia, Massachusetts, Michigan, New Mexico, and Oregon--
where we spoke with child welfare agency officials, caseworkers,
parents, court personnel, and private adoption agency officials to
better understand states' strategies for placing children with
appropriate adoptive families.[Footnote 2] We selected these states for
diversity in the size of their foster care populations, location, and
program administration, and for the different degree of success they
have had in finalizing adoptions. In addition, we selected and reviewed
10 states' Child and Family Services Plans and Annual Progress and
Services Reports--documents that HHS requires as part of its ongoing
child welfare oversight--in order to obtain information on how states
were using the adoption incentive funds. Further, we reviewed federal
adoption assistance and adoption incentive laws and regulations, as
well as additional adoption-related research and evaluations conducted
by HHS, the states, and nongovernmental organizations. We also
interviewed HHS officials and staff from independent child welfare
organizations, and we conducted discussion groups with adoptive parents
and adoption program managers from around the country at two national
conferences. We conducted our work between May 2004 and April 2005 in
accordance with generally accepted government auditing standards. A
more detailed discussion of our scope and methodology appears in
appendix I.
Results in Brief:
According to state officials, limited resources, court processes, and
delays in completing interstate placements were the major challenges to
successful special needs adoptions. These challenges hindered efforts
to recruit families and delayed the adoption process. According to
state officials in 4 of the 5 states we visited, budget issues in their
states have caused reductions in or elimination of adoption services.
In part because of these resource limitations, adoptive parents in many
states received lower subsidies and fewer services than foster parents.
Our survey asked states about 13 types of services or support. For 9 of
the 13 services, fewer states reported providing them to adopted
children than to foster children. In addition to reporting limited
resources, child welfare officials, court staff, and judges from our
site visit states said that the adoption process can take many months
to complete because hearings to terminate parental rights are hard to
schedule, and appeals by parents and other relatives may add months to
the process. Further, although federal law requires states to
facilitate the timely adoptive placement of children through the
effective use of cross-jurisdictional resources, interstate placements
can be delayed, in part, by the slow completion of home studies to
determine the qualifications of prospective families. HHS officials
said that there are no data to assess the timeliness of such
placements. However, they are in the process of updating their central
data system and informed us that they are considering many revisions to
improve data collection.
States and HHS have developed and implemented both general and targeted
strategies to promote special needs adoptions, but few evaluations
measure their effectiveness. All 5 of the states we visited partner
with adoption exchanges--information and referral services for adoptive
families--to operate electronic registries of children awaiting
adoption, and all 5 states worked with private agencies to promote
adoption. In addition to these general activities, many states used
targeted recruitment strategies. For example, states hosted adoption
promotion events geared toward matching prospective families with
certain children, such as those who have been waiting the longest for
placements. Four of the 5 states we visited sponsored formal post
adoption resource centers. However, only 9 of 49 states responding to a
relevant question in our survey indicated that they had evaluated the
effectiveness of their post adoption services. At the federal level,
HHS has supported and promoted local innovation through its programs,
provided technical assistance, and disseminated information to increase
public awareness about the need for adoptive families. However, the
agency has done little to assess the effectiveness of its programs.
Moreover, when HHS has taken steps to have participating states assess
specific projects, few of the evaluations produced reliable data. We
found that five of the seven evaluations we reviewed lacked sufficient
rigor to determine whether the projects had met their intended goals.
HHS officials acknowledged the need for more rigorous evaluation.
However, they informed us that once they approve the projects, they
have very little control over how the evaluations are actually
conducted because states manage the evaluations.
While the adoption assistance and adoption incentive programs have
supported special needs adoption, data are lacking to determine if
changes are needed to better facilitate adoptions. For example, the
Adoption Assistance Program uses an income threshold or need standard
from the expired Aid to Families with Dependent Children program, which
is more restrictive than other cash assistance programs and therefore
limits eligibility. HHS does not separately collect data on the
characteristics of children who do not meet IV-E eligibility, so the
number of children with special needs from low-income families is
unknown, and we cannot determine the extent to which this population is
being underserved. With regard to the Adoption Incentives Program, all
states have received financial awards for adoption achievements at
least once since 1998. However, the program is not currently designed
to provide a specific inducement for interstate placements. Data to
track and give credit to states for collaborating on interstate
placements are not available.
Given the challenges states face with respect to special needs
adoptions, the limited assessments available to determine best
practices, and the lack of data available to determine if changes to
federal adoption programs are needed, we recommend that HHS (1) assist
states in collecting and reporting data related to interstate
placements and analyze this data to provide a basis for facilitating
timelier placements, (2) facilitate the evaluation of federal and state
strategies and programs that promote special needs adoption, and (3)
gather data on the economic circumstances of special needs children who
do not currently qualify for the Adoption Assistance Program and assess
the impact of expanding eligibility on federal cost.
HHS provided written comments on a draft of this report but did not
explicitly agree or disagree with the recommendations. In its comments,
HHS stated that changes to address the recommendations designed to
improve data collection were being considered in conjunction with
efforts to revise its central data system. While HHS said that our
recommendation to improve evaluations was unnecessary because the
agency has taken steps to strengthen evaluations, it acknowledged that
projects have sometimes not yielded useful results, because of problems
adhering to evaluation protocols. Also, HHS stated that it will
continue to work with states to identify rigorous, administratively
feasible evaluation strategies. We continue to recommend that HHS
develop additional guidance to improve evaluations. Such guidance is
needed to help assess the effectiveness of funded projects.
Background:
Most children enter foster care when the state's child welfare agency
determines that they have been subjected to abuse or neglect and it is
not in their best interest to immediately return home. On September 30,
2002--the latest date for which HHS figures were available for our
review, 532,000 children were in foster care in the United
States.[Footnote 3] Generally, after investigating the circumstances
that contributed to the abuse or neglect, state child welfare agency
staff develop a plan to help the parent make improvements and create a
safe and stable family environment. ASFA requires that states hold a
permanency planning hearing at least once every 12 months to determine,
among other things, when and if reunification with the child's family
is a safe and practical option. HHS estimated that just over 50 percent
of the 281,000 children who exited foster care during fiscal year 2002
were reunified with a parent or principal caretaker.
If the parent has not followed child welfare agency plans or has failed
to change behaviors to make reunification safe, the state may identify
an alternative goal to establish a permanent home for the child. These
goals include adoption, independence, or legal guardianship.
Independent living arrangements may be attained once children reach the
age of 18--or 21 in some jurisdictions--and have not been reunified
with their families or adopted and for whom federal reimbursement for
foster care expenditures is no longer available. Legal guardianship is
a judicially created relationship between a child and a caretaker
whereby the caretaker is awarded custody and decision-making rights
with respect to the child. An October 2004 report indicated that 35
states and the District of Columbia had established subsidized
guardianship programs to help ensure permanent families for
children.[Footnote 4] The federal government typically does not
reimburse states for costs associated with subsidized guardianship.
However, 7 states have operated or are currently operating federally
funded guardianship projects through their participation in the Title
IV-E waiver program. HHS data show that 4 percent of children exited
foster care through guardianship in fiscal year 2002.
HHS reports that in fiscal year 2002, 17 percent of children exited
foster care through adoption. Unless a parent voluntarily relinquishes
his or her rights, states must petition the court for a termination of
parental rights (TPR) before a foster child can be adopted. ASFA
requires, with few exceptions, that states file a TPR petition when a
child has been in foster care for 15 of the most recent 22 months, but
ASFA does not address the length of time needed to grant the petition
to terminate. Before the termination is completed, states can begin to
recruit for an adoptive family and even place a child in a pre-adoptive
home with an interested family after this family has been approved. The
adoptive family approval process generally involves background checks
and a home study--a detailed examination of a family's circumstances,
including its employment and finances and family medical history--to
ensure that the family will provide a safe and suitable placement. The
key steps in the process for adopting children from state child welfare
agencies are summarized in figure 1.
Figure 1: Flowchart of a Typical Adoption Process:
[See PDF for image]
[End of figure]
In order to be eligible to receive federal funding, ASFA requires that
states do not delay or deny the placement of a child for adoption when
an approved family is available outside the jurisdiction that currently
handles the child's case[Footnote 5] and requires states to facilitate
the timely adoptive placement of children through the effective use of
cross jurisdictional resources.[Footnote 6] States govern the placement
of children across state lines through a compact known as the
Interstate Compact on the Placement of Children (ICPC). At the time of
publication, the compact was being rewritten to improve the process of
placing children across state lines.
Families who adopt children with special needs can receive monthly
subsidies. The Adoption Assistance Program, under Title IV-E of the
Social Security Act, authorizes the federal government to partially
reimburse the states for the subsidies they provide to families who
adopt special needs children. Payments to the parents of an eligible
child with special needs can include both one-time adoption assistance
for expenses such as attorney fees and ongoing monthly assistance,
which is used for any identifiable needs of the child. Special needs
children must meet at least one criterion from the following list: (1)
the child is a dependent child who would have been eligible for AFDC,
as it existed in 1996;[Footnote 7] (2) the child is eligible for
Supplemental Security Income (SSI);[Footnote 8] (3) the child is a
child of a minor parent who is in foster care already and receiving
foster care maintenance payments under Title IV-E; or (4) the child
received adoption assistance previously, but the adoption dissolved or
the adoptive parents died. If the child does not meet these eligibility
criteria, but still meets the state's definition of special needs, the
state can provide a subsidy to the child's adoptive family, but cannot
claim federal reimbursement.
The amount of the subsidy is determined through negotiations between
the adoptive parents and a representative of the state agency based on
the needs of the child and circumstances of the adoptive family. The
subsidies are intended to help adoptive families manage the cost of
caring for their special needs children. Adopted children often have
difficulties with issues of loss, attachment, and identity formation
that can lead to behavioral and developmental problems and require
professional treatment. In addition, special needs children with
physical and other mental disabilities may require specialized care and
treatment. Adoption subsidies are available to families until children
reach age 18 but may be extended to age 21 if a mental or physical
disability necessitates continuation.
In addition to reimbursing states for the adoption subsidies, the
federal government pays adoption incentive funds to qualifying states.
Under the Adoption Promotion Act of 2003, (Pub. L. No. 108-145), which
amended the Adoption Incentives Program, a state is eligible for an
award if the number of adoptions from the foster care system for the
fiscal year under review exceeds the state's baseline year, the highest
number of adoptions in any previous year, beginning with fiscal year
2002. States may also receive an incentive payment based on the
adoptions of children having special needs or children older than age
9. Specifically, when a state exceeds its baseline year in each
category, it will receive an incentive payment of $4,000 for each child
adopted from foster care, $2,000 for the adoption of each special needs
child younger than age 9, and $4,000 for the adoption of each child
aged 9 or older. Thus, the program encourages adoption generally while
emphasizing the adoption of children with special needs. In fiscal year
2003, the federal government paid states more than $17 million in
incentive payments through this program.
Title IV-E adoption subsidies and adoption incentive awards are not the
only federal assistance available to support adoption. Funds authorized
under Title IV-B of the Social Security Act, the Temporary Assistance
for Needy Families program (TANF), and the Social Services Block Grant
(SSBG) have also been used to facilitate and sustain
adoptions.[Footnote 9] We reported that in fiscal year 2002 states used
more than $5 million in Title IV-B funds on adoption subsidy payments,
more than $9 million on recruitment and training for foster and
adoptive parents, and nearly $29 million on adoption support and
preservation services.[Footnote 10] A recent survey on states' fiscal
year 2002 allocations of federal funds for child welfare found that
states reported spending $56 million in TANF funds, $44 million in
Title IV-B funds, and $22 million in SSBG funds on adoption and support
services for adopted children.[Footnote 11]
HHS's Children's Bureau administers and oversees federal funding to
states for child welfare services under Titles IV-B and IV-E of the
Social Security Act, and states provide these child welfare services,
either directly or indirectly through contracts with private agencies.
Among other activities, HHS staff are responsible for developing
appropriate policies and procedures for states to follow and conducting
administrative reviews to ensure that states are in compliance with
established policies. HHS staff from its 10 regional offices provide
technical assistance to states, review state planning documents, assist
with state data system reviews, and assess states' use of funds for
foster care maintenance payments. Between 2001 and 2004, HHS completed
its first round of Child and Family Services Reviews (CFSR), which
assessed child welfare outcomes in all 50 states, the District of
Columbia, and Puerto Rico. These reviews assessed states' progress and
achievement in many areas and found weaknesses related to adoption. For
example, HHS reported that at least 27 states experienced challenges
seeking terminations of parental rights in accordance with ASFA. In
addition, HHS also reported that 37 of the 52 states failed to meet the
national standard of finalizing adoptions within 24 months of the
child's most recent entry into foster care.
To evaluate states' performance on child welfare indicators, such as
timely adoptions, HHS relies, in part, on its Adoption and Foster Care
Analysis and Reporting System (AFCARS) to capture, report, and analyze
information collected by the states. In addition, AFCARS is used to
generate annual reports on foster care and adoption programs
nationwide, and it is the primary source of data for the Adoption
Incentives Program. We reported that the AFCARS data were not reliable
and recommended that HHS make improvements. HHS officials agreed with
our findings and stated that several data definitions in AFCARS would
be updated and revised.[Footnote 12] In June 2004, HHS officials stated
that the regulations related to making these changes were being
drafted. As of April 2005, the regulations had not been issued, and HHS
officials said they did not have a specific planned release date.
States Reported That Limited Resources, Court-Related Processes, and
Interstate Placement Delays Impede the Adoption of Special Needs
Children:
States we visited reported that limited resources, court-related
processes, and delays in completing interstate placements were the
major challenges to special needs adoption. The limited resources
impeded state agencies' efforts to recruit adoptive families.
Additionally, officials said that difficulties scheduling cases and the
time involved with other court proceedings delayed finalizing
adoptions. Officials also reported that delays in completing home
studies hindered adoptions that involved interstate placements.
State Adoption Officials Report That Limited Resources Impede
Adoptions:
In part because of resource limitations, adoptive parents in many
states received lower subsidies and fewer services than foster parents.
Officials in 4 of the 5 states we visited told us that budget issues in
their states have caused reductions in or eliminations of adoption
services. States are prohibited by statute from providing monthly
adoption assistance payments that exceed the foster care maintenance
payments that would have been paid if the child had been in a foster
home. Officials in 4 of the states we visited said that most special
needs children are adopted by their foster parents, and a 2002 report
found that nearly two-thirds of children adopted from the child welfare
system are adopted by their foster parents.[Footnote 13] In responding
to a question in our survey, 31 of 49 states reported that adoption
assistance payments were lower than foster care maintenance payments in
those states, and more than half of the 31 states viewed lower adoption
payments as a moderate to very great hindrance to the adoption of
special needs children. According to an official in one of the states
we visited, adoption subsidies are critical to helping families who
adopt special needs children pay for the care and services these
children need. Families adopting special needs children may face
substantial costs for medical care and mental health services, and
several of the experts we interviewed explained that prospective
adoptive families may hesitate to adopt special needs children because
they are concerned about the costs of providing services to meet their
needs. In addition, services, such as respite care, provided by the
state for foster children may be provided to a lesser degree or not at
all to adopted children or to children being cared for by legal
guardians. Our survey asked states about 13 types of services. For 9 of
the 13 services, fewer states reported providing the services to
adopted children than to foster children; for every service, the fewest
number of states extended these services to children in guardianship
arrangements. (See fig. 2.) Further, officials in 4 of the 5 states we
visited confirmed that subsidies and services declined when foster
parents became adoptive parents.
Figure 2: Types of Support Provided to Families Caring for Children
with Special Needs:
[See PDF for image]
Notes: Data based on survey responses from 47 states, the District of
Columbia, and Puerto Rico.
Maintenance payments are payments to foster parents to reimburse them
for the costs associated with caring for foster children. Analogous
payments can be made to adoptive parents in the form of adoption
subsidies.
Agency caseworker services are ongoing case management services,
provided by trained agency staff that can include, among other things,
information and referral services that adoptive or foster families
might need.
Medical supplies can include reimbursement for physical therapy or
medical equipment, such as wheelchairs.
Residential treatment is a therapeutic intervention process for
children who cannot or do not function satisfactorily in their own home
environments.
Respite service is temporary care for foster or adoptive children so
that foster or adoptive parents can be relieved of the responsibility
for the children's daily care for a period of time (several hours or
several days).
Crisis intervention is provided on an emergency basis and can include
mental health treatment or family counseling in response to severe
emotional or health issues that threaten the stability of a foster care
or adoptive placement.
Individual/group therapy and family therapy include psychological and
emotional counseling for children in the care or their adoptive or
foster parents.
Post secondary waivers provide free or reduced tuition for adoptive or
foster children in state-supported post secondary educational programs.
[End of figure]
In addition, many states reported that it was difficult to recruit
families and limited resources affected their efforts. Nearly half of
the 49 states responding to a relevant question in our survey indicated
that difficulty recruiting families was a great or very great challenge
to the adoption of special needs children. In 4 of the 5 states we
visited, child welfare staff we interviewed told us that high caseloads
limited the time caseworkers could spend recruiting families and
placing children. In some cases, tight budgets led officials to make
personnel decisions that made fewer experienced staff available to
recruit adoptive parents. In Georgia, officials explained that because
of budget and staffing constraints, instead of having workers who could
specialize in various processes, such as recruiting adoptive parents,
child welfare workers had to handle multiple aspects of each case.
Further, in Michigan, officials explained that a budget saving plan to
encourage early retirement led many experienced child welfare staff to
retire. While the child welfare agency hired new workers, nearly all of
them were inexperienced and needed both formal and on-the-job training.
As a result, according to the foster and adoptive parents we
interviewed in that state, these inexperienced workers were less
effective than experienced workers at meeting families' needs.
Additionally, in part because of staffing and resource constraints,
there are concerns about how long it takes to place children with
families. Both a home study and a background check are required for
adoptive families, but according to adoptive and waiting parents in one
state, high caseloads limited the time caseworkers could spend
completing these studies, and frequently it was several months from the
time families indicated interest in adopting until their home studies
were completed. In addition, states typically provide adoptive families
with an orientation to the adoption process and relevant training, but
caseworkers in one of the states we visited told us that because of
resource constraints, training of prospective adoptive parents is
limited, particularly in the rural areas.
After home studies are completed and the families have been approved,
families often wait for suitable placements. One study found that the
matching and placement phase involved more uncertainty and
misunderstanding for prospective adoptive families than any other step
in the adoption process.[Footnote 14] The same study also found that
one-quarter of potential adoptive parents felt that they were not given
an accurate estimate of the time it would take for a placement. Another
report noted that infrequent contact between caregivers--foster parents
and guardians--and case managers resulted in caregivers leaving the
foster care system and not pursuing adoption.[Footnote 15] In 3 of the
states we visited, foster, adoptive, and pre-adoptive parents told us
that because of staff shortages, high caseloads, and other duties,
caseworkers did not give them the attention they needed. As a result,
some adoptive and pre-adoptive parents who were trained lost interest
or sought children through other means, such as private placements. In
New Mexico, almost all of the potential adoptive families we talked
with in one rural area had been waiting for more than a year to adopt.
They expressed frustration over the lack of contact from the child
welfare agency while they knew that there were many children waiting
for placements. Correspondingly, 20 of 46 states responding to an open-
ended question in our survey reported that high caseloads or
insufficient staff were among the three greatest challenges to
facilitating or finalizing the adoption of special needs children.
Officials Cited Court Delays as a Challenge to the Adoption of Special
Needs Children:
Court-related delays were also cited as a challenge to the adoption of
special needs children. Twenty-two of the 46 states responding to a
relevant question in our survey indicated that court-related delays
were among the three greatest challenges to the adoption of special
needs children. In 3 of the states we visited, judges told us that it
was hard to schedule termination of parental rights hearings because
court dockets were full and because of the many parties involved in
some hearings. In some cases, the participants include the judge,
biological parents, foster parents, the caseworker, and multiple
attorneys--one for each child in a sibling group, one for each
biological parent, and one for the caseworker or child welfare
department. Scheduling a hearing date that fits everyone's schedule and
allows all parties to attend can be difficult.
In addition to difficulties in scheduling hearings, termination
proceedings can last months. Many judges want to be sure that the
biological parents have had sufficient opportunity to remedy the
problems that led to their children being removed. If a parent seems to
be making progress, even if the parent is not yet ready to resume
custody of his or her child, the judge may postpone a decision. Even in
cases in which the likelihood for reunification is low, attorneys in 3
of the 5 states we visited told us that some courts hesitate to
terminate parental rights until adoptive families are found for
children. According to HHS's analysis of its Child and Family Services
Reviews, in over half of the states reviewed between 2002 and 2004,
many judges were reluctant to terminate parental rights either because
adequate services had not been provided to parents or because an
adoptive family had not been identified.[Footnote 16] Yet while some
judges may not want to create a legal orphan before an adoptive
placement is identified, judges we spoke with in 3 of the 5 states we
visited said that the identification of prospective adoptive families
did not play a role in their decision to terminate parental rights.
Furthermore, the termination process can be delayed if an appeal is
filed by a biological parent or a relative raises an objection. In
Michigan, court officials told us that children's relatives may come
forward to protest when such a decision is imminent. Relatives'
objections can create delays because the child welfare agency must
determine whether the relatives can be involved in the children's care,
and the court may also schedule further hearings concerning the details
of their objections.
Delays Completing Home Studies Have Hindered Some Interstate Adoptive
Placements:
Delays in completing home studies impeded the interstate placement of
children and therefore delayed the adoption process. Of the 49 states
responding to our survey, 26 cited the lengthy process to place
children across state lines as a moderate to very great hindrance to
the adoption of special needs children. In the course of seeking an
adoptive placement, sometimes a child welfare agency in the state where
the child resides finds a suitable family in another state. The agency
in the state with the child, known as the sending state, seeks a
placement in the state where a potential adoptive family lives--the
receiving state. Generally, caseworkers from the sending state request
that a receiving state complete a home study of the prospective family.
However, caseworkers in the receiving state may assign this request a
low priority because conducting the home study would take time away
from their own caseloads. According to a survey of state officials
conducted by the American Public Human Services Association (APHSA), 32
of the 45 respondents cited staffing and workload issues as the leading
cause for delay in completing home studies requested by other states.
Another frequently cited cause of delay was the low priority assigned
to interstate placements by local workers.[Footnote 17] According to
current interstate compact guidelines, 6 weeks or 30 working days is
the recommended processing time from the date the receiving state gets
notice from the sending state until the placement request is approved
or denied. However, APHSA notes that sometimes the receiving state does
not complete home studies for many months. In some cases, therefore,
children linger in foster care when interstate placements are delayed.
While the Adoption and Safe Families Act includes a provision that
directs states to develop plans to facilitate the timely adoptive
placement of children through the effective use of cross-jurisdictional
resources, there are no national data to assess the timeliness of these
placements. Data from AFCARS can show whether or not children were
adopted outside their home state, and they also can be used to track
the length of time from entry into foster care to termination of
parental rights and adoption. However the system does not capture which
states were involved or when placement requests were made or completed.
Without such specific data, HHS does not know the extent to which
states are cooperating, which states may need to improve their
processes, or whether certain states are burdened by high numbers of
requests for home studies in support of interstate placement. APHSA has
developed a database for tracking interstate adoptions. Unlike HHS's
system, this database tracks the total number of children any
participating state sent out of state or received for adoption and the
total number of finalized adoptions a state made after receiving
requests from other states. Participation in the association's database
is voluntary, and as of November 2004, 16 state agencies had provided
their information.
States and HHS Have Promoted Special Needs Adoption, but Few
Evaluations Measure Program Effectiveness:
States and HHS have developed strategies and implemented programs to
promote special needs adoptions, but few evaluations measure their
effectiveness. States used both general and targeted recruitment
efforts to help identify adoptive homes for special needs children.
States have also provided special services and programs to help sustain
adoptions. To assist states in their adoption efforts, HHS has
supported many demonstration programs over the years. Although HHS has
disseminated information and summaries about some of the programs and
services, little has been done to assess the effectiveness of such
programs, and as a result, neither HHS nor the states know which
approaches have been most successful.
States Used General and Targeted Approaches to Identify Adoptive
Families and Promote Adoption:
States have used various methods to recruit adoptive families. They
have placed ads on billboards; distributed or posted fliers and posters
at booths during public events or in special locations, such as
shopping malls, libraries, churches, and businesses; sent caseworkers
to community fairs and parades; and used special public service
announcements and media campaigns to generally recruit adoptive
families. Many states have observed and participated in National
Adoption Awareness Month each November, and some states have promoted
adoptions by designating other special days.[Footnote 18] For example,
officials in Massachusetts told us that they finalized 32 adoptions on
a single day in May 2004. According to the National Adoption Day
organization, more than 3,100 adoptions were finalized during National
Adoption Awareness Month in 2003.
To help facilitate adoption, states have contracted with private
adoption agencies to recruit and train prospective families, developed
Web sites, and partnered with adoption exchanges. Of the 49 states
responding to our survey, 40 indicated that contracts with private
agencies were an essential or very important recruitment method. In
addition, all 5 of our site visit states, as well as others, operated
Web sites that include photo listings of children awaiting adoption as
well as information on adoption procedures and resources for
prospective adoptive families. Also, 4 of the 5 states we visited, as
well as other states, partnered with adoption exchanges--information
and referral services for prospective adoptive families--to operate
electronic registries of waiting children. For example, Michigan's
adoption resource exchange operates a Web site containing a calendar of
training opportunities and events, a searchable database of children
awaiting adoptive families, and general information on the adoption
process.
In addition, most states used targeted recruitment strategies that
focused on a specific group of children. Of the 49 states responding to
a question in our survey on methods for recruiting adoptive families
for special needs children, 37 reported that television advertisements
and stories were essential or very important, 35 states reported that
advertisements in magazines and other periodicals were essential or
very important, and 22 responded similarly regarding mass mailings or
flyer distribution. For example, Kentucky officials noted in our survey
that they created a special television public service announcement to
recruit adoptive families for special needs children. The advertisement
was filmed at the Governor's home and included children with special
needs. Another state, Georgia, issued a photo listing book, entitled
"My Turn Now," that includes those children who have been awaiting
adoption for the longest period of time.
Many states also hosted adoption promotion events throughout the year
that targeted certain children, such as minorities or those in sibling
groups. In Massachusetts, for example, the state agency has partnered
with a local furniture store to host several adoption parties. The goal
of the event is to help match prospective families with those children
in attendance. State officials credit this business partnership with a
number of successful adoptive matches. Another targeted strategy, known
as the Heart Gallery, has been under way in New Mexico since 2001 and
has also been implemented by a number of other states. This event has
showcased professional photographs of children waiting to be adopted.
Though the organizers in New Mexico have not collected data to track
matches resulting from participation in the gallery event, one
organizing official told us that several children who were showcased at
the events have been adopted. Further, a Massachusetts official stated
that within 2 months of implementing the Heart Gallery in that state,
placements were found for half of the children showcased. In addition,
some states are working with local community organizations and churches
to help recruit and place particular children in adoptive homes.
According to a National Governor's Association report, 30 states and
the District of Columbia have participated in an adoption program
called One Church One Child, since 1980. The program seeks to recruit
one family from each African-American church to adopt an African-
American child.
States Provided Some Services and Resources to Help Sustain Adoptions:
As indicated earlier in figure 2, states are providing some post-
adoption services and resources, which many experts have said are
critical to helping families sustain adoptions. Generally, post-
adoption services are provided with the recognition that parents
adopting children often face challenges they did not anticipate and for
which they are not fully prepared, especially when the children have
special needs. These services are intended to help reduce the number of
adoptions that are dissolved.[Footnote 19] As previously noted, states
generally provide fewer services to adoptive families than to foster
families. However, 4 of the 5 states we visited have established
centers to assist families after their adoptions were finalized--see
table 1.
Table 1: Characteristics of Post Adoption Resources Available in Five
States:
Georgia:
State resource: Georgia Center for Adoption Resources and Support--a
statewide service center located in Atlanta, Georgia. The center became
operational in 2002 and is part of Georgia's Office of Adoptions.
Resource Advisors are located in each of the regions of the Department
of Human Resources throughout the state;
Key features of post adoption service:
* Toll-free number: Connects families with the resource center, lending
library, and Resource Advisors;
* Post adoption advisors: Assist families in locating resources;
* Newsletter: Provides articles of interest to adoptive families;
* Adoptive Family Network: Matches adoptive families with "buddy"
families who adopted children with similar needs;
* Web site: Provides current information on resources and special
events;
* Lending library: Contains a collection of books, magazines, and
videotapes covering a variety of adoption, parenting, and child
development issues;
Eligibility regulations: Services provided through the Georgia Center
for Adoption Resources and Support are available to all adoptive
families residing in Georgia.
State resource: Georgia's Office of Adoptions--created to develop,
promote, and support quality adoptive placements and services;
Key features of post adoption service:
* A TEAM mentoring program: Provides mentoring for adopted teens in
grades 6-12;
* Intervention team: Provides early intervention to improve the
family's well being, and to decrease adoption disruption and
dissolution;
* Tutorial services: Provides educational support services for children
who need tutorial intervention;
* Camp Promise: Provides an opportunity for adopted children to attend
a summer camp program with other adopted children;
* Respite care: Provides short-term, time-limited care for adopted
children;
Eligibility regulations: With the exception of services provided by the
Georgia Center for Adoption Resources and Support, services provided by
the Office of Adoptions are available only to families who have adopted
children from the state's public child welfare agency.
Massachusetts:
State resource: Adoption Journeys (formerly known as Adoption
Crossroads)--a statewide program founded in 1997. Services are
administered and coordinated by the Child and Family Services Agency
for the state, and are provided through a network of five affiliate
agencies located in different geographic regions of the state;
Key features of post adoption service:
* Toll-free number: Connects families and professionals to a 24-hour
toll-free phone line that offers information, joint problem solving,
and immediate emotional support;
* Family support groups: Meet on a weekly basis in all regions of the
state;
* Regional response teams: Work with families to address a range of
problems that could jeopardize the long-term success of the adoption;
* Advocacy and coordination: Empowers families and enhances their self-
advocacy skills;
* Training for mental health and social service professionals: Provides
consultation and training;
* Respite care: Provides short-term, time-limited care for adopted
children;
Eligibility regulations: Services are available to all state residents
who have adopted children or legalized guardianships, including those
originating from state, private, or international sources.
Michigan:
State resource: Regional Resource Centers for Post Adoption Services--
established in 2001. At the time of our site visit, there were seven
centers serving specific counties in the state;
Key features of post adoption service:
* Toll-free number: Connects families to a toll-free line to obtain
information on free and low-cost services that are available around the
state;
* Parent support groups: Allow parents to meet and connect with others
facing similar situations;
* Family support events: Allow adoptive families to connect while
taking the time to relax and enjoy activities;
* Parent training: Provides training for adoptive parents to become
educated on issues that affect their families;
Eligibility regulations: Services are available to families who have
adopted children from the state's foster care system. The child must be
under 18 years of age, receive an adoption subsidy, and reside in the
county in which the center provides services.
New Mexico:
State resource: According to state officials, no formal post adoption
program exists in the state. Families needing assistance can call their
caseworkers for information and referral and may be linked to training
and support groups that private agencies provide.
Oregon:
State resource: Oregon Post Adoption Resource Center--a statewide
service founded in 1999. The center, a program of the Oregon Department
of Human Services, is federally funded;
Key features of post adoption service:
* Parent support groups: Provide on-site assistance, training, and
technical support for adoptive parent support groups;
* Parent training: Provides formal on-site training twice a year in
each of the state's four regions;
* Directory: Lists local, regional, and statewide resources for parents
in need of therapists, respite care, support groups, camps, public
school programs, special educational facilities, and other services;
* Lending library: Includes videos, books, self-study courses, and
information packets;
* Respite care: Develops and maintains systems that help families
connect with respite resources;
Eligibility regulations: Services are available to families who have
adopted children from the state's foster care system.
Source: GAO summary of resources, as described by state resource
centers.
[End of table]
However, according to state adoption officials, caseworkers, and
adoptive parents we met during our site visits, better post adoptive
mental health services are needed. In addition, several of the experts
we interviewed expressed the opinion that many mental heath providers
needed to develop and improve their competencies in adoption-related
topics such as trust, abandonment, and attachment. Some states have
established programs to do just this. For example, New Jersey's
Adoption Certificate Program, in coordination with Rutgers University
School of Social Work and Continuing Education Department, developed a
45-hour postgraduate training program leading to an adoption
certificate for mental health clinicians. The certificate program is
intended to increase the knowledge of mental health practitioners
regarding the core issues facing adoptive families, and to expand their
clinical skills in attachment-based, family-focused therapeutic
interventions. Oregon's efforts present another example. Portland State
University, in collaboration with Oregon's Department of Human Services
and Oregon's Post Adoption Resource Center, has also developed a
postgraduate training certificate program for mental health providers
working with adoptive families. The training program includes hands-on
strategies for coaching and working with adoptive parents to address
their children's challenging behaviors. According to program officials,
the program has trained 27 therapists, and 15 more are expected to
complete the program by June of 2005. The names of these therapists
have been or will be forwarded to Oregon's adoptions resource center to
be included in referral information sent to adoptive families in need
of mental health therapists.
Most states have not conducted evaluations of their post adoption
services. In responding to our survey, 9 states indicated that they
have completed evaluations of post adoption services; 8 states said
that they had evaluations under way, and 30 informed us that they had
not conducted any evaluations prior to their completion of our survey.
Evaluations play an important role in improving program operations.
They can identify which services are most important to families, as
well as help managers determine whether the services are achieving
desired goals and if they can be provided more efficiently. Evaluation
results can help individual states improve their programs and, if
shared, can provide other states with valuable information to help
avoid costly mistakes.
HHS Has Administered Many Programs to Help States' Adoption Efforts:
Various HHS activities have helped states' adoption efforts. Over the
years, HHS has administered programs, sponsored campaigns, funded a
resource center, and taken steps to disseminate information about
adoptions. According to HHS officials, special needs children
constitute the majority of children waiting for adoptive homes, and as
such, they are the beneficiaries of the agency's efforts to support
adoption.
HHS has promoted innovation for many years through the Adoption
Opportunities Program and the Title IV-E Child Welfare Demonstration
Program. The Adoption Opportunities Program, authorized by the Child
Abuse Prevention and Treatment and Adoption Reform Act of 1978, as
amended, generally provides 3-to 5-year grants and contracts to public
and private adoption agencies. These grants and contracts have been
used to support states' efforts, such as increasing placement of
minority children, recruiting minority adoptive families, and providing
post adoption services for families with special needs children. Since
the program's inception, Congress has obligated more than $300 million
for the Adoption Opportunities Program. In 2003, HHS administered about
$7.3 million in first-year funding for 20 projects and in 2004 awarded
$4.4 million in first-year funding for 13 projects. Also, to promote
innovation, HHS has administered the Title IV-E Child Welfare
Demonstration Program since 1994. Among other things, this program
allows states to waive certain restrictions on the use of Title IV-E
funds that heretofore have prevented states from providing support to
guardians. Since 1996, 7 states have operated or are currently
operating waiver projects that have provided monthly payments to
relatives and other caregivers who agree to become a child's legal
guardian. The objective is to test whether providing monthly support to
guardians, which is generally less than payments made to foster
parents, can help reduce a state's overall foster care costs and
improve permanency outcomes for children.
Since 2002, HHS has supported local efforts to recruit and support
adoptive families and increase public awareness about adoption by
sponsoring AdoptUSKids--a national initiative promoting adoption that
is operated by a coalition under contract with HHS. AdoptUSKids has
partnered with the Ad Council--a provider of public service
announcements to raise awareness about social issues--to develop a
national campaign to recruit adoptive families, and HHS has contributed
more than $4.1 million to the effort. The campaign is expected to run
for 3 years and feature a variety of public service announcements on
television and radio, and in print media. Of this amount, AdoptUSKids
has allocated $2 million to support state recruitment response teams to
handle the anticipated interest the campaign is designed to generate.
Members of these state-based teams are expected to respond to calls and
e-mails from prospective parents, link them with the appropriate state
agencies, keep prospective parents engaged in the adoption process by
providing a point of contact, and help parents overcome the barriers
they may face in pursuing adoption. Response teams are also expected to
encourage local media stations to run AdoptUSKids ads and to network
with local politicians and community leaders.
The AdoptUSKids initiative also helps fund adoptive parent
organizations around the country to recruit prospective adoptive
families and support existing ones. As of October 2004, AdoptUSKids had
awarded a total of $420,000 to 105 parent groups in 44 states. To
recruit prospective adoptive parents, AdoptUSKids operates a national
database of children waiting to be adopted and has established a Web
site that includes photos; demographic profiles; and brief descriptions
of interests, special needs, and the types of adoptive families that
would be the most appropriate for the children. The site is available
to the public, although prospective adoptive families can inquire about
specific children only after their state has approved them for
adoption. According to AdoptUSKids, as of April 2005, about 41 percent
of the children featured on the Web site had been placed with families
in pre-adoptive homes.
Further, HHS has also dedicated the resources of one of its seven
federally funded national resource centers to specifically address
special needs adoption.[Footnote 20] Based in Michigan, the National
Child Welfare Resource Center for Adoption provides training and
technical assistance to states to help them achieve timely adoptions
and develop program improvement plans to correct weaknesses identified
through federal reviews. HHS has provided about $1 million annually to
support this resource center.
HHS also has acknowledged the work of others to promote adoption and
has disseminated adoption-related information. HHS established the
Adoption Excellence Awards in 1997 and since then has presented the
award to public and private organizations, courts, and individuals. In
2004, HHS acknowledged the efforts of 17 groups and individuals who had
a role in increasing the number of foster children placed in permanent
homes. According to agency officials, the nonmonetary awards aim to
raise awareness about adoption and publicly acknowledge best practices.
To disseminate information about its programs and other activities
concerning adoption, HHS has sponsored conferences devoted to adoption
issues and sends a monthly electronic newsletter, the Children's Bureau
Express, to more than 9,700 readers. This newsletter highlights new
developments in the adoption field, as well as provides readers
information on conferences and funding opportunities. The agency also
maintains an e-mail distribution list of states' adoption and foster
care program managers to help disseminate information on policies,
procedures, and practices to the states and also maintains a Web site,
operated by the National Adoption Information Clearinghouse, which
collects and disseminates information concerning all aspects of
adoption.
HHS Has Done Little to Assess the Effectiveness of Its Programs:
Although HHS has administered demonstration programs for many years,
the agency has done little to evaluate the projects funded through
these programs and therefore does not know which ones have been most
successful. For example, the Adoption Opportunities Program has been
under way since the late 1970s, but HHS did not require evaluations
from the grantees until 2002. In the absence of evaluations, the agency
has published summaries of grantees' final reports. For example, a
document provided by HHS staff in 2002 and disseminated by the
Clearinghouse synthesized the findings from 8 of 19 projects funded
under this program. The document contains some information on the
projects' challenges, lessons learned, and accomplishments, as well as
recommendations from the grantees. However, HHS has prefaced this
material with a disclaimer, noting that it does not represent the
official views of the agency. Although evaluations have been required
for the last several years, HHS's program staff told us they were still
in the early stages of identifying criteria to help ensure that future
evaluations from grantees will be done with sufficient rigor to help
assess effectiveness.
HHS has also required evaluations from Title IV-E waiver recipients,
but little is known about the effectiveness of these projects, even
though HHS has provided staff and technical assistance to help state
grantees design, implement, and evaluate their projects. Rigorous
design is an essential component to incorporate when evaluations are
intended to develop conclusions about the effectiveness of a project.
Such design could include random assignment or controlled quasi-
experimental design.[Footnote 21] Of the seven state evaluations
submitted between 2002 and 2004 that addressed guardianship, two were
designed in a manner that allowed for comparisons between experimental
and control groups. For example, the evaluation in selected regions of
Illinois was the most methodologically rigorous of the seven, and its
design incorporated random assignment, which allowed for reliable
comparison between the control and experimental groups. The Illinois
evaluation's findings suggest that children for whom subsidized
guardianship was an option experienced a 6 percent higher permanency
rate than those in the control group and guardianship was also
comparable with adoption in terms of safety and ensuring a child's well
being. The evaluations from the other 5 states were less rigorous in
their design or implementation. For example, comparison groups used to
evaluate guardianships in Oregon and New Mexico were not necessarily
comparable in composition or makeup with the guardianship population
supported by the project. Consequently, the difference in outcomes for
those in guardianships could be due to internal differences or
characteristics, rather than to the treatment (i.e., guardianship)
itself. Other project evaluations were limited by reliance on group
numbers too small for generalization and by poor response rates to
assessment surveys and interviews. While the size of the project and
the costs associated with measuring outcomes and collecting data should
be considered in conducting evaluations, HHS officials acknowledged the
weaknesses of the current work conducted by grantees and said they have
learned more about the need for greater rigor as evaluations have been
submitted. They also indicated that evaluations are managed by the
states and HHS has very little control over how they are completed.
Meanwhile, HHS has posted summaries of projects undertaken through the
waiver program, and according to agency officials, they have drafted a
synthesis of findings reported by grantees.
The Adoption Promotion Programs Have Supported Special Needs Adoption,
but Data Are Lacking to Determine if Changes Are Needed:
The adoption assistance and adoption incentive programs have supported
the adoption of special needs children, but data are lacking to
determine if changes are needed to better facilitate adoption. The
Title IV-E Adoption Assistance Program uses an income threshold for
eligibility that is outdated and more restrictive than other cash
assistance programs' standards of needs and therefore limits
eligibility. With regard to adoption incentives, all states have
increased their annual number of adoptions enough to receive financial
awards for doing so at least once but data are lacking to assess
interstate placement challenges and credit states for collaborating.
Adoption Assistance Income Criteria Are Outdated, and Eligibility
Determinations Are Difficult to Make:
The Title IV-E Adoption Assistance Program was designed to help support
the adoption of economically disadvantaged children with special needs.
However, the income measure used to assess the standards of need in the
AFDC program, as it existed in 1996, is outdated and in many states
more restrictive than other programs' standards of need, such as the
measure used for TANF cash assistance eligibility.[Footnote 22] For
example, in Massachusetts, a family of three could earn up to $633 per
month and qualify for TANF, but this family would not qualify for AFDC
unless the earnings were no more than $579--a difference of $54 per
month. According to an HHS official, eligibility for AFDC and TANF is
governed by complex rules, which therefore complicate comparison.
Nonetheless, more than one-third of the 39 states responding to an open-
ended question in our survey, as well as officials in 4 of the 5 states
we visited, expressed the view that Title IV-E income eligibility
criteria--based on AFDC eligibility--should be less restrictive.
Further, making the income determinations has presented problems for
some states. We asked officials in each of our 5 site visit states to
comment on the administrative burden associated with the income
eligibility criteria. Officials in 4 states said that determining
whether children met the income requirements, by virtue of the parents'
income, was time-consuming and challenging, particularly if their
incomes were not readily available through a state-maintained database.
Between fiscal years 2000 and 2004, HHS found that nearly all states
had made errors in applying the income criteria and determining the
income eligibility for foster care maintenance determinations. Since
states must also base adoption assistance income eligibility on
parents' income, similar mistakes are likely. HHS fined 50 of the 52
states it reviewed between 2000 and 2004 more than $14 million for
claiming foster care maintenance payments for ineligible cases, and one
of the most frequent reasons for fines, according to HHS officials, was
the inappropriate application of the AFDC income criteria.[Footnote 23]
Data Are Lacking to Estimate the Cost of Changing or Eliminating the
Income Requirement:
While members of Congress, the Administration, and others have proposed
changing or eliminating income requirements, HHS lacks data to assess
the likely cost to the federal government of doing so. Nevertheless,
state officials and adoption subsidy managers from 4 of the 5 states we
visited recommended that Title IV-E not be tied to criteria once used
for the old AFDC program. The Pew Commission on Children in Foster
Care--a national nonpartisan group formed in 2003 and composed of
legislators, judges, child welfare administrators, and others--has
estimated that eliminating the AFDC criteria from the foster care and
adoption programs would cost the federal government $1.6 billion
annually. The commission based its figure on fiscal year 2002
expenditure data as well as estimated projections of the percentage of
children who qualify under current regulations. A more reliable
estimate cannot be made because HHS does not maintain critical data on
those children and their families who are not eligible. Specifically,
for those children deemed ineligible, HHS does not maintain family
income data or data on the presence or absence of special needs. As a
result, no one can determine how many families just missed the
eligibility criteria and how many of these children had special needs.
According to an HHS official, the agency has not done a formal cost
estimate of expanding Title IV-E eligibility criteria, but it has been
developing an approach in support of proposals that the administration
has made since 2004. According to one agency official, these proposals
would eliminate income eligibility determinations for foster care.
However, without critical data and a cost estimate, the extent to which
expanding eligibility for the Adoption Assistance Program would
contribute to the nation's growing fiscal imbalance is unknown.
All States Have Claimed Adoption Incentive Funds at Least Once:
With regard to the Adoption Incentives Program, as figure 3 indicates,
all states have been able to increase their annual number of adoptions
enough to receive financial awards at least once since 1998.
Figure 3: Frequency of States' Attainment of the Adoption Incentive
Award, 1998-2003:
[See PDF for image]
[End of figure]
From 1998 to 2003, only South Dakota and Texas claimed the award each
year, and 42 states earned it at least three times. The number of
states receiving the award has fluctuated from year to year, however,
as figure 4 illustrates. In 1999, 44 states earned the award--a
reflection, perhaps, of states' implementation of ASFA and their
pursuit of permanency through adoption. By 2001, though, the number of
states receiving the award dropped to 24, which may have been due to
states' inability to sustain high levels of adoptions. Since 2001, the
number of states receiving the award has been on the rise. However,
fewer states received the award in 2003 than in 1998, when the program
began.
Figure 4: Number of States Claiming Award, by Earning Year:
[See PDF for image]
[End of figure]
Adoption incentive award amounts have varied, and states have used the
funds to support an array of activities. For example, award amounts
Texas earned ranged from $68,000 to nearly $3 million. States
participating in a 2000 study reported using these awards to fund a
variety of onetime activities, such as investing in post adoption
services and making performance-based awards to local offices or
counties.[Footnote 24] Our review of Child and Family Services Plans
and Annual Progress and Services Reports from 5 states that received
the award in 2002, found that these states used the funds to develop ad
campaigns to recruit adoptive families, provide free legal services for
adoption, and support child care for adoptive families.
The Adoption Incentives Program rewards states for exceeding baselines.
Some states reported that they focused on adoption prior to the
implementation of the program but have since seen declines in the rate
at which children enter foster care, and thus have been unable to
finalize enough adoptions to claim the reward. According to officials
from Massachusetts, while the state has continued to focus on adoption,
it does not perceive the program to be an appropriate incentive because
it simply rewards states for exceeding baselines rather than for other
improvements such as placing children who have been in care the
longest. As figure 5 indicates, a state theoretically could increase
adoptions in the years subsequent to the establishment of its baseline
and still not be in a position to claim the reward, especially if its
baseline had been calibrated at a level it might not reach again.
Figure 5: Illustration of the Difficulty in Claiming an Award under the
Adoption Incentives Program:
[See PDF for image]
[End of figure]
According to our survey, respondents had mixed opinions about the
extent to which the program served as an incentive to promote special
needs adoption. Twenty-two of the 49 states responding to a relevant
survey question said the program was a great or very great incentive,
while 24 responded that the program was a moderate or weak motivator.
In addition, several of these respondents suggested that HHS further
modify its baseline calculations. For example, states suggested adding
a category to reward states for the adoption of children who have been
in foster care for long periods of time, or altering the baseline to
reflect increases year-to-year rather than rewarding states for
exceeding historic baselines.
Data Are Lacking to Assess Interstate Placement Challenges and Credit
States for Collaborating:
In addition, the program does not provide a specific inducement for
interstate placements. Under the program's authorizing statute, the
sending state can count the finalized adoption in its totals, but the
receiving state does not get any credit for facilitating a placement,
even though the receiving state must conduct the home study--a critical
step in the adoption process. We do not have estimates of the costs
incurred by states for conducting a home study, but officials in 1
state told us that prospective adoptive families who adopt through
private agencies may pay as much as $3,000 to complete home studies.
HHS officials noted that it would be difficult to track which states
should be receiving the credit for facilitating interstate placements,
given the limitations in the data collected in AFCARS. Furthermore,
officials informed us that they do not have the authority to split the
incentive award. Nevertheless, they acknowledged the challenges states
face with regard to interstate placement and expressed the view that
changes that would provide an incentive to facilitate interstate
adoptions could help.
Conclusions:
While many states have increased the adoption of children with special
needs, data and evaluations are lacking to assess the degree to which
federal and state programs have promoted special needs adoptions.
Interstate placements have delayed adoptions, but data to assess the
timeliness of these placements are not available. Without such data,
HHS cannot identify those states that may need to improve their
processes or those burdened by requests for assistance. As a result,
delays associated with interstate placements will likely persist, and
some special needs children may linger in foster care. Although states
and HHS have developed strategies and innovative programs to promote
and support special needs adoptions, HHS has done little to assess the
effectiveness of its programs and funded projects. As a consequence,
HHS does not know which projects have been most successful and cannot
be assured that federal funds used to support state projects have been
used wisely. While Title IV-E Adoption Assistance has supported special
needs adoption, it is unclear how many more children would qualify for
the program if income standards were adjusted to today's income
standards of need. Further, without critical data and a cost estimate
of expanding eligibility, the extent to which increasing the number of
qualified children would contribute to the nation's growing fiscal
imbalance is unclear. As for the Adoption Incentives Program, it does
not encourage states to collaborate on interstate placements, therefore
failing to support an area that already presents barriers.
Recommendations for Executive Action:
We are making three recommendations to further improve the process and
programs related to special needs adoption.
* To better understand delays associated with interstate placements,
the Secretary of HHS should assist states in collecting and reporting
data related to the interstate placement processes, especially the time
needed to complete home studies and the sending and receiving state for
each child placed across state lines. Such assistance could include
modifying HHS's central data system, AFCARS, in conjunction with the
agency's ongoing efforts to update and revise this system. HHS should
analyze the data to assess the extent to which home studies cause
delays or impede interstate adoptions and to identify which states are
facilitating timely interstate placements. If supported by its
findings, HHS should consider proposing legislation to amend existing
law so that both sending and receiving states could claim an interstate
adoption for purposes of determining award eligibility.
* To improve HHS's ability to assess the effectiveness of its funded
projects, the Secretary of HHS should develop guidance to ensure that
rigorous design elements are incorporated into projects and related
evaluations. Such guidance could consider the nature and structure of
the projects and include measures to control costs.
* To assess the extent to which Title IV-E adoption assistance
eligibility criteria exclude some economically disadvantaged children
with special needs, the Secretary of HHS should (1) gather data on the
economic circumstances of special needs children who do not currently
qualify for IV-E and (2) develop a model to estimate the federal cost
of expanding eligibility.
Agency Comments:
We received written comments on a draft of this report from HHS. These
comments are reproduced in appendix II. HHS also provided technical
comments, which we incorporated when appropriate. :
HHS did not explicitly agree or disagree with the recommendations, but
stated that two of our recommendations were being considered as part of
a process to determine what, if any, revisions would be made to the
agency's central data system, AFCARS. Specifically, HHS stated that the
recommendation to collect data related to interstate placements and the
recommendation to gather data on disadvantaged children with special
needs would be considered as part of its AFCARS review.
With regard to our recommendation that HHS develop guidance to improve
project evaluations and help assess the effectiveness of funded
projects, HHS stated that such actions were unnecessary and noted that
it had taken steps to strengthen evaluation requirements and provided
technical assistance. Nevertheless, HHS acknowledged that a number of
demonstration projects have sometimes yielded results of limited
utility because of problems adhering to negotiated evaluation
protocols. Also, HHS stated that it is committed to continuing to
improve the quality of information generated by funded projects and it
will continue to work with states to identify rigorous,
administratively feasible evaluation strategies. We continue to
recommend that HHS develop additional guidance to improve evaluations.
Such guidance is needed to improve the quality of the results from
funded projects which will enable managers to assess their
effectiveness.
HHS also commented on our findings related to the evaluations conducted
under the Title IV-E waiver program. HHS stated that our summary of
these evaluations was somewhat misleading. It noted that several states
in which guardianship is a focus of the demonstration have used
experimental design. Also HHS said that the Oregon demonstration was
focused primarily on testing the use of flexible funding, and therefore
the evaluation of the guardianship components used other methods and
focused on descriptive data. We modified the report to clarify the
aspects of rigorous design. However, we did not change our description
of the Oregon evaluation because it accurately portrayed the
evaluation, which included information on the impact and effectiveness
of the guardianship component of the project.
We also provided a copy of our draft report to child welfare officials
in the 5 states we visited and received technical comments from
Georgia, Massachusetts, Michigan, and Oregon. We incorporated these
comments when appropriate.
As arranged with your office, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 30 days
from its issue date. At that time we will send copies of this report to
the Secretary of Health and Human Services, state child welfare
directors, and other interested parties. In addition, we will make
copies available to others on request. Also, this report will be
available at no charge on GAO's Web site at http://www.gao.gov. If you
or your staff have any questions about this report, please contact me
at (202) 512-8403 or AshbyC@gao.gov. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last
page of this report. GAO staff who made major contributions to this
report are listed in appendix III.
Signed by:
Cornelia M. Ashby, Director:
Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
Objectives:
The objectives of our study were to (1) identify the major challenges
to placing and keeping special needs children in adoptive homes, (2)
examine what states and the Department of Health and Human Services
(HHS) have done to facilitate special needs adoptions, and (3) assess
how well the Adoption Assistance Program and the Adoption Incentives
Program have worked to facilitate special needs adoptions and what
changes, if any might be needed to further facilitate adoptions.
Scope and Methodology:
To gather information about these objectives, we utilized multiple
methodologies: (1) a Web-based survey to state child welfare agencies;
(2) site visits to 5 states; (3) interviews with HHS officials, staff
from key National Resource Centers, and child welfare researchers and
practitioners, as well as discussion groups with adoptive parents and
state adoption program managers; (4) a review of 10 selected states' 5-
year reports and 5-year plans that HHS requires as part of its ongoing
child welfare oversight, as well as a review of federal adoption
assistance and promotion laws and HHS regulations; and (5) a review of
adoption-related studies and evaluations conducted by HHS, the states,
and nongovernmental organizations. We conducted our work between May
2004 and April 2005 in accordance with generally accepted government
auditing standards.
Survey:
To gather information about states' experiences with special needs
adoption, we distributed a Web-based survey to the adoption program
managers in all 50 states, the District of Columbia, and Puerto Rico on
September 17, 2004. The survey contained a number of both closed-and
open-ended questions. To determine whether the survey questions were
clear, unbiased, and used appropriate language, we pretested the survey
instrument with officials in Delaware, Pennsylvania, Maryland, New
York, Virginia, Ohio, and the District of Columbia prior to
distribution. After an appropriate period of time had passed after
initial survey distribution, we conducted an extensive follow-up
process that included e-mails and phone calls to states that had not
yet completed the survey. At the culmination of this process, we
received and analyzed responses from 50 states.[Footnote 25]
Because this was not a sample survey, there are no sampling errors.
However, the practical difficulties of conducting any survey may
introduce errors, commonly referred to as nonsampling errors. For
example, difficulties in how a particular question is interpreted, in
the sources of information that are available to respondents, or in how
the data are entered into a database or were analyzed can introduce
unwanted variability into the survey results. We took steps in the
development of the questionnaire, the data collection, and the data
analysis to minimize these nonsampling errors. For example, social
science survey specialists designed the questionnaire in collaboration
with GAO staff with subject matter expertise. Then, the draft
questionnaire was pretested with a number of state officials to ensure
that the questions were relevant, clearly stated, and easy to
comprehend. When the data were analyzed, a second, independent analyst
checked all computer programs. Since this was a Web-based survey,
respondents entered their answers directly into the electronic
questionnaire. This eliminated the need to have the data keyed into a
database, thus removing an additional source of error.
We took several steps to assess the reliability of the data obtained
through our survey. During our pretests, we asked state officials
questions to determine the reliability of the data they could provide,
such as how accurate their data entry systems were and how confident
they would be estimating the data we requested. On the basis of these
responses, we decided to include an open-ended question in the survey
instrument that would give states an opportunity to discuss any
limitations in the data they sent us. After receiving final surveys
from 50 states, we examined the responses to that particular open-ended
question, along with all the closed-ended data questions, and made
decisions about which to report on. We then examined the output to test
for inconsistencies, took steps to resolve these inconsistencies with
the relevant states, and determined that the data were sufficient and
reliable for the purposes of our report.
Site Visits:
To gather more detailed information about the challenges states face
promoting and sustaining adoption, as well as some of the practices
they've implemented to overcome challenges, we selected 5 states to
visit--Georgia, Massachusetts, Michigan, New Mexico, and Oregon--based
on differences in their success achieving adoption incentive awards,
along with their differences in location, size of child welfare
population, degree of privatization of services, and whether they had
state or locally administered systems. In preparation for the visits
and to understand the unique circumstances in each state, we talked
with HHS's regional office staff and field experts and obtained and
reviewed relevant literature from each of the 5 states, such as studies
of adoption efforts and promising practices. During our visits to each
state, we talked with officials from the state child welfare agency,
along with officials and staff from at least one local agency office.
Specifically, in each state we spoke with the adoption program manager;
caseworkers and supervisors; foster and adoptive parents; judges,
attorneys, and other court personnel, such as guardians and advocates;
and private agency officials under contract with the state.
Interviews and Discussion Groups:
To gather information about HHS's role in promoting special needs
adoption and generating related research and evaluation, we interviewed
HHS officials from Central Office and all the Regional Offices. We also
spoke with staff from National Resource Centers involved in special
needs adoption and permanency issues and interviewed nearly 20 child
welfare experts and researchers to learn additional information about
challenges confronting states' promotion and maintenance of special
needs adoption.
We also conducted separate discussion groups with adoptive parents and
state adoption program managers. We conducted a discussion with 11
adoptive parents from 8 states who were attending the annual conference
of the North American Council on Adoptable Children to learn their
perspectives on the adoption process, subsidy rates, and post-adoption
services. We also held a discussion group with adoption program
managers from 18 states during the annual meeting of the National
Association of State Adoption Programs. During this discussion, we
learned more about the federal role in promoting and sustaining
adoption and obtained managers' perspectives on Title IV-E funding and
the provision of subsidies to adoptive parents.
Review of States' Reports, Federal Laws, and HHS Regulations:
To learn more about how states were spending the adoption incentives
funds they had received and what their plans were to recruit and retain
adoptive families using federal funds, we reviewed 10 states' 2005-2009
Child and Family Services Plans and 2004 Annual Progress and Services
Reports--documents required by HHS as part of federal funding
participation. We selected 10 states--half of which received an
adoption incentive award in 2002--the latest date for which figures
were available at the time of our selection and analysis--and half of
which did not. Since we wanted to include documents from our 5 site
visit states in the sample, we collected the plans and reports from
another 5 states, selected randomly based on their receipt or
nonreceipt of the award. Among the 10 states whose documents we
reviewed, Georgia, Kentucky, New Hampshire, Oregon, and Pennsylvania
received an award in 2002, and Alaska, Massachusetts, Michigan,
Mississippi, and New Mexico did not. We summarized the plans and
reports that HHS's regional offices provided to us for these states,
including excerpts from unapproved plans, and included this information
where appropriate. We also reviewed relevant laws and regulations
describing the Adoption Assistance and Adoption Incentives Programs.
Review of Studies and Evaluations:
During the course of the work, we reviewed more than 20 adoption
studies that had been conducted by states, university professors, and
independent child welfare researchers. We also reviewed 14 evaluations,
including those required under the federal Title IV-E waiver program,
that were designed to assess the effectiveness of adoption, permanency,
and post adoption projects. For each of the selected studies that are
used in this report, we determined whether the study's findings were
generally reliable. To do so, two GAO social science analysts evaluated
the methodological soundness of the studies using common social science
and statistical practices. For example, they examined each study's
methodology, including its limitations, data sources, analyses, and
conclusions.
[End of section]
Appendix II: Comments from the Department of Health and Human Services:
DEPARTMENT OF HEALTH & HUMAN SERVICES:
Office of Inspector General:
Washington, D.C. 20201:
MAY 18 2005:
Ms. Cornelia M. Ashby:
Director, Education, Workforce, and Income Security Issues:
U.S. Government Accountability Office:
Washington, DC 20548:
Dear Ms. Ashby:
Enclosed are the Department's comments on the U.S. Government
Accountability Office's (GAO's) draft report entitled, "CHILD WELFARE -
Better Data and Evaluations Could Improve Processes and Programs for
Adopting Children with Special Needs" (GAO-05-292). The comments
represent the tentative position of the Department and are subject to
reevaluation when the final version of this report is received.
The Department provided several technical comments directly to your
staff.
The Department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Signed by:
Daniel R. Levinson:
Acting Inspector General:
Enclosure:
The Office of Inspector General (OIG) is transmitting the Department's
response to this draft report in our capacity as the Department's
designated focal point and coordinator for U.S. Government
Accountability Office reports. OIG has not conducted an independent
assessment of these comments and therefore expresses no opinion on
them.
COMMENTS OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES ON THE U.S.
GOVERNMENT ACCOUNTABILITY OFFICE'S DRAFT REPORT ENTITLED, "CHILD
WELFARE--BETTER DATA AND EVALUATIONS COULD IMPROVE PROCESSES AND
PROGRAMS FOR ADOPTING CHILDREN WITH SPECIAL NEEDS" (GAO-O5-292):
The Department of Health and H Human Services (H INS) appreciates the
opportunity to comment on the U.S. Government Accountability Office's
(GAO's) draft report.
GAO Recommendation:
We are making three recommendations to further improve the processes
and programs related to special needs adoption.
To better understand delays associated with interstate placements, the
Secretary of the Department of Health and Human Services (TINS) should
assist States in collecting and reporting data related to the
interstate placement processes, especially the time needed to complete
home studies and the sending and receiving State for each child placed
across State lines. Search assistance could include modifying HHS's
reporting system (Adoption and Foster Care AnalysIs (and Report System)
(AFCARS) in conjunction with the agency's ongoing efforts to update and
revise this system. HHS should analyze the data to assess the extent to
which home studies cause delays or impede interstate adoptions and to
identify which States are facilitating timely interstate placements. If
supported by its findings, HHS should consider proposing legislation to
amend existing law so that both sending and receiving States could
claim an interstate adoption for purposes of determining award
eligibility.
* To improve HHS's ability to assess the effectiveness of its funded
projects, the Secretary of HHS should develop guidance to ensure that
rigorous design elements are incorporated into projects and related
evaluations. Such guidance could consider the nature and structure of
the projects and include measures to control costs.
* To assess the extent to which Title IV-E adoption assistance
eligibility criteria exclude some economically disadvantaged children
with special needs, the Secretary of HHS should (I) gather data on
economic circumstances of special needs children who do not currently
qualify for IV-E and (2) develop a model to estimate the federal cost
of expanding eligibility.
NS Response:
Given that AUCARS is a decade old, the Administration for Children and
Families (ACF) is evaluating AFCARS to ascertain what revisions, if
any, are in order. The recommendations identified in the first and
third bullets above are being considered as part of that process. This
comprehensive review of AFCARS began in 2003. Input from the field was
obtained through notice and comment published in the Federal Register
and a series of focus groups. Input from comments received as a result
of the Federal Register notice, focus groups, recommendations from GAO
and the Office of Inspector General-as well as new legislative
requirements, have been consolidated into an internal working document.
The document will be used to set forth recommendations and further
steps.
111 HS views the second bullet above as unnecessary. As the report
notes. ACF has already taken steps to strengthen evaluation
requirements in discretionary grants. Discretionary funding
announcements require applicants to describe an evaluation plan as part
of their program approach, to provide foe-an independent project
evaluation, and to utilize a specific percentage of grant funds to be
devoted to evaluation. Review criteria for funding applications direct
review panels to evaluate the strength of applicants' evaluation plans.
Once discretionary grants have been funded, the Children's Bureau
provides technical assistance on evaluations to individual grant
programs. At the conclusion of the demonstration projects, ACF reviews
evaluations and, in recent years, has begun producing a synthesis of
evaluation findings from specific grant clusters or topic areas. In
addition, ACF continues to take the steps necessary. to improve the
quality of evaluations through contractor support.
The report's depiction of evaluations conducted under the Title IV-E;
waiver demonstrations is somewhat misleading. A key requirement of the
waiver demonstrations is that they be evaluated by an independent
evaluator, using a rigorous methodology. Since the inception of these
projects, ACF has encouraged States to conduct demonstrations employing
a true experimental design using random assignment of cases to
experimental and control groups. In fact, every applicant For a waiver
demonstration receives a technical assistance kit that explains the
reasons for using random assignment and answers questions about this
approach.
Since 1996, 17 States have implemented 25 child welfare waiver
demonstration project components through ?() Title IV-E waiver
agreements. Only five of the 17 States that have been approved to
conduct waiver demonstrations were approved to use quasi-experimental
methodologies for one or more of their project components. The most
frequent reason for employing, an alternative design (such as the use
of comparison counties) has been to assess the impact of flexible
funding demonstrations in which a capped amount of Title TV-F funds is
provided to localities to use for a range of purposes. In these
instances, random assignment of cases is not generally feasible.
With respect to the demonstrations testing subsidized guardianship, all
four States in which guardianship is the primary focus of the
demonstration have used experimental designs. (This includes the State
custody guardianship component of the New Mexico guardianship waiver
demonstration mentioned in the report, although the Tribal components
of that waiver demonstration are being evaluated using quasi-
experimental methods.) In two States, including the State of Oregon
referenced in the GAO report, guardianship was a strategy included in
the context of a demonstration focused primarily on testing the use of
flexible funding. Therefore, the evaluation of the guardianship
component used other methods and focused primarily on descriptive data.
While rigorous evaluation methodologies have been required, ACF
acknowledges that a number of demonstration projects have yielded
results of limited utility due to problems in the implementation of
programmatic elements of the demonstrations and sometimes problems in
adhering to negotiated evaluation protocols. Ultimately, as noted in
the report, it is the responsibility of the State to implement the
project as designed and to oversee the conduct of the evaluation.
However, ACF does provide technical assistance to both State officials
and their independent evaluators and is committed to continuing to
improve the quality of information generated by the projects.
Moving forward, ACF will continue to work with States to identify
rigorous, administratively feasible and ethical evaluation strategies.
For instance, in fiscal year 2004, HHS approved two new waiver projects
(including a new guardianship demonstration) both of which will employ
random assignment. ACF is also working with States to better coordinate
collection of consistent data elements across States conducting similar
demonstrations to facilitate future cross-site comparisons. Finally, as
referenced in the report, ACF will be issuing several papers
synthesizing the findings generated by demonstration projects begun
during the 1990's and will disseminate these findings broadly.
[End of section]
Appendix III: GAO Contact and Acknowledgments:
GAO Contact:
Cornelia M. Ashby (202) 512-8403:
Staff Acknowledgments:
In addition to those named above, Joy Gambino, Joah Iannotta, Kopp
Michelotti, Vernette Shaw, and Carolyn M. Taylor made key contributions
to this report. Susan Bernstein, Karen Burke, Michele Fejfar, Catherine
Hurley, Kevin Jackson, Stuart Kaufman, Jason Kelly, Luann Moy, and Jay
Smale also provided key technical assistance.
[End of section]
Related GAO Products:
Indian Child Welfare Act: Existing Information on Implementation Issues
Could Be Used to Target Guidance and Assistance to States. GAO-05-290.
Washington, D.C.: April 4, 2005.
Foster Youth: HHS Actions Could Improve Coordination of Services and
Monitoring of States' Independent Living Programs. GAO-05-25.
Washington, D.C.: November 18, 2004.
D.C. Child and Family Services Agency: More Focus Needed on Human
Capital Management Issues for Caseworkers and Foster Parent Recruitment
and Retention. GAO-04-1017. Washington, D.C.: September 24, 2004.
Child and Family Services Reviews: States and HHS Face Challenges in
Assessing and Improving State Performance. GAO-04-781T. Washington,
D.C.: May 13, 2004.
Child and Family Services Reviews: Better Use of Data and Improved
Guidance Could Enhance HHS's Oversight of State Performance. GAO-04-
333. Washington, D.C.: April 20, 2004.
D.C. Family Court: Operations and Case Management Have Improved, but
Critical Issues Remain. GAO-04-685T. Washington, D.C.: April 23, 2004.
Child Welfare: Improved Federal Oversight Could Assist States in
Overcoming Key Challenges. GAO-04-418T. Washington, D.C.: January 28,
2004.
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: Better Policy Implementation and
Documentation of Related Activities Would Help Improve Performance. GAO-
03-646. Washington, D.C.: May 27, 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: Kinship Care Quality and Permanency Issues. GAO/HEHS-99-
32. Washington, D.C.: May 6, 1999.
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 did not receive responses from Alabama and Nevada.
[2] This report uses the word "states" to refer to the 50 states, the
District of Columbia, and Puerto Rico.
[3] Data were preliminary fiscal year 2002 estimates as of August 2004.
[4] Children's Defense Fund. "States' Subsidized Guardianship Laws at a
Glance." Washington, D.C., October 2004.
[5] 42 U.S.C. §671(a)(23)(A).
[6] 42 U.S.C. §622(b)(12).
[7] To be eligible for AFDC, a child (defined as a dependent child
under the AFDC statute) has to be a needy child who (1) has been
deprived of parental support due to the death or absence, or physical
or mental incapacity, of a parent; or (2) has been deprived of parental
support due to the unemployment of the parent who is the principal
earner; and (3) is living with one of a number of specified relatives;
and (4) is generally under the age of 18.
[8] To be eligible for SSI benefits, a child must be either blind or
have other impairments. An individual is eligible if he or she has a
medically determinable physical or mental impairment, which results in
marked and severe functional limitations and can be expected to result
in death, or has lasted or can be expected to last for a continuous
period of not less than 12 months. In addition, the child or his or her
family must have limited income and resources.
[9] Title IV-B of the Social Security Act, consisting 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. TANF was
created by the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 to provide assistance and work opportunities
for a limited time to individuals and families. SSBG is authorized
under Title XX of the Social Security Act as a block grant to states
for the provision of social services for adults and children.
[10] See GAO, 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).
[11] The Urban Institute received survey responses from 50 states,
including the District of Columbia, but some states were unable to
provide all of the information requested so spending amounts may
underestimate true spending. The Urban Institute. The Cost of
Protecting Vulnerable Children, IV. December 2004.
[12] See GAO, 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).
[13] American Public Human Services Association. "Understanding Delays
in the Interstate Home Study Process." September 2002.
[14] Geen, Rob, Karin Malm, and Jeff Katz, "A Study to Inform the
Recruitment and Retention of General Applicant Adoptive Parents."
Adoption Quarterly, 7 (4).
[15] Lutz, Lorrie, "Achieving Permanency for Children in the Child
Welfare System: Pioneering Possibilities Amidst Daunting Challenges."
National Resource Center for Foster Care and Permanency Planning. New
York. November 2003.
[16] U.S. Department of Health and Human Services. "General Findings
from the Federal Child and Family Services Review." No date.
[17] American Public Human Services Association. Understanding Delays
in the Interstate Home Study Process. September 2002
[18] November was proclaimed National Adoption Month in 1990. Its
purpose is to promote adoption, support adoptive families, and increase
the awareness of children in foster care nationwide who need permanent
families.
[19] Dissolutions occur when a child is returned to foster care after
the adoption has been finalized.
[20] HHS's other resource centers also provide some technical
assistance to states regarding adoption matters, but they primarily
focus on other topics, such as organizational improvement and data and
technology.
[21] Experimental evaluations involve random assignment of participants
to one group or the other in order to increase the likelihood that the
two groups are roughly equivalent on all characteristics that could
affect outcomes. In a quasi-experimental design, a comparison group is
composed of individuals who share characteristics with program
participants but who have not been randomly assigned. With this design,
statistical controls are needed to isolate the program from other
factors that could influence outcomes.
[22] Under the AFDC program, states set eligibility criteria within
federal guidelines and the federal government and states shared the
costs of providing benefits to eligible families. Under TANF, the
federal government provides states a fixed amount of funds each year--
through a block grant--and the states have much more flexibility in
determining eligibility criteria and services provided. With this
increased flexibility and in keeping with the TANF program goals of
promoting work, many states have increased the amount of earnings a
parent may make while still receiving cash benefits. However, states
also have the flexibility to impose a less generous standard of need
for TANF.
[23] Other reasons were complications associated with obtaining
required judicial determinations, lapsed foster family licenses, and
limited resources to adequately monitor and relicense families whose
licenses had expired.
[24] Cornerstone Consulting Group, Inc. A Carrot among the Sticks: The
Adoption Incentive Bonus. 2001.
[25] We did not receive responses from Alabama and Nevada.
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