Child Welfare
Improving Social Service Program, Training, and Technical Assistance Information Would Help Address Long-standing Service-Level and Workforce Challenges Gao ID: GAO-07-75 October 6, 2006Despite substantial federal and state investment, states have not been able to meet all outcome measures for children in their care. Given the complexity of the challenges that state child welfare agencies face, GAO was asked to determine (1) the primary challenges state child welfare agencies face in their efforts to ensure the safety, well-being, and permanent placement of the children under their supervision; (2) the changes states have made to improve the outcomes for children in the child welfare system; and (3) the extent to which states participating in the Department of Health and Human Services (HHS) Child and Family Services Reviews (CFSR) and technical assistance efforts find the assistance to be helpful. GAO surveyed child welfare agencies in 50 states, the District of Columbia, and Puerto Rico and visited 5 states, interviewed program officials, and reviewed laws, policies, and reports.
In response to a GAO survey, state child welfare agencies identified three primary challenges as most important to resolve to improve outcomes for children under their supervision: providing an adequate level of services for children and families, recruiting and retaining caseworkers, and finding appropriate homes for certain children. State officials also identified three challenges of increasing concern over the next 5 years: children's growing exposure to illegal drugs, increased demand to provide services for children with special needs, and changing demographic trends or cultural sensitivities in providing services for some groups of children in the states' child welfare systems. Most states reported that they had implemented initiatives to address challenges associated with improving the level of services, recruiting and retaining caseworkers, and finding appropriate homes for children. These initiatives, however, did not always mirror the major challenges. For example, with respect to services, states most frequently identified that they were challenged by the lack of mental health and substance abuse services for children and families, yet only a fourth of the dissatisfied states reported having initiatives to improve the level of these services. In states where evaluations of their initiatives had been completed under a federal demonstration project, the evaluations generally showed that states had achieved mixed results across child welfare outcomes. States we visited reported that HHS reviews of their child welfare systems and training and technical assistance efforts helped them improve their child welfare programs. For example, officials in three of the five states we visited reported that the CFSRs prompted them to develop interagency strategies for providing an array of needed services to children and families. Similarly, nearly all states in our survey reported that HHS-sponsored technical assistance was helpful to some degree. However, HHS officials said that several factors limited their ability to use their technical assistance tracking system as a management tool. For example, not all service providers are included in the tracking system, and some providers inconsistently enter required data into the system. As a result, HHS may be limited in its ability to determine how best to allocate technical assistance resources to help maximize states' ability to address child welfare issues.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-07-75, Child Welfare: Improving Social Service Program, Training, and Technical Assistance Information Would Help Address Long-standing Service-Level and Workforce Challenges
This is the accessible text file for GAO report number GAO-07-75
entitled 'Child Welfare: Improving Social Service program, Training,
and Technical Assistance Information Would Help Address Long-standing
Service-level and Workforce Challenges' which was released on October
6, 2006.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Report to the Ranking Minority Member, Subcommittee on Human Resources,
Committee on Ways and Means, House of Representatives:
United States Government Accountability Office:
GAO:
October 2006:
Child Welfare:
Improving Social Service Program, Training, and Technical Assistance
Information Would Help Address Long-standing Service-Level and
Workforce Challenges:
Child Welfare:
GAO-07-75:
GAO Highlights:
Highlights of GAO-07-75, a report to Minority Member, Subcommittee on
Human Resources, Committee on Ways and Means, House of Representatives
Why GAO Did This Study:
Despite substantial federal and state investment, states have not been
able to meet all outcome measures for children in their care. Given the
complexity of the challenges that state child welfare agencies face,
GAO was asked to determine (1) the primary challenges state child
welfare agencies face in their efforts to ensure the safety, well-
being, and permanent placement of the children under their supervision;
(2) the changes states have made to improve the outcomes for children
in the child welfare system; and (3) the extent to which states
participating in the Department of Health and Human Services (HHS)
Child and Family Services Reviews (CFSR) and technical assistance
efforts find the assistance to be helpful. GAO surveyed child welfare
agencies in 50 states, the District of Columbia, and Puerto Rico and
visited 5 states, interviewed program officials, and reviewed laws,
policies, and reports.
What GAO Found:
In response to a GAO survey, state child welfare agencies identified
three primary challenges as most important to resolve to improve
outcomes for children under their supervision: providing an adequate
level of services for children and families, recruiting and retaining
caseworkers, and finding appropriate homes for certain children. State
officials also identified three challenges of increasing concern over
the next 5 years: children's growing exposure to illegal drugs,
increased demand to provide services for children with special needs,
and changing demographic trends or cultural sensitivities in providing
services for some groups of children in the states‘ child welfare
systems.
Figure: Chila Welfare Challenges Reported by States, in Fiscal Year
2006, as the Top Three Most Important Challenges to Resolve:
[See PDF for Image]
Source: GAO analysis of state child welfare survey responses.
[End of Figure]
Most states reported that they had implemented initiatives to address
challenges associated with improving the level of services, recruiting
and retaining caseworkers, and finding appropriate homes for children.
These initiatives, however, did not always mirror the major challenges.
For example, with respect to services, states most frequently
identified that they were challenged by the lack of mental health and
substance abuse services for children and families, yet only a fourth
of the dissatisfied states reported having initiatives to improve the
level of these services. In states where evaluations of their
initiatives had been completed under a federal demonstration project,
the evaluations generally showed that states had achieved mixed results
across child welfare outcomes. States we visited reported that HHS
reviews of their child welfare systems and training and technical
assistance efforts helped them improve their child welfare programs.
For example, officials in three of the five states we visited reported
that the CFSRs prompted them to develop interagency strategies for
providing an array of needed services to children and families.
Similarly, nearly all states in our survey reported that HHS-sponsored
technical assistance was helpful to some degree. However, HHS officials
said that several factors limited their ability to use their technical
assistance tracking system as a management tool. For example, not all
service providers are included in the tracking system, and some
providers inconsistently enter required data into the system. As a
result, HHS may be limited in its ability to determine how best to
allocate technical assistance resources to help maximize states‘
ability to address child welfare issues.
What GAO Recommends:
GAO recommends that HHS develop a strategy to centralize federal
program information, record all technical assistance to states in its
Technical Assistance Tracking Internet System, and ensure that these
data are complete, accurate, and timely. HHS agreed that data should be
complete, accurate, and timely, but disagreed that centralized program
information and recording all technical assistance would adequately
address states‘ child welfare challenges or improve their ability to
more effectively allocate technical assistance to states. GAO continues
to support these recommendations.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-75].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cornelia M. Ashby at
(202) 512-7215 or ashbyc@gao.gov.
[End of Section]
Contents:
Letter:
Results in Brief:
Background:
States Identified Several Long-standing and Emerging Challenges to
Ensuring Child Safety, Well-Being, and Permanency:
Emerging Challenges Include Children's Exposure to Illegal Drugs,
Caring for Special Needs Children, and Responding to Changing
Demographics of the Child Welfare Population:
State Initiatives Insufficiently Address State Challenges to Improve
Child Outcomes, and Evaluations Showed Mixed Results:
States Generally Found HHS Reviews and Technical Assistance Helpful,
but HHS's Monitoring System Has Limitations:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Objectives, Scope, and Methodology:
Appendix II: Federal Funding for State Child Welfare Programs:
Appendix III: Type, Description, and Status of Title IV-E Waiver
Demonstration Programs, as of August 2006:
Appendix IV: Department of Health and Human Services Child Welfare
National Resource Centers and whether They Are Included in the
Technical Assistance Tracking Internet System Database:
Appendix V: Comments from the Department of Health and Human Services:
Appendix VI: GAO Contacts and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: Child and Family Services Review Results Related to the Three
Most Important Child Welfare Challenges Reported by States:
Table 2: State-Reported Use and Assessment of HHS Training and
Technical Assistance:
Figures:
Figure 1: Child Welfare Challenges Reported by States as the Three Most
Important Challenges to Resolve:
Figure 2: States Reporting Dissatisfaction with the Level of Services
Provided to Children in the Child Welfare System:
Figure 3: States Reporting Dissatisfaction with the Level of Services
Provided to Parents of At-Risk Families in the Child Welfare System:
Figure 4: States Reporting Dissatisfaction with the Level of Services
Provided to Children and to Parents of At-Risk Families in the Child
Welfare System:
Figure 5: States Reporting Dissatisfaction with Factors That Could
Affect the State's Ability to Recruit and Retain Caseworkers:
Figure 6: States Reporting Factors of Greatest Concern in Making
Appropriate Placements for Children:
Figure 7: State-Reported Emerging Issues That Are Likely to Affect
Children in Child Welfare System over the Next 5 Years:
Figure 8: State-Reported Initiatives to Improve Services to Children
and Families:
Figure 9: State-Reported Initiatives to Recruit and Retain Caseworkers:
Figure 10: State-Reported Initiatives to Find Appropriate Homes for
Children:
Abbreviations:
ACF: Administration for Children and Families:
CAPTA: Child Abuse Prevention and Treatment Act:
CFDA: Catalog of Federal Domestic Assistance:
CFSR: Child and Family Services Reviews:
CHA: Children's Health Act:
CPS: Child Protective Services:
CWLA: Child Welfare League of America:
HHS: Health and Human Services:
NRC: national resource center:
PIP: program improvement plan:
TANF: Temporary Assistance for Needy Families:
TATIS: Technical Assistance Tracking Internet System:
VCAA: Victims of Child Abuse Act:
United States Government Accountability Office:
Washington, DC 20548:
October 6, 2006:
The Honorable Jim McDermott:
Ranking Minority Member:
Subcommittee on Human Resources:
Committee on Ways and Means:
House of Representatives:
Despite substantial federal and state investment in various social
services, states continue to receive more than 2 million reports of
child maltreatment each year and report having more than half a million
children in state foster care systems. While children in foster care
were removed from their homes to protect them from harm or neglect,
states have struggled to meet established federal child welfare
standards for ensuring the safety and well-being of these children in
their care. Between March 2001 and March 2004, in its first round of
Child and Family Services Reviews (CFSR) evaluating each
state's[Footnote 1] child welfare program, the U.S. Department of
Health and Human Services (HHS) found that no state had achieved all of
the federal outcome measures for ensuring the safety, well-being, and
permanency[Footnote 2] of children.
For fiscal year 2006, Congress appropriated about $8 billion to support
the ability of state child welfare systems to provide services that
protect children from abuse and neglect, promote their physical and
mental well-being, find them a permanent home, and enable families to
successfully care for their children, including those children with
special needs.[Footnote 3] At the federal level, HHS's Children's
Bureau under the Administration for Children and Families (ACF)
establishes federal policy, oversees states' child welfare programs in
part through its CFSRs, and provides technical assistance to states
primarily through its national resource centers (NRCs) and HHS regional
offices. State child welfare agencies administer the programs and
monitor the children and their families. States use federal funds to
support all aspects of the child welfare program, including helping
families stay together; providing financial support for families
fostering children who had been removed from their homes; finding
adoptive or other permanent homes for children; and recruiting, hiring,
and training child welfare employees.
Given the complexity of the challenges facing state child welfare
agencies, you asked us to determine (1) the primary challenges state
child welfare agencies face in their efforts to ensure the safety, well-
being, and permanency of the children under their supervision; (2) the
changes states have made since January 1, 2002[Footnote 4], to improve
the outcomes for children in the child welfare system; and (3) the
extent to which states participating in HHS's Child and Family Services
Reviews and technical assistance efforts find the assistance to be
helpful. As part of this work, GAO also examined the extent to which
states had developed written child welfare disaster plans for dealing
with the dispersion of children under state care to other counties or
states, because of disasters. In July 2006, GAO issued the report Child
Welfare: Federal Action Needed to Ensure States Have Plans to Safeguard
Children in the Child Welfare System Displaced by Disasters (GAO-06-
944) in response to the disaster planning part of your request.
We used multiple data collection methods to obtain this information.
First, we surveyed state child welfare directors in 50 states, the
District of Columbia, and Puerto Rico to obtain information on the most
important challenges that their agencies faced, the changes that their
agencies had made since 2002 to improve the outcomes for children, the
extent to which their states participated in HHS's oversight and
technical assistance efforts, and the extent to which they viewed the
assistance as helpful. We achieved a 96 percent response rate. Second,
we interviewed child welfare officials in five states: California, New
York, North Carolina, Texas, and Utah. These states were selected for
variance in program administration (state-administered, state-
supervised/county-administered, state-and county-administered), the
predominance of urban or rural characteristics, the achievement of
child welfare standards on the CFSRs, changes in the number of children
reported to be in foster care, and geographic location. We interviewed
federal child welfare officials and representatives from national child
welfare organizations concerning state child welfare programs, the
changes that states had made since 2002 to improve the outcomes for
children, and the extent to which states participated in HHS's CFSRs
and technical assistance efforts. In addition, we reviewed several
national studies and our previous child welfare reports to determine
the challenges that states face in their efforts to ensure the safety,
well-being, and permanency of the children under their supervision.
Finally, we analyzed agency documentation, legislation, and other
documentation related to child welfare programs and requirements. We
conducted our work between October 2005 and August 2006 in accordance
with generally accepted government auditing standards.
Results in Brief:
State child welfare agencies identified three primary challenges as
most important to resolve to improve outcomes for children under their
supervision: providing an adequate level of services for children and
families, recruiting and retaining caseworkers, and finding appropriate
homes for certain children. Specifically, most states expressed
dissatisfaction with the level of mental health and substance abuse
services for both parents and children, the high average number of
child welfare cases per worker, and their ability to find homes for
children with special needs, such as those with developmental
disabilities. GAO, child welfare organizations, and the Administration
have consistently shown these issues to be long-standing challenges for
most states and have pointed to the need for a multi-agency approach to
addressing them. For example, to address the lack of information on
available services, the White House Task Force for Disadvantaged Youth
recommended in 2003 that the Catalog of Federal Domestic Assistance
(CFDA)--a repository of information on all federal assistance programs-
-be modified to provide a search function of the locations where more
than 300 federal programs are operating to assist youth and families.
State officials also identified three challenges of increasing concern:
children's growing exposure to illegal drugs; increased demand to
provide services for children with special needs; and changing
demographic trends or cultural sensitivities in providing services for
some groups of children in the states' child welfare systems.
Most states reported that they had implemented initiatives to address
challenges associated with improving the level of services, recruiting
and retaining caseworkers, and finding appropriate homes for children.
The frequency of these initiatives, however, did not always mirror the
levels of dissatisfaction with the major challenges. For example, with
respect to services, state child welfare agencies responding to our
survey most frequently identified that they were challenged by the lack
of mental health and substance abuse services for children and
families, yet only a fourth of the states reporting dissatisfaction in
these areas also reported having initiatives to improve the level of
these services. One reason may be that these services are typically
provided outside of the child welfare system, and about half of the
states reporting this challenge also reported initiatives to improve
collaboration with other agencies. Most states reported that they had
implemented initiatives to improve recruitment and retention of child
welfare caseworkers, but states reported little or no action to address
two of the most frequently reported factors underlying this challenge.
For example, while most states reported dissatisfaction with caseworker
supervision, only two states reported specific initiatives to address
this challenge, and no states reported initiatives to address
caseworker administrative burden. Similarly, most states reported
initiatives to find appropriate homes for children, including finding
and supporting kinship homes, but only three states had initiatives to
find appropriate homes for older youth and four to find homes for
children with special needs. In states where evaluations of their
initiatives had been completed under a federal demonstration project,
the evaluations generally showed that states had achieved mixed results
across child welfare outcomes.
States we visited reported that HHS's Child and Family Services Reviews
and training and technical assistance efforts helped them assess their
efforts and ability to achieve safety, permanence, and well-being for
the children and families under their care and develop the necessary
program improvement plans to meet federal requirements for improving
their child welfare programs. For example, officials in three of the
five states we visited reported that the CFSRs prompted them to develop
interagency strategies for providing an array of needed services to
children and families. Nearly all states in our survey reported that
HHS-sponsored technical assistance was helpful to some degree. However,
HHS officials said that its technical assistance tracking system has
several limitations that hinder its use as a management tool. For
example, only 8 of the 11 NRCs are required to report to the tracking
system, and those that do inconsistently enter information into the
system. As a result, HHS officials told us that it is difficult to
determine how best to allocate technical assistance resources to help
maximize states' ability to address child welfare issues.
We are making three recommendations to the Secretary of Health and
Human Services for improving awareness of, and access to, various
social services, and improving the department's ability to manage
technical assistance. HHS agreed that technical assistance data should
be complete, accurate, and timely, but disagreed that centralized
program information and recording all technical assistance would
adequately address states' child welfare challenges or improve their
ability to effectively allocate technical assistance to states. GAO
continues to believe that implementing these recommendations would help
states address their long-standing child welfare challenges.
Background:
The well-being of children and families has traditionally been
understood as a primary duty of state governments, and state and local
governments are the primary administrators of child welfare programs
designed to protect children from abuse or neglect. Child welfare
caseworkers investigate allegations of child maltreatment and determine
what services can be offered to stabilize and strengthen a child's own
home. If remaining in the home is not a safe option for the child--he
or she may be placed in foster care while efforts to improve the home
are made. In these circumstances, foster care may be provided by a
family member, also known as kinship care; caregivers previously
unknown to the child; or a group home or institution. In those
instances where reuniting the child with his or her parents is found
not to be in the best interest of the child, caseworkers must seek a
new permanent home for the child, such as an adoptive home or
guardianship. Some children remain in foster care until they "age out"
of the child welfare system. Such children are transitioned to
independent living, generally at the age of 18 years.
Federal Funding for State Child Welfare Programs:
States use both dedicated and nondedicated federal funds for operating
their child welfare programs and providing services to children and
families. In fiscal year 2006, the federal government provided states
with about $8 billion in dedicated child welfare funds, primarily
authorized under Title IV-B and Title IV-E of the Social Security Act.
(See app. II.) Nearly all of this funding is provided under Title IV-E,
which provides matching funds to states for maintaining eligible
children in foster care, providing subsidies to families adopting
children with special needs, and for related administrative and
training costs.[Footnote 5] About 9 percent of funding is provided
under Title IV-B, which provides grants to states primarily for
improving child welfare services, including a requirement that most
funds be spent on services to preserve and support families.
A significant amount of federal funding for child welfare services also
comes from federal funds not specifically dedicated for child welfare-
-including the Temporary Assistance for Needy Families (TANF) block
grant, Medicaid, and the Social Services Block Grant. These and
hundreds of other federal assistance programs for children and
families, including many that serve low-income populations, are listed
in a centralized database administered by the General Services
Administration that has a search feature by type of assistance and
eligible population. The Congressional Research Service conservatively
estimated that the median share of total federal child welfare spending
derived from nondedicated federal funding equaled nearly half of all
the federal dollars (47 percent) expended by state child welfare
agencies,[Footnote 6] based on state child welfare agency data reported
to the Urban Institute for state fiscal year 2002.[Footnote 7]
Despite the large amount of federal funds spent on child welfare from
nondedicated sources, the Congressional Research Service reported that
attention to federal child welfare financing has focused almost
exclusively on dedicated child welfare funding streams and is driven in
part by the belief that the current structure hampers the ability of
state child welfare agencies to achieve positive outcomes for children.
Common charges are that the current structure does not grant states the
flexibility needed to meet the needs of children and their families,
and encourages states to rely too heavily on foster care. Congress
authorized HHS to conduct demonstration projects whereby states were
allowed to waive certain funding restrictions on the use of Title IV-B
and Title IV-E funds under the condition that the flexible use of funds
would be cost-neutral to the federal government. HHS reported that 24
states had participated in demonstration projects across eight child
welfare program areas, such as caseworker training and services to
caretakers with substance abuse disorders. States were required to
conduct an evaluation of project success in terms of both improving
children and family outcomes and cost neutrality.
HHS Child and Family Services Reviews and Technical Assistance:
As Congress authorized funds for state child welfare programs, it has
also required states to enact policies and meet certain standards
related to those programs. HHS evaluates how well state child welfare
systems achieve federal standards for children through its child and
family services reviews. The CFSR process begins with a state
assessment of its efforts, followed by an on-site review by an HHS team
that interviews various stakeholders in the child welfare system and
usually reviews a total of 50 child welfare case files for compliance
with federal requirements. After receiving the team's assessment and
findings, the state develops a program improvement plan (PIP) to
address any areas identified as not in substantial conformity. Once HHS
approves the PIP, states are required to submit quarterly progress
reports. Pursuant to CFSR regulations, federal child welfare funds can
be withheld if states do not show adequate PIP progress, but these
penalties are suspended during the PIP implementation term.
HHS provides training and technical assistance to help states develop
and implement their PIPs through its training and technical assistance
network. This training and technical assistance focuses on building
state agency capacity and improving the state child welfare system.
Technical assistance providers in this network include HHS's Children's
Bureau and regional offices, as well as NRCs and the department's Child
Welfare Information Gateway.[Footnote 8]
States Identified Several Long-standing and Emerging Challenges to
Ensuring Child Safety, Well-Being, and Permanency:
State child welfare agencies identified three primary challenges as the
most important to resolve to improve outcomes for children under their
supervision: providing an adequate level of services for children and
families, recruiting and retaining caseworkers, and finding appropriate
homes for children. HHS, GAO, and child welfare organizations have
consistently shown these issues to be long-standing challenges for most
states. In addition, state officials identified three challenges of
increasing concern: children's exposure to illegal drugs; increased
demand to provide services for children with special needs, such as
those with developmental disabilities; and changing demographic trends
or needs for cultural sensitivity for some groups of children in care
and their families.
Long-standing Challenges Include Providing Adequate Services,
Recruitment and Retention of Caseworkers, and Placement Issues:
In responding to our survey, states most frequently identified the
following three child welfare challenges as the most important to
resolve in order to improve the safety, permanency, and well-being of
children under states' care: providing adequate services to children
and families, recruiting and retaining caseworkers, and finding
appropriate homes for children. (See fig. 1.)
Figure 1: Child Welfare Challenges Reported by States as the Three Most
Important Challenges to Resolve:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
GAO and child welfare organizations have previously reported on the
long-standing nature of these challenges. For example, GAO previously
reported that gaps in the availability and access to services delayed
states' ability to file for a petition to terminate parental rights--a
necessary step in obtaining a permanent home for children who cannot
live with their parents--because parents were unable to obtain timely
access to substance abuse treatment and other services, such as mental
health services and housing.[Footnote 9] GAO and other organizations
have also previously reported that public and private child welfare
agencies face a number of challenges recruiting and retaining qualified
caseworkers and supervisors.[Footnote 10] For example, we reported that
high caseloads, poor supervision, and the burden of administrative
responsibilities have, in some cases, prompted caseworkers to
voluntarily leave their employment with child welfare agencies. We also
reported difficulties in recruiting adoptive parents for children with
special needs. [Footnote 11]
The most important challenges identified by state child welfare
agencies are consistent with HHS's CFSR findings and states' self-
assessments of their programs. For example, according to the
Congressional Research Service, HHS reviewers found that 43 states
needed improvement in providing accessible services to children and at-
risk families in all jurisdictions of the state and 31 states needed
improvement in conducting diligent recruitment of foster and adoptive
parents.[Footnote 12] The number of states needing improvement in
performance indicators related to child welfare services, recruitment
and retention of caseworkers, and placement of children in appropriate
homes is shown in table 1.
Table 1: Child and Family Services Review Results Related to the Three
Most Important Child Welfare Challenges Reported by States:
Child welfare challenge: Services;
Performance Indicator: Providing accessible services to children and at-
risk families in all jurisdictions within a state;
Number of states needing improvement: 43.
Child welfare challenge: Services;
Performance Indicator: Responsiveness of services to the needs of
children and at-risk families;
Number of states needing improvement: 27.
Child welfare challenge: Services;
Performance Indicator: Tailoring services to the unique needs of
children and at-risk families;
Number of states needing improvement: 22.
Child welfare challenge: Recruitment and retention of caseworkers;
Performance Indicator: Providing ongoing training for staff that
addresses the skills and knowledge needed to carry out their duties;
Number of states needing improvement: 25.
Child welfare challenge: Recruitment and retention of caseworkers;
Performance Indicator: Providing initial training for all staff who
provide child welfare services;
Number of states needing improvement: 18.
Child welfare challenge: Placement of children in appropriate homes;
Performance Indicator: Ensuring the diligent recruitment of foster and
adoptive parents;
Number of states needing improvement: 31.
Source: GAO analysis of Congressional Research Service data.
[End of table]
A Large Array of Specific Services Needed by Children and Families,
Especially in the Area of Mental Health and Substance Abuse, Underlie
the Challenge:
State child welfare agencies identified specific services underlying
their challenge to serve children and families, citing constraints on
federal funding and limited awareness of services among eligible
families as contributing factors. Regarding children, more than half of
states reported that they were dissatisfied with the level of mental
health services, substance abuse services, housing for foster youth
transitioning to independence, and dental care. (See fig. 2.)
Figure 2: States Reporting Dissatisfaction with the Level of Services
Provided to Children in the Child Welfare System:
[See PDF for image]
Source: GAO analysis of
[End of figure]
States also reported that they were dissatisfied with the level of
services provided to at-risk families in the child welfare system.
These services are needed to help prevent the removal of children from
their homes or help facilitate the reunification of children with their
parents after removal. Specifically, more than half of states responded
that they were dissatisfied with mental health services, substance
abuse services, transportation services, and housing for parents of at-
risk families. (See fig. 3.)
Figure 3: States Reporting Dissatisfaction with the Level of Services
Provided to Parents of At-Risk Families in the Child Welfare System:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
For some types of services, states expressed more dissatisfaction with
services available to at-risk families than with services available to
children. For example, more states reported dissatisfaction with the
level of at-risk family services than with children's services in the
areas of assessment of their service needs, legal services, and
advocacy or case management. (See fig. 4.)
Figure 4: States Reporting Dissatisfaction with the Level of Services
Provided to Children and to Parents of At-Risk Families in the Child
Welfare System:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
States we visited reported that funding constraints were among the
reasons maintaining an adequate level of services was difficult. For
example, while maintenance payments to foster families for children
under state care is provided as an open-ended entitlement for federal
funding under Title IV-E, federal funding for family support services
is capped at a much lower level under Title IV-B. In addition, because
the proportion of children in foster care who are eligible for federal
support has been declining, states had to provide a greater share of
funding at a time when many states were experiencing budget deficits
that adversely affected overall funding for social services. In
prioritizing funding needs, child welfare officials in 40 states
responding to our survey reported that family support services, such as
those that could prevent removal of a child or help with reunification
of a family, were the services most in need of greater federal, state,
or local resources. Officials from 29 states responded that child
protective services such as investigation, assessment of the need for
services, and monitoring were next in need of additional resources.
Officials in a state we visited indicated that some caseworkers and
families may be unaware of the array of existing services offered by
numerous public and private providers. In North Carolina, for example,
state officials reported that about 70 percent of children and families
in the child welfare system received services from multiple public
agencies, and the CFDA--a repository of information on all federal
assistance programs that is periodically updated--lists over 300
federal programs that provide youth and family services. However,
caseworkers and families are not always aware of the range of services
that are available to support them, and child welfare officials cited
the need for additional information to help link children and families
with needed services. In October 2003, the White House Task Force for
Disadvantaged Youth recommended that the CFDA be modified to provide a
search feature linked to locations where federally funded programs were
operating. A similar model may be found on an HHS Web link,
http://ask.hrsa.gov/pc/, where users can enter a ZIP code to find the
closest community health center locations offering medical, mental,
dental, and other health services on a sliding fee scale.
Large Caseloads, Administrative Burden, and the Effectiveness of
Supervision Underlie the Caseworker Recruitment and Retention
Challenge:
State child welfare officials most frequently reported dissatisfaction
with the current status of three underlying factors that affect the
state's ability to recruit and retain caseworkers. Specifically, more
than half of the states reported dissatisfaction with the average
number of cases per worker, administrative responsibilities of
caseworkers, and effectiveness of caseworker supervision. (See fig. 5.)
Figure 5: States Reporting Dissatisfaction with Factors That Could
Affect the State's Ability to Recruit and Retain Caseworkers:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
Child welfare officials in each of the states we visited reported
having trouble recruiting and retaining caseworkers because many
caseworkers are overwhelmed by large caseloads. According to a 2006
Child Welfare League of America (CWLA) report, some programs lack
caseload standards that reflect time needed to investigate allegations
of child maltreatment, visit children and families, and perform
administrative responsibilities. The report also cites CWLA's caseload
standards of no more than 12 cases per caseworker investigating
allegations of child maltreatment, and no more than 15 cases for
caseworkers responsible for children in foster care. However, according
to the report, most states, average caseloads in some areas are often
more than double the CWLA standards.
State child welfare officials we interviewed also reported that
increasing amounts of time spent on administrative duties made it
difficult to recruit and retain staff and limiting the amount of time
caseworkers could spend visiting families. For example, child welfare
officials in three states we visited estimated that some caseworkers
spent a significant amount of time on administrative duties such as
entering case data in automated systems, completing forms, and
providing informational reports to other agencies. This administrative
burden has limited caseworker ability to ensure timely investigations
of child maltreatment and to make related decisions concerning the
removal of children from their homes, according to officials, and
influenced caseworker decisions to seek other types of employment.
Some states we visited reported that the lack of effective supervision
also adversely affected staff retention and sometimes resulted in
delays providing appropriate services to children and families. Lack of
supervisory support was cited as a problem in terms of supervisor
inexperience and inaccessibility. For example, a Texas state official
said that because of high turnover, caseworkers are quickly promoted to
supervisory positions, with the result that the caseworkers they
supervise complain of poor management and insufficient support. In
Arizona, caseworkers have expressed dissatisfaction in the support they
received from their supervisors, and this has negatively affected
recruitment and retention. Child welfare officials reported that lack
of access to supervisors was frustrating to caseworkers because it
delayed their ability to specify appropriate permanency goals for
children and to develop case plans to meet the needs of children and
families in their care.
Recruiting and Retaining Foster Parents for All Kinds of Children, but
Especially for Children Who Are Older or Have Special Needs, Are Some
of the Underlying Placement Challenges for States:
Relative to other challenges, state child welfare officials most
frequently identified four factors underlying the challenge to find
appropriate homes for children. (See fig. 6.) Recruiting and retaining
foster parents and serving children with special needs were at the top
of the list. Also, more than half of the states reported that finding
homes for children with special needs, older youth, and youth
transitioning into independent living, and finding and supporting
kinship homes, were among their greatest concerns.
Figure 6: States Reporting Factors of Greatest Concern in Making
Appropriate Placements for Children:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
Child welfare officials in two states we visited said that the lack of
therapeutic foster care homes that can properly care for children who
have significant physical, mental, or emotional needs makes it
challenging to find them an appropriate home. In addition, these
officials said that some of the existing facilities are inappropriate
for child placement because they are old and in poor condition or
provide outmoded treatment services. Because of the absence of high-
quality therapeutic settings, child welfare officials said that it has
become increasingly difficult to place children in homes that can
appropriately address their individual needs.
Recruiting and retaining foster and adoptive parents has become an
increasingly difficult aspect of placement for a variety of reasons,
such as the lack of a racially and ethnically diverse pool of potential
foster and adoptive parents, and inadequate financial support. For
example, child welfare officials said that some locations have
relatively small populations of certain races and ethnicities, making
it difficult to recruit diverse foster and adoptive parents.[Footnote
13] Inadequate financial support also hinders recruiting and retaining
foster and adoptive families. Financial support for foster and adoptive
families varies widely among states and local areas, and may not keep
up with inflation. According to a California child advocacy
organization, for example, the state's payments to foster parents of
$450 per month per child have not been adjusted for inflation since
2001. As a result, according to the organization, the supply of foster
care providers has not increased markedly during this time.
Obtaining permanent homes for older youth and for youth aging out of
foster care is a continuing placement challenge for states. For
example, Texas child welfare officials said that it is difficult to
place adolescents with adoptive parents because older youth can choose
not to be adopted. Finding housing for youth transitioning into
independence also can be difficult in high-cost areas or in areas where
special arrangements have not been made with housing agencies and
landlords that typically require a cosigner on the rental application
or a large deposit before moving in.[Footnote 14]
More than half of the states also reported that limitations in their
ability to identify and support placements with family members or legal
guardians limited opportunities to place children in appropriate homes.
For example, child welfare officials in Ohio reported a lack of
resources to conduct outreach to family members that may be able to
provide a stable home for children in foster care with less disruption
to the child. Michigan officials also reported that the lack of
financial resources made it difficult for the state to meet its
placement goals for those children who had been removed from their home
and who had been directed by the court to be placed with other family
members.
Emerging Challenges Include Children's Exposure to Illegal Drugs,
Caring for Special Needs Children, and Responding to Changing
Demographics of the Child Welfare Population:
While states have experienced child welfare challenges for many years,
states identified several emerging issues that are of increasing
concern because of their impact on the well-being of children in the
child welfare system. Most states reported a high likelihood that three
issues will affect their systems over the next 5 years: children's
exposure to illegal drugs, caring for special or high-needs children,
and changing demographics and cultural sensitivities. (See fig. 7.)
Figure 7: State-Reported Emerging Issues That Are Likely to Affect
Children in Child Welfare System over the Next 5 Years:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
Although the overall percentage of drug-related child welfare cases has
not increased, officials in the states we visited reported that the
type and location of drug abuse underlying maltreatment cases is
changing, requiring increased attention by child welfare agencies in
certain areas. For example, child welfare officials reported an
increasing number of children entering state care as a result of
methamphetamine use by parents, primarily in rural areas. Child welfare
agencies in these areas may need to train caseworkers on how this drug
is likely to affect parents or caregivers who use it in order to safely
investigate and remove children from homes, as well as assess the
service needs of affected families to develop an appropriate case
plan.[Footnote 15]
State child welfare officials in all five states we visited said that
finding homes for special needs children is a growing issue because it
is hard to find parents willing to foster or adopt these children and
who live near the types of services required to meet the children's
needs. For example, child welfare officials in one of the states we
visited reported that the state does not have a sufficient number of
adoptive homes for children with special needs. As a result, these
children generally stay in foster care for longer periods of time.
Child welfare officials we interviewed also said that the growing
cultural diversity of the families who come in contact with the child
welfare system has prompted the need for states to reevaluate how they
investigate allegations of maltreatment and the basis on which they
make decisions that could result in the removal of children from their
homes. Child welfare officials in several states reported that the
current protocols for investigating and removing children from their
homes do not necessarily reflect the cultural norms of some immigrant
and other minority families. These differences include limitations in
family functioning that may be caused by poverty, the environment, or
culture as opposed to those that may be due to unhealthy family
conditions or behaviors. In response to growing cultural diversity,
several states we visited stated that they are revising their protocols
to account for religious and language differences among families who
come in contact with the child welfare system.
State Initiatives Insufficiently Address State Challenges to Improve
Child Outcomes, and Evaluations Showed Mixed Results:
Most states reported that they had implemented initiatives since
January 2002 to address challenges associated with maintaining an
adequate level of services, recruiting and retaining caseworkers, and
finding appropriate homes for children. However, these initiatives did
not address all of the key factors states reported being associated
with these challenges. In states where evaluations of their initiatives
had been completed under a federal demonstration project, the
evaluations generally showed that states had achieved mixed results
across child welfare outcomes.
State Initiatives Did Not Address All the Key Factors Related to the
Three Challenges Cited as Most Important to Improve Child Outcomes:
States reported implementing various initiatives to improve child
outcomes, but these initiatives did not always mirror those factors
states reported as most necessary to address in overcoming their
primary challenges. For example, with respect to services, states most
frequently identified that they were challenged by the lack of mental
health and substance abuse services for children and families, yet only
a fourth of the 32 states dissatisfied with these services reported
having initiatives to improve the level of these services. (See fig.
8.) This may be because these services are typically provided outside
the child welfare system by other agencies. About half of the states
reporting dissatisfaction also reported initiatives to improve
collaboration with other agencies.[Footnote 16]
Figure 8: State-Reported Initiatives to Improve Services to Children
and Families:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[A] Other initiatives include court-required changes of services,
focusing on children 0-3 years of age, and creating a family division
in the court system.
[End of figure]
Similarly, most states reported that they had implemented initiatives
to improve recruitment and retention of child welfare caseworkers, but
states reported little or no action to address two of the most
frequently reported factors underlying this challenge. (See fig. 9.)
While most states reported dissatisfaction with the supervision of
caseworkers, only two reported specific initiatives to address this
challenge. Similarly, while over half of the states reported
dissatisfaction with the administrative responsibilities of
caseworkers, no state reported an initiative to address this challenge.
One way of streamlining administrative responsibilities--through new
technology--may be difficult for many states because nearly half of the
states reported that they did not have an operational statewide
automated child welfare information system.
Figure 9: State-Reported Initiatives to Recruit and Retain Caseworkers:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[A] Other initiatives include developing a child welfare leadership
program, centralizing hiring processes, and expanding community-based
services.
[End of figure]
Almost all states reported implementing initiatives to improve their
ability to find appropriate homes for children, but few states
addressed two of the three most frequently reported factors underlying
this challenge (see fig. 10). For example, three states reported
initiatives to find appropriate homes for older youth transitioning to
independence and four states reported initiatives to find appropriate
homes for children with special needs.[Footnote 17]
Figure 10: State-Reported Initiatives to Find Appropriate Homes for
Children:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[A] Other initiatives include working with Native American groups on
child placement, implementing team decision making, and ensuring that
children in out-of-region placements are seen regularly.
[End of figure]
States implementing initiatives under federal demonstration projects
were required to conduct evaluations, and these evaluations showed
mixed results. In general, the demonstration projects offered states
the flexibility to use federal funding under Title IV-B and Title IV-E
in eight different program areas in an effort to improve services and
placements--addressing the three primary challenges reported by states
(see app. III). As of 2006, 24 states had implement 38 child welfare
waiver demonstrations. However, evaluation results were mixed across
child welfare outcomes. For example, while Illinois found strong
statistical support for the finding that funding for assisted
guardianships increased attainment of permanent living arrangements,
none of the other four reporting states found similar conclusive
evidence of this finding. Similarly, among four states using Title IV-
E funds to fund services and supports for caregivers with substance
abuse disorders, Illinois was the only state that demonstrated success
in connecting caregivers to treatment services. States can no longer
apply for participation in federal demonstration projects because the
program authorization expired in March 2006.
States Generally Found HHS Reviews and Technical Assistance Helpful,
but HHS's Monitoring System Has Limitations:
States we interviewed reported that HHS's CFSR and technical assistance
efforts were helpful in implementing federal child welfare
requirements. Similarly, nearly all states in our survey reported that
HHS-sponsored technical assistance was helpful to some degree. However,
HHS officials said that limitations in their technical assistance
tracking system made it difficult to maximize its use as a management
tool.
HHS Child and Family Services Reviews Helped States Assess Needs and
Make Improvements:
State child welfare officials generally reported that HHS's CFSR
reviews have assisted them in assessing their efforts and ability to
achieve the safety, permanence, and well-being for the children under
their care and develop the necessary program improvement plans to meet
federal requirements in this regard. Specifically, state officials
responding to our survey reported that the reviews had helped them to
implement system wide child welfare reform, improve their quality
assurance systems, and increase their collaboration with other child
welfare-related agencies. Additionally, child welfare officials in
three of the five states we visited reported that the reviews prompted
them to develop interagency strategies for providing an array of needed
services, such as mental health services and education for children and
families.
Most states reported that there was not much need to improve the
usefulness of the CFSR process to help the state ensure safety,
permanence, and well-being of children in the child welfare system, but
some state officials expressed concern about the outcome measures used.
Of the 48 states responding to our survey question about the CFSR
process, 33 states reported that the usefulness of the CFSR process
needed little to none or some improvement. Some state officials we
interviewed were concerned, however, that the outcomes being measured
in the reviews may not accurately reflect their child welfare program
performance. In addition, officials in three of the five of the states
we visited expressed concern about the small number of sample cases
used by the reviewers to evaluate their state's performance.
Specifically, officials in one state reported that evaluating only 50
cases left the state with uncertainty about how pervasive problems are
in the state and what its priority areas should be.[Footnote 18]
Although the first round of HHS's reviews showed that no state had
reached substantial conformity on all of the federal outcome goals for
state child welfare systems, HHS officials said that states had made
progress in implementing federal requirements and improving their child
welfare systems. For example, HHS officials said that the quality of
data has improved because states have put a greater focus on having
accurate and reliable data and many states are examining their data in
greater detail than before in an effort to identify problems in their
child welfare systems and to figure out how to meet the CFSR
requirements. The next round of reviews is scheduled to begin at the
end of fiscal year 2006, when HHS officials will once again measure
states' progress in meeting federal child welfare requirements.
States Generally Viewed Federal Technical Assistance as Helpful, but
HHS's Monitoring System Has Limitations as a Management Tool:
Nearly all states reported in our survey that the federal technical
assistance they received to improve their child welfare programs was
helpful to some degree,[Footnote 19] although some resources were given
higher ratings than others, as shown in table 2. States generally
reported the highest levels of satisfaction with assistance provided by
two of HHS's national resource centers that had primary responsibility
for helping with child protective service and organizational
improvement. The federal resources providing technical assistance in
the areas of substance abuse, community-based child abuse prevention,
and abandoned infants received the fewest requests from states.
Table 2: State-Reported Use and Assessment of HHS Training and
Technical Assistance:
National child welfare resource centers: Center for Child Protective
Services;
Number of states using technical assistance: 33;
Number of states finding assistance very or extremely helpful: 31;
Number of states finding assistance somewhat or moderately helpful: 2.
National child welfare resource centers: Center for Organizational
Improvement;
Number of states using technical assistance: 36;
Number of states finding assistance very or extremely helpful: 32;
Number of states finding assistance somewhat or moderately helpful: 3.
National child welfare resource centers: Center for Youth Development;
Number of states using technical assistance: 27;
Number of states finding assistance very or extremely helpful: 22;
Number of states finding assistance somewhat or moderately helpful: 5.
National child welfare resource centers: Collaboration to AdoptUsKids;
Number of states using technical assistance: 37;
Number of states finding assistance very or extremely helpful: 30;
Number of states finding assistance somewhat or moderately helpful: 6.
National child welfare resource centers: Center for Family-Centered
Practice and Permanency Planning;
Number of states using technical assistance: 34;
Number of states finding assistance very or extremely helpful: 26;
Number of states finding assistance somewhat or moderately helpful: 8.
National child welfare resource centers: Center for Adoption;
Number of states using technical assistance: 24;
Number of states finding assistance very or extremely helpful: 18;
Number of states finding assistance somewhat or moderately helpful: 5.
National child welfare resource centers: Center on Legal & Judicial
Issues;
Number of states using technical assistance: 26;
Number of states finding assistance very or extremely helpful: 19;
Number of states finding assistance somewhat or moderately helpful: 5.
National child welfare resource centers: Center for Child Welfare Data
& Technology;
Number of states using technical assistance: 31;
Number of states finding assistance very or extremely helpful: 20;
Number of states finding assistance somewhat or moderately helpful: 11.
Other federal resources: National Adoption Information Clearinghouse;
Number of states using technical assistance: 29;
Number of states finding assistance very or extremely helpful: 23;
Number of states finding assistance somewhat or moderately helpful: 6.
Other federal resources: National Clearinghouse on Child Abuse and
Neglect Information;
Number of states using technical assistance: 33;
Number of states finding assistance very or extremely helpful: 22;
Number of states finding assistance somewhat or moderately helpful: 11.
Other federal resources: HHS regional offices;
Number of states using technical assistance: 47;
Number of states finding assistance very or extremely helpful: 31;
Number of states finding assistance somewhat or moderately helpful: 16.
Other federal resources: Center on Substance Abuse and Child Welfare;
Number of states using technical assistance: 17;
Number of states finding assistance very or extremely helpful: 11;
Number of states finding assistance somewhat or moderately helpful: 4.
Other federal resources: Center for Community-Based Child Abuse
Prevention Programs;
Number of states using technical assistance: 11;
Number of states finding assistance very or extremely helpful: 7;
Number of states finding assistance somewhat or moderately helpful: 4.
Other federal resources: National Abandoned Infants Assistance Resource
Center;
Number of states using technical assistance: 6;
Number of states finding assistance very or extremely helpful: 1;
Number of states finding assistance somewhat or moderately helpful: 4.
Source: GAO analysis of state child welfare survey responses.
[End of table]
HHS's Technical Assistance Tracking Internet System (TATIS) monitors
federal training and technical assistance requested and provided to
states, but several limitations that hinder its use as a management
tool. One limitation is that the system was designed to capture only
assistance provided by eight NRCs. (See app. IV.) Because TATIS does
not capture training and technical assistance provided by the remaining
three NRCs, other federal resource centers, and HHS's regional offices,
HHS officials do not have a complete picture of the assistance
requested by states and provided to them. For example, the NRC for
substance abuse is not required to enter data into TATIS, but NRC
records show that it provided 47 on-site technical assistance visits to
16 states in fiscal year 2005, making it among one of the most frequent
providers of on-site federal assistance. A second limitation is that
the eight NRCs do not always enter information into TATIS as required,
raising concerns about the ability of HHS to determine how often states
use its various resources and for what purpose. For example, an
official from one of the eight NRCs we interviewed said that his center
is not as conscientious as it should be about entering all of the
required data into TATIS. HHS officials said that without this
information, it is difficult to determine how best to allocate
technical assistance resources to help maximize states' ability to
address child welfare issues.
Conclusions:
States have been facing some of the same child welfare challenges for
many years, and predict that some emerging challenges will have impacts
in the next several years. The federal government has funded hundreds
of programs to meet families' mental health, substance abuse treatment,
and other social service needs that could help prevent child
maltreatment and keep families together. However, the inability to
query the federal government's central source of information--the CFDA-
-to identify which services across program and agencies are available
in various locations makes it difficult to determine the extent of
services available at the local level to serve children and families in
the child welfare system.
HHS has provided state child welfare systems an array of training and
technical assistance that states report as helpful for improving their
child welfare programs. Maximizing the value of its training and
technical assistance is compromised, however, because HHS's information
system does not capture all training and technical assistance provided
to states from various HHS-sponsored providers, and compliance with the
reporting requirements has not been enforced. In the absence of
complete and timely information, HHS may be limited in its ability to
determine how best to allocate technical assistance resources to help
maximize states' ability to address child welfare issues.
Recommendations for Executive Action:
We are making the following three recommendations to the Secretary of
Health and Human Services for improving awareness of and access to
various social services, and improving the department's ability to
manage technical assistance provided to state child welfare agencies.
* Develop a strategy to centralize information on federal assistance
programs that are available to meet child welfare program and service
needs and that can be accessed by state and local child welfare staff
and providers. This strategy could follow a previous Administration
recommendation to develop an Internet-based search for services through
the Catalog of Federal Domestic Assistance (CFDA) that is linked to
grantees by ZIP code.
* Require all HHS technical assistance providers, including HHS
regional offices and all national resource centers, to enter training
and technical assistance data into the department's Technical
Assistance Tracking Internet System.
* Establish policies and procedures to ensure that complete and
accurate data are timely reported to the Technical Assistance Tracking
Internet System.
Agency Comments and Our Evaluation:
We provided a draft of this report to HHS for review and comment. HHS's
written comments are reprinted in appendix V, and the Department's
technical comment was incorporated into the report. In its written
comments, HHS stated that the report substantially supports many of the
findings of the CFSRs, and agreed with one of our three
recommendations. The department agreed with our recommendation to
establish policies and procedures to ensure complete and accurate
reporting of data into TATIS and said it intended to provide written
guidance to the resource centers requiring this reporting. However, the
department stated that the report misconstrued the intent of the CFSRs
and that the remaining recommendations do not adequately match the
articulated needs of state welfare agencies.
HHS disagreed with GAO's reference that no state had achieved all of
the federal outcome measures for ensuring the safety, well-being, and
permanency of children. The department stated that it makes separate
determinations regarding substantial conformity for each of the seven
outcome measures and each of the seven systemic factors reviewed. We
revised the text to reflect that no state had reached substantial
conformity on all of the federal outcome goals for state child welfare
systems in lieu of stating that no state had achieved all of the
federal performance goals.
HHS disagreed with our recommendation to increase awareness of federal
assistance programs by modifying the CFDA, stating that it was
misleading to assume that state challenges could be significantly met
or appreciably altered by a list of resources, in part because the
recommendation incorrectly implies that local child welfare agencies
are not aware of many valuable services; underestimates the substantive
knowledge of resources currently being utilized by caseworkers; child
welfare staff need access to actual services or service providers
rather than general information on federal assistance programs;
resource lists quickly become outdated with state and county programs
and service providers changing annually based on their budgets; and
certain federal programs are designed to meet the needs of very
specific, and sometimes very small, populations.
We acknowledge that increasing awareness of available federal resources
is not the only action needed to address the various challenges facing
state child welfare agencies, but believe that caseworker awareness and
referral of children and families to existing resources is an important
first step in meeting the challenge to provide an adequate level of
services to them. As our report states, our current and past work has
found that some caseworkers were unaware of the full array of federal
resources, such as health and housing services, available in their
locales, or had not coordinated with other agencies and organizations
to access them. We continue to support the view that modifying the CFDA
would allow caseworkers and others to more easily identify services and
service providers funded by federal agencies in closest proximity to
the families they serve. As the department points out, modifying the
CFDA would not address issues related to outdated listings of state or
local resources; however, the CFDA is updated biweekly or more often in
response to new or changing information regarding federal assistance.
Further, while it is true that some federal programs target specific
populations, these populations are often low-income or minority groups
that are also served by the child welfare system.
The department also disagreed with our recommendation to require all
HHS technical assistance providers to enter data into TATIS, stating
that the system was not designed to monitor all technical assistance
provided to states, nor would it be an effective stand-alone mechanism
to determine how best to allocate technical assistance resources to
states; the recommendation does not give sufficient weight to the CFSR
process; including training and technical assistance by regional
offices in TATIS would be superfluous as these activities are in
regional office job descriptions; and the recommendation does not
recognize that training and technical assistance is provided to a
variety of audiences beyond the state child welfare agencies, and
including more information would confuse the tracking of technical
assistance.
Our report recognizes that TATIS was designed to monitor on-site
training and technical assistance provided by 8 of the 11 resource
centers. However, we continue to believe that expanding TATIS to
capture the substantial on-site assistance provided by the remaining
resource centers and other HHS providers would enhance its contribution
to the department in determining how best to allocate training and
technical assistance resources to states. We acknowledge the benefit of
the CFSRs in identifying states' technical assistance needs. However,
state implementation of program improvement plans in response to the
CFSR findings is only a part of training and technical assistance
requested and provided to states. In addition, while regional office
job descriptions may include training and technical assistance
responsibilities, we do not believe that capturing the amount and type
of this assistance actually provided to states would be superfluous,
but rather provide a more complete picture of the on-site assistance
received by states. Further, our recommendation was not intended to
include training and technical assistance provided to audiences beyond
the state child welfare agencies, and we modified the report text to
clarify this point.
Copies of this report are being sent to the Secretary of Health and
Human Services, relevant congressional committees, and other interested
parties. We will also make copies available to others upon request. In
addition, the report will be made available at no charge on GAO's Web
site at [hyperlink, http://www.gao.gov]. Please contact me on (202) 512-
7215 if you or your staff have any questions about this report. Other
contacts and major contributors are listed in appendix VI.
Sincerely yours,
Signed by:
Cornelia M. Ashby:
Director, Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
We were asked to examine (1) the primary challenges state child welfare
agencies face in their efforts to ensure the safety, well-being, and
permanency of the children under their supervision; (2) the changes
states have made since January 1, 2002, to improve the outcomes for
children in the child welfare system; and (3) the extent to which
states participating in the Department of Health and Human Services
(HHS) Child and Family Services Reviews (CFSR) and technical assistance
efforts find the assistance to be helpful. As part of this work, GAO
also examined the extent to which states had developed written child
welfare disaster plans for dealing with the dispersion of children
under state care to other counties or states, because of disasters. In
July 2006, GAO issued the report Child Welfare: Federal Action Needed
to Ensure States Have Plans to Safeguard Children in the Child Welfare
System Displaced by Disasters (GAO-06-944) in response to the disaster
planning part of your request.
To learn more about these objectives, we conducted a Web-based survey
of state child welfare directors and conducted site visits in five
states where we interviewed state officials. We also interviewed
federal child welfare officials and representatives from national child
welfare organizations concerning state child welfare programs, the
changes that states had made since 2002 to improve the outcomes for
children, and the extent to which states participated in HHS's CFSR and
technical assistance efforts. In addition, we reviewed several national
studies and our previous child welfare reports to determine the
challenges that states face in their efforts to ensure the safety, well-
being, and permanency of the children under their supervision. Finally,
we analyzed agency documentation, legislation, and other documentation
related to child welfare programs and requirements. We conducted our
work between October 2005 and August 2006 in accordance with generally
accepted government auditing standards.
Web-Based Survey:
To obtain state perspectives on our objectives and the relative
priority state child welfare agencies place on the challenges they
face, we conducted a Web-based survey of child welfare directors in the
50 states, the District of Columbia, and Puerto Rico. The survey was
conducted using a self-administered electronic questionnaire posted on
the Web. We contacted directors via e-mail announcing the survey and
sent follow-up e-mails to encourage responses. The survey data were
collected between February and May 2006. We received completed surveys
from 48 states, the District of Columbia, and Puerto Rico (a 96 percent
response rate). The states of Massachusetts and Nebraska did not return
completed surveys.
To develop the survey questions, we reviewed several national studies
and our previous child welfare reports to determine the challenges that
states face in their efforts to ensure the safety, well-being, and
permanency of the children under their supervision. We analyzed agency
documentation to identify HHS's oversight and technical assistance
efforts. In November 2005, we also held two discussion groups with
representatives from child welfare stakeholder groups to identify any
additional issues that may not be covered in the published documents we
reviewed. The stakeholders included representatives from the
Association of Administrators of the Interstate Compact on the
Placement of Children, the Child Welfare League of America, the
National Association of Public Child Welfare Administrators, the AARP
Grandparent Information Center, the Pew Commission on Children in
Foster Care, the Urban Institute, American Bar Association Center on
Children and the Law, the Center for the Study of Social Policy, the
American Public Human Services Association, and Casey Family Services.
We worked to develop the questionnaire with social science survey
specialists. Because these were not sample surveys, there are no
sampling errors. However, the practical difficulties of conducting any
survey may introduce errors, commonly referred to as nonsampling
errors. For example, differences in how a particular question is
interpreted, in the sources of information that are available to
respondents, or how the data are entered into a database can introduce
unwanted variability into the survey results. We took steps in the
development of the questionnaires, the data collection, and data
analysis to minimize these nonsampling errors. For example, prior to
administering the survey, we pretested the content and format of the
questionnaire with several states to determine whether (1) the survey
questions were clear, (2) the terms used were precise, (3) respondents
were able to provide the information we were seeking, and (4) the
questions were unbiased. We made changes to the content and format of
the final questionnaire based on pretest results. In that these were
Web-based surveys in which respondents entered their responses directly
into our database, there was a reduced possibility of data entry error.
We also performed computer analyses to identify inconsistencies in
responses and other indications of error. In addition, an independent
analyst verified that the computer programs used to analyze the data
were written correctly.
Site Visits:
We visited five states--California, New York, North Carolina, Texas,
and Utah. We selected these states because they represent different
types of program administration (state-administered, state-supervised
and county-administered, state-and county-administered), the
predominance of urban or rural characteristics, the achievement of
child welfare standards on the CFSR, changes in the number of children
reported to be in foster care, and are geographically diverse. During
these visits, we interviewed state child welfare officials and
collected relevant state agency policies and procedures and reports.
Information that we gathered on our site visits represents only the
conditions present in the states and local areas at the time of our
site visits. We cannot comment on any changes that may have occurred
after our fieldwork was completed. Furthermore, our fieldwork focused
on in-depth analysis of only a few selected states. On the basis of our
site visit information, we cannot generalize our findings beyond the
states we visited.
[End of section]
Appendix II: Federal Funding for State Child Welfare Programs:
Program: Child welfare total;
Fiscal year: 2004: 7,756;
Final funding (in millions of dollars): Fiscal year 2005: 7,764;
Final funding (in millions of dollars): Fiscal year: 2006: 7,676;
President's budget request: Fiscal year: 2007: 7,989.
Program: Title IV-E of the Social Security Act: Title IV-E subtotal;
Final funding (in millions of dollars): Fiscal year: 2004: 6,866.2;
Final funding (in millions of dollars): Fiscal year: 2005: 6,861.9;
Final funding (in millions of dollars): Fiscal year: 2006: 6,772;
President's budget request: Fiscal year: 2007: 7,048.9.
Program: Title IV-E of the Social Security Act: Foster care--Open-ended
reimbursement of eligible state claims for maintaining children in
foster care and for related administrative and training costs;
Final funding (in millions of dollars): Fiscal year: 2004: 4,974;
Final funding (in millions of dollars): Fiscal year: 2005: 4,896;
Final funding (in millions of dollars): Fiscal year: 2006: 4,685;
President's budget request: Fiscal year: 2007: 4,786.
Program: Title IV-E of the Social Security Act: Adoption assistance--
Open-ended reimbursement of eligible state claims for providing
subsidies to special needs adoptees and for related administrative and
training costs;
Final funding (in millions of dollars): Fiscal year: 2004: 1,700;
Final funding (in millions of dollars): Fiscal year: 2005: 1,770;
Final funding (in millions of dollars): Fiscal year: 2006: 1,883;
President's budget request: Fiscal year: 2007: 2,047.
Program: Title IV-E of the Social Security Act: Foster care
independence--Formula grants to states for provision of independent
living services to youth expected to age out of foster care and to
youth who have aged out of care;
Final funding (in millions of dollars): Fiscal year: 2004: 140;
Final funding (in millions of dollars): Fiscal year: 2005: 140;
Final funding (in millions of dollars): Fiscal year: 2006: 140;
President's budget request: Fiscal year: 2007: 140.
Program: Title IV-E of the Social Security Act: Education and training
vouchers--Formula grants to states to provide education and training
vouchers to youth who have aged out of foster care;
Final funding (in millions of dollars): Fiscal year: 2004: 44.7;
Final funding (in millions of dollars): Fiscal year: 2005: 46.6;
Final funding (in millions of dollars): Fiscal year: 2006: 46.2;
President's budget request: Fiscal year: 2007: 46.2.
Program: Title IV-E of the Social Security Act: Adoption incentives--
Bonus funds to states that increase the number of foster children
adopted;
Final funding (in millions of dollars): Fiscal year: 2004: 7.5;
Final funding (in millions of dollars): Fiscal year: 2005: 9.3;
Final funding (in millions of dollars): Fiscal year: 2006: 17.8;
President's budget request: Fiscal year: 2007: 29.7.
Program: Title IV-B of the Social Security Act: IV-B subtotal;
Final funding (in millions of dollars): Fiscal year: 2004: 700.4;
Final funding (in millions of dollars): Fiscal year: 2005: 701.4;
Final funding (in millions of dollars): Fiscal year: 2006: 708.3;
President's budget request: Fiscal year: 2007: 748.3.
Program: Title IV-B of the Social Security Act: Promoting safe and
stable families--Formula grants to states for four kinds of services:
family preservation, family support, time- limited reunification, and
adoption promotion and support;
Final funding (in millions of dollars): Fiscal year: 2004: 404;
Final funding (in millions of dollars): Fiscal year: 2005: 404;
Final funding (in millions of dollars): Fiscal year: 2006: 394;
President's budget request: Fiscal year: 2007: 434.
Program: Title IV-B of the Social Security Act: Child welfare services--
Formula grants to states to improve public child welfare services;
Final funding (in millions of dollars): Fiscal year: 2004: 289;
Final funding (in millions of dollars): Fiscal year: 2005: 290;
Final funding (in millions of dollars): Fiscal year: 2006: 287;
President's budget request:Fiscal year: 2007: 287.
Program: Title IV-B of the Social Security Act: Court improvement--
Formula grants to states' highest courts to strengthen handling of
court child welfare proceedings;
Final funding (in millions of dollars): Fiscal year: 2004: NA;
Final funding (in millions of dollars): Fiscal year: 2005: NA;
Final funding (in millions of dollars): Fiscal year: 2006: 20;
President's budget request: Fiscal year: 2007: 20.0.
Program: Title IV-B of the Social Security Act: Child welfare training--
Competitive grants to private nonprofit institutions of higher
education to develop and improve education and training programs for
child welfare workers;
Final funding (in millions of dollars): Fiscal year: 2004: 7.4;
Final funding (in millions of dollars): Fiscal year: 2005: 7.4;
Final funding (in millions of dollars): Fiscal year: 2006: 7.3;
President's budget request: Fiscal year: 2007: 7.3.
Program: Child Abuse Prevention and Treatment Act (CAPTA): CAPTA
subtotal;
Final funding (in millions of dollars): Fiscal year: 2004: 89.5;
Final funding (in millions of dollars): Fiscal year: 2005: 101.8;
Final funding (in millions of dollars): Fiscal year: 2006: 95.2;
President's budget request: Fiscal year: 2007: 95.2.
Program: Child Abuse Prevention and Treatment Act (CAPTA): Community-
based grants for child abuse prevention--Formula grants to lead entity
in each state to support community-based services designed to prevent
child abuse and neglect;
Final funding (in millions of dollars): Fiscal year: 2004: 33.2;
Final funding (in millions of dollars): Fiscal year: 2005: 42.9;
Final funding (in millions of dollars): Fiscal year: 2006: 42.4;
President's budget request: Fiscal year: 2007: 42.4.
Program: Child Abuse Prevention and Treatment Act (CAPTA): Basic state
grants--Formula grants to states to improve their child protection
services;
Final funding (in millions of dollars): Fiscal year: 2004: 21.9;
Final funding (in millions of dollars): Fiscal year: 2005: 27.3;
Final funding (in millions of dollars): Fiscal year: 2006: 27.0;
President's budget request: Fiscal year: 2007: 27.0.
Program: Child Abuse Prevention and Treatment Act (CAPTA):
Discretionary activities--Competitive grants for research and
demonstration programs related to preventing or treating child
maltreatment;
Final funding (in millions of dollars): Fiscal year: 2004: 34.4;
Final funding (in millions of dollars): Fiscal year: 2005: 31.6;
Final funding (in millions of dollars): Fiscal year: 2006: 25.8;
President's budget request: Fiscal year: 2007: 25.8.
Program: Victims of Child Abuse Act (VCAA): VCAA subtotal;
Final funding (in millions of dollars): Fiscal year: 2004: 26.9;
Final funding (in millions of dollars): Fiscal year: 2005: 28.6;
Final funding (in millions of dollars): Fiscal year: 2006: 28.8;
President's budget request: Fiscal year: 2007: 25.8.
Program: Victims of Child Abuse Act (VCAA): Court-appointed special
advocates--Competitive grants to support advocacy in court for child
victims of abuse and neglect;
Final funding (in millions of dollars): Fiscal year: 2004: 11.6;
Final funding (in millions of dollars): Fiscal year: 2005: 11.7;
Final funding (in millions of dollars): Fiscal year: 2006: 11.7;
President's budget request: Fiscal year: 2007: 11.8.
Program: Victims of Child Abuse Act (VCAA): Children's advocacy
centers--Competitive grants for services to child victims of abuse (and
nonoffending family members), to coordinate child abuse investigations
in ways that reduce their trauma, and for related training and
technical assistance;
Final funding (in millions of dollars): Fiscal year: 2004: 13.0;
Final funding (in millions of dollars): Fiscal year: 2005: 15.0;
Final funding (in millions of dollars): Fiscal year: 2006: 14.8;
President's budget request: Fiscal year: 2007: 11.7.
Program: Victims of Child Abuse Act (VCAA): Training for judicial
practitioners and personnel-- Competitive grant to improve court
handling of child abuse and neglect cases;
Final funding (in millions of dollars): Fiscal year: 2004: 2.3;
Final funding (in millions of dollars): Fiscal year: 2005: 1.9;
Final funding (in millions of dollars): Fiscal year: 2006: 2.3;
President's budget request: Fiscal year: 2007: 2.3.
Program: Children's Health Act (CHA): CHA subtotal;
Final funding (in millions of dollars): Fiscal year: 2004: 12.8;
Final funding (in millions of dollars): Fiscal year: 2005: 12.8;
Final funding (in millions of dollars): Fiscal year: 2006: 12.7;
President's budget request: Fiscal year: 2007: 12.7.
Program: Children's Health Act (CHA): Infant adoption awareness--
Competitive grants to train staff in non-profit health centers about
adoption;
Final funding (in millions of dollars): Fiscal year: 2004: 9.8;
Final funding (in millions of dollars): Fiscal year: 2005: 9.8;
Final funding (in millions of dollars): Fiscal year: 2006: 9.7;
President's budget request: Fiscal year: 2007: 9.7.
Program: Children's Health Act (CHA): Special needs adoption awareness--
Competitive grants for a public campaign about adoption of children
with special needs;
Final funding (in millions of dollars): Fiscal year: 2004: 3.0;
Final funding (in millions of dollars): Fiscal year: 2005: 3.0;
Final funding (in millions of dollars): Fiscal year: 2006: 3.0;
President's budget request: Fiscal Year: 2007: 3.0.
Program: Other programs: Subtotal (other);
Final funding (in millions of dollars): Fiscal year: 2004: 59.3;
Final funding (in millions of dollars): Fiscal year: 2005: 59.1;
Final funding (in millions of dollars): Fiscal year: 2006: 58.6;
President's budget request: Fiscal year: 2007: 58.6.
Program: Other programs: Adoption opportunities--Competitive grants to
eliminate barriers to adoptions--especially to special needs adoptions;
Final funding (in millions of dollars): Fiscal year: 2004: 27.2;
Final funding (in millions of dollars): Fiscal year: 2005: 27.1;
Final funding (in millions of dollars): Fiscal year: 2006: 26.8;
President's budget request: Fiscal year: 2007: 26.8.
Program: Other programs: Children's Justice Act grants--Formula grant
to states to improve the handling, investigation, and prosecution of
child abuse and neglect cases;
Final funding (in millions of dollars): Fiscal year: 2004: 20.0;
Final funding (in millions of dollars): Fiscal year: 2005: 20.0;
Final funding (in millions of dollars): Fiscal year: 2006: 20.0;
President's budget request: Fiscal year: 2007: 20.0.
Program: Other programs: Abandoned infants assistance--Competitive
grants to prevent abandonment of infants exposed to HIV/AIDS or drugs
and for services and programs to address needs of abandoned children;
Final funding (in millions of dollars): Fiscal year: 2004: 12.1;
Final funding (in millions of dollars): Fiscal year: 2005: 12.0;
Final funding (in millions of dollars): Fiscal year: 2006: 11.8;
President's budget request: Fiscal year: 2007: 11.8.
Source: Congressional Research Service documents.
[End of table]
[End of section]
Appendix III: Type, Description, and Status of Title IV-E Waiver
Demonstration Programs, as of August 2006:
Project type and description: Assisted guardianship/ kinship
permanence: Relatives/other caregivers who assume legal custody of
children are eligible for a monthly subsidy equal or comparable to
foster care payments;
Status of demonstration by state: Active demonstrations: Under original
waiver: Montana (2006); New Mexico (2005);
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty];
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: Illinois (2008); North Carolina, Oregon (2009);
Status of demonstration by state: Completed demonstrations: On time:
Delaware (2002); Maryland (2004);
Status of demonstration by state: Completed demonstrations: Terminated
early: [Empty];
Status of demonstration by state: Approved, not implemented: Minnesota;
Wisconsin;
Evaluation progress: Completed: Delaware, Illinois, Maryland, North
Carolina, Oregon, New Mexico; Expected: Montana March 2007.
Project type and description: Capped IV-E allocations and flexibility
to local agencies: States give counties or other local entities
flexibility in spending child welfare dollars for new services and
supports in exchange for a capped per child/per family allocation of
Title IV-E funds;
Status of demonstration by state: Active demonstrations: Under original
waiver: [Empty];
Status of demonstration by state: Active demonstrations: Under short-
term extension: Indiana (2005);
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: North Carolina, Ohio, Oregon (2009);
Status of demonstration by state: Completed demonstrations: On time:
[Empty];
Status of demonstration by state: Completed demonstrations: Terminated
early: [Empty];
Status of demonstration by state: Approved, not implemented: [Empty];
Evaluation progress: Completed: Indiana, North Carolina, Ohio, Oregon.
Project type and description: Services to caretakers with substance use
disorders: States use Title IV-E dollars to fund services and supports
for caregivers with substance abuse disorders;
Status of demonstration by state: Active demonstrations: Under original
waiver: Illinois (2005);
Status of demonstration by state: Active demonstrations: Under short-
term extension: New Hampshire (2005);
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: [Empty];
Status of demonstration by state: Completed demonstrations: On time:
Delaware (2002);
Status of demonstration by state: Completed demonstrations: Terminated
early: Maryland (2002);
Status of demonstration by state: Approved, not implemented: [Empty];
Evaluation progress: Completed: Delaware, Illinois; Expected: New
Hampshire Pending Exemption: Maryland.
Project type and description: Managed care payment systems: States use
alternative managed care financing mechanisms to reduce child welfare
costs while improving permanency, safety, and well-being outcomes for
targeted families;
Status of demonstration by state: Active demonstrations: Under original
waiver: [Empty];
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty];
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: [Empty];
Status of demonstration by state: Completed demonstrations: On time:
Michigan (2003);
Status of demonstration by state: Completed demonstrations: Terminated
early: Colorado, Washington (2003), Connecticut, Maryland (2002);
Status of demonstration by state: Approved, not implemented: [Empty];
Evaluation progress: Completed: Colorado, Connecticut, Michigan,
Washington; Exemption: Maryland.
Project type and description: Intensive service options: States
increase the variety and intensity of services and supports to reduce
out-of-home placement rates and improve other permanency and safety
outcomes;
Status of demonstration by state: Active demonstrations: Under original
waiver: [Empty];
Status of demonstration by state: Active demonstrations: Under short-
term extension: California (2005);
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: [Empty];
Status of demonstration by state: Completed demonstrations: On time:
[Empty];
Status of demonstration by state: Completed demonstrations: Terminated
early: Mississippi (2004);
Status of demonstration by state: Approved, not implemented: [Empty];
Evaluation progress: Completed: California, Mississippi.
Project type and description: Adoptions and post-permanency services:
States strengthen existing or provide new post-adoption and
postpermanency services and supports;
Status of demonstration by state: Active demonstrations: Under original
waiver: [Empty];
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty];
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: [Empty];
Status of demonstration by state: Completed demonstrations: On time:
Maine (2004);
Status of demonstration by state: Completed demonstrations: Terminated
early: [Empty];
Status of demonstration by state: Approved, not implemented: Minnesota;
Evaluation progress: Completed: Maine.
Project type and description: Tribal administration of IV-E funds:
Tribes develop administrative and financial systems to administer Title
IV-E foster care programs independently and directly claim federal
reimbursement;
Status of demonstration by state: Active demonstrations: Under original
waiver: New Mexico (2005);
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty];
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: [Empty];
Status of demonstration by state: Completed demonstrations: On time:
[Empty];
Status of demonstration by state: Completed demonstrations: Terminated
early: [Empty];
Status of demonstration by state: Approved, not implemented: [Empty];
Evaluation progress: Completed: New Mexico.
Project type and description: Enhanced training for child welfare
staff: Training for public and private sector child welfare
professionals serving children and their families to improve permanency
and safety outcomes;
Status of demonstration by state: Active demonstrations: Under original
waiver: Illinois (2007);
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty];
Status of demonstration by state: Active demonstrations: Under 5-year
extension[A]: [Empty];
Status of demonstration by state: Completed demonstrations: On time:
[Empty];
Status of demonstration by state: Completed demonstrations: Terminated
early: [Empty];
Status of demonstration by state: Approved, not implemented: [Empty];
Evaluation progress: Expected: Illinois June 2008.
Source: GAO analysis of HHS information on child welfare waiver
demonstrations.
[A] Evaluations will be submitted by the four states with 5-year
extensions.
[End of table]
[End of section]
Appendix IV: Department of Health and Human Services Child Welfare
National Resource Centers and whether They Are Included in the
Technical Assistance Tracking Internet System Database:
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS):
National Child Welfare Resource Center for Organizational Improvement;
Description: Assists with strategic planning, CFSRs, outcome evaluation
and workforce training and development; facilitates the involvement of
stakeholders; and monitors the technical assistance progress;
Web site: http://www.nrcoi.org.
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS):
National Resource Center for Child Protective Services (CPS);
Description: Works to build state and local CPS capacity, assists in
determining eligibility for the Child Abuse Prevention and Treatment
Act (CAPTA) grant, and provides support to state liaison officers;
Web site: http://www.nrccps.org.
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS):
National Child Welfare Resource Center on Legal and Judicial Issues;
Description: Provides states legal and judicial issue analysis for the
CFSRs, assists in action planning and implementation of program
improvement plans;
Web site: http://www.abanet.org/child/rclji.
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS):
National Resource Center for Family-Centered Practice and Permanency
Planning;
Description: Provides assistance through all stages of the CFSRs,
emphasizes family-centered principles and practices, and builds
knowledge of foster care issues;
Web site: http://www.nrcfcppp.org.
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS):
National Resource Center for Child Welfare Data and Technology;
Description: Provides support for technical issues, conducts data use
and management training, and helps in preparation and use of state data
profiles;
Web site: http://www.nrccwdt.org.
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS):
National Child Welfare Resource Center for Adoption;
Description: Analyzes adoption and permanency options, provides support
for increasing cultural competency, and examines systematic problems
and solutions;
Web site: http://www.nrcadoption.org.
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS):
National Child Welfare Resource Center for Youth Development;
Description: Supports youth participation in child welfare policy,
program development and planning, offers assistance for foster care
independence and education voucher program implementation;
Web site: http://www.nrcys.ou.edu/nrcyd.
National resource center: National Resource Centers Included In the
Technical Assistance Tracking Internet System Database (TATIS): The
Collaboration to AdoptUsKids;
Description: Provides training and technical assistance on quality
recruitment and retention services for foster and adoptive families;
Web site: http://www.adoptuskids.org.
National resource center: National resource centers not included In
TATIS: National Center on Substance Abuse and Child Welfare
(cosponsored with the Substance Abuse and Mental Health Services
Administration);
Description: Works to develop knowledge and provides assistance to
child welfare agencies on substance abuse related disorders in the
child welfare and family court systems;
Web site: http://www.ncsacw.samhsa.gov.
National resource center: National resource centers not included In
TATIS: National Abandoned Infants Assistance Resource Center;
Description: Works to enhance the quality of social and health services
for children abandoned because of the presence of drugs or HIV in the
family;
Web site: http://aia.berkeley.edu/.
National resource center: National resource centers not included In
TATIS: National Resource Center for Community-Based Child Abuse
Prevention Programs;
Description: Focuses on primary child abuse and neglect prevention,
assists in implementation for family support strategies;
Web site: http://www.friendsnrc.org.
Source: HHS training and technical assistance documents.
[End of table]
[End of section]
Appendix V: Comments from the Department of Health and Human Services:
Office of the Assistant Secretary for Legislation:
Department Of Health & Human Services:
Washington, D.C. 20201:
Sep 22 2006:
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) draft report entitled, "Child Welfare:
Access to Information About Federal Social Service Programs Needed to
Help States Address Long-Standing Challenges " (GAO-06-964), before its
publication.
The Department provided several technical comments directly to your
staff.
These comments represent the tentative position of the Department of
Health and Human Services and are subject to reevaluation when the
final version of this report is received.
Sincerely,
Signed by:
Vincent J. Ventimiglia, Jr.
Assistant Secretary for Legislation:
Comments Of The Department Of Health And Human Services On The
U.S.Government Accountability Office's Draft Report Entitled, "Child
Welfare: Access To Information About Federal Social Service Programs
Needed To Help States Address Long-Standing Challenges" (GAO-06-964):
The Department appreciates the opportunity to comment on the Government
Accountability Office (GAO) draft report, which addresses the
challenges faced by Child Welfare Agencies and substantially supports
many of the findings of the Child and Family Services Reviews (CFSRs).
The report clearly outlines in the findings three key challenges facing
State agencies: lack of adequate child and family services,
difficulties with recruitment and retention of caseworkers, and the
struggle to identify appropriate placement for children. However, the
recommendations fail to adequately match the articulated needs.
The Department appreciates GAO's acknowledgement of the importance of
the CFSRs in assisting States to focus funding, resources and long-term
planning to address the barriers States face in providing effective
services to families and children in the Child Welfare system. However,
the intent of the first round of CFSRs is misconstrued in the repeated
reference that no State had achieved all of the Federal outcome
measures for ensuring the safety, well-being and permanency of
children.
It should be noted that the CFSR is not a pass or fail review. The
Department makes separate determinations regarding substantial
conformity for each of the seven outcomes and each of the seven
systemic factors reviewed. All States reviewed during the first round
of CFSRs were found to be in substantial conformity on some of these
areas, and not in substantial conformity on others. The design of the
reviews provides an opportunity for States to enter into Program
Improvement Plans (PIPS) to move towards improving performance in
identified outcomes and systemic factors. It is by focusing States on
long-term strategic and active program improvement that the reviews
achieve their objective. The awareness cited in the GAO report on the
part of State Administrators of the challenges faced by their States
and the need to vigorously address these challenges also demonstrates
the positive impact of the reviews.
GAO Recommendations:
We are making the following two recommendations to the Secretary of
Health and Human Services for improving awareness of and access to
various social services, and improving the Department's ability to
manage technical assistance.
* Develop a strategy to centralize information on Federal assistance
programs that are available to meet child welfare program and service
needs and that can be accessed by state and local child welfare staff
and providers. This strategy could follow a previous Administration
recommendation to develop an Internet-based search for services through
the Catalog of Federal Domestic Assistance that is linked to grantees
by ZIP code.
HHS Comment:
We do not believe that cataloging and making available Federal
resources would be a primary solution to the Child Welfare Agencies'
current concerns, nor would it help States address their increasing
concerns of changing demographic trends in the Child Welfare system, or
the needs of children with special needs or those exposed to illegal
drugs. To assume that these expressed challenges or concerns could be
significantly met or appreciably altered by a list of resources is
misleading. What Child Welfare Agencies might tell you would be that
resource lists quickly become outdated or services unavailable due to
fiscal restraints. In addition, certain Federal programs are designed
to meet the needs of very specific, and sometimes very small,
populations. The recommendation also appears to underestimate the
substantive knowledge of resources currently being utilized by
caseworkers, and incorrectly implies that local Child Welfare Agencies
are not aware of many valuable services in their own districts or
within the Federal system.
It is not clear how this recommendation could be achieved effectively
at the Federal level since State and county programs and service
providers change annually based on their budgets. Many localities
maintain their own listing of service providers, which must be updated
regularly. Individual Child Welfare staff generally need access to the
actual services or service providers rather than general information on
Federal assistance programs.
GAO Recommendation:
* Require all HHS technical assistance providers, including HHS
regional offices and all national resource centers, to enter training
and technical assistance data into the department's Technical
Assistance Tracking Internet System.
HHS Comment:
The GAO report incorrectly states that the Technical Assistance
Tracking Internet System monitors Federal training and technical
assistance (T/TA) requested and provided to States. There is a
Technical Assistance Tracking Information System (TATIS) developed
specifically to track the days that the Children's Bureau-funded
National Resource Centers are on-site in States providing technical
assistance on a specific Federal requirement. This system was never
meant to monitor all technical assistance provided to States, nor would
TATIS be an effective stand-alone mechanism to determine how best to
allocate technical assistance resources to maximize States' ability to
address Child Welfare issues.
TATIS was designed to be one of many management tools in responding to
and coordinating technical assistance needs. A complex multi-level
strategy brings together the knowledge of the Federal project officers
and regional office representatives in regular meetings to address
technical assistance needs and resources. The decisions involved in the
design and current distribution of T/TA responsibilities was the result
of a two-year project with multiple subcommittees reviewing technical
assistance use, needs and availability. There is currently a specific
evaluation of the technical assistance of the Children's Bureau-funded
National Resource Centers, which has been funded for the current grant
cycle that will inform future allocations of T/TA resources.
Additionally, the CFSR findings are invaluable in pointing out States'
T/TA needs and challenges.
The recommendation is targeted at increasing technical assistance
training and implementation of policies and procedures for ensuring the
accuracy of data entry, but by doing so, it fails to give sufficient
weight to the work of the regional offices and the CFSR process.
Through the CFSRs, the Children's Bureau is able to tailor any
subsequent PIP to the individual State findings; specifically, matching
those findings to technical assistance needs. In fact, the GAO report
documents that the Department of Health and Human Services (HHS)
officials agree that the quality of data has improved since the first
round of CFSRs. A trend that we expect will continue.
The recommendation suggests that HHS regional offices should enter T/TA
into TAXIS. In the course of daily work activities, HHS regional staff
provides extensive program guidance to States in meeting Federal
requirements. The staff frequently provide clarification of laws and
regularly monitor States' compliance with Federal requirements. These
activities are a regular part of their job descriptions and would be
superfluous to TATIS.
The GAO report acknowledged the need for coordination across program
lines in order to develop adequate services for children and families.
Specifically, actual direct services such as mental health, health,
education and substance-abuse treatment are not actually provided by
Child Welfare Agencies on a broad scale. Instead the Child Welfare
Agencies refer to community services, contract for some limited
specialized services and utilize existing Medicaid and insurance to pay
providers for services. ACF's Children's Bureau is actively involved in
collaborative activities with other HHS programs to provide a wide
variety of technical assistance to respond to the needs of children and
families who require Child Welfare Agency intervention for the
children's safety and well-being. The Children's Bureau directly funds
T/TA entities to provide assistance directly to the State Child Welfare
Agencies and to the court systems that oversee those agencies. However,
the Children's Bureau maximizes impact by entering into Memorandums of
Understanding with other HHS programs to ensure that as service systems
are developed by other Federal programs; those systems maintain an
awareness of the service needs of families and children who are served
by the State Child Welfare systems.
By stating that all technical assistance that may benefit Child Welfare
populations and outcomes be entered into one central TATIS, there is a
failure to recognize that T/TA is provided to a variety of audiences
beyond the State Child Welfare Agencies.
In the GAO report T/TA providers that respond to different audiences
are compiled in one list. For example, the National Clearinghouses
respond not only to requests from State Child Welfare Agencies but also
to individuals. It would only confuse the tracking of technical
assistance to include their responses to the general public or specific
caseworkers in TATIS.
GAO Recommendation:
* Establish policies and procedures to ensure that complete and
accurate data are timely reported to the Technical Assistance Tracking
Internet System.
HHS Comment:
The Department agrees with this GAO recommendation for the Children's
Bureau-funded National Resource Centers that currently enters
information into the TATIS, and intends to provide written guidance to
the resource centers requiring this reporting.
[End of section]
Appendix VI: GAO Contacts and Staff Acknowledgments:
GAO Contact:
Cornelia M. Ashby, (202)512-7215, ashbyc@gao.gov:
Staff Acknowledgments:
Cindy Ayers (Assistant Director) and Arthur T. Merriam Jr. (Analyst-in-
Charge) managed all aspects of the assignment. Mark E. Ward made
significant contributions to this report, in all aspects of the work.
Christopher T. Langford and Kathleen L. Boggs analyzed the results of
the GAO survey of child welfare challenges and assisted in the report
development. In addition, Carolyn M. Taylor contributed to the initial
design of the engagement, Carolyn Boyce provided technical support in
design and methodology, survey research, and statistical analysis;
James Rebbe provided legal support; and Charles Willson assisted in the
message and report development.
[End of section]
Related GAO Products:
Child Welfare: Federal Action Needed to Ensure States Have Plans to
Safeguard Children in the Child Welfare System Displaced by Disasters.
GAO-06-944. Washington, D.C.: July 28, 2006.
Foster Care and Adoption Assistance: Federal Oversight Needed to
Safeguard Funds and Ensure Consistent Support for States'
Administrative Costs. GAO-06-649. Washington, D.C.: June 15, 2006.
Child Welfare: Federal Oversight of State IV-B Activities Could Inform
Action Needed to Improve Services to Families and Statutory Compliance.
GAO-06-787T. Washington, D.C.: May 23, 2006.
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.
D.C. Family Court: Operations and Case Management Have Improved, but
Critical Issues Remain. GAO-04-685T. Washington, D.C.: April 23, 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.
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] In this report, we use the term states to refer collectively to the
50 states plus the District of Columbia and Puerto Rico.
[2] Permanency is defined as providing a lifetime commitment to a child
in a setting where he or she is safe, can have a sense of belonging and
well-being, and can live to adulthood.
[3] Special needs are factors that can include medical, emotional,
mental, or behavioral needs that will require ongoing assistance and
support, age, or membership in a minority group.
[4] The first round of HHS's Child and Family Services Reviews began in
March 2001. By January 2002, states had begun to develop programs
improvement plans and implement changes to address the child welfare
areas that were identified as needing improvement during the reviews.
[5] Title IV-E also provides grants to states for providing independent
living services to youth who are expected to age out of foster care or
who have already aged out of care. Grants are also provided to states
for providing education and training vouchers for youth aging out of
care.
[6] States' use of nondedicated federal funding varied considerably
from a high of 75 percent of total federal child welfare funds expended
in Alabama to less than 2 percent of total federal child welfare funds
expended in North Carolina.
[7] The Congressional Research Service reported that this is likely an
understatement of nondedicated federal funding states used for their
child welfare programs.
[8] The Information Gateway provides consolidated access to information
on a Web site about a range of child welfare topics, including
international adoption, foster care, family preservation, and child
abuse.
[9] One provision of the Adoption and Safe Families Act of 1997
requires states to file a termination of parental rights with the
courts if the child has been in foster care for 15 of the most recent
22 months unless, among other reasons, the state has not provided
services needed to make the home safe for the child's return. For
additional information, see GAO, 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).
[10] See GAO, 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.: Sept. 24,
2004), and 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).
[11] See GAO-02-585, and GAO, Child Welfare: Better Data and
Evaluations Could Improve Processes and Programs for Adopting Children
with Special Needs, GAO-05-292 (Washington, D.C.: June 13, 2005)
[12] See Congressional Research Service, Child Welfare: State
Performance on Child and Family Services Reviews, (Washington, D.C.:
June 29, 2005).
[13] Generally, states and other entities involved in adoption or
foster care are prohibited by law from delaying or denying the
placement of a child for adoption or into foster care, on the basis of
the race, color, or national origin of the adoptive or foster parent,
or the child, involved. 42 U.S.C. § 1996b.
[14] See GAO, Foster Youth: HHS Actions Could Improve Coordination of
Services and Monitoring of States' Independent Living Programs, GAO-05-
25 (Washington, D.C.: Nov. 18, 2004).
[15] Methamphetamine users often exhibit poor judgment, confusion,
irritability, paranoia, and increased violence.
[16] We previously reported on how problems requiring interagency
solutions often go unaddressed in such areas as transportation and
housing. See GAO-05-25 and GAO, Child Welfare: Improved Federal
Oversight Could Assist States in Overcoming Key Challenges. GAO-04-418T
(Washington, D.C.: Jan. 28, 2004).
[17] GAO previously reported that child welfare agencies focused on
preparing youth for independent living while they were in foster care,
but were less apt to work with other agencies--such as the local
housing authority--to transition youth out of care because of
conflicting policies and a lack awareness about needed services. See
GAO-05-25.
[18] See GAO, 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.: Apr. 20, 2004).
[19] States responded to a survey question and said that HHS technical
assistance was most often either helpful, very helpful, or extremely
helpful.
GAO's Mission:
The Government Accountability Office, the investigative arm of
Congress, exists to support Congress in meeting its constitutional
responsibilities and to help improve the performance and accountability
of the federal government for the American people. GAO examines the use
of public funds; evaluates federal programs and policies; and provides
analyses, recommendations, and other assistance to help Congress make
informed oversight, policy, and funding decisions. GAO's commitment to
good government is reflected in its core values of accountability,
integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through the Internet. GAO's Web site ( www.gao.gov ) contains
abstracts and full-text files of current reports and testimony and an
expanding archive of older products. The Web site features a search
engine to help you locate documents using key words and phrases. You
can print these documents in their entirety, including charts and other
graphics.
Each day, GAO issues a list of newly released reports, testimony, and
correspondence. GAO posts this list, known as "Today's Reports," on its
Web site daily. The list contains links to the full-text document
files. To have GAO e-mail this list to you every afternoon, go to
www.gao.gov and select "Subscribe to e-mail alerts" under the "Order
GAO Products" heading.
Order by Mail or Phone:
The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or
more copies mailed to a single address are discounted 25 percent.
Orders should be sent to:
U.S. Government Accountability Office
441 G Street NW, Room LM
Washington, D.C. 20548:
To order by Phone:
Voice: (202) 512-6000:
TDD: (202) 512-2537:
Fax: (202) 512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: www.gao.gov/fraudnet/fraudnet.htm
E-mail: fraudnet@gao.gov
Automated answering system: (800) 424-5454 or (202) 512-7470:
Public Affairs:
Jeff Nelligan, managing director,
NelliganJ@gao.gov
(202) 512-4800
U.S. Government Accountability Office,
441 G Street NW, Room 7149
Washington, D.C. 20548:
