Child Welfare
Additional Federal Action Could Help States Address Challenges in Providing Services to Children and Families Gao ID: GAO-07-850T May 15, 2007Despite substantial federal and state investment, states have had difficulty ensuring the safety, well-being, and permanency of children in foster care. Ensuring these outcomes becomes even more difficult in the event of disasters such as Hurricanes Katrina and Rita, when children and families may become displaced across state lines. This testimony discusses (1) the issues that states reported as most important to resolve now and in the future to improve outcomes for children under their supervision (2) initiatives states reported taking to address these issues and how recent law provides support for additional state efforts and (3) federal action taken to assist states' efforts in developing child welfare disaster plans. This testimony is primarily based on our October 2006 report on state child welfare challenges (GAO-07-75) and our July 2006 report on state child welfare disaster planning (GAO-06-944). The Department of Health and Human Services (HHS) and the Congress took action that addressed our July report recommendations. However, HHS disagreed with our October report recommendation to improve awareness of and access to federal social services by modifying the Catalog of Federal Domestic Assistance or other means. We continue to believe that taking such action would help improve services to children and families.
States reported in our survey that inadequate levels of mental health and substance abuse services, the high average number of child welfare cases per worker, and the difficulty finding homes for children with special needs were the most important challenges to resolve in order to improve outcomes for children under states' care. Child welfare officials cited various reasons these challenges existed in their states, such as a lack of funding for family support services and a lack of caseload standards. Over the next 5 years, major challenges for state child welfare systems were cited as serving a growing population of children with special needs or who have been exposed to illegal drugs, and changing demographic trends that will require greater multicultural sensitivity in providing services to some groups of children and their families. States have some initiatives in place to address these challenges, but these initiatives do not always address areas of states' greatest concern. For example, only 4 of 31 states dissatisfied with substance abuse services reported initiatives to improve the level of these services. Similarly, states reported little or no action to address two of the most frequently reported factors underlying the challenge to recruit and retain caseworkers - the administrative burden on caseworkers and effective supervision. Recent law provides additional requirements and funding to help states address these challenges. Some states implemented initiatives under federal demonstration projects, including those to improve substance abuse services and permanent homes for children. However, outcome evaluations of these initiatives have shown mixed results. Several actions have been taken by HHS and the Congress to better ensure that states are prepared to continue child welfare services for children displaced by disaster. Our earlier work showed that although 29 states, plus Puerto Rico, experienced a federally declared disaster in 2005, only 8 of these states reported having a written child welfare disaster plan. Since that time, HHS has updated its guidance to states and provided technical assistance. In addition, the Congress passed the Child and Family Services Improvement Act of 2006, requiring that states have procedures in place concerning how state child welfare agencies would respond in the event of a disaster. The deadline set by HHS for submission of these plans is June 30, 2007.
GAO-07-850T, Child Welfare: Additional Federal Action Could Help States Address Challenges in Providing Services to Children and Families
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Testimony:
Before the Subcommittee on Income Security and Family Support,
Committee on Ways and Means, U.S. House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:00 a.m. EDT:
Tuesday, May 15, 2007:
Child Welfare:
Additional Federal Action Could Help States Address Challenges in
Providing Services to Children and Families:
Statement of Cornelia M. Ashby, Director:
Education, Workforce, and Income Security Issues:
GAO-07-850T:
GAO Highlights:
Highlights of GAO-07-850T, a testimony before the Subcommittee on
Income Security and Family Support, Committee on Ways and Means, House
of Representatives
Why GAO Did This Study:
Despite substantial federal and state investment, states have had
difficulty ensuring the safety, well-being, and permanency of children
in foster care. Ensuring these outcomes becomes even more difficult in
the event of disasters such as Hurricanes Katrina and Rita, when
children and families may become displaced across state lines. This
testimony discusses (1) the issues that states reported as most
important to resolve now and in the future to improve outcomes for
children under their supervision (2) initiatives states reported taking
to address these issues and how recent law provides support for
additional state efforts and (3) federal action taken to assist states‘
efforts in developing child welfare disaster plans.
This testimony is primarily based on our October 2006 report on state
child welfare challenges (GAO-07-75) and our July 2006 report on state
child welfare disaster planning (GAO-06-944). The Department of Health
and Human Services (HHS) and the Congress took action that addressed
our July report recommendations. However, HHS disagreed with our
October report recommendation to improve awareness of and access to
federal social services by modifying the Catalog of Federal Domestic
Assistance or other means. We continue to believe that taking such
action would help improve services to children and families.
What GAO Found:
States reported in our survey that inadequate levels of mental health
and substance abuse services, the high average number of child welfare
cases per worker, and the difficulty finding homes for children with
special needs were the most important challenges to resolve in order to
improve outcomes for children under states‘ care. Child welfare
officials cited various reasons these challenges existed in their
states, such as a lack of funding for family support services and a
lack of caseload standards. Over the next 5 years, major challenges for
state child welfare systems were cited as serving a growing population
of children with special needs or who have been exposed to illegal
drugs, and changing demographic trends that will require greater
multicultural sensitivity in providing services to some groups of
children and their families.
Figure: State-Reported Emerging Issues That Are Likely to Affect
Children in the Child Welfare System over the Next 5 Years:
[See PDF for Image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
States have some initiatives in place to address these challenges, but
these initiatives do not always address areas of states‘ greatest
concern. For example, only 4 of 31 states dissatisfied with substance
abuse services reported initiatives to improve the level of these
services. Similarly, states reported little or no action to address two
of the most frequently reported factors underlying the challenge to
recruit and retain caseworkers – the administrative burden on
caseworkers and effective supervision. Recent law provides additional
requirements and funding to help states address these challenges. Some
states implemented initiatives under federal demonstration projects,
including those to improve substance abuse services and permanent homes
for children. However, outcome evaluations of these initiatives have
shown mixed results. Several actions have been taken by HHS and the
Congress to better ensure that states are prepared to continue child
welfare services for children displaced by disaster. Our earlier work
showed that although 29 states, plus Puerto Rico, experienced a
federally declared disaster in 2005, only 8 of these states reported
having a written child welfare disaster plan. Since that time, HHS has
updated its guidance to states and provided technical assistance. In
addition, the Congress passed the Child and Family Services Improvement
Act of 2006, requiring that states have procedures in place concerning
how state child welfare agencies would respond in the event of a
disaster. The deadline set by HHS for submission of these plans is June
30, 2007.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-850T].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cornelia Ashby at (202)
512-8403 or ashbyc@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
I am pleased to be here today to present information from our recent
reports on the challenges that state foster care systems face in
serving the more than half a million children under their
care.[Footnote 1] 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 permanent homes, and
enable families to successfully care for their children. State and
local governments contributed more than $12 billion for these purposes,
according to information available from 2004.[Footnote 2] Despite this
substantial investment, federal evaluations of state child welfare
programs showed that states continue to struggle to meet federal
outcome goals established by the Department of Health and Human
Services (HHS) to ensure the safety, well-being, and permanency of
children in foster care. Ensuring these outcomes becomes even more
difficult in the event of disasters such as Hurricanes Katrina and Rita
for states that do not have plans in place to continue child welfare
services for children and families who may become displaced within or
across state lines.
State child welfare agencies are responsible for administering their
programs within federal policies established by the Children's Bureau
under the Administration for Children and Families within the
Department of Health and Human Services. This federal agency oversees
states' child welfare programs in part through its child and family
services reviews (CFSR), which measure states' performance in meeting
federal outcome goals. During its first round of CFSRs, completed in
the 3 year period ending March 2004, HHS reported that no state had
substantially conformed with all federal performance goals, and half or
more states did not meet performance indicators such as providing
adequate services for children and families, providing child welfare
staff with the ongoing training needed to fulfill their duties, and
ensuring the diligent recruitment of foster and adoptive homes.
Further, while HHS requested states to submit plans that address the
challenges of serving child welfare families in times of disaster, we
reported that as of July 2006, few states had comprehensive plans in
place. Since our reports, HHS and the Congress have taken action to
help states address some of these long-standing challenges and HHS has
begun its next round of CFSRs. My testimony today will focus on (1) the
issues that states reported as most important to resolve now and in the
future to improve outcomes for children under their supervision, (2)
initiatives states reported taking to address these issues and how
recent law provides support for additional state efforts, and (3)
federal action taken to assist states' efforts in developing child
welfare disaster plans. My testimony is based primarily on findings
from our July and October 2006 reports. Those findings were based on
multiple methodologies including a survey of child welfare directors on
challenges they face in improving outcomes for children and the extent
that they had developed child welfare disaster plans. We supplemented
these surveys by conducting multiple site visits to states and counties
and by interviewing child welfare experts and HHS child welfare
officials. We conducted our work in accordance with generally accepted
government auditing standards.
In summary, states reported that inadequate levels of mental health and
substance abuse services, the high average number of child welfare
cases per worker, and the difficulty of finding homes for children with
special needs were the most important challenges to resolve in order to
improve outcomes for children under states' care. Child welfare
officials cited various reasons these challenges existed in their
states. One reason maintaining an adequate level of services is
difficult, for example, is that the funding for family support services
has not kept up with the need, which in turn may result in children
entering foster care and staying there longer. Some states did not have
caseload standards to ensure that caseworkers had enough time to
adequately serve each child and family, and caseworkers in some areas
of most states often carried more than double the caseload standard
established by the Child Welfare League of America (CWLA).[Footnote 3]
State child welfare officials predict that these caseloads will
continue to become increasingly complex and culturally diverse. Growing
challenges for state child welfare systems in the next 5 years were
cited as serving the population of children with special needs or who
have been exposed to illegal drugs, and changing demographic trends
that will require greater multicultural sensitivity in providing
services to some groups of children and their families. States have
some initiatives in place to address challenges, but the frequency of
initiatives states reported did not always mirror the levels of
dissatisfaction with the major challenges. For example, 4 of 39 states
dissatisfied with the level of service in finding homes for children
with developmental disabilities or other needs reported initiatives in
this area. Recently enacted legislation, the Child and Family Services
Improvement Act of 2006[Footnote 4], assists states in addressing some
important challenges by targeting funds to children affected by
substance abuse and to activities designed to recruit and retain
caseworkers. Our October report had recommended that HHS also take
action to improve awareness of and access to federal social services by
such means as modifying the Catalog of Federal Domestic Assistance. In
its comments, however, HHS disagreed with this recommendation, stating
that it was insufficient to address the problem and incorrectly implied
that caseworkers were not already aware of existing resources. We
continue to support the recommendation based on the results of our
work. HHS has taken action along with the Congress to better ensure
that states are planning for the challenges they will face in
safeguarding children and families displaced by disaster, per our July
report recommendations. HHS has updated its guidance and provided
technical assistance. In addition, the law now requires all states to
submit child welfare disaster plans to HHS. The deadline set by HHS for
submission of these plans is June 30, 2007.
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 (this is known as kinship care), caregivers previously
unknown to the child, or a group home or institution. In those
instances in which 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.
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.
Nearly all of this funding is provided under Title IV-E, which provides
matching funds to states for maintaining eligible children in foster
care,[Footnote 5] providing subsidies to families adopting children
with special needs, and for related administrative and training
costs.[Footnote 6] About 9 percent of funding is provided under Title
IV-B, which provides grants to states primarily for improving child
welfare services and requires 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 to 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 7] based on state child welfare agency data reported
to the Urban Institute for state fiscal year 2002.[Footnote 8]
The Congress has authorized funds for state child welfare programs and
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 with
federal requirements. 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 2-
year PIP implementation term. HHS conducted its first round of CFSRs
for all states from March 2001 through March 2004 and began the second
round of CFSRs in March 2007.
States must also meet a set of program requirements that are described
in their 5-year Child and Family Services Plans to receive federal
child welfare funds.[Footnote 9] Until recently, however, there were no
federal requirements for states to develop plans that address the needs
of children during disasters. In 2005, 29 states and Puerto Rico
experienced federally declared disasters--most commonly severe storms
and flooding. However, a disaster can affect states that do not
directly experience the disaster when they receive children evacuated
from affected states. For example, two 2005 disasters--Hurricanes
Katrina and Rita--resulted in a prolonged interruption of child welfare
services and the dispersion of thousands of Louisiana's child welfare
recipients to 19 states.
Current and Future Issues That Challenge States' Ability to Improve
Child Outcomes:
States reported that their ability to improve child outcomes was
challenged most by inadequate levels of mental health and substance
abuse services available to children and families, too few caseworkers
for too many child welfare cases, and a lack of homes that can meet the
needs of certain children, such as those with developmental
disabilities. Challenges are expected to grow in future years related
to serving children with special needs or who have been exposed to
illegal drugs, and changing demographic trends that will require
greater multicultural sensitivity in providing services to an
increasingly diverse child welfare population.
Inadequate Levels of Mental Health, Substance Abuse, and Other Services
Challenge States' Ability to Meet the Needs of Children and Families:
State child welfare agencies identified specific services underlying
their challenge to serve children and families, citing constraints on
federal funding, service gaps, and limited awareness of services
outside the child welfare system as contributing factors. Regarding
services provided to 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. 1.)
Figure 1: Fig. 1: States Reporting Dissatisfaction with the Level of
Services Provided to Children in the Child Welfare System:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[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 to 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 in at-risk families. (See fig. 2.)
Figure 2: States Reporting Dissatisfaction with the Level of Services
Provided to Parents in 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 are 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, many
states experienced 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.
Another reason providing services may be challenging in some states or
areas is 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 Catalog of Federal
Domestic Assistance (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 children and families, 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 that can be used to identify
locations where federally funded programs were operating.[Footnote 10]
High Caseloads and Other Factors Challenge the Ability of Child Welfare
Staff to Adequately Serve Children and Families:
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 to serve children and
families in the child welfare system. 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. 3.)
Figure 3: 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 the Child
Welfare League of America, some child welfare programs lack caseload
standards that reflect time needed to investigate allegations of child
maltreatment, visit children and families, and perform administrative
responsibilities. CWLA set 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 CWLA, in 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 limited 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 also expressed dissatisfaction with 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.
Serving Children with Special Needs Is among Factors Challenging
States' Ability to Place Children in Appropriate Homes:
State child welfare officials most frequently identified four factors
underlying the challenge to find appropriate homes for children. (See
fig. 4.) More than half of the states reported that finding homes for
children with special needs, recruiting and retaining foster and
adoptive parents, serving older youth and youth transitioning into
independent living, and finding and supporting kinship or guardianship
homes were among their greatest concerns.
Figure 4: 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
11] 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 12]
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.
Increasing Complexity and Diversity of Child Welfare Population
Expected to Challenge States in the Future:
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. 5.)
Figure 5: State-Reported Emerging Issues That Are Likely to Affect
Children in the 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 13]
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 who are 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 Texas
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 to Resolve Challenges:
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 reported that they were challenged by the lack of mental
health and substance abuse services for children and families, yet only
four states reported having initiatives to improve the level of these
services. (See fig. 6.) This may be because these services are
typically provided outside the child welfare system by other
agencies.[Footnote 14] Recent legislation supports states' efforts to
improve substance abuse services. For each fiscal year from 2007
through 2011, the Child and Family Services Improvement Act of 2006
reserves funds under the Promoting Safe and Stable Families program for
competitive grants to improve outcomes of children affected by parent/
caretaker abuse of methamphetamine or another substance.[Footnote 15]
Figure 6: State-Reported Initiatives to Improve Services to Children
and Families:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
Most states also reported that they had implemented initiatives to
improve recruitment and retention of child welfare caseworkers, but few
states reported initiatives to address two of the most frequently
reported factors underlying this challenge--the administrative burden
on caseworkers and effective supervision. (See fig. 7.) Recent law
supports states' efforts in this area as well. For fiscal years 2008
through 2011, the Child and Family Services Improvement Act reserves
funds to support monthly caseworker visits to children who are in
foster care with an emphasis on activities designed to improve
caseworker retention, recruitment, training, and ability to access the
benefits of technology.[Footnote 16] In addition, the law reorganized
the Child Welfare Services program funded under Title IV-B, adding a
purpose section to the law that included: "providing training,
professional development, and support to ensure a well-qualified child
welfare workforce."[Footnote 17]
Figure 7: State-Reported Initiatives to Recruit and Retain Caseworkers:
[See PDF for image]
Source: GAO analysis of state child welfare survey responses.
[End of figure]
Almost all states reported implementing initiatives to improve their
ability to find appropriate homes for children, but few states reported
initiatives that addressed two of the three most frequently reported
factors underlying this challenge (see fig. 8). 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 18]
Figure 8: State-Reported Initiatives to Find Appropriate Homes for
Children:
[See PDF for image]
Source; GAO analysis of state child welfare survey responses.
[End of figure]
Some states implemented initiatives under federal demonstration
projects, and evaluations of outcomes states were required to conduct
under these projects 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[Footnote 19] in an effort to improve services and placements--
addressing the three primary challenges reported by states. As of 2006,
24 states had implement 38 child welfare demonstration
projects.[Footnote 20] 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.
Federal Action Taken To Ensure States Develop Plans to Serve Children
and Families Displaced by Disaster:
Several actions have been taken by HHS and the Congress to better
ensure that states are prepared to continue child welfare services for
children and families displaced by disaster across county or state
lines. We reported in July 2006 that although 29 states, plus Puerto
Rico, experienced a federally declared disaster in 2005, only 8 of
these states reported having a written child welfare disaster plan.
(See fig. 9.)
Figure 9: Fig. 9: Disaster Plan Status for States with Federally
Declared Disasters in 2005:
[See PDF for image]
Source: Analysis of GAO national survey of state child welfare systems
challenges; Map, Map Resources.
[End of figure]
In addition, while 21 states in all reported having a disaster plan in
place, there was great variance in the extent to which they addressed
selected child welfare program elements. For example, most states
included strategies to preserve information, but few states had
included strategies for placing children from other states. (See
fig.10) The need for such plans was highlighted when close to 2,000 of
the 5,000 children in Louisiana's child welfare system were displaced
in the aftermath of Hurricane Katrina.
Figure 10: Fig. 10: Program Components Addressed by State Disaster
Plans:
[See PDF for image]
Source: Analysis of GAO national survey of state child welfare systems
challenges.
[End of figure]
At the time of our review, HHS had issued guidance to states in 1995 to
help states develop child welfare disaster plans and also provided
nearly $3 million for technical assistance to states. This guidance,
however, did not address strategies states needed to continue services
to child welfare families displaced across county or states lines.
State child welfare officials reported that additional federal
assistance would be helpful, including information on disaster planning
requirements or criteria, training on how to develop a disaster plan,
examples of good plans, and forums for exchanging information with
other states.
HHS took action that addressed states' concerns and our report
recommendations including updating its 1995 disaster plan guidance,
providing technical assistance, and asking states to voluntarily submit
copies of their disaster plans for review by December 2006.[Footnote
21] Further, the Child and Family Services Improvement Act of 2006 also
established a legislative requirement for states to submit child
welfare disaster plans to HHS that prepare for displacement of
children. The deadline set by HHS for submission of these plans is June
30, 2007.
Concluding Observations:
State challenges in serving the children and families in the child
welfare system are long-standing and continuing. Resolving these
problems has been difficult, however, in part due to the child welfare
system's heavy reliance on various nondedicated funding streams at the
federal and state levels that require an interagency approach to
establish appropriate priority and funding for child welfare families
across different programs and populations. As funding fluctuates or
declines, full awareness of resources outside the child welfare system
becomes especially important, and we recommended in our October 2006
report that the Secretary of HHS improve awareness of and access to
various social services funded by the federal government.
HHS disagreed with our recommendation, stating that it was insufficient
to address the need for additional services and that the recommendation
incorrectly implied that local child welfare agencies were not already
aware of and using such resources. We acknowledged that increasing
awareness of existing federal resources is not the only action needed,
but in the course of our work we found that caseworkers sometimes were
unaware of the full array of federal resources, such as health and
housing, available in their locale or had not coordinated with other
agencies to use them. We continue to support the view that federal
action, such as 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.
History has shown that in the absence of specific federal requirements
or dedicated child welfare funding, many states have been slow to
address existing and future challenges, such as recruiting and
retaining child welfare workers or preparing child welfare disaster
plans. Recent federal action has been taken to establish requirements
and dedicate funding to states to help address these specific problems
now and in the future. The next round of HHS state oversight reviews
will determine the extent that these actions and others taken by states
have been able to improve child outcomes.
GAO Contacts:
For further information regarding this testimony, please contact me at
(202) 512-7215. Individuals making key contributions to this testimony
include Lacinda Ayers and Cathy Roark.
[End of section]
Related GAO Products:
Child Welfare: Improving Social Service Program, Training, and
Technical Assistance Information Would Help Address Longstanding
Service-Level and Workforce Challenges. GAO-07-75. Washington, D.C.:
October 6, 2006.
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.
Lessons Learned for Protecting and Educating Children after the Gulf
Coast Hurricanes, GAO-06-680R. Washington, D.C.: May 11, 2006.
Hurricane Katrina: GAO's Preliminary Observations Regarding
Preparedness, Response, and Recovery, GAO-06-442T. Washington, D.C.:
March 8, 2006.
Hurricanes Katrina and Rita: Provision of Charitable Assistance, GAO-
06-297T. Washington, D.C.: December 13, 2005.
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.
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.
FOOTNOTES
[1] GAO, Child Welfare: Improving Social Service Program, Training, and
Technical Assistance Would Help Address Longstanding Service-Level and
Workforce Challenges, GAO-07-75 (Washington, D.C.: Oct. 6, 2006), and
GAO, 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).
[2] The Urban Institute, The Cost of Protecting Vulnerable Children V:
Understanding State Variation in Child Welfare Financing (Washington
D.C.: May 2006).
[3] CWLA is an association of nearly 800 public and private nonprofit
agencies with a mission to ensure the safety and well-being of children
and families. CWLA sets and promotes standards for best practice and
advocates for the advancement of public policy.
[4] Pub. L. No. 109-288.
[5] States are entitled to Title IV-E reimbursement on behalf of
children who would have been eligible for Aid to Families with
Dependent Children (AFDC) (as AFDC existed on July 16, 1996), but for
the fact that they were removed from the home of certain specified
relatives. While the AFDC program was replaced by the Temporary
Assistance for Needy Families Program in 1996, eligibility for Title IV-
E payments remains tied to the income eligibility requirements of the
now defunct AFDC program. In addition, certain judicial findings must
be present, and all other requirements included in section 472 (a) and
(b) of the Social Security Act must be met, in order for the child to
be eligible for Title IV-E foster care maintenance payments.
[6] 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.
[7] 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.
[8] The Congressional Research Service reported that this is likely an
understatement of nondedicated federal funding states used for their
child welfare programs.
[9] States were required to develop and submit a 5 year Child and
Family Services Plan for fiscal years 2005-2009, by June 30, 2004.
[10] 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.
[11] Generally, states and other entities that receive federal
financial assistance and are involved in adoption or foster care are
prohibited 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. § 671(a)(18). However, HHS guidance recognizes that
some children may have specific needs based on the child's race or
ethnicity, and HHS has required that states put in place a process for
ensuring the diligent recruitment of potential foster and adoptive
families that reflects the ethnic and racial diversity of children
needing homes.
[12] 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).
[13] Methamphetamine users often exhibit poor judgment, confusion,
irritability, paranoia, and increased violence.
[14] 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).
[15] The law reserves $40 million for fiscal year 2007, $35 million for
fiscal year 2008, $30 million for fiscal year 2009, and $20 million for
each of fiscal years 2010 and 2011.
[16] The law directs the Secretary of HHS to reserve the following
amounts: $5 million for fiscal year 2008, $10 million for fiscal year
2009, and $20 million for each of fiscal years 2010 and 2011.
[17] Pub. L. No. 109-288, sec. 6(b)(3) (codified at 42 U.S.C. 621).
[18] 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 of awareness about needed services. See
GAO-05-25.
[19] Projects in the eight program areas included (1) providing monthly
subsidies equal or comparable to foster care maintenance payments to
relatives or other caregivers who assume legal custody of children; (2)
providing capped Title IV-E allocations in exchange for flexibility in
spending child welfare dollars for new services and supports; (3) using
Title IV-E dollars to fund services and supports for caregivers with
substance abuse disorders; (4) using alternative managed care financing
mechanisms to reduce costs; (5) increasing the variety and intensity of
services and supports to reduce out-of-home placement rates and improve
other outcomes; (6) strengthening existing or provide new post-adoption
and post-permanency services and supports; (7) tribal development of
administrative and financial systems to independently administer Title
IV-E foster care programs and directly claim federal reimbursement; and
(8) training for public and private sector child welfare professionals
serving children and their families.
[20] States can no longer apply for participation in federal
demonstration projects because the program authorization expired in
March 2006.
[21] GAO's July 2006 report recommended that HHS guidance to states
address the dispersion of children and families within and across state
lines, and also recommended that HHS develop and provide training to
states on child welfare disaster planning. This report also asked the
Congress to consider requiring states to develop and submit child
welfare disaster plans for HHS review.
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