Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Retaining 
Foster Parents 
JANET REHNQUIST 
Inspector General 
MAY 2002 
OEI-07-00-00601  O I G
FFICE OF  NSPECTOR  ENERAL

http://www.oig.hhs.gov/ 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as amended, 
is to protect the integrity of the Department of Health and Human Services (HHS) programs, as well as 
the health and welfare of beneficiaries served by those programs.  This statutory mission is carried out 
through a nationwide network of audits, investigations, and inspections conducted by the following 
operating components: 
Office of Audit Services 
The OIG's Office of Audit Services (OAS) provides all auditing services for HHS, either by conducting 
audits with its own audit resources or by overseeing audit work done by others.  Audits examine the 
performance of HHS programs and/or its grantees and contractors in carrying out their respective 
responsibilities and are intended to provide independent assessments of HHS programs and operations 
in order to reduce waste, abuse, and mismanagement and to promote economy and efficiency 
throughout the Department. 
Office of Evaluation and Inspections 
The OIG's Office of Evaluation and Inspections (OEI) conducts short-term management and program 
evaluations (called inspections) that focus on issues of concern to the Department, the Congress, and 
the public.  The findings and recommendations contained in the inspections reports generate rapid, 
accurate, and up-to-date information on the efficiency, vulnerability, and effectiveness of departmental 
programs. 
Office of Investigations 
The OIG's Office of Investigations (OI) conducts criminal, civil, and administrative investigations of 
allegations of wrongdoing in HHS programs or to HHS beneficiaries and of unjust enrichment by 
providers.  The investigative efforts of OI lead to criminal convictions, administrative sanctions, or 
civil monetary penalties.  The OI also oversees State Medicaid fraud control units which investigate and 
prosecute fraud and patient abuse in the Medicaid program. 
Office of Counsel to the Inspector General 
The Office of Counsel to the Inspector General (OCIG) provides general legal services to OIG, rendering 
advice and opinions on HHS programs and operations and providing all legal support in OIGs internal 
operations. The OCIG imposes program exclusions and civil monetary penalties on health care providers 
and litigates those actions within the Department. The OCIG also represents OIG in the global 
settlement of cases arising under the Civil False Claims Act, develops and monitors corporate integrity 
agreements, develops model compliance plans, renders advisory opinions on OIG sanctions to the health 
care community, and issues fraud alerts and other industry guidance.  E X E C U T I V E   S U M M A R  Y  
PURPOSE 
To identify challenges in retaining foster parents. 
BACKGROUND 
State child welfare agencies are tasked with the responsibility of protecting children from 
abuse and neglect, which sometimes requires that children be removed from their homes 
and placed in foster care. Based on information reported to the Administration for 
Children and Families (ACF) via the Adoption and Foster Care Analysis and Reporting 
System, as of March 31, 2000, there were 581,000 children in foster care. Forty-seven 
percent of those children were cared for in non-relative foster family homes. 
The ACF has regulatory oversight of the Title IV-E foster care program. The Title IV-E 
foster care program is designed to assist States in covering the costs for children in foster 
care by providing States with unlimited matching funds for children who meet income 
eligibility and other program requirements. Federal expenditures for the Title IV-E foster 
care program expenses totaled $4 billion in fiscal year (FY) 1999 and $4.3 billion in 
FY 2000. Federal funding for the Title IV-E foster care program totalled $4.4 billion in 
FY 2001. Estimated Federal funding for the program is $5.1 billion in FY 2002. 
This report focuses on States efforts to retain foster care families.  A separate report, 
Recruiting Foster Parents, (OEI-07-00-00600), addresses the issues associated with the 
recruitment of these families. We used two mechanisms to conduct this inspection.  The 
primary source of the information presented in this report stems from focus group 
discussions with child welfare staff and foster parents in five States. We used a mail 
survey to obtain additional information from the foster care program managers in the 
50 States, the District of Columbia, Puerto Rico, and the Virgin Islands to determine their 
efforts to retain foster care families. 
FINDINGS 
Foster Families Desire Greater Opportunity to Voice Their Concerns 
Foster parents assert that they have many expectations placed on them by the foster care 
agencies, but are frustrated by their perception that they have no voice in many important 
decisions regarding the lives of the foster children in their care. Suggestions by foster 
parents concerning the needs and best interests of foster children can go unheeded. 
i 
Retaining Foster Parents  OEI-07-00-00601  They Experience Limited Caseworker Support 
Caseworkers are a potentially valuable resource to the foster care program because they 
can provide foster families with the support and assistance necessary to facilitate smooth 
transitions into temporary homes for foster children. However, foster parents said 
caseworkers are often inaccessible and slow to respond to the needs of children and foster 
parents.  Multiple responsibilities placed on caseworkers contribute to unmanageable 
workloads and high turnover, creating a disconnect in relationships between foster 
parents and caseworkers. Because of this, foster parents expressed difficulty establishing 
positive rapport with caseworkers. 
They Need More Help Obtaining Services for Themselves and Their Foster 
Children 
Because children enter foster care with more health and behavior problems than in the 
past, the need for quality and accessible services has increased significantly. However, 
foster parents are finding it increasingly difficult to obtain necessary support services, 
such as respite, child care, dental, medical, and mental health, for the children in their 
care. 
False Allegations of Abuse and Investigations Trouble Foster Parents 
Foster parents and caseworkers agree that foster families are often falsely accused of 
abuse or neglect by the children entrusted to their care. Many new foster parents are 
unaware of the intrusiveness and impact investigations of such abuse and neglect have on 
the lives of foster parents. Foster families decide to exit the system because of the 
repercussions from false allegations by foster children. 
Program Managers Lack Data Needed to Improve Retention 
States lack the performance indicators and data collection tools needed to accurately 
assess why families choose to discontinue fostering. The absence of these data elements 
may explain why there are discrepancies between what foster parents and foster care 
program managers consider the reasons families choose to no longer continue fostering. 
RECOMMENDATIONS 
Foster parents who decide to no longer foster leave with a wealth of experience and 
knowledge, and the foster care program loses a home for a child in need. While foster 
parents leave the system for a variety of reasons, many leave because they are frustrated 
and exhausted. They are weary from navigating a foster care system that is difficult and 
inoperable. To facilitate the transition of the foster care program to adapt to the changes 
ii 
Retaining Foster Parents  OEI-07-00-00601  of todays American families and improve retention practices, we offer suggestions and 
recommendations to both States and ACF which will facilitate: 
!  access to needed services; 

!  improved foster parent supports; and

!  the collection of information to identify and address the challenges

associated with retaining foster parents. 
AGENCY COMMENTS 
We received comments on this report from ACF. The ACF concurs with our findings and 
recommendations, stating that the information presented in this report will be useful to 
them in their continued efforts to meet the needs of this countrys children and families. 
Their comments emphasize ACFs continued focus on the importance of childrens 
issues. In addition, ACF provided important contextual information and suggestions 
which served to enhance the report. We have made revisions to the report based on 
ACFs comments. The full text of their comments is contained in the appendix. 
iii 
Retaining Foster Parents  OEI-07-00-00601  T A B  L E  O F  C O N T E N T S  
PAGE

EXECUTIVE SUMMARY ...................................................... i

INTRODUCTION .............................................................1

FINDINGS

Lack of Agency Supports .................................................. 5

Limited Caseworker Support ...............................................7

Inadequate and Inaccessible Services  ........................................8

Negative Effects of Abuse Allegations  .......................................9

States Lack of Retention Data  .............................................10

RECOMMENDATIONS  ...................................................... 11

APPENDIX

Agency Comments ......................................................13

ACKNOWLEDGMENTS  ..................................................... 19
 I N T R O D U C T  I O N  
PURPOSE 
To identify challenges in retaining foster parents. 
BACKGROUND 
The ideal foster care system would have a sufficient number of foster families with the 
skills to meet the needs of children removed from their homes.  However, States are 
experiencing a shortage of families willing to provide foster care, especially those 
willing or able to meet the specific needs of the children in care (e.g., children with 
mental disabilities, physical disabilities, behavior problems).  These shortages are 
indicative of States problems recruiting foster families (Recruiting Foster Parents, 
OEI-07-00-00600) and retaining those families already in the system. This report 
identifies why non-relative foster families discontinue fostering as described by foster 
parents, caseworkers, and program managers. 
The majority of children in the foster care system are cared for in foster family homes; the 
remainder are cared for in institutions, group homes, or other group settings.  Based on 
information reported to the Administration for Children and Families (ACF) by 
45 jurisdictions, the District of Columbia, and Puerto Rico, via the Adoption and Foster 
Care Analysis and Reporting System (AFCARS) for the semi-annual reporting period 
March 31, 2000, approximately 581,000 children were in foster care. Forty-seven percent 
of those children were cared for in non-relative foster family homes. The remaining 
53 percent were cared for in a variety of foster care settings as outlined in the table on the 
following page. Between April 1, 1998, and March 31, 1999, the number of children in 
foster care increased by 38,000. The mean length of time a child remained in foster care 
was 32 months. 
The ideal foster care system would have a sufficient number of families with the skills to 
meet the needs of the children removed from their homes. Retaining foster parents, 
especially those willing to care for children with mental, behavioral, or emotional issues 
is essential to States efforts to provide care for children in need. 
1
Retaining Foster Parents   OEI-07-00-00601  Placement Settings of Children in Foster Care 
During Fiscal Year 2000 
Children In Placement 
Placement Setting  Percent of  Num ber of 
Foster Children  Foster Children 
Foster Family Homes (Non-Relative)  47  274,100 
Foster Family Homes (Relative)  26  151,864 
Institutions  10  57,590 
Group Homes  8  46,279 
Pre-Adoptive Homes  4  22,484 
Trial H ome V isits (with own families)  2.7  15,818 
Runaway and H omeless Youth Shelters  1.4  7,886 
Supervised Independent Living Facilities  .9  4,979 
Total Num ber of Children in Foster Care  100  581,000 
Source: AFCARS 2000 
* Pre-Adoptive Homes, Trial Home Visits (with childs family), Runaway and Homeless Youth Shelters, 
Supervised Independent Living Facilities 
Federal Role in Foster Care 
Federal financial assistance for children and families began with implementation of the 
Aid to Families with Dependent Children (AFDC) program, Title IV-A of the Social 
Security Act, in 1935. The Federal role in foster care began in 1961, when Federal funds 
were made available to provide maintenance payments for children removed from AFDC 
eligible families in accordance with Federal requirements. 
The Federal role was further expanded with implementation of the Adoption Assistance 
and Child Welfare Act of 1980 (P.L. 96-272). The Act amended child welfare services 
laws to institute financial incentives for States to provide certain protections for children 
in foster care under Section 427 of the Social Security Act (Title IV-B) and established 
the Title IV-E foster care program. As a result, the foster care component of the AFDC 
program was transferred to the new Title IV-E program in October 1982, and Federal 
Title IV-E foster care funds became available to provide maintenance payments for 
children removed from AFDC eligible families in accordance with Federal requirements. 
As such, States can claim reimbursement for foster care maintenance payments made on 
behalf of children who meet the eligibility criteria outlined in Section 472 of the Social 
Security Act. The Adoption and Safe Families Act (ASFA) of 1997 was intended to 
provide States with the necessary tools and incentives to achieve the safety, permanency, 
and well-being goals indicated in Public Law 96-272. As a result of ASFA, many States 
have chosen to recruit jointly for adoptive and foster families. 
2
Retaining Foster Parents   OEI-07-00-00601  The Title IV-E foster care program is designed to assist States in providing safe and 
appropriate care for children in placements outside their homes, whether in foster family 
homes, residential child care facilities, or other eligible foster care facilities. The 
program provides unlimited matching funds to States to assist with the cost of foster care 
payments for children who meet income eligibility requirements and have been removed 
from their home as the result of a judicial determination that continuation in the home 
would be contrary to the welfare of the child.  Funds are also available to cover certain 
administrative and training costs associated with the provision of foster care. 
The ACF has regulatory oversight of the Title IV-E foster care program, including 
approval of State plans to ensure State foster care programs are operating within Federal 
guidelines. States administer the Title IV-E program in accordance with the approved 
State plans. The ACF has recently begun to monitor States conformity with their State 
plans through Children and Family Services reviews. 
The ACF also provides limited technical assistance to States through the Childrens 
Bureau National Resource Centers. However, most network technical assistance is 
focused on safety and permanency placements of children who enter the child welfare 
system. States can also request onsite training and technical assistance from the Centers, 
but receive little, if any, technical assistance to assist them specifically with the retention 
of foster parents. 
Funding for Foster Care 
Title IV-E is an entitlement program; therefore States can claim Federal reimbursement 
for foster care maintenance payments made on behalf of all children whose families meet 
the income and program eligibility criteria for program participation under Section 472 of 
the Social Security Act and implementing regulations. The ACF provides States with 
Federal funds by reimbursing a certain percentage of each States own expenditures for 
foster care maintenance costs. The rates at which the Federal government reimburses the 
States Title IV-E expenditures for the cost of foster care maintenance are the same rates 
at which the Centers for Medicare and Medicaid Services matches State expenditures for 
medical assistance (Medicaid), and range between 50 and 78 percent. The Federal match 
rates for administrative and training costs associated with the Title IV-E foster care 
program are set at 50 and 75 percent respectively. 
Because the Title IV-E foster care program is an entitlement program, Federal 
expenditures for all Title IV-E program expenses are open-ended and will increase in 
accordance with State expenditures for eligible children. Federal expenditures for 
Title IV-E foster care program totaled $4 billion in fiscal year (FY) 1999 and 
$4.3 billion in FY 2000. Federal funding for the Title IV-E foster care program totalled 
$4.4 billion in FY 2001. Estimated Federal funding for the program is $5.1 billion 
in FY 2002. 
3
Retaining Foster Parents   OEI-07-00-00601  METHODOLOGY 
We used two mechanisms to conduct this inspection.  We judgementally selected a 
sample of five States (California, Florida, Illinois, New York, and Texas) as the primary 
source for data collection. Based on FY 1999 AFCARS data reported to ACF, 
approximately 53 percent of the nations foster children reside in these 5 States.  In 
addition to geographic diversity, the five States provided a mix of both county 
administered (California and New York) and State administered (Florida, Illinois, and 
Texas) foster care programs. 
In the five States, we collected in-depth information about retention issues through 
personal interviews with State foster care program managers, and focus group interviews 
with child welfare staff and current and former foster parents. Child welfare staff 
interviewed included caseworkers, caseworker supervisors, foster care recruitment 
specialists, and staff from private foster care agencies with whom the State foster care 
agencies contract. At a minimum, we conducted one foster parent and one foster care 
program staff focus group interview in both an urban and rural location in each of the 
five States. In total, we conducted 14 foster parent and 11 child welfare staff focus 
groups in the 5 States, interviewing 115 foster parents and 107 child welfare staff 
respectively. 
We also used a mail survey to solicit information from the foster care program managers 
for the 50 States, the District of Columbia, and Puerto Rico to determine their efforts to 
retain foster care families. We received survey responses from 41 foster care program 
managers. We did not receive responses from the District of Columbia, Hawaii, Indiana, 
Louisiana, Maryland, Montana, Ohio, Oregon, Puerto Rico, Washington, or Wisconsin. 
The completed survey from Kentucky was received after our analysis was completed. 
However, these 12 entities account for only 19 percent of the children in non-relative 
foster care homes and 9 percent of the total number of the children in foster care. 
The report focuses primarily on information provided by foster parents. We believed they 
were best positioned to describe issues related to retention.  When we were able, we 
linked the statements of foster parents with those of caseworkers and program managers. 
It should be noted that we made no attempt to assess State reimbursement rates for foster 
care. 
We conducted this inspection in accordance with the Quality Standards for Inspections 
issued by the Presidents Council on Integrity and Efficiency. 
4
Retaining Foster Parents   OEI-07-00-00601  F I N D I N G S  
The Title IV-E foster care program was developed in an era when women typically 
worked at home to maintain their households and care for children and other family 
members. Today, the world is different. In two-parent families, both parents often work 
outside the home, leaving their children in the care of daycare providers or other care 
givers. An ever-increasing number of households are managed by single working 
parents. However, the foster care program has failed to keep pace with changes in the 
American family. Foster parents believe foster care programs continue to operate based 
on the assumption that they can willingly choose not to work, be available at all times, 
and independently locate and secure the services necessary to meet the needs of the 
children in their care. 
During the course of this inspection, we had the opportunity to talk with foster parents 
with varying levels of experience in the foster care system. Some foster parents had cared 
only for one child, while others had entered the foster care system only as an avenue to 
adoption. Other foster parents had cared for hundreds of children over the course of 
many years. Despite these differences, most foster parents said fostering affords them 
opportunities to give back to their communities and make a difference in the lives of the 
children placed in their care. Every foster parent we spoke with said they had, at some 
time, considered leaving the foster care system. Even so, many foster parents continue to 
foster because of the personal satisfaction they receive from fostering. 
In our discussions with foster parents, caseworkers, and program managers, we were 
advised of the many frustrating reasons families choose to no longer foster. Many of the 
reasons are not new and little has changed over the years. What has changed are family 
dynamics and the increased needs of foster children, greatly intensifying the challenges 
faced by foster parents. Foster parents in all five States visited indicated that children 
coming into care have more behavioral problems than in the past (e.g., reactive 
attachment disorder, higher incidence of physical and/or sexual abuse), creating a greater 
need for support and assistance from foster care agencies and caseworkers. 
Foster Families Desire Greater Opportunity to Voice Their 
Concerns 
The reality of foster care programs is that foster parents are often left to their own devices 
to navigate the complex foster care system. According to foster parents, families willing 
to provide safe homes for foster children receive only limited information to assist them 
in locating and obtaining the services necessary to meet the needs of children in their 
care. Foster parents said inadequate supports, limited agency recognition, and the 
financial strain of fostering often leaves them feeling frustrated and unappreciated. 
5
Retaining Foster Parents   OEI-07-00-00601  Insufficient Agency Supports Discourages Foster Parents 
Many foster parents expressed feeling unsupported and unappreciated by foster care 
agencies. Many families believe caseworkers and agency staff fail to value their 
suggestions and opinions regarding the needs of children in their care. They were also 
unaware of any formal procedures to allow them to voice their concerns.  Foster parents 
said they are the most knowledgeable of the needs of the children in their care, and 
believe it is essential that they be included as part of the team involved in decisions 
concerning foster children in their care. However, we heard several instances in which 
families were left out of the important decisions concerning the children (e.g., returning 
children to their biological parents, medical necessities, psychological treatment options). 
Foster parents in many States have developed local foster parent associations. Statewide 
foster parent associations also exist in 36 of the 41 States responding to our survey. Local 
organizations maintained and administered by foster parents strive to provide foster 
families with resources and supports that they might otherwise be without (e.g., clothing, 
food, cleaning supplies). Several families indicated these local associations are a 
valuable resource, but are weakened by their inability to influence local foster care 
program administrators and legislators. 
Foster Parents Pay for Additional Expenses 
Foster parents in all five States described incurring expenses exceeding their foster care 
reimbursement and the negative impact it has on retention. During foster parent focus 
groups, we heard stories of families receiving children with nothing more than the clothes 
they were wearing at the time. In other instances, families have paid for transportation to 
numerous medical, psychological, and caseworker appointments. Foster parents 
emphasized the needs of these children are often immediate. To ensure their social 
development, it is equally important that foster children participate in extra-curricular 
activities (e.g., sporting and social events). However, foster parents are often left to pay 
for the costs associated with a foster childs participation in these activities (e.g., sports 
equipment and fees). In all five site visits, foster parents reported contemplating no 
longer fostering because of the additional financial strain it places on them. 
Foster care program managers and caseworkers did not perceive the expense of fostering 
as important an element in retention as foster parents.  In fact, only six of the program 
managers responding to our survey cited financial issues as a primary barrier to retaining 
foster families. While caseworkers included in our focus groups were more sensitive to 
the impact that additional expenses have on foster families, they believed a lack of 
available services has a greater impact on retention than do expenses associated with 
fostering. 
6
Retaining Foster Parents   OEI-07-00-00601  They Experience Limited Caseworker Support 
The foster care system is designed as a system of supports, primarily targeted to promote 
the safety and well-being of each child in care. An essential link in providing a safe and 
nurturing environment for the children in foster care is the relationship between 
caseworkers and foster parents.  Caseworkers are most often the front line support to 
foster parents. When poor relationships exist between caseworkers and foster parents, the 
availability of services and information needed to make the best choices for foster 
children becomes limited. 
Caseworkers are too Often Inaccessible 
In each of the five States we visited, foster parents reported the need for greater support 
and assistance from caseworkers, and said they are encountering greater difficulty 
accessing caseworkers. Several of the foster parents said that caseworkers did not return 
their calls for days or even weeks. Even when able to contact caseworkers, foster parents 
said they have experienced difficulty in getting them to respond to their needs in a timely 
manner. Caseworker unresponsiveness left foster parents feeling frustrated and uncertain 
about how to resolve problems. 
When asked about their inaccessibility, caseworkers agreed that they are often difficult to 
reach or slow to respond. They attributed their inaccessibility to multiple responsibilities 
and high caseloads.  For the 28 States that reported caseworker caseloads, the average 
caseload per worker ranged from 8 to 66, and may include case management for the 
childs entire family.  In addition to their regular caseloads, many caseworkers are also 
required to assist in recruiting, training, and licensing new foster parents; some are 
responsible for facilitating pre-service training classes for prospective foster parents; 
some caseworkers attend court proceedings involving foster children; and some assist 
families in completing home studies. These additional responsibilities further limit 
caseworkers abilities to address foster families concerns in an efficient and timely 
manner. 
High Caseworker Turnover Leads to a Lack of Rapport 
In all five site visits, foster parents expressed difficulty in creating a consistent rapport 
with caseworkers because caseworker tenure is short, thus creating a revolving door of 
employees within the agencies. Of the 30 State responses we received to a question about 
caseworker tenure, foster care program managers in 13 States indicated the average tenure 
for child welfare workers in their States ranged between 13 and 24 months; seven 
program managers reported the average tenure to be between 25 and 48 months. Foster 
parents said they find it difficult to build rapport and a positive working relationship with 
caseworkers because new workers are constantly being assigned to the children in their 
care. 
Foster care caseworker positions tend to be entry-level and are usually filled with recent 
college graduates who may not fully understand the role the foster parent plays in the 
7
Retaining Foster Parents   OEI-07-00-00601  lives of the children in their care. Often, new caseworkers have limited child welfare 
experience and may be unfamiliar with the types of children in foster care. They may also 
be unfamiliar with the available services or how to access them. Foster parents in focus 
groups described what they perceived as a lack of training for new caseworkers regarding 
effective communication with foster children and parents, and contend that the lack of 
training is manifested in the treatment they receive from caseworkers. 
Multiple Caseworkers Create Difficulties 
Foster parents also expressed frustration in dealing with multiple caseworkers. Because 
caseworkers are assigned to individual children or sibling groups, foster families caring 
for more than one foster child may have several caseworkers. As such, foster parents 
often must deal with differing expectations regarding the kind of care and services the 
children need.  Additionally, appointments with caseworkers and foster children become 
numerous and burdensome as foster parents attempt to coordinate their schedules and 
those of the children with their assigned caseworkers. For families already facing 
excessive demands on their time and energy, these situations can be particularly difficult. 
They Need More Help Obtaining Services for Themselves and 
Their Foster Children 
Caring for foster children can be more demanding than caring for ones own children. 
This situation is readily apparent in families caring for both their birth children and foster 
children in their care. Parents must take special care when securing child care or respite 
services. They must seek medical and dental services that meet the requirements of the 
program. While Medicaid is available to pay for dental and medical services for foster 
children, these services are limited in their locality and availability. Ultimately, the 
burden to procure these necessities rests primarily on the shoulders of foster parents. 
Respite and Child Care Services are Limited 
In four States, foster parents expressed frustration with insufficient or non-existent respite 
and child care services. Foster parents portray these services as paramount in the 
retention of families because they allow foster parents to work, complete other necessary 
activities (e.g., taking other children to medical appointments and attending school 
conferences), and provide opportunities for foster parents to take a break from the 
physical and emotional stress that accompanies fostering. Obtaining these services can be 
problematic because some agencies require that respite and child care providers be 
licensed and graduates of the pre-service training classes required of foster parents. Such 
requirements, although imposed to ensure the safety of children in foster care, greatly 
limit the pool of families. In addition, families report receiving little, if any, information 
regarding respite care givers and are often forced to seek respite services on their own. 
Program managers also alerted us to the fact that agencies limit the number of hours for 
which families can claim reimbursement for respite care each month, and that some 
agencies provide no reimbursement for such care. 
8
Retaining Foster Parents   OEI-07-00-00601  Despite foster parent concerns about the lack of respite and child care, State foster care 
program managers frequently did not rate these services as important to retention. Only 
14 of 41 program managers listed the need for respite and child care as important services 
in the retention of foster care families. These results may partially reflect the States own 
difficulty in addressing this need. 
When asked about foster parents concerns regarding the lack of respite and child care, 
State foster care program managers and caseworkers noted that the difficulties families 
have in obtaining those services may be a result of limited State funds. One foster care 
program manager said that there are times when they do not inform families about child 
care services because they lack the fiscal resources to administer them. 
Dental and Medical Services are Difficult to Obtain 
In four of the site visits, foster parents expressed frustration with the lack of dental care 
available to foster children. They report that access to dental care is difficult because of 
the limited number of dentists who accept Medicaid. The lack of dentists is particularly 
problematic because most States require that children receive dental services while in the 
care of a foster family.  Foster parents said they are finding it increasingly difficult to 
locate dentists willing to accept Medicaid patients, traveling long distances to acquire 
dental services, and encountering problems scheduling dental appointments (i.e., some 
dentists see Medicaid patients only on certain days of the week or month, during limited 
set hours, or only care for a limited number of Medicaid patients). 
Foster parents also expressed difficulty locating and accessing other medical and mental 
health services. In three States, foster parents stated that medical care is very difficult to 
obtain because fewer physicians are participating in the Medicaid program. Like dentists, 
many of the physicians that do participate in the Medicaid program have chosen to limit 
the care they provide and the hours and days they will treat Medicaid patients. Because 
all children in foster care are Medicaid eligible, locating and obtaining providers who 
accept Medicaid is essential. 
Only one of the State foster care program managers who responded to the survey listed 
access to medical care as one of the primary reasons families choose not to continue 
fostering. However, foster parents report that the difficulties associated with accessing 
medical care contribute to their fatigue and frustrations with fostering. 
False Allegations of Abuse and Investigations Trouble Foster 
Parents 
In every foster parent focus group conducted, foster parents expressed concerns about 
being investigated for false allegations of abuse and neglect. They said that, while they 
understand procedures to address allegations are essential in protecting children, false 
allegations can greatly harm the emotional well-being of foster parents. Such allegations 
can also be a financial drain on foster parents and affect their professional credibility. In 
9
Retaining Foster Parents   OEI-07-00-00601  addition to the embarrassment and disruption that false allegations may bring, foster 
parents worry that their biological or adopted children will be removed from their home 
because of an allegation of abuse regarding a foster child. 
According to foster parents who have been fostering for several years, many new foster 
families are unaware of the likelihood that they will be accused and investigated for abuse 
and are unprepared for the impact it will have on them. One experienced foster parent 
said its not a matter of if you will be accused of abuse and neglect, but when you will be 
accused. If you remain a foster parent long enough, it will eventually happen to you. 
The strong likelihood of being accused of abuse or neglect can lead families to leave the 
foster care system. Yet, only 8 of 41 State program managers selected investigations of 
abuse as one of the reasons families are leaving the system. 
Another concern foster families have with abuse allegations is the length of time an 
unfounded or false allegation remains in the State system. Although the length of time 
varies from State to State, we heard that such allegations can remain in the State system 
as long as 7 years before they are expunged. Foster parents who have been cleared of all 
allegations brought against them contend that it is not merely the fact that their names are 
on record for an extended period of time, but that it is disheartening that their names were 
placed on record in the first place. Foster parents also said the investigations associated 
with such allegations leave them feeling insulted, distrusted, and potentially labeled as 
child abusers. Many foster parents expressed the emotional trauma they felt after being 
accused of the very thing they are trying to prevent. False allegations of abuse strip foster 
parents of their trust in the State system and leave them feeling unprotected. 
Program Managers Lack the Data Needed to Improve 
Retention 
States lack the performance indicators, benchmarks, and data collection tools needed to 
accurately assess why families choose to discontinue fostering. Despite the fact that 30 of 
the 41 foster care program managers who responded to our survey said they attempt to 
determine why families are leaving, only 4 program managers indicated they had 
established benchmarks for retention and only 10 had developed retention goals. While 
some States have attempted to determine why foster parents leave (e.g., conducting exit 
interviews or follow up surveys), most States have no systematic approach to determine 
why foster parents choose not to continue fostering. 
10
Retaining Foster Parents   OEI-07-00-00601  R E C O M M E N D A T  I O N S  
Every family leaving the foster care system takes with them many hours of specialized 
training.  Those who have fostered for years also take with them their experience in 
navigating the system, in finding needed services, and in caring for children with varied 
problems. The loss of these trained and experienced foster parents greatly impacts the 
foster care program. We believe it may have an even greater impact on programs than 
failing to recruit new foster families. 
Nevertheless, the foster parents with whom we spoke expressed a strong commitment to 
fostering. They are willing to commit time, resources, and energy to provide foster 
children with a stable and safe home environment. Yet, limited supports and a lack of 
services creates significant stresses and problems. Many foster parents struggle to care 
simultaneously for children, coordinate with multiple caseworkers, identify and access 
services, work, and maintain a household. It is imperative that efforts be made to reduce 
barriers to continued fostering. 
Suggested Improvements 
Based on information provided by foster parents, foster care program managers, and 
caseworkers, we offer the following suggestions to State foster care program managers, 
local public and private foster care agencies, and foster care associations to augment the 
supports and services available to foster families: 
!	 develop a State-wide Foster Parent Tool Kit to provide foster parents 
with information about what they can expect from foster care agencies, 
their role, rights, and protections as foster parents, and procedures for 
voicing their concerns regarding the children in their care; 
!	 promote the designation of foster parent advocates to work directly with 
foster parents and the agency to represent the concerns of foster families 
and give them a voice in determining both their best interests and the 
interests of the children in their care; 
!	 encourage networking and information sharing among foster parents 
through local and national foster parent associations, support groups, 
foster parent community newsletters, and agency alerts regarding policy 
changes; 
!	 establish clothes closets to disseminate clothing and provide household 
necessities to foster parents in an effort to reduce their out-of-pocket 
expenses and designate funds to cover one-time expenses (e.g., sports 
equipment); 
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Retaining Foster Parents   OEI-07-00-00601  !	 provide opportunities to develop consistent rapport between foster parents 
and caseworkers; 
!	 promote collaborative efforts by ACF, State agencies, and national 
organizations to make child care and respite care services more accessible 
to foster parents; 
!  establish local networks of licensed child and respite care providers; 
!	 provide foster parents with information (e.g., foster parent handbooks, 
manuals) to assist them in navigating the foster care system and accessing 
dental, medical, and any other needed services; and 
!	 provide information to foster parents on how to cope emotionally and 
financially with investigations of abuse. This can by accomplished by 
including the information in existing training curriculum, and developing 
training specifically focused on investigation survival. 
Develop Retention Tracking Systems 
We noted numerous instances where foster care program managers did not fully 
appreciate the extent to which foster families viewed aspects of the program as barriers to 
continued fostering. We attribute this, in part, to the lack of retention goals and 
benchmarks that States currently utilize. To the extent that resources are available, ACF 
should provide technical assistance to assist States in improving retention through the 
!	 development of outcome-based retention strategies to determine why 
families choose not to continue fostering; 
!  development of data tracking tools to collect retention information; 
!  establishment of benchmarks and performance indicators; and 
!  collection of retention data. 
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Retaining Foster Parents   OEI-07-00-00601  A G E N C Y  C O M M E N T S  
We received comments on this report from the Administration for Children and 
Families (ACF). The ACF concurs with our findings and recommendations, stating that 
the information presented in this report will be useful to them in their continued efforts to 
meet the needs of this countrys children and families. Their comments emphasize 
ACFs continued focus on the importance of childrens issues. In addition, ACF 
provided important contextual information in which, for example, ACF notes that States 
can use some Federal funds for child care and respite care services and that 64 percent of 
foster children adopted in 1999 were adopted by foster parents. This information is 
beneficial in understanding the overall issues related to foster care. We believe that this 
kind of information provides valuable insight for the States, counties, and others working 
to enhance foster care programs across the country. 
We have made revisions to the report based on ACFs comments.  The full text of their 
comments is contained in the appendix. 
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Retaining Foster Parents   OEI-07-00-00601  APPENDIX 
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Retaining Foster Parents   OEI-07-00-00601  A C K N O W L E D G  M E N T S  
This report was prepared under the direction of Brian T. Pattison, Regional Inspector General for 
Evaluation and Inspections in Kansas City. Other principal Office of Evaluation and Inspections 
staff who contributed include: 
Deborah Walden, Project Leader  Linda Hall, Program Specialist

Mike Craig, Program Analyst

Steve Milas, Program Analyst

Gary Reese, Program Analyst

Technical Assistance 
Barbara Tedesco, Technical Support Staff 
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Retaining Foster Parents   OEI-07-00-00601