Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

JANET REHNQUIST 

Inspector General 

MAY 2002 

OEI-07-00-00601 

Retaining 

Foster Parents 
OFFICE OF INSPECTOR GENERAL

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 OIG’s 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. 
EXECUTIVE SUMMA RY 

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. 

Retaining Foster Parents i 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 

Retaining Foster Parents ii OEI-07-00-00601 
of today’s 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 country’s children and families. 

Their comments emphasize ACF’s continued focus on the importance of children’s 

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 

ACF’s comments. The full text of their comments is contained in the appendix. 

Retaining Foster Parents iii OEI-07-00-00601 
TA BLE OF CONTENTS 

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
INTRODUC TION 

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. 

Retaining Foster Parents 1 OEI-07-00-00601 
Placement Settings of Children in Foster Care 

During Fiscal Year 2000 

Placement Setting 

Children In Placement 

Percent of 

Foster Children 

Num ber of 

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 child’s 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. 

Retaining Foster Parents 2 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 Children’s 

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 State’s 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. 

Retaining Foster Parents 3 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 nation’s 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 President’s Council on Integrity and Efficiency. 

Retaining Foster Parents 4 OEI-07-00-00601 
FINDINGS 

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. 

Retaining Foster Parents 5 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 child’s 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. 

Retaining Foster Parents 6 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 

child’s 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 

Retaining Foster Parents 7 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 one’s 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. 

Retaining Foster Parents 8 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 State’s 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 

Retaining Foster Parents 9 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 “it’s 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. 

Retaining Foster Parents 10 OEI-07-00-00601 
RECOMMENDA TIONS 

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); 

Retaining Foster Parents 11 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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A GENCY COMMENTS 

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 country’s children and families. Their comments emphasize 

ACF’s continued focus on the importance of children’s 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 ACF’s comments. The full text of their 

comments is contained in the appendix. 

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APPENDIX 

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A CKNOWLED GMENTS 

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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