United States Government Accountability Office

GAO Testimony 

Before the Subcommittee on Income 

Security and Family Support, Committee 

on Ways and Means, U.S. House of 

Representatives

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 

For Release on Delivery

Expected at 10:00 a.m. EDT 

Tuesday, May 15, 2007

 

GAO-07-850T 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

May 15, 2007

CHILD WELFARE

Additional Federal Action Could Help 

States Address Challenges in Providing 

Services to Children and Families 

Highlights of GAO-07-850T, a testimony 

before the Subcommittee on Income 

Security and Family Support, Committee 

on Ways and Means, House of 

Representatives 

Despite substantial federal and 

state investment, states have had 

difficulty ensuring the safety, wellbeing, 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. 

State-Reported Emerging Issues That Are Likely to Affect Children in the Child Welfare 

System over the Next 5 Years 

Number of states

Source: GAO analysis of state child welfare survey responses.

0 5 10 15 20 25 30 35 40 45

Overprescribing psychotropic

drugs to foster children

Violent behavior in children,

including access to weapons

Demographic changes and

changes in cultural sensitivity

Care for special needs children

Children's exposure to illegal drugs 41

33

29

19

15

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. 

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.. 
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.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 2004.2

 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 

 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). 

Page 1 GAO-07-850T 
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).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

 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. 

Page 2 GAO-07-850T 
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 20064

, 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. 

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 

Background 

 4

 Pub. L. No. 109-288. 

Page 3 GAO-07-850T 
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,5

 providing subsidies 

to families adopting children with special needs, and for related 

administrative and training costs.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) 

 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. 

Page 4 GAO-07-850T 
expended by state child welfare agencies,7

 based on state child welfare 

agency data reported to the Urban Institute for state fiscal year 2002.8

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.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.

 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. 

Page 5 GAO-07-850T 
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.) 

Page 6 GAO-07-850T 
Fig. 1: States Reporting Dissatisfaction with the Level of Services Provided to

Children in the Child Welfare System

0 5 10 15 20 25 30 35

Advocacy or case management

services for children

Physical health services

and access to Medicaid

Legal services for children

Medical care for special or

high needs-children

Assessments of the

need for services

Mentoring for youth

Educational services for

special or high-needs children

General education

services for children

Dental care for children

Housing for foster youth

transitioning to independence

Substance abuse

services for children

Mental health

services for children

Number of states

Source: GAO analysis of state child welfare survey responses. 

32 

31 

31 

29 

19 

17 

17 

13 

13 

12 

10 

8 

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.) 

Page 7 GAO-07-850T 
Figure 2: States Reporting Dissatisfaction with the Level of Services Provided to

Parents in At-Risk Families in the Child Welfare System

0 5 10 15 20 25 30 35

Educational services for parents

Assessments of family's

need for services

Advocacy or case

management services

Legal services for parents

Physical health services

and access to Medicaid

Prevention services

Housing for parents

Transportation for parents

Substance abuse

services for parents

Mental health services

for parents

Number of states

Source: GAO analysis of state child welfare survey responses. 

32 

30 

28 

26 

21 

18 

18 

18 

16 

16 

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 

Page 8 GAO-07-850T 
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.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.) 

 10A 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. 

Page 9 GAO-07-850T 
Figure 3: States Reporting Dissatisfaction with Factors That Could Affect the 

State’s Ability to Recruit and Retain Caseworkers 

0 5 10 15 20 25 30 35 

Qualifications established 

for positions

Quality of training or professional 

development for caseworkers

Caseworker pay and benefits

relative to similar professions

Quality of training or professional 

development of supervisors

Effectiveness of 

caseworker supervision 

Administrative responsibilities

of caseworkers

Average number of 

cases per worker 

Number of states

Source: GAO analysis of state child welfare survey responses. 

34 

28 

28 

21 

21 

12 

9 

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 

Page 10 GAO-07-850T 
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. 

Page 11 GAO-07-850T 
Figure 4: States Reporting Factors of Greatest Concern in Making Appropriate 

Placements for Children

0 5 10 15 20 25 30 35 40

Arranging out-of-state and

international placements

Maltreatment of foster children

Identifying and supporting kinship

or guardianship homes

Serving aging youth and those

transitioning into independent living

Recruiting and retaining

foster and adoptive parents

Serving children with special needs

(e.g., developmental disabilities)

Number of states

Source: GAO analysis of state child welfare survey responses. 

39 

38 

34 

28 

7 

3 

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 

Page 12 GAO-07-850T 
and adoptive parents.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.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. 

 11Generally, 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. 

12See 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). 

Page 13 GAO-07-850T 
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 

Number of states

Source: GAO analysis of state child welfare survey responses. 

0 5 10 15 20 25 30 35 40 45

Overprescribing psychotropic

drugs to foster children

Violent behavior in children,

including access to weapons

Demographic changes and changes in

cultural sensitivity (e.g., assessment protocols

that consider immigrant populations)

Care for special needs children

(e.g., developmental disabilities)

Children's exposure to illegal drugs 41 

33 

29 

19 

15 

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.13

 13Methamphetamine users often exhibit poor judgment, confusion, irritability, paranoia,

and increased violence. 

Page 14 GAO-07-850T 
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. 

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.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 

State Initiatives to 

Resolve Challenges 

 14We 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). 

Page 15 GAO-07-850T 
program for competitive grants to improve outcomes of children affected

by parent/caretaker abuse of methamphetamine or another substance.15

 15The 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. 

Page 16 GAO-07-850T 
Figure 6: State-Reported Initiatives to Improve Services to Children and Families 

Number of states

Source: GAO analysis of state child welfare survey responses.

0 2 4 6 8 10 12 14 16 18 20

Transportation services

Housing for at-risk families and children

Educational services

Aging youth services

Diversity or cultural issues (e.g., language challenges)

Mental or behavioral health services

Training caseworkers

Substance abuse services

Physical health services

Child placement services

Funding of services

Other initiativesa

Prevention of child removal

Collaboration (e.g., child advocacy organizations)

Assessment of child and at-risk families

Case management 19 

17 

14 

12 

8 

6 

4 

4 

4 

4 

4 

3 

3 

2 

2 

1 

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 

Page 17 GAO-07-850T 
designed to improve caseworker retention, recruitment, training, and 

ability to access the benefits of technology.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.”17

 16The 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).

Page 18 GAO-07-850T 
Figure 7: State-Reported Initiatives to Recruit and Retain Caseworkers

0 3 6 9 12 15

Training supervisors

Diversity or cultural issues

(e.g., language challenges)

Supervision of caseworker

Collaboration (e.g., universities)

Funding recruitment and retention

Other initiativesa

Recruitment of caseworkers

Hiring qualification

Support for caseworkers

Average caseload reduction

Training caseworkers

Pay and benefits for caseworkers

Number of states

Source: GAO analysis of state child welfare survey responses.

14 

12 

11 

8 

8 

7 

7 

5 

4 

3 

1 

1 

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 

Page 19 GAO-07-850T 
independence, and four states reported initiatives to find appropriate 

homes for children with special needs.18

 18GAO 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. 

Page 20 GAO-07-850T 
Figure 8: State-Reported Initiatives to Find Appropriate Homes for Children

Number of states

Source: GAO analysis of state child welfare survey responses.

0 2 4 6 8 10 12 14 16 18

Child maltreatment removal

Out-of-state and international placement

Aging youth transitioning into independence

Funding for placement

Pay and benefits for foster care providers

Training caseworkers

Special needs (e.g., developmental disabilities)

Mental health services

Other initiativesa

Support for foster care providers

Training foster care providers

Permanency of the child

Collaboration

(e.g., behavioral health institution)

Kinship placement

Recruitment of foster care providers

Placement services 17 

14 

14 

14 

8 

8 

8 

8 

6 

3 

3 

1 

1 

3 

4 

4 

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 

Page 21 GAO-07-850T 
Title IV-E in eight different program areas19 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.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. 

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.) 

Federal Action Taken 

To Ensure States 

Develop Plans to 

Serve Children and 

Families Displaced by 

Disaster 

 19Projects 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.

20States can no longer apply for participation in federal demonstration projects because the

program authorization expired in March 2006. 

Page 22 GAO-07-850T 
Fig. 9: Disaster Plan Status for States with Federally Declared Disasters in 2005 

Source: Analysis of GAO national survey of state child welfare systems challenges; Map, Map Resources.

No 2005 federally declared disaster

2005 federally declared disaster and reported having a plan

2005 federally declared disaster and did not report having a plan

R.I.

D.C.

Puerto Rico

Alaska

Hawaii

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 

Page 23 GAO-07-850T 
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. 

Page 24 GAO-07-850T 
Fig. 10: Program Components Addressed by State Disaster Plans 

0

2

4

6

8

10

12

14

16

18

20

Number of plans

Source: Analysis of GAO national survey of state child welfare systems challenges.

Preserving

Coordinating

Continuing

Identifying

Identifying

Identifying new

Coordinating with

Placing children

Providing in-home

information

in-state services

services

children

caseworkers

cases

other states

from other states

services

19

14 14

13

12

11

10

6

5

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 

Page 25 GAO-07-850T 
copies of their disaster plans for review by December 2006.21 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. 

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. 

Concluding 

Observations 

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 

 21GAO’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.

Page 26 GAO-07-850T 
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. 

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. 

GAO Contacts 

Page 27 GAO-07-850T 
Page 28 GAO-07-850T 

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.

Page 29 GAO-07-850T 
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. 

(130672) Page 30 GAO-07-850T 
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