Department of Health and Human Services 

OFFICE OF


INSPECTOR GENERA .


. 

OVERSIGHT OF STATE CH LD WELFARE


PROGRAMS


+<’ “’? 

~v JUNE GIBBS BROWN 

:

G Inspector General 

~ ‘b 

%%.,> JUNE 1994 

OEI-01-92-00770 
EXECUTIVE SUMMARY


PURPOSE 

Toassess andtofind ways to improve oversight of State child welfare programs. 

BACKGROUND 

In 1980, Congress passed The Adoption Assistance and Child Welfare Act


(P.L. 96-272) in order to “lessen the emphasis on foster care placements and to


encourage greater efforts to find permanent homes for children.” The law signaled a


new direction in child welfare and highlighted an awakened Federal interest in how


States manage their child welfare programs.


The Department of Health and Human Services (HHS) funds State child welfare


services through three significant mechanisms, all of which are under the Social


Security Act. The largest proportion of monies comes from Title IV-E, with lesser


amounts from Title XX and Title IV-B (see appendix A for details on the programs).


The HHS’S Administration for Children and Families (ACF) oversees State child


welfare services using the following formal mechanisms: Title IV-E reviews, Section


427 reviews, program reviews, and State plans (see appendix B for details on oversight


mechanisms). The content of both Title IV-E and Section 427 reviews is determined


by P.L. 96-272.


Members of Congress, HHS officials, the General Accounting Office, directors of


State child welfare agencies, and representatives of the Child Welfare League of


America and the American Public Welfare Association are among those who have


voiced concerns about these processes. In particular, they have been concerned that


the reviews elevate process issues over quality of services.


On August 10, 1993, the President signed into law the Omnibus Budget Reconciliation


Act of 1993. This law increased funding for Title IV-B to encourage State efforts to


support and preserve families. The original version of the bill proposed major


alterations to the oversight process. While the law, as passed, left most of the


oversight processes unchanged, the fact that Congress considered reshaping these


requirements indicates a high level of interest and concern about oversight issues.


Given this level of interest and activity, changes to the oversight system are likely.


This report presents information which we hope will be helpful to decision makers as


they consider improvements to oversight of child welfare programs. In this report, we


evaluate the scope of and approach to Federal oversight activities (which includes the


statutorily mandated features of oversight), as well as the conduct of these activities.


This report is focused on a range of Federal oversight activities, including technical


assistance, planning, and review of programs. The focus is primarily on ACF oversight


i 
activities, although HHS leadership and Congress have significant roles in determining 

these activities. Audits and reviews conducted by agencies other than ACF, such as 

the Office of Audit Services in the OIG or the General Accounting Office (GAO), 

were not within the scope of this study. Furthermore, we did not reevaluate specific 

findings or disallowances from any reviews of State child welfare programs. We intend 

this report to establish the context and provide general perspective for officials to 

make improvements in the oversight system. Our Office of Audit Services has issued 

a draft report which focuses on specific improvements in the eligibility process. 

Finally, because ACF itself has expressed concerns about the oversight processes and 

has initiated several examinations of them, we are certain ACF is familiar with many 

of the shortcomings we identi~ in this report. Our focus is not primarily on assessing 

how good a job ACF is doing in conducting oversight, but on assisting ACF in its 

deliberations on improving the processes. 

We collected data from three primary sources. First, we reviewed the results of the 

most recent Section 427 reviews, Title IV-E reviews, and program reviews conducted 

in each State in the last five years. Second, we interviewed State child welfare officials 

in 13 States. Finally, we interviewed officials in each of the 10 ACF regional offices 

and had numerous discussions with officials in the central office of ACF. 

ACCOMPLISHMENTS 

Federal overnight of State child welfare prograrm has served some tiportant purposes, 

pam”cular$ in establkhing new directions for chiki welfare ik the early 1980s. 

Since the early 1980s, Federal oversight of State child welfare programs has been 

focused on assuring States’ adherence to P.L. 96-272. Several State and Federal 

officials we intemiewed spoke about the positive new directions in State programs 

resulting from P.L. 96-272 and Federal reviews focused on the law. In addition, 

oversight has helped prevent States from illegally receiving Federal funds for ineligible 

activities or on behalf of ineligible families. There is little question that the oversight 

mechanisms in use since the early 1980s have served important purposes. 

SHORTCOMINGS 

Despite the accomplishments stated above, there are indications that the oversight 

mechanisms and framework make it difficult for the Federal government to provide 

adequate stewardship of Federal funds or leadership to States for the 1990s and 

beyond. Evidence of these indications follows. There are shortcomings both in the 

overall approach to oversight as well as in the individual processes. Many of the 

shortcomings stem directly from the requirements set out by Federal statute, while 

others are matters of administrative discretion not strictly determined by statute. 

ii 
The overall approach to Federal overnight has not addressed many of the vzlal irsues 

States face in administetig child we~are program. 

�	 Federal oversight has not recently prompted States to improve and address new 

and complex problems in child welfare. 

�	 Federal oversight reviews have not identified severe problems with several 

States’ child welfare programs that were specified unsuccessful lawsuits against 

the States. 

�	 Section 427 and Title IV-E reviews have been focused onthewritten record of 

case work, not on how well children are served. 

�	 Disallowances have often been based on issues that child welfare agencies do 

not control. 

�	 The ACF has movided limited technical assistance to States; State officials say 

that ACF does’ not provide them with new information when it identifies “ 

program strengths and weaknesses and solutions to problems. 

I+obIems with the conduct of Federal review and phmning actiw”hmhave hampered their 

eficienq and q$ectiventxr. 

�	 Federal review activities have been resource intensive for State agencies and 

ACF regional offices. 

.	 Review reports have not been issued to States in a timely manner. This has 

diminished their capacity to improve child welfare programs. 

�	 States expressed confusion about the Federal review procedures resulting from 

poor communication by Federal officials. 

.	 There has been inadequate Federal/State interaction on child welfare oversight 

issues. 

�	 Officials from ACF and States question whether Federal review and planning 

mechanisms have been adequately meeting their stated objectives. 

RECOMMENDATIONS 

Oversight of State child welfare programs continues to be of intense interest to the 

Congress, HHS, the States, and others. The ACF, itself, is engaged in efforts to 

improve its oversight. We hope this report can provide information to help guide 

decisions on the course of oversight. It is important for ACF to pursue two principles 

in its oversight of State child welfare programs. The ACF must continue to assure the 

integrity of States’ use of Federal funds. It is equally necessary for ACF to work in 

... 

111 
partnership with States tomakeprograms work well. Our recommendations are 

focused at helping ACF and the States pursue both these principles. 

We present a wide range of options for each recommendation. Some options are not 

consistent with others, while other options fit together very well. Our goal is to 

provide as many practical ideas as possible. 

In many cases, the current oversight approaches and processes are set by Federal 

statute. Some of the options we present, if implemented, may therefore require 

legislative changes (these are denoted by a 6). Other options could be enacted at the 

discretion of ACF without Congressional approval. 

In order to tiprove its ovecrzght of State child we~are programs, the ACF shoti 

Provide States with more and better feedback on issues related to program 

performance. 

Implementation options 

Performance Indicators Develop performance indicators, collect State-by-State 

information on them, and disseminate this information to all States on a periodic 

basis. 

�	 Outcome-Based Reviews J Replace existing review mechanisms with new review 

processes that relate resources to outcomes. 

Find new ways to work with States to make program improvements and address 

problems. 

Implementation options 

�	 Corrective Action PlansJ Rather than automatically sanctioning States financially 

in response to adverse review findings, use, when appropriate (i.e., at the discretion 

of the Secretary), the results of reviews to develop corrective action plans, with 

agreed-upon time frames, to improve programs and enforce legal requirements. 

Waive or reduce disallowances, when appropriate (at the discretion of the 

Secretary), if States comply with plans and time frames. 

�	 AccreditationJ Using new or existing accreditation bodies, make accreditation of 

programs a Title IV-B State plan requirement. Oversee the accreditation bodies to 

assure that they are fair, reasonable, and pursuing continuous improvement. 

‘May require new legislation. 

iv 

c 
. Qualitv Assurance Require States to have quality assurance programs that look at 

the quality of case work. 

Improve current planning and review processes to make them more effective. 

Implementation options 

�	 Title IV-B Plannin~ Emphasis Put less emphasis on compliance reviews (such as 

the Section 427 reviews) to assure protections are in place in States and, instead, 

use a revitalized joint planning pro~ess to provide strategic direction that will lead 

States to effective child welfare programs. 

�	 Substantive Title IV-E ReviewsJ Use the Title IV-E review process to assure 

States are substantially complying with foster care case planning and review and 

judicial determination requirements. Limit disallowances to instances of substantial 

non-compliance. 

�	 Section 427 Incentivesd Alter the Section 427 review process to provide better 

incentives for improvement. Rather than using full compliance with process 

requirements as the standard for 427 funding, score States based on quality of case 

planning and reviews once they have passed a triennial review and make the size 

of the grants in the coming three years dependent on the scores. 

�	 Focus Program Reviews Change the approach of program reviews to use them 

only when indicators of problems are raised through other reporting or review 

mechanisms. Develop strategies to address those problems only. 

�	 One State PlanJ Require States to submit one coordinated State plan for all child 

welfare services. 

Make more efficient use of resources required to conduct reviews. 

Implementation options 

� Title IV-E Reviews - Automation Automate the Title IV-E review process. 

�	 Title IV-E Reviews - Self-CertificationJ Allow States to certi@ that their payments 

are eligible under Title IV-E. 

�	 Title IV-E Reviews - Limited Scope& Limit the Title IV-E reviews to income 

eligibility and payment allowability issues. 

‘May require new legislation. 

v 
�	 Section 427 ReviewsJ Discontinue Section 427 reviews or sharpjy reduce the use 

of them. 

�	 Discontinue Planning and Prom-am Reviews J Use other technical assistance efforts 

instead of Title IV-B joint planning and program reviews. 

�	 Limit Background Sections Shorten introductions to reports, which often focus on 

information about which the States are aware. 

Provide States with more useful, comprehensive, and expert advice on management 

program, and technical issues. 

Implementation options 

�	 Existing Mechanisms Focus more resources on joint planning, program reviews, 

and the training of regional officials to conduct technical assistance. 

�	 Non-~overnmental Contracts Use funds to contract with non-governmental 

organizations to provide general technical assistance to States. 

�	 Problem Areas Using a combination of ACF officials and outside contractors, 

provide intensive technical assistance to States or regions of States that have 

extreme problems. 

More effectively share information with and among States. 

Implementation options 

�	 Effective Practices Using oversight mechanisms, identify effective practices. 

Produce regular (at least semi-annual) reports that outline these practices and list 

contacts in the States. Actively share reports and State plans that outline effective 

practices. 

�	 On-Line Service Develop a simple, electronic, on-line service for States to share 

information about strategies, innovations, and other issues. 

Improve and clar@ communication with States about program standards. 

Implementation options 

�	 Reasonable Efforts Collect information on States’ definitions of “reasonable 

efforts” and identi~ model definitions. 

‘May require new legislation. 

vi 
�	 Central Office Hotline Establish a central office hotline to respond promptly to 

regional office and State inquiries about review policy, standards, and 

interpretation of regulations and statements. Follow up inquiries w“th written 

confirmations that are shared with all States and regional offices. 

�	 Program Remdations Publish comprehensive program regulations for Section 427 

and Title IV-E that would be subject to notice and comment. 

Improve the timeliness of reporting on results of reviews. 

Implementation options 

�	 Mandatom Turnaround Require reports to be issued within a set time after a 

review is complete. 

�	 Performance Reporting Develop goak for turnaround of reports. Then collect 

and disseminate information on the timeliness of reporting. 

�	 Streamline Decision-making Clari& who in ACF has the authority to decide on 

policy matters and final reports. 

�	 Limit Scope of Reviews J Reduce the complexity of the reports by narrowing the 

scope of the reviews. 

COMMENTS ON OUR DRAFI’ REPORT 

We shared our draft report with and solicited comments from the Administration for 

Children and Families (ACF), the Assistant Secretary for Planning and Evaluation 

(ASPE), the Assistant Secretary for Management and Budget (ASMB), and the 

Assistant Secretary for Legislation. We received written comments from ACF and 

ASPE. We reproduce these comments and provide detailed responses to each in 

appendix C. 

We are pleased that both ACF and ASPE concurred w-th our recommendations and 

found the report useful. We made changes in our report based on the technical 

comments we received. 

‘May require new legislation. 

vii 
TABLE OF CONTENTS


PAGE 

EXECUTNE SUMMARY 

~oIWmW
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1


ACCOMPLISHMEm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7


SHORTCO~GS


O=RALL APPROACH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8


PROCESS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13


RECOMMENDATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...19


cO=~ONTHE DRAFT REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . ...29


APPENDI~


&Major Child Welfare Programs . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . A-1


B: Federal Oversight Mechanisms for State Child Welfare Programs . . . . . . . . . B-1


C:	 Detailed Comments andOIG Response . . . . . . . . . . . . . . . . . . . . . . . .


. . . . c-1


D: Methodolo~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..D-l 

E: Detailed Evacuation of Implementation Options . . . . . . . . . . . . . . . . . . . . . . E-1


ENotes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..F-l 
INTRODUCTION 

PURPOSE 

To assess and to find ways to improve oversight of State child welfare programs. 

BACKGROUND 

In 1980, Congress passed The Adoption Asistance and Child Welfare Act 

(P.L. 96-272) in order to “lessen the emphasis on foster care placements and to 

encourage greater efforts to find permanent homes for children.”1 The law signaled a 

new direction in child welfare and highlighted an awakened Federal interest in how 

States manage their child welfare programs. Among other things, the law increased 

funding for a variety of State child welfare semices and separated funding for foster 

care and adoption assistance payments from Title IV-A of the Social Security Act (Aid 

to Families with Dependent Children, or AFDC). It also refocused Federal oversight 

of child welfare by requiring that certain child protections be in place for States to be 

eligible for Federal funds for foster care and other child welfare services. One major 

change was a greater emphasis on the enforcement of legal requirements to ensure 

the eligibility of children in the foster care system. For example, State court judges 

were required to include certain findings about the appropriateness of the foster care 

placement before a child could be considered eligible for Federal matching payments. 

Fundkg 

The Federal government funds State child welfare services through three significant 

mechanisms, all of which are under the Social Security Act .2 The largest proportion 

of monies comes from Title IV-E, with lesser amounts from Title XX and Title IV-B 

(see appendix A for more details). A majority of Federal funding goes for foster care 

maintenance payments and administrative and training expenses associated with foster 

care under Title IV-E.3 Costs for administration and training are a huge and growing 

proportion of Federal child welfare funding! 

Title IV-E 

Title IV-E funding is limited to foster care, adoption assistance, independent living, 

and administration and training associated with those programs; only children whose 

families are eligible for AFDC are eligible for Title IV-E foster care and adoption 

assistance funding. Title IV-E is an open-ended entitlement program.5 In fiscal year 

1993, it is estimated that $2.9 billion was spent on Title IV-E programs. 

1

Title XX 

Title XX-funded social semices block grants may be used for a variety of child welfare 

services. In total, Title XX social selvice block grants were funded for $2.8 billion in 

1993. The money may be used to help States meet five social services objectives; only 

one is directly related to child welfare services. According to a 1986 survey conducted 

by the American Public Welfare Association, States spent 27.5 percent of Title XX 

funding on child welfare services. 

Title IV-B 

Title IV-B Subpart 1 is a capped entitlement program that can be used for a wide


variety of child welfare services; children and families who benefit from the services do


not have to meet any income eligibility criteria. Substantial supplemental Title IV-B


funding is available to States under Section 427.6 The Section 427 funding was set up


to provide incentives to States to establish and maintain certain protections for


children in the States’ care. The Title IV-B appropriation for fiscal year 1993 was


$295 million. The Omnibus Budget Reconciliation Act of 1993 (OBRA 93) created


Subpart 2 under Title IV-B. This new capped entitlement is for family preservation


and family support services. Congress authorized $60 million in Subpart 2 funding for


fiscal year 1995 and $930 million over five years. Section 427 is not applicable to


Subpart 2 funding.


OvernightMechanisms 

The Federal government, through the Department’s Administration for Children and 

Families (ACF), oversees State child weifare services using the following formal 

mechanisms: Title IV-E reviews, Section 427 reviews, program reviews, and State plans 

(see appendix B for details on oversight mechanisms). In addition, ACF acts as a 

resource for States on a variety of fiscal, administrative, and programmatic issues. The 

ACF has not conducted reviews of Title XX block grants, although it has the authority 

to do SO. 

Title IV-E Reviews 

Title IV-E reviews are intended to assure that States spend Title IV-E money 

appropriately. They are usually conducted by a team of both fiscal and programmatic 

staff from the ACF regional office and, when possible, from ACF headquarters.’ The 

ACF conducts reviews of Title IV-E foster care maintenance payments, adoption 

assistance payments, and, occasionally, administrative and training expenses. 

The foster care and adoption assistance reviews determine, through record reviews, 

whether the child’s family is financially eligible, whether there is documentation 

indicating adequate review by courts and case workers, whether foster homes are 

licensed, and whether individual payments are allowable. 

2

The administrative and training reviews focus on whether systems for claiming and 

apportioning costs are accurate. Included in these reviews are checks on systems for 

internal control in the areas of rate setting and of payment and edit check procedures, 

and examination of the accuracy of methods used for assigning administrative and 

training costs to Title IV-E. 

Standards for Title IV-E reviews are based on specific statutory requirements. 

Section 427 Reviews 

The main objective of Section 427 reviews is to ensure that States have the necessary 

systems and policies in place to be eligible for incentive funds. Among the required 

protections are that States must take steps to prevent the need for removal of a child 

from his/her home, they must develop a case plan and review system for each child, 

and they must set goals for all children in foster care. States must also have 

implemented a Statewide information system on children in foster care. 

Federal oversight of Section 427 is a two-stage process: (1) an administrative review 

that is done the year after a State claims to be eligible for 427 funds, and (2) a survey 

of case records which is done periodically after the administrative review has been 

passed.8 The Administrative Procedures Review determines whether States have 

developed systems to assure protections for children in foster care. The Case Record 

Survey confirms that the Section 427 protections are in place in a certain percentage 

of children’s records in the State review files. If a State is found out of compliance, 

ACF issues a disallowance against the State’s allotment of Title IV-B funds for the 

following fiscal year and incentive funds are no longer granted.9 

Standards for Section 427 reviews are based on specific statutory requirements. ~ 

Program Reviews 

Prior to 1980, qualitative program reviews were the primary mechanism for Federal 

oversight of States’ child welfare systems. With the move toward fiscal and 

compliance-based reviews as a result of P.L. 96-272, the Federal government 

suspended program reviews in 1983. Program reviews were reinstated in 1990 when 

ACF identified the need for States to have their child welfare programs assessed in a 

systematic way and to receive more technical assistance.l” 

The ACF designed program reviews to improve semices to children and their families 

by periodically assessing State and local programs. States participate voluntarily. 

Teams of State agency staff, Federal regional office reviewers, and a Children’s 

Bureau specialist conduct on-site interviews and review case records with State agency 

officials, program beneficiaries, and staff of local agencies. 

The objectives of a program review are (1) to provide a systematic method of 

assessing the effectiveness and efficiency of child welfare programs at the State and 

3 
local levels of service delivery; (2) to provide a basis for assisting States and local sites 

to identi& areas in which program improvement is needed; and (3) to provide a flow 

of management information between the States, local sites, and the Children’s 

Bureau.11 Program reviews identifi exemplary programs as well as program 

weaknesses and recommend specific p]ans for improvement. There are no penalties 

attached to the reviews, nor are States required to implement the recommendations. 

State Plan Processes 

P.L. 96-272 also requires ACF to confer with States about their child welfare programs 

through the State plan process. States must have specific plans for the provision of 

child welfare services in order to be eligible for payments under Titles IV-B and 

IV-E.*2 There are separate planning processes for Titles IV-B and IV-E. 

State and HHS staff jointly develop the Title IV-B State plan; the plans describes 

States’ child welfare setices and the steps they plan to take to expand and strengthen 

en”sting programs. These plans must be submitted at least once every three years. 

The Title IV-E foster care and adoption assistance programs are included in States’ 

Title IV-B plans, but these programs apply only to children eligible for AFDC.13 

There is a separate Title IV-E State plan which is developed by the State, and 

submitted to the Secretary for approval. It is based on a set of questions developed 

by HHS requiring information from the States about specific goals as to the maximum 

number of children in care for more than two years, a description of steps to meet 

these goals, and a case plan review system. 

Z’?ieOmnibus Budget Reconciliation Act of 1993 (OBRA 93) 

On August 10, 1993, the President signed into law OBRA 93. This law increased 

funding for Title IV-B to encourage State efforts to support and preseme families 

(known as Title IV-B Subpart 2). The original version of the bill proposed major 

alterations to the oversight process. 14 The law, as passed, left most of the oversight 

processes unchanged. The OBRA 93 has an impact on oversight in three areas. First, 

additional Title IV-B Subpart 2 funding ($2 million in fiscal year 1994 and $6 million 

thereafter) has been authorized for ACF to use for evaluation, research, training, and 

technical assistance; next, Title IV-B State plan requirements were changed to reflect 

Subpart 2; and finally, the Federal government was barred from issuing disallowances 

as a result of Section 427 and Title IV-E reviews until October 1, 1994. 

Basis for and Scope of Our Study 

Members of Congress, HHS officiak, the General Accounting Office, directors of 

State child welfare agencies, and representatives from the Child Welfare League of 

America and the American Public Welfare Association are among those who have 

voiced concerns about the Federal oversight processes.ls At hearings conducted in 

1991 by the House Committee on Ways and Means, witnesses testified at length about 

4 
the problems with Federal oversight; in particular, they were concerned that the


reviews elevate process issues over quality of services.lG


Critics believe that, in several ways, the oversight processes do not support the intent


of P.L. 96-272. In addition to the OBRA 93 moratorium, Congress twice acted to


suspend penalties levied against States that have been found out of compliance during


427 reviews.17 The ACF has convened several task forces and engaged in high-level


deliberations about how to improve the review processes.18 As part of their efforts


to improve oversight, ACF officials requested that we prow”de them with an


assessment of oversight activities and develop a range of proposals to address


problems we identified.


Given the level of interest expressed by Congress, the States, the Administration, and


child welfare advocates in child welfare and Federal oversight of State programs,


changes to the oversight system are likely. This report presents information which we


hope will be helpful to decision makers as they consider improvements to the


oversight of child welfare programs. In this report, we evaluate the scope of and


approach to Federal oversight activities (which includes the statutorily mandated


features of oversight), as well as the conduct of these activities.


This report is primarily focused on the review and planning mechanisms used by ACF


to oversee State child welfare programs. In our interviews with State and ACF


officials we also discussed the other less formal mechanisms that ACF uses to oversee


States such as technical assistance efforts, The report therefore often uses the term


“oversight activities” in a general way, This report is not focused on reevaluating


specific findings or disallowances from any reviews of State child welfare programs.


We assume, and have no reason to believe otherwise, that all disallowances taken as a


result of reviews were based on direct application of Federal statute.


In addition, although our primary focus is on ACF oversight activities, we feel it is


simpler and more appropriate to speak about “Federal” oversight activities. The ACF


is not alone in responsibility for administering and designing oversight activities. The


HHS and Congress have significant roles in this process. As noted throughout the


report, many aspects of the oversight processes are defined by Federal statute.


However, our use of the term “Federal oversight” is not intended to include reviews


and audits of State child welfare programs outside of ACF’S purview--for example,


reviews and audits conducted by the OIG Office of Audit Services or the General


Accounting Office.


While many observers of and participants in the oversight processes have raised issues


similar to those raised in this report, this report is meant to serve several unique


purposes. First, we provide detailed analysis of the oversight process, using multiple


sources of information. The methods we used allow us to make well-balanced and


conclusive statements about the approaches and performance of oversight. Second, as


mentioned above, we assessed the entire system of Federal oversight including


technical assistance activities, planning activities, and review activities. Finally, our


5 
central objective is to find ways to improve oversight. We do not prescribe a specific 

course of action, but instead identify key areas in which improvement is necessary. 

We then present a range of implementation options in each area. The report is, 

therefore, meant to be a single, comprehensive document that will hopefully establish 

the context and provide general perspective for officials to make improvements in the 

oversight system. Our Office of Audit Services has issued a draft report which focuses 

on specific improvements in the eligibility process.lg 

Methodology 

We collected data from three primary sources. First, we conducted document reviews.


We reviewed all available reports from Section 427 reviews, Title IV-E reviews, and


program reviews conducted in each State in the last five years. We gathered and


analyzed reports, journal articles, legislative and regulatory proposals, and information


from court proceedings. Second, we interviewed State child welfare officials. We


conducted inteniews on-site in 3 States and over the telephone in 10 States--one in


each HHS region. Finally, we intemiewed officials in each of the 10 ACF regional


offices over the telephone and held numerous discussions with officials in the central


office of ACF. (See appendix D for a complete description of the primary data


collection methods and sample selection criteria.)


In our presentation, we blended information from these three sources. We


supplemented the opinions and conclusions of State and ACF officials with evidence


from review reports, literature, laws, regulations, and court proceedings. Whenever


possible, to account for potential biases, we balanced interview data from State


officials with interview data from ACF officials. We did not evaluate the accuracy of


statements made in interviews about the accomplishments and shortcomings of


Federal oversight except by using the above-noted sources. Nonetheless, because


State officials frequently agreed with ACF officials and the evidence from reports and


other sources support the interview information, we are confident of the validity of our


conclusions.


We conducted this inspection in accordance with the Quality Sandards for Inspections


issued by the President’s Council on Integrity and Efficiency.


6

ACCOMPLISHMENTS 

Federal ovtzright of State child welfare programs has served some important purposes, 

parh”cuhw-lyin establishing new directions for child welfare in the early 1980s. 

Since the early 1980s, Federal oversight of State child welfare programs has been 

focused on assuring States’ adherence to P.L. 96-272. Several State and Federal 

officials we interviewed spoke about the positive new directions in State programs 

resulting from P.L. 96-272 and Federal reviews focused on the law. States were 

prompted to develop written case plans and conduct periodic judicial and 

administrative reviews of children’s cases; these were procedural breakthroughs in 

many States. The requirement to make reasonable efforts to prevent family breakups 

and reunify separated families was a significant shift in objectives on the part of the 

Federal government. State officials we spoke with said that oversight led them to 

create new laws parallel to Federal laws, clean up existing laws, and formalize existing 

procedures. Officials from ACF cited more effective coordination between agencies 

and State judiciaries, and better family-centered services resulting from the law and 

the oversight process, and mentioned that children are less likely to get lost in the 

foster care system. 

In addition, oversight has helped prevent States from illegally receiving Federal funds 

for ineligible activities or on behalf of ineligible families. For example, in one State, 

ACF recovered over $200,000 in Federal funds because payments were made to 

ineligible or unlicensed providers. In another State, ACF recovered over $190,000 

spent by the State for children from families without financial need. The fact that 

ACF verifies through a review process that funds are spent legally undoubtable deters 

States from making ineligible claims. While it is impossible to measure this effect, it is 

nonetheless important. 

There is, therefore, little question that the oversight mechanisms in use since the early 

1980s have served important purposes. There are indications, however, that the 

oversight mechanisms and framework do not allow the Federal government to provide 

adequate stewardship of Federal funds or leadership to States for the 1990s and 

beyond. Evidence of these indications follows. Many of the shortcomings stem 

directly from the requirements set out by Federal statute, while others are matters of 

administrative discretion not strictly determined by statute. 

7

SHORTCOMINGS 

IN GENERAL APPROACH 

i%e overall approach to Federal ovemzght has not addressed many of the vital ti 

States face in adminktetig child welfare programs. 

�	 Federal oversight has not recently prompted States to improve and address ne 

and complex problems in child welfare. 

The state of child welfare services has changed significantly since P.L. 96-272 was 

passed. Many sources have identified a crisis in child welfare services. Numerous 

disastrous incidents have occurred lately to children under State supervision.20 State 

child welfare agencies are overwhelmed by escalating case loads and the increasingly 

complex problems of children in care. There are increasing numbers of infants in 

State care, many of whom have difficult medical problems caused by substanceabusing parents.z* In addition, adolescents and teenagers in care frequently have 

substance abuse or mental health problems, or have been involved in criminal 

offenses .22 These issues complicate substitute care situations and greatly decrease 

the chances of successful permanent placements. They also place ‘tremendous burden 

on case-worker systems that are already at or above capacity. 

State officials we spoke with did not think recent Federal oversight activities have 

helped them cope with current crises, because reviews do not address the most 

important issues in child welfare (such as appropriate methods to assist very troubled 

children and families). Some program improvements (such as reductions in numbers 

of children in long-term foster care placement and more effective coordination 

between agencies and their judiciaries) have occurred recently, but oversight is usually 

not spurring advancements in State programs. In fact, some States find that Federal 

oversight has had detrimental effects or has never had much positive effect on their 

programs. Some cited no changes at all. States cited a variety of changes that 

oversight has recently spurred that were not positive. For example, State officials felt 

that alterations to the case review process such as timing of the reviews, new 

procedural changes to an automated pa~ment system, and changes to a case planning 

document to assure the documentation of requirements had no positive effects; in fac 

they felt these responses required attention and resources that could have been used 

to address important issues. 

Several State officials mentioned that they had a hard time convincing their 

legislatures of the need for change without Federal dollars being at risk. Nevertheless, 

even though every State has had a 427 review, only five States have failed 427 reviews 

since 1988 and, because of Congressional moratoria, no State has lost Federal funding 

because of a failure in that time period. Some observers feel it is time to move 

beyond the Section 427 requirements, in part because most States have adequately 

met the requirements. z States have been somewhat less successful in Title IV-E 

8

reviews; nevertheless, of the States reviewed by ACF, only twelve States have had 

major (Stage II) disallowances in Title IV-E foster care reviews and only two States 

have had major (Stage 11) disallowances in Title IV-E adoption assistance reviews in 

the last five years. 

Even if the reviews were addressing the current set of problems, State action as a 

result of the reviews is voluntary. Except in the rare cases of disallowances, 

disregarding ACF findings may not have ramifications for the States. When States 

fare poorly, ACF’S only mechanism for verifying improvement is to review them in the 

future. In general, ACF does not monitor or require documentation of policy, 

program, or system responses to Federal reviews. 

.	 Federal oversight reviews have not identified severe problems with several 

States’ child welfare programs that were specified in successful lawsuits against 

States. 

In 4 of the 13 States in our study, lawsuits based on charges that States were violating


Federal law resulted in court-approved settlements. These suits all were initiated after


the passage of P.L. 96-272. While the allegations of the lawsuits were never subject to


court adjudication, the plaintiffs in these suits accused the States of not making


“reasonable efforts” to prevent removal of children from their homes and/or to


rehabilitate their families so that the children could return home. Titles IV-B and IV­


E require States to make these efforts. Problems identified in these cases included


failure to adequately track children in care, poor-quality child protection investigations,


extremely long placements in out-of-home care, and lack of State oversight of county-


based sewices.24 Lawsuits have been brought against more than 20 States; many


have been based on violation of Federal law.fi


In three of the four cases, according to State officials, Federal reviews covered the


period of time that the suits’ plaintiffs were in State care. In the other case, according


to State officials, the lawsuit was not specific as to timeframe, According to officials in


all four States, Federal officials did not identify the issues raised in the suits during


reviews conducted before the States were sued. During reviews, ACF made no


explicit mention of States inadequately preventing removal or rehabilitating families.


.	 Section 427 and Title IV-E reviews have been focused on the written record of 

case work, not on how well children are served. 

The review standards for Section 427 and Title IV-E reviews, which are derived from 

Federal statute, are oriented toward documentation and the meeting of timing 

requirements. The Section 427 reviews look solely at whether actions were taken (and 

documented), not whether the actions were done well or had any positive impact on 

the child. The Title IV-E foster care and adoption assistance re~iews also look at 

documentation issues and not at how well services were provided. 

9

It is not clear that the statuto~ requirements for these reviews ensure effective sewice 

provision. In fact, several State and regional officials raised the possibility that States 

could pass reviews and still have poor child welfare programs. Most of the State 

officials and all of the regional officials we spoke with had problems with the “process” 

orientation of the Section 427 and Title IV-E reviews. Officials from every regional 

office mentioned that there needs to be more emphasis on qualitative measures and 

less on quantitative measures. A common concern was that the Section 427 reviews 

only check to make sure States are meeting certain timeframes rather than whether 

services provided yield improvement. This focus has made States emphasize passing 

the reviews rather than following the intent of the law. 

Almost all State and regional office officials felt the Section 427 reviews should have 

objectives in addition to ensuring certain child protections are in place and assuring 

implementation of information systems on children in foster care.ti Eight of eleven 

responding States and se~en of ten responding regional offices felt that the 427 

reviews should have different objectives. Officials in seven States and in six regions 

wanted the objectives to be focused on quality issues such as how fast a child gets 

placed and whether case plans are appropriate. 

Many State and regional office officials felt that IV-E reviews should have objectives 

in addition to determining whether payments are made on behalf of eligible children, 

assuring payments are made to eligible providers, and assessing whether payment 

levels are allowable.2G For example, officials in some States felt that the IV-E 

reviews should be focused on quality issues such as whether children are being moved 

through and out of the system quickly enough. Regional officials said that the reviews 

should have a variety of other objectives including focusing more on administrative 

and training costs, assessing fiscal and program issues together, and measuring quality. 

State and regional office officials suggested changes to the entire oversight system to 

address these problems. Officials in almost every State and many regional officials 

expressed, in a variety of ways, a desire to have the Federal oversight system focused 

less on compliance with standards and more on the quality of child welfare services. 

Common suggested improvements included changing the process to be more helpful; 

focusing efforts on technical assistance; having oversight be outcomes-based, and 

emphasizing models for good practice.27 

�	 Disallowances have often been based on issues that child welfare agencies do 

not control. 

Several of the items that Federal statute requires ACF to review in Section 427 

reviews and Title IV-E reviews relate to issues over which State child welfare agencies 

do not have complete control. For example, during Title IV-E reviews, the Federal 

government verifies that court orders indicate that reasonable efforts were taken to 

prevent family breakup or to reuni~ the family; and during Section 427 reviews, ACF 

checks each case to be sure that dispositional hearings are held within 18 months of 

the original placement. A 1993 survey of States done by the American Public Welfare 

10 
Association found that the leading reason for failure on Title IV-E reviews was related


to judicial determinations; and on 427 reviews, was related to dispositional hearings.a


Our respondents also reported difficulties complying with Federal requirements


related to court orders and timing of hearings; our analysis of review reports


demonstrated this problem as well.29 In theory, taking money away from State child


welfare agencies (and therefore from State budgets) might influence State courts to


respond with new policies or procedures, but many State officials spoke about the lack


of control and leverage they have over courts, and therefore, how unfair and


ineffective it is to impose disallowances based on problems with the courts.


The courts, in some cases of disallowances, may simply be neglecting to provide


needed documentation. For example, ACF officials we spoke with mentioned that, for


some cases, they were able to assess that high quality case work was being done that


would meet any standard of “reasonable efforts,” and yet the court documents did not


include language to that effect. These reviewers speculated that court officials simply


neglected to put the language in the documents; the fact that they failed to include the


language did not indicate that they thought efforts were less than reasonable. Despite


this, ACF reviewers were required to find cases such as these in error.


A draft OIG report, by the Office of Audit Services, further discusses the difficulties


States have complying with statutory eligibility requirements.30 The report also


examines problems raised by legal determinations prepared by courts and discusses the


notion that eligibility requirements can be satisfied when substantial compliance has


been achieved through reasonable efforts.


�	 The ACF has provided limited technical assistance to States; State officials say 

that ACF does not provide them with new information when it identifies 

program strengths and weaknesses and solutions to problems. 

The most direct forms of technical assistance ACF has provided to States are now 

rarely available. Funding is no longer available for technical assistance provided by 

Child Welfare Resource Centers (CWRCS). Most State and regional office officials 

who had experience with or knowledge of the CWRCS felt they had provided useful 

setices to States. (However, some central office officials felt that some non-CWRC 

contractors who offer technical assistance have provided States with inaccurate and 

overly expensive services.) Program reviews, the only oversight mechanism explicitly 

designed to provide technical assistance, have not been performed on a wide scale and 

have often been fraught with problems. The reviews have been done in only 15 States 

since being reinstituted in 1990 and, according to a senior ACF official, ACF is not 

planning to conduct more in the near future. Many State and regional officials 

mentioned problems with the timeliness, scope, and design of program reviews (we 

detail many of these problems later in this report). 

Many State and regional office officials would like ACF to be more involved in and 

better trained at providing technical assistance. Officials in some States would like to 

see the entire orientation of Federal oversight to be on technical assistance. Many 

11

others felt this was an important role, but recognized that Federal officials are not 

expert in providing technical assistance and need to be better informed about the field 

of child welfare. Some regional officials also expressed a desire to be more involved 

in consultative work with the States. Many recognized a need to be more 

knowledgeable about State programs, specialized areas, and innovations in child 

welfare in general. Officials in the central office of ACF were particularly concerned 

that ACF has not provided adequate assistance to States on legal and compliance 

issues. 

The ACF has convened regular meetings of States and made other efforts to share 

information with them, but many State officials said that ACF has not adequately 

shared information among States. Officials in States mentioned the specific need for 

the Federal government to share information on exemplary programs, on emerging 

issues, and on State practices. State officials also mentioned their desire to be able to 

read other States’ plans in order to get a sense of issues, problems, and innovations. 

Despite the fact that one of the goals of program reviews is to identify exemplary 

approaches, Federal officials have acknowledged that no formal effort has been made 

to share information from these reviews among the States. In addition, central office 

officials point out that knowledge about States is usually localized to particular 

individuals in regional offices; there is no existing central repository for information 

about States. 

It appears that, in general, Federal oversight has not effectively identified program 

strengths and weaknesses and helped States solve problems. All the responding States 

felt that the information ACF provided them on strengths, weaknesses, and solutions 

was information of which they were already aware. On average, respondents from 

States rated the effectiveness of Title IV-E reviews, 427 reviews, and the Title IV-B 

State planning process in identi~ing strengths, weaknesses, and solutions as less than 

“adequate.” Regional office ratings were slightly higher, but respondents from 

individual regions felt these processes couid more effectively address program issues in 

States. 

12

SHORTCOMINGS IN PROCESS


Problems with the conduct of Federal review and planning activities have hampered thek 

@i%iency and effectiveness. 

�	 Federal review activities have been resource intensive for State agencies and 

ACF regional offices. 

Almost every State felt that preparing for and participating in Federal reviews was an 

unnecessarily time-consuming process. Some State officials complained that far too 

much time and money are invested in reviews that no longer do much to improve the 

quality of services for children and families. State officials stated that many hours are 

spent preparing for, participating in, and following up on an individual review (officials 

in one State estimated that 4,400 staff hours were spent on these activities for one 

review). The ACF’S own estimates make clear how resource intensive preparing for, 

conducting, and following up on Section 427 and Title IV-E reviews have been for 

States and the Federal government (see figure 1). 

All of the States with 

county-administered 

child welfare 

programs we spoke 

with said they have 

faced additional 

burdens when 

preparing for Federal 

reviews. Because 

their programs are 

decentralized, they 

have an additional 

layer of bureaucracy 

to deal with in 

preparing for reviews. 

For example, one 

State official 

FIGURE 1 

How Labor Intensive Are Federal Reviews? 

Mm; 

12s0 

mm 

7SQ 

Sm 

2s0 

o — 

explained that costs in one county for copying and shipping records to the State office 

for a 427 review were over $2,000. 

On average, according to ACF central office officials, program reviews have involved 

15 people as reviewers and dozens more as participants. One large State, which has a 

county-based child welfare program, had a program review that involved over 100 

people from ACF central and regional offices, the State ageney, county agencies, State 

universities, agency staff, clients, and advocacy groups.31 

13

Almost every State we spoke with has spent significant time and money monitoring


cases to ensure compliance with Federal requirements. Some States have established


elaborate systems whose primary purpose is to prepare cases for Title IV-E and


Section 427 reviews.


Federal officials spend much time drafting and redrafting reports. Central office


officials point out that many reports to States include lengthy introductory and


background sections that go into extensive detail on the States’ organization,


operation, and program choices--which is information about which the States are fully


aware.


�	 Review reports have not been issued to States in a timely manner. This has 

diminished their capacity to improve child welfare programs. 

Six of the 15 States that had program reviews in the last five years had not yet 

received even draft copies of their review reports by April 1993. Two States in our 

sample had yet to receive reports for Title IV-E reviews--one of which was conducted 

in 1983. Two States had yet to receive Section 427 review reports; one of these States 

had not received any formal feedback from reviewers who conducted their 427 review 

in 1987. 

Officials in 11 out of the 13 States recounted specific incidents of not receiving review 

reports in a timely manner once the review had been completed. For example, 7 of 

the 12 States that had had IV-E reviews reported that they had waited at least one 

year for their final reports. Officials in regional offices supported State claims that 

there have often been long lag times between the conduct and issuance of review 

reports, particularly for Title IV-E and program reviews. In fact, eight of the nine 

responding regional offices said that Title IV-E review reports were rarely or never 

timely; all of the responding regional offices report that program reviews were rarely 

or never timely. 

Moreover, as our examination of 69 review reports show, reviews have taken place 

and reports have been released long after the fiscal year under review was over. On 

average, Title IV-E reviews were released over two and a half years after the end of 

the fiscal year under review and Section 427 review reports were released almost a 

year-and-a-quarter after the end of the fiscal year under review. 

Despite the fact that States have often been briefed on the findings of a review during 

an exit conference, State and regional officials reported that delays in issuing review 

reports diminished their effectiveness and usefulness. Regional and State officials 

considered the retrospective nature of reviews to be a significant weakness of the 

oversight process because it focuses attention on past rather than current practice; this 

problem is heightened by a lack of timeliness in issuing the reports. State officials 

mentioned that untimely reviews have identified issues that have become irrelevant to 

current State programs; others were frustrated because windows of opportunity for 

14

change have been closed by the time reports are released. In some cases, States have 

been left wondering about the outcomes or bases for disallowances. 

Officials in all of the responding regional offices identified central office reviews as a 

major barrier to timely reporting. The ACF does not impose requirements on 

turnaround time for review of reports in the central office. Most regional officials 

claimed that reports have been reviewed by too many central office staff. The ACF 

central office is aware of this problem, and has recently taken steps to remedy it for 

program reviews. They have revised the review protocol for program review reports 

so that reports are circulated only through the Children’s Bureau rather than all of 

Administration on Children, Youth and Families (ACYF) before being returned to the 

regional offices. 

Also, central office officials, while acknowledging shortcomings in the report review 

process, pointed out that this is not the sole source of problems with timeliness. They 

viewed the report writing process as a collaborative one and therefore felt that both 

regional and central offices are responsible for the timeliness of reporting. 

�	 States expressed confusion about the Federal review procedures resulting from 

poor communication by Federal officials. 

While most State officials said that they were given information about standards by 

their regional offices prior to the reviews, officials in 11 of the 13 States cited specific 

problems with the transmission and communication of standards. State officials 

mentioned difficulty getting ACF to resolve review-specific policy issues, differing 

interpretations of standards between ACF central office and regional office staff, 

recently issued review handbooks that were already obsolete, and inconsistent 

messages in reviews over time. This poor communication apparently caused serious 

problems for States. For example, one State was unsure how to claim foster parent 

training costs; another could not get policy guidance on State and tribal jurisdiction. 

Inconsistent messages about sample selection for Section 427 reviews has made 

another State unsure about when to conduct periodic reviews and judicial 

determinations (see table 1 for other examples of States’ problems with 

communication of standards). We did not independently validate the accuracy of 

States’ claims about inconsistencies and inadequacies in communication about 

standards. Nevertheless, we believe the very fact that States feel these are problems 

indicates a need for better communication. 

Some State and regional office officials have attributed poor communication of review 

standards and regulations to the lack of formal review guidelines and regulations. For 

example, Section 427 reviews were first implemented in 1980, and to date, there are 

still no regulations. Another source of confusion has been the absence of final Title 

IV-E review regulations on methodology and audit procedures. 

While States have cited problems with communication of standards, we did not find 

evidence that ACF has misapplied Federal statutory requirements in developing 

15 
TABLE 1 

SPIXIFXC PROBLEMS WITH STANDARDS 

ACCORDING TO WATE OFFICIALS 

COMMUNICATION 

* 

* 

* 

* 

* 

* 

* 

* 

* 

* 

The State was never given a cow of the most recent Title IV-E review handbook 

A critical change to the IV-E review checklist was not communicated in advance. 

The State has not yet seen the IV-E foster parent training regulations. 

Z$ere was somt confhsion in communication fi-om the Federal government over how dtjjferent 

fimding streams work 

Ihe current 427 handbook k already out-o fidate. 

Some standards in the reviews are not consistent with information presented in policy guidances. 

Because communication from the regional ofice is poor and sometimes incoruistent, the State 

speh directly with central ofice ACF officials and outside organimdons about interpretatiotw 

Subtle twkts and variations on standards have been added during reviews. 

Rep”onal of~ces and States had d~ficulty resolving policy questions around m“balversus State 

jurisdictions (re: fitnding). 

States were unable to get reg”onal office response on whether medical and educm’on records were to 

be included in the Section 427 reviews. 

CONSISTENCY OVER TIME 

* 

* 

* 

* 

* 

* 

* 

* 

The State was cnticued for something that it had been praised for two years earlier.


I%ere was a new twist in the latest review on whether administrative case plain should be signed in


evety review.


Zkere has been a lack of coritktency in guidance on what to consider the date of removal.


There has been a lack of consistency in communications about whether to include children in


relative care in the 427 sample.


The reg”onal ofice has changed its opinion on whether standards applied to adoption services.


The regional ofice ha inconstktently ruled on whether agreed orders are acceptable.


The State was sutprised by the standards on licensure and on child support enforcement issues on


the Title IV-E review.


Review standards have become sti”cter over time.


CONSISZENCYACROSS SZAIES 

* 

* 

* 

* 

* 

Source: 

Note: 

The State wm required to pay back voluntary IV-E money, while another State was not (this was


appealed and the State won).


Federal oficials did a ~“ennial 427 review@ years after the State had pawed a triennial review.


U4thin the region there have been different interpretations in several States on how to allocate


university training costs for IV-E admt”nistrative cost claims.


The removal-from-home standard was different for a State in another regio~


States are held to standards issued after the end of the fucal year under review.


Interviews with 13 States conducted by Ofice of Inspector Genera~ May 1993. 

Z% OIG did not inakperuiew~ validate the accuracy of dwse claims. 

16

review standards. 

�	 There has been inadequate Federal/State interaction on child welfare oversight 

issues. 

The majority of regional officials said that States should be reviewed more frequently. 

0fficialsin60f the 10regional offices reported that States have not been retiewed 

frequently enough. Since 1988, according to ACF records, five States have not had 

their Title IV-E foster care or adoption assistance payments reviewed; only 15 States 

have hadprogram reviews since they were reinstatedin 1990. State officials stated 

that the lack of contact has made it difficult for ACF officials to understand the local 

child welfare context. 

Many State and regional office officials would like to increase the level of 

collaboration around the IV-B joint State plan process. Officials in about half of the 

States viewed the Title IV-B joint State planning process as an effective mechanism, 

but usually despite, and not because of, ACF involvement. State officials cited a 

general lack of contact with regional office officials as a major problem with the 

process. Most regional officials reported that they were only able to make one or two 

visits to the States per year to work on the joint State plan, but they believed for 

planning to be truly collaborative they should be making quarterly visits. Regional 

officials felt the lack of travel money constrained them from conducting site visits to 

the States. 

�	 Officials from ACF and States question whether Federal review and planning 

mechanisms have been adequately meeting their stated objectives. 

Many regional and State officials were uncertain about whether the Title IV-E review 

process was meeting all of its objectives. Regional officials, in particular, said that the 

Title IV-E reviews were too broad; they were expected to examine so many different 

areas that it was almost impossible to check any one area as thoroughly as they would 

have liked. Because the Title IV-E review was so broad, regional office and State 

officials questioned how well these reviews assured that payments were made to high 

quality homes and institutions. There was no effort to inspect the sites, and most 

reviewers just checked to see if homes and institutions were on a list provided by the 

State. Some regional and State officials were also uncertain about whether payment 

levels were allowable under Office of Management and Budget (OMB) provisions.32 

This was primarily due to lack of knowledge of what the Federal and State funding 

levels should be. 

Officials in seven of eight responding regions said that program reviews were not 

meeting at least one of their objectives. The most frequently mentioned reason why 

they thought program reviews were not meeting their objectives was that they were 

too comprehensive. Other problems with the program review cited by regions were 

lack of any clear methodology, an unwieldy data collection instrument, inconsequential 

findings, and lack of information to help States solve programmatic problems. 

17 
Half of the regional offices reported that Section 427 reviews have not been meeting 

all of their objectives. In particular, they thought these reviews were not adequately 

assuring the implementation of a State-wide foster care information system. Regions 

said that the level of sophistication of the State-wide information systems varied from 

simple handwritten lists of cases to computerized management information systems. 

Most regional office and State officials thought that Title IV-B joint State plans have 

not been developed collaboratively. Many State officials mentioned that the process 

was not truly “joint” because the Federal government does not provide much in the 

way of suggestions for planning. Some did not find the State plan at all helpful. Six 

States remarked that ACF has done nothing in the way of oversight or assistance to 

assure that the State plans are implemented. 

The Title IV-E State plan was seen as largely a paper exercise. State officials and 

ACF officials agreed that it is rarely, if ever, looked at by ACF. 

18

RECOMMENDATIONS


Oversight of State child welfare programs continues to be of intense interest to the 

Congress, HHS, the States, and others. Congress has placed a moratoriumon Section 

427 and Title IV-E review disallowances untilOctober 1994. This moratorium has 

coincided with efforts thatACF is makingto reevaluate monitoring activities 

throughout the agency andlook specifically at program review and State planning 

actiw”ties. Many review activities are on hold. Senior ACF officials have indicated, in 

discussions with us, their desire for improvements to the oversight process; they view 

the coming year as an opportune time for changes. Legislation proposing to reshape 

certain aspects of the oversight process (such as eliminating Section 427 and 

reformulating some arts of it as State plan requirements) was introduced on 

f November 17, 1993.3 

We hope this report will provide information to help guide decisions on the course of 

oversight. We intend for the following recommendations to set out the key areas in 

which improvements are needed. We list broad recommendations, then more specific 

implementation options for each. We do not prescribe a specific course of action, but 

instead offer options for policymakers to consider and leads for them to follow as they 

develop an oversight framework and specific approaches (see appendix E for a more 

detailed evaluation of the options). Some options are not consistent with others, while 

other options fit together very well. Our goal is to offer as many practical ideas as 

possible. 

Coming up with solutions to the problems we have raised will not be easy. In many 

cases, the current oversight approaches and processes are set by Federal statute. 

Some of the options we present may therefore require changes to the statute (these 

are denoted by a 6). Other options could be implemented at the discretion of ACF 

without Congressional approval (see appendix E). 

In recent years, ACF has focused oversight activities primarily on assuring that Federal 

funds are spent legally--that eligibility requirements are met, that legal protections are 

documented, that claims are valid, etc. It is important for ACF to maintain this 

principle of stewardship of Federal funds. It is at least as important for ACF to work 

in partnership with States to make programs work well. Therefore, as a second and 

equal principle, oversight activities should encourage States to constantly improve 

programs so as to better assist families and children in need. The ACF’S oversight 

activities, for a variety of reasons, have not adequately encouraged States to improve. 

Our recommendations are focused at helping ACF and the States pursue both these 

principles. 

19

In order to improve it$ ovenight of State chiki weljare programs, the ACF should 

Provide States with more and better feedback on issues related to program 

performance. 

Officials at the State and Federal level asserted that the current oversight mechanisms 

focus too much on process issues that have little to do with the quality of services 

provided to children in need. 

Implementation options 

�	 Performance Indicators Develop pe~onnance indicators, collect State-by-State 

informah”on on them, and dkseminate this information to all States on a periodic 

bask Because there are not any widely accepted definitions of successful child 

welfare practice, it could be extremely complicated to develop performance 

indicators. The task could be limited initially by pilot-testing a small number of 

indicators. Some of the difficulty gaining States’ acceptance of the indicators would 

be lessened by not linking the indicators to financial sanctions. States would likely 

find it very helpful to track performance over time and compare themselves with 

others. Getting this information would help raise questions and keep State officials 

focused on results. The development and testing of performance indicators in this 

way could evolve into an outcomes-based review system as outlined below. The 

ACF could pursue one of a number of avenues in its development of performance 

indicators; here we suggest two. One idea is for ACF to identi~ how States 

currently measure their own performance and what kinds of information they 

collect on a regular basis to inform their funding and program decisions. It could 

be that many States already agree upon a small set of measures and these could be 

used as a basis for pilot testing national collection of this information. Another 

idea is to hire a contractor, possibly one associated with a national association that 

already has contact with the States, to develop a pilot indicator system.x 

� Outcome-Based Reviews8 Replace exzking review mechanisms with new review 

processes that relate resources to outcomes. Some States have argued that this is the 

direction they think reviews should go--in part because it would allow them to 

argue very forcefully with their legislatures for adequate funding (in fact, several 

legislatures are considering requiring agencies to justi~ funding based on 

outcomes). On the other hand, the difficulties mentioned above about 

development of performance indicators would be heightened if outcomes measures 

were used in reviews. If financial assistance were based on performance, it could 

be enormously difficult to decide upon measures to be used. It will be necessa~ to 

develop measures using the approach outlined in the first option in order to reach 

a practical consensus on expectations. This option might require new legislation. 

‘May require new legislation. 

20 
� 

Any of the existing review mechanisms, including Title IV-E reviews, 

altered to become outcome-based. 

Find new ways to work with States to make program improvements and 

problems. 

could be 

address 

Existing oversight mechanisms do very little to encourage States to make 

improvements and to address problems. The mechanisms are not helping States be 

innovative and do not encourage continuous improvement. 

Implementation options 

�	 Corrective Action PlansJ Rather than automatically sanctioning States financially in 

response to adverse review findings, use, when appropriate (i.e., at the discretion of the 

Secreta~), the results of reviews to develop corrective action plans, with agreed-upon 

time frames, to improve programs and enforce legal requirements. Waive or reduce 

dkallowances, when appropriate (at the dkcretion of the Secreta~), if States comply 

with plans and time frames. 35 The existing oversight system, with its disallowances 

and financial penalties, can have the effect of further weakening States that are 

having problems. By allowing for improvement and laying out specific actions that 

must be taken, ACF would become a partner with States and prospects for 

improvements in programs would be greater. The law might have to be altered to 

implement this option without precluding ACF from disallowing State funding 

when Federal law is being significantly neglected and without imposing a “rereview” burden on ACF. Any existing or future review mechanisms could use 

corrective action plans. 

� Accreditationd Using new or existing accreditation bodies, make accreditation of 

programs a Title IV-B State plan requirement. Oversee the accreditation bodies to 

assure that they are fair, reasonable, and pursuing continuous improvement. By 

relying on independent bodies to accredit States, ACF could potentially avoid some 

conflict with States and free up resources for other oversight mechanisms. 

Finalizing reliable accreditation standards will not be simple for any body to devise, 

but work has begun in this area already. To change State plan requirements, it is 

important to change the law. States would have to be able to get reimbursement 

from ACF for the costs of accreditation. 

Qualitv Assurance Require States to have quality assurance programs that look at the 

quality of case work Many States conduct quality assurance activities that look 

primarily at whether documents are in place to comply with Federal requirements. 

The units that conduct these activities could be focused on more significant quality 

assurance activities; they could involve case workers in the assessment exercises. 

Although the States could see this as too prescriptive, ACF could specify in 

‘May require new legislation. 

21 
guidance or regulation what types of quality assurance should be done by States. 

This would put the onus of program improvement on the States. According to 

some ACF officials, the States are harder on themselves than ACF is. The 

additional administrative expenses for States could be significant for this option, 

but it would, after implementation, require little day-to-day management by ACF. 

An important issue to resolve is the level and nature of Federal reviews of each 

State’s quality assurance activities. 

Improve current planning and review processes to make them more effective. 

State and ACF officials feel the current review processes are too focused on 

unimportant documentation details. The current methods also do not give States 

incentives to improve. If the current review methods are replaced in the future, new 

methods should remain attentive to issues of effectiveness. 

Implementation options 

�	 Title IV-B Planning Emphasis Put less emphasis on compliance reviews (such as the 

Section 427 reviews) to assure protections are in place in States and, instead, use a 

revitalized joint planning process lo provide strategic direction that will lead States to 

effech’ve child welfare programs. While the Title IV-B planning process is currently 

not very effective, more leadership from ACF on the process could allow it to push 

for the types of improvements that many of the compliance reviews now seek. 

Regional staff might need additional training to properly undertake this role, but 

this shift in roles could make the oversight process more efficient and effective. 

The ACF has mentioned in draft program instructions the possibility of more 

emphasis on joint planning. 

�	 Substantive Title IV-E Reviews8 Use tile Title IV-E review process to assure States 

are substantially complying with foster care case planning and review and judicial 

determination requirements. Limit disallowances to instances of substantial noncompliance. 36 The Title IV-E review process is often focused on whether certain 

forms are filled out appropriately rather than whether, in fact, the purpose of the 

law in preventing unnecessary placements is being met. The option may require 

reviewers to dig much deeper into case records to test whether the States have 

“substantially complied” with requirements. This will make the reviews more laborintensive and may require training of reviewers to make them able to judge 

substantial compliance. Legislation to alter current law would be necessary to 

implement this option. A draft OIG report, by the Office of Audit Sem”ces, 

includes much detail on this subject. 37 Clearly, this option might lessen the 

responsibility and authority the courts have in assuring child protections. One 

approach that might preserve the authority of the courts and address some 

problems would be for reviewers to make independent judgments on compliance 

‘May require new legislation. 

22 
with the court-related protections only when the courts did not make explicit 

judgment one way or the other on the protections. For example, if a court simply 

did not specify that reasonable efforts were made, using this approach, reviewers 

would be able to make that judgment independently. However, if the court 

specified that reasonable efforts were NOT made, reviewers could not secondguess this judgment. 

�	 427 IncentivesJ Alter the Section 427 review process to provide better incentives for 

improvement. Rather than having full compliance with process requirements be the 

standard for 427 funding score States bused on qualip of case planning and reviews 

once they have pas.wd a triennial review and make the size of the grunts in the coming 

three years dependent on the scores. States may prefer the current system, but this 

option would allow for two things: (1) qualitative assessments of State 

performance and (2) explicit incentives for improvement. Creating a qualitative 

assessment mechanism would be very complex--the outcomes measures mentioned 

in the first recommendation might be necessary. With the current moratorium on 

427 disallowances and many observers calling into question the whole mechanism, 

it may not be sensible to seek adjustments to Section 427. This approach could 

require legislative action. 

“	 Focus Program Reviews Change the approach of program reviews to use them only 

when indicators of problems are raked through other reporting or review mechanisms. 

Develop strategies to address those problems only. This option would significantly 

change the purpose and conduct of program reviews by requiring them to be much 

more focused on investigating particular problems. By focusing the reviews, the 

likelihood of the reviews adding value to the States would be increased. While an 

attempt to address any one problem could require an analysis of many aspects of a 

State’s child welfare program, a scope that is narrower than all child welfare 

services would likely be less costly than current reviews. Also, with a narrower 

scope, it would be more likely ACF could produce reports in a timely fashion. 

“	 One State PlanJ Require States to submit one coordinated State plan for all child 

welfare services. Currently States must submit separate planning documents for 

Title IV-B Subpart 1 child welfare services, Title IV-B Subpart 2 family 

preservation and family support, Title IV-E foster care and adoption assistance, 

Title IV-E independent living, and child abuse and neglect. The Title IV-E foster 

care and adoption assistance plan, in particular, appears to serve little purpose. 

The ACF could coordinate all of these planning activities and thus encourage 

States to think comprehensively about child welfare services. The law might have 

to be changed to implement this option. The ACF mentioned in draft program 

instructions the possibility of creating a consolidated State planning process. 

‘May require new legislation. 

23 
� 

Make more efficient use of resources required to conduct reviews. 

Significant State and Federal resources go into preparing for and conducting reviews. 

It appears that the reviews may not be conducted efficiently. Improved review 

efficiency could allow ACF a more active role in other important areas such as 

technical assistance. If current review processes are not going to be replaced, they 

should be made more efficient; regardless, the lessons learned here should be heeded 

under any oversight system. 

Implementation options 

Title IV-E Reviews - Automation Automate the Title IV-E review process. This 

would require a massive investment in improving management information systems 

in States (a worthwhile cause in its own right), but could allow for much simpler 

review and oversight of eligibility and payment issues. Clearly, this is not an option 

that could be pursued in the short run, but may be a long run objective. 

.	 Title IV-E Reviews - Self-CertificationJ Allow States to certifi that their payments 

are eligz”bleunder Tide IV-E. Some States argued that they are being reviewed over 

and over for the same issues. The Federal government allows States to conduct 

State-wide (A-128) audits. The State-wide auditors look at the same issues as ACF 

auditors. In general, when a State has conducted an A-128 audit, ACF will accept 

the State’s findings and not conduct a review in that year. This practice could be 

expanded or some other form of self-certification or review could be instituted. 

The ACF would have to be aggressive about following up on self-certification or 

audit processes. 

�	 Title IV-E Reviews - Limited Scope& Limit the Title IV-E reviews to income 

eligibility and payment allowability bsues. Given the lack of control State child 

welfare agencies have over courts, basing disallowances on issues such as content 

and timing of court orders may be the wrong emphasis. Furthermore, giving States 

fewer resources may not make it any easier for States to meet these requirements. 

It is possible that ACF could use other mechanisms--such as technical assistance or 

better State planning efforts--to encourage States to meet the spirit of these 

requirements. Since Federal statute lays out these requirements, in order to 

implement this option, the law would have to be changed. 

�	 Section 427 Reviewsd Dkcontinue Section 427 reviews or sharph reduce the use of 

them. Most States have been successful on Section 427 reviews. It may no longer 

be cost-efficient to review all States for these requirements. Once a State has 

passed a triennial review, it could be argued that it has met Federal requirements 

and does not have to be reviewed using the same standard again. It could also be 

argued that because the reviews look only at process issues, they should not be 

‘May require new legislation. 

24 
doneat all. However, this would miss the few States that arenot currently in 

compliance with the Section and might allow currently complying States to fall out 

of compliance. 

�	 Discontinue Planning and Program Revie~ d Use other technical assktance eflorts 

instead of Title IV-B joint planning and program reviews. If technical assistance is 

going to be provided by outside contractors as stated above, it may not make sense 

for ACF to be heavily imolved in technical assistance. In fact, many ACF and 

State officials felt that many ACF staff have not been given sufficient training to 

perform technical assistance. 

“	 Limit Backmound Sections Shorten introductions to reports, which often focus on 

information about which the States are aware. This option would make the product 

of reviews more readable and would probably improve timeliness of reporting. It 

would, however, make reports less effective as general informational resources for 

ACF and for other States. 

Provide States with more usefu~ comprehensive, and expert advice on managemen~ 

program, and technical issues. 

A common theme in comments by State and ACF officials was the need for better 

and more technical assistance. Good technical assistance can help States devise 

solutions to problems. It probably does not make sense, for reasons of cost, to 

implement more than one of these options. 

Implementation options 

�	 Existing Mechanisms Focus more resources on joint planning program reviews, and 

the training of re~”onaloflciak to conduct technical assistance. While planning and 

program reviews have had many problems, more attention and funding to them 

would greatly alleviate many of the issues. To increase these efforts effectively, 

central office and regional office officials should have access to adequate training 

in program areas and technical assistance. Coordinating training so that all ACF 

officials providing technical assistance in a particular area will provide similar 

information to States would be helpful. 

“	 Non-~overnmental Contracts Use funds to contract with non-govenlrnental 

organizations to provide general technical assktance to States. This option has the 

advantage of depending on existing expertise. Since some ACF officials have 

expressed concerns about some technical assistance providers, the process for 

selecting contractors would likely need to be rigorous. While the contracts could 

be similar to ones for the former Child Welfare Resource Centers, States did not 

use the centers’ services fully because they were unable to afford the services. 

Therefore, the Federal government will likely need to provide much more funding 

to have States utilize the contracts fully. This effort would require significant new 

25 
funding. The ACF has indicated its plans to continue to contract with nongovernmental organizations to provide technical assistance to States. 

s Problem Areas Using a combination of ACF ofjicials and outside contractor, 

provide intensive technical assktance to Stales or regions of States lhul have exlreme 

problems. This allows the combined strengths of ACF officials and outside 

contractors to be used to focus on big problems. While individual efforts would be 

expensive and disruptive to daily work, this approach would not require ongoing 

funding or staff attention. It has been done in one State successfully. The focused 

program reviews, mentioned above, could be tied in with these efforts. 

More effectively shareinformation withandamong States. 

Many States mentioned the need for more and better information about what other 

States are doing. 

Implementation options 

�	 Effective Practices Using oversight mechamkms, identifi ej$ective practices. Produce 

regular (at least semi-annual) reports that oudine these practices and list contacts in 

the Slates. Actively share reports and State plans that outline eflective practices. This 

would be a relatively low-cost process. It appears regional offices are already 

identifying effective practices in many review reports; they are just not sharing this 

information widely. State officials spoke about difficulty getting ACF to share 

information from other States. While ACF currently has no central repository for 

reports and State-specific information, States and ACF might find it very helpful if 

a repository were developed and information from it were distributed. 

s	 On-Line Service Develop a simple, electronic, on-line service for States to share 

informan”on about strategies, innovations, and odler ksues. While this option might 

be expensive to set up, it would be inexpensive to run and would encourage active 

dialogue among States. 

Improveand clarifj communication w“thStates
aboutprogramstandards.


State officials expressed a high degree of dissatisfaction with communication about 

standards for reviews. The ACF has recently funded a contract for a policy retrieval 

system that will make all policy issuances, program announcements, information 

memoranda, etc., electronically available to States and others. While this should 

improve the situation, we offer some further suggestions. 

Implementation options 

� Reasonable Efforts Collect information on States’ definitions of “reasonable efforts” 

and identifi model definitions. One of the key areas about which States are 

extremely confused is in the definition of this term; Congress is considering 

26 
requesting a study on this issue.% Identifying model definitions would help States 

immensely but would cause controversy. 

. Central Office Hotline Establish a central ojj?ce hotline 10 respond prompdy to 

regional office and State inquiries about review policy, s~andards, and interpretation of 

regulations and statements. Follow up inquin”eswith wnlten confhnations that are 

shared with all States and regional offices, A hotline would require responsive 

decision making and authoritative statements on matters of concern to States. It 

might take some responsibility and autonomy away from the regional offices, but 

could address significant problems States have had getting clear and prompt 

responses. It could possibly result in States having less frequent and, therefore, 

less productive contact with regional offices; on the other hand, it could free 

regional officials from having to provide review-specific policy interpretations and 

allow them to have more contact on programmatic issues. 

“	 Promam Redations Publish comprehensive program regulations for Section 427 

and Title IV-E that would be subject to notice and comment. State officials and 

others have noted a need to have review policies much more clearly defined. The 

most straightfonvard solution would be to produce final regulations. 

Improvethetimeliness ofreporting on results
 ofreviews.


One of the least complex problems identified in this report was the lack of timeliness 

of reporting to States the results of Federal reviews. 

Implementation options 

“	 Mandatorv Turnaround Require reports to be issued within a set time after a review 

k complele. This is the most straightforward way to improve timeliness, but it may 

bind ACF too much. If ACF does not complete reviews in a timely manner, States 

would be able to appeal decisions on that ground alone. 

�	 Performance Reporting Develop goals for turnaround of reports. T+en collect and 

disseminate information on the timeliness of reporting. This is a low-risk option for 

ACF, but it may not provide enough incentive for improvement. Increasing the 

awareness of the magnitude of timeliness problems would likely be helpful. 

� Streamline Decision-making Clanjj who in ACF has tile authority to decide on 

policy matters and final reports. Currently, there are frequent discussions over who 

has authority to make what decision. This change could clari~ roles quite a bit 

and potentially speed the process. The recent initiative to streamline the review 

process on program reviews is a step in the right direction. Similar (and further) 

streamlining could be considered for all types of reports. 

27

� Limit Scope of Reviews6Reduce dte complexity of Chereports by narrowing the 

scope of the reviews. It could be that by narrowing the scope of the reviews, the 

ACF report clearance process would be dramatically simplified. There are several 

options on how to lessen the complexity of the reviews, including limiting the scope 

of Title IV-E reviews (as noted above) and parsing reviews into stages. 

‘May require new legislation. 

28 
COMMENTS ON THE DRAFT REPORT


We shared our draft report with and solicited comments from the Administration for 

Children and Families (ACF), the Assistant Secretary for Planning and Evacuation 

(ASPE), the Assistant Secretary for Management and Budget (ASMB), and the 

Assistant Secretary for Legislation (ASL). The ASMB and ASL advised us that they 

had no comments. We received written comments from ACF and ASPE. We 

reproduce these comments and provide detailed responses to each in appendix C. 

We are pleased that ACF concurred with our recommendations and found the report 

useful. While ACF did not suggest any changes to the report, we altered the report to 

reflect the action they have taken already on the recommendations. Staff in ACF 

informally provided minor technical comments to the report which resulted in several 

changes. 

We are also pleased that ASPE felt the report was informative and valuable. The 

ASPE made several technical comments, mostly aimed at clarifying our discussion of 

the Family Presemation and Family Support Act. We have made necessary changes in 

response to those comments. 
APPENDIX A


MAJOI­ FEDERJ L CHILD 1 !ELFARE PROGRAMS

TITLE	 1993 

estimated 

funding 

fV-E $2.854 Billion 

IV-B $295 Million 

$770 Million 

(estimated 

claims for 

child welfare 

Seticea) 

Funding type 

Open-ended 

entitlement 

Capped 

entitlement 

with incentive 

funding 

Block grant 

Covered services 

Foster care and


adoption


assistance


maintenance


payments,


independent living,


administration and


training


Full range of child


welfare sewiccs


including family


presenfat ion


efforts, child


protection


sesvices, and


reunification


services.


Social services


including child


protective acrvicea,


services to prevent


placement in


foster care, and


substitute care


programs.
 ____l


A-1 

~~ 

E[igibihy Match role Financial 

cn’tm”a oversight 

mechanisms 

Children from Medicaid Title IV-E 

AFDC-eligible match rate for reviews, Tkle 

families only maintenance, IV-E State plans 

50 percent for 

administration, 

and 75 percent 

for training 

None 75 percent	 Title W-B joint 

plans, Section 

427 reviews 

None	 No State ~ None 

funding 

required 

xx 
APPENDIX B


FEDERAL OVERSIGHT MECHANISMS 

FOR STATE CHILD WELFARE SERVICES 

REV7EW Servicer 

PROCESS reviewed 

Tkle IV-E Foster care 

reviews and adoption 

assistance 

Section 427 Foster care 

reviewa 

Program AN child 

reviews welfare 

services 

STATE PLAN Services 

PROCESS covered 

Title fV-B	 AU child 

welfare 

aeMcea, 

i Are case 

~ records 

! reviewed? 

~ How many are 

! rm,iewed? 

~ Yes. Stage I 

~ reviews 50 

~ payments. If 

!	 high error 

rate. then 

: Stage 11 

\ reviews at least 

~ 200 payments 

!	 Yes. Sample 

of 140 Casea 

drawn from 

children in 

‘	 fo.wer care for 

at least 6 

months. 

I	 an tx, but no 

number is set 

in advance. 

How ofsen ore 

1 ~t~iued? 

At least once 

every three 

years. 

Can monq be 

taken away as a 

re.su[t of reviews? 

Yea. Stage 1: 

only claims in 

error are 

recouped. S[age 

II: sample error 

rate applied to 

univeme of 

payments 

Yes. State can 

lose incentive 

Are How ofien are Are the 

administrative the reviews reviews 

costs reviewed? conhcted? manaktory? 

Yes, either in No set Yes. statea 

combination schedule. are subject to 

with or Some States review once 

separately are reviewed they receive 

from other yearly others Title IV-E 

reviews. have not been funding. 

reviewed in 

over five years. 

No, but At least once Yes. Statea 

administrative eve~ three are subject to 

funding. I	 procedures years. review once 

are reviewed they certi~ 

in the initial eligibility for 

review. 427 funds. 

No.	 h’o, but No set No. 

administration schedule. No 

of the State has been 

program is reviewed more 

reviewed. than once 

since 

reinstated. 

Do States Format Are annual Are there 

develop it alone? I Updam.r perraltitn ~ 

required?	 State plans 

ore not 

adhered to? 

No. Statea and The format is Yea. No.


ACF are relatively


supposed to unstructured.


develop plans


jointly


Yea.	 Statea fill out No. No. 

preprinted 

forms. 

including Title 

fV-E services 

and setices 

not funded by 

HHS 

fitle fV-E Foster care, At least once 

adoption evety three


assistance, yeara.


independent


living, training


and


administration


for AFDC-


eligible


children.


B-1

APPENDIX C


DETAILED COMMENTS ON THE DRAFT REPORT AND 

OIG RESPONSE TO THE COMMENTS 

In this appendix, we present in full the comments on the draft report offered by the 

Administration for Children and Families (ACF) and the Assistant Secretary for 

Planning and Evaluation (ASPE). We also present our response to each set of 

comments. 

c-1 
�

�

P’”“’”’”\ 

~’ 

z DEPARTMENT OF HEALTH & HUMAN !jERVICEs : 

z

.4 + *.*~* 

>

ADMINiSTRATION FOR CHILDREN ANO FAMILIE 

Office of Ihe Assistant SeCf6!la(y, Suite 600 

370 L’En(ant Promenade. S.W. 

Washington, D.C.20447 

April 13, 1994 

TO:	 June Gibbs Brown


Inspector General


FROM: Ma&: Jo Bane -V’&+_
 Assistant Secretary


for Children and Faud.lias


SUBJECT: of state Child Welfan OIG Draft Report: llov~r~igh~

Programs,11()~1-01-92-0()770 

Thank you for the opportunity to comment on the draft report, 

“Oversight of state Child Welfare Programs.” We appreciate the 

thoughtful and provocative document that your office has 

developed in its review of the Federal stewardship process and We 

concur with the issues and recommendations that are outlined in 

thQ report. 

The Administration for Children and Families (ACF) is presently 

involved in revising its monitoring policies and procedures, and 

this report is especially ttiely and helpful in that regard. It 

will also assist the M)? in establishing guidelines to ensure the 

administration of quality child welfare programs which will 

positively affect children and families. 

staff from the Children9s Bureau (CB) have collaborated with your 

staff and have commented on earlier versions of this report; 

their commants have been incorporated. The ACF has already begun


to implement some of the recommendations that are presented in


this report. Specifically, the development of a single,


coordinated State Plan that encompasses title IV-B, title IV-E,


child abuse and neglect, and thQ range of child welfare services


into one document is a proposal that we are pursuing actively.


The AFCARS (Adoption and Foster Care Analysis and R~po~thg


System) regulations have been published and the CB expects to


begin receiving State-specific data by May 1995. Further, the


CB plans to negotiate with private contractors to provide general


technical assistance to states. Finally, several months ago the


CB awarded a contract for a policy retrieval system that will


make all policy issuances, program announcements, information


memoranda, etc., electronically available to State and local


agencies, public and private organizations, advocacy groups,


educational institutions, and the general public. This system


will be fully operational in July 1994.


We look forward to the issuance of a final report and a


continuing dialogue with you and your staff.

OIG RESPONSE TO ACF COMMENTS 

We are pleased that ACF concurs with our issues and recommendations. We are also 

pleased that it has already begun to implement some of the recommendations. We 

have made changes in our report to reflect these actions. 

In particular, we included references to the action ACF is considering on consolidating 

the State planning processes, added a reference to the continuation of nongovernmental contracts to provide general technical assistance, made clear the action 

ACF has taken on improving policy dissemination, and removed references to the 

need to develop final regulations for the Adoption and Foster Care Analysis and 

Reporting System. 

Staff at ACF informally extended minor technical comments to the draft report, all of 

which resulted in changes to the report. None of these changes affected the thrust of 

our discussion. 

The ACF recently drafted a report on its monitoring activities (including for child 

welfare). It indicates a bold, ambitious, and extremely important new direction for 

monitoring. If implemented, the ACF’S draft recommendations would address many 

of the issues and respond to many of the recommendations in our report. 

c-3 
DEPARTMENT OF HEALTH& HUMAN SERVICES C) fflce of the Secretary 

Washington, D.C. 20201 

~ 41994 

TO:	 June Gibbs Brown 

Inspector General 

FROM: Assistant Secretary 

for Planning and Evaluation 

SUBJECT : OIG Draft Report ‘oversight of State Child Welfare 

Programs,” OEI-01-92-O0770 

Thank you for the opportunity to review and comment on the draft 

report “Oversight of State Child Welfare Programs.” I found it 

to be an informative report that provides useful information 

regarding Federal oversight of State child welfare program. 

While, as the report notes, many of the observations have also 

been made by other sources, independent confirmation is helpful. 

This report should prove valuable as H13S considers changes in 

these programs. In particular, the observation that oversight 

activities focus primarily on narrow papemork compliance issues 

rather than on how well children are being served should lead us 

to improve these programs and our admini.strati.on of them. 

We have attached Some comments, most of which clarify the 

discussion of the new Family Preservation and Support law. 

Attachment 

PREPARED BY:OS/ASPE/HSP/CYP:BBroman: 690-6461 

.-

C-4

Comments on OIG oversight of State Child Welfare PrOgrms 

1. On pages vii and 29, the report indicates the need to 

publish	 the Adoption and Foster Care Reporting System 

(AFCARS) regulations, They were published in the Federal 

Reuister on December 22, 1993. Also, you should note that 

OBRA 93 provided for an enhanced match for AFCARS. The 

interium final rule on this provision was also published in . the Federal Reulstez on December 22, 1993. 

2. The Title IV-B discussion on page 2 is inaccurate. The new 

Family Preservation and Support capped entitlement program, 

passed as part of OBRA 93, established a new Subpart 2 of 

the Title IV-B Child Welfare Services section. This capped 

entitlement is $60 million in FY 95 and $930 million over 

five years. The existing Child Welfare Services program, a 

discretionary program of $295 million in FY 9S, is now 

Subpart 1 of lV-B. Section 427 only applies to Subpart 1. 

A discussion of the services under each of these subparts 

should be handled separately. Other places in the report, 

such as on page 25, will also need to be changed. 

3.	 The discussion of OBRA 93 on page 4 also needs to be changed 

to reflect our comment above. In addition there are several 

other problems with the section--

0 The oriqinal bill, which was the Administration’s bill, 

include~ not only the new family preservation and 

support program but a variety of improvements to the 

current child welfare and foster care programs. These 

were dropped due to the Byrd rule. 

o	 The other provisions passed in OBRA 93 that you refer 

to are confusing. 

--First, the $2 million in FY 95 and $6 million each 

year thereafter for research, evaluation, training and 

technical assistance is for the new Title IV-B Subpart 

2 capped entitlement for family preservation and 

support. It i.s not for broad child welfare senices 

evaluation and training and technical assistance. ASPE 

and ACF have developed an evaluation strategy for this 

new program and work has begun to award contracts for 

this work. The bulk of the funding set-aside in the 

capped entitlement will be for evaluation. 

--Second, the changes in the state plan requirements 

for the child welfare services program was dropped from 

the law due to the Byrd rule. 

4.	 On page 7, we sugguest that you review the statement that 

children no longer get lost in the foster care system to 

C-5 
States are improving their ability to track children in 

foster care. 

5.	 The reference on page 22 and 27 to the researc~j, training, 

and technical assistance should be dropped sin~e this setaside is for the family preservation and suppo:t program. 

6.	 The discussion on page 23 about corrective action plans 

could be strengthen by mentioning that the Administration’s 

bill included a provision on conformity review:. While this 

provision got dropped because of the Bryd rule it does 

demonstrate that the Department recognizes tha= changes to 

this process are needed. 

7. You may want to mention under Title IV-B Planr!ina EmDhasis 

on page 24, and again on page 25 under One st~~e Plan, that 

ACF discusses the possibility of a joint planning process in 

the Program Instructions for the Family PreserTJation and 

Support program. 

8. Also , on page 24 under the Substantive Title ~~-E Reviews 

you may want to mention the grants to States co assess and 

improve handling of proceedings relating to fester care and 

adoption. These are funded out of the new Title IV-B 

Subpart 2 capped entitlement program for family preservation 

and support. 

9.	 On page 18, you indicate that congress is conci.dering 

requesting a study on reasonable efforts. We suggest that 

YOU clarify this to indicate that the Congress included in 

the Conference Report accompanying OBRA 93 thz.t the 

Department should conduct a study on reasonable efforts. 

10.	 We suggest that you drop the reference to OMB on pag@ z% 

program regulations. It refers to an internal review 

process in which we should not single out OMB. 

C-6

OIG RESPONSE TO ASPE COMMENTS 

We are pleased that ASPE found our report informative and useful and that the 

Department is considering changes to the programs. 

The ASPE had a number of technical comments, most of which related to our 

discussion of the Omnibus Budget Reconciliation Act of 1993 provisions related to 

Family Preservation and Famiiy Support. We have made a number of improvements 

to the report in response to those comments. In particular, we removed our reference 

to the need to publish final regulations on the Adoption and Foster Care Reporting 

System, clarified our discussion of Title IV-B changes in several places in the report, 

eliminated references to the newly available technical assistance funds, included 

references to ACF’S proposal to consolidate planning activities, and deleted our 

reference to OMB review of regulations. 

We did not, however, make changes in the report to reflect the provisions of the 

Family Presemation and Family Support Act that were not adopted because of the 

“Byrd rule.” Instead, we make a general reference to the more recent Senate bill that 

proposes these same provisions. 

c-7 
APPENDIX D


METHODOLOGY 

DOCUMENT RHZEWS 

We reviewed relevant literature and reports. We also analyzed current and proposed 

legislation, regulations, and policy statements. 

ANALYSIS OF ACF REWEW REPOR73’: 

We first requested copies of all review reports sent to States since January 1988. We 

then reviewed 69 reports from ACF-conducted reviews to profile content, reporting 

procedures, timing of reviews and reports, and resources used in the reviews.39 

When we were given multiple years of one type of report for a given State, we 

reviewed only the most recent report. We only reviewed reports that were actually 

sent to States (some reports we received had not yet been sent either as draft or final 

reports to the State). 

INTERVIEWS: 

State Officials 

We conducted two day, on-site interviews with various child welfare officials in three 

States (Maine, Ohio, and Washington). These States were selected from the group of 

States in which ACF had conducted a Title IV-E review, a program review, and a 

Section 427 review in the past 5 years. The selection was based on getting diversity in 

terms of geography and size; we also wanted to visit at least one State in which child 

welfare services were county-based and at least one State in which the services were 

State-run, 

We conducted telephone intemiews with senior child welfare officials in ten States-­

one per HHS region (Connecticut, New Jersey, the District of Columbia, Florida, 

Wisconsin, Oklahoma, Missouri, Montana, Nevada, and Oregon). These States were 

selected using a weighted random selection method. Each State that was not a sitevisit State was assigned a weight (W) equivalent to the number of different types of 

reviews (i.e., Title IV-E, Section 427, and program reviews) in the past 5 years plus 

half of the number of reviews beyond one for each type of review. Each State’s odds 

of selection were equal to W divided by the sum of W for all States in the region. 

D-1

ACF Officials 

We conducted telephone interviews with senior officials in each ACF regional office. 

We also had discussions and other detailed communication with officials in ACYF, 

Children’s Bureau. 

Other Exuerts 

We held discussions with other Departmental staff, Congressional staff, GAO staff, 

interest group representatives, and academic experts. 

D-2

APPENDIX E 

DETAILED EVALUATION OF IJfPLEMENTATION OPTIONS 

E-1 
--------------- ----- ----- ----- -------------- -------------- --------------- -------------- -------------

DETAILED EVALUATION OF IMPLEMENTATION OPTIONS 

)ption Likefy Budget May Need May Need Likely State jike[y Possible Major Pros? ~ Major Cons? 

[mpact? 

. -------------, Legislation? Regulation? Reaction? I’iming? 

‘performance Use new technical No No Relatively positive Pilot soon Raises questions Complicated to 

ndicators assistance money Focuses on results kvelop 

May evolve into Could be ignored 

rcwimvs by Stfilcs .— — .—-.—---

Mtcome+tased Redirect money Yes Ycs Rclalivcly negative [-ong term Results bccomc Ilighly 

kviews from other reviews entire focus comrovcrsial 

Allows States to Long dcxwlopmcnt 

argue forcefully period 

with their 

legislatures —— 

~orrect ive Act ion Minimal Yes Yes Strongly positive Soon Build partnership Lessening of 

‘lans improvements sanctions 

more likely More difficult to 

No further do than straighl 

weakening of weak reviews 

States — 

kcreditation More Yes Yes Relatively negative Long term Relies on outside Iack of direct 

administrative experlise Federal control 

funds necessary Focuses on Controvemy about 

proactive action standards 

2uality Assurance More No Yes Relatively negative Soon Gives States Difficulty 

administrative control designing 

funds necessary States would be Could be very 

tough on expensive 

themselves 

lltle Redirect money No No Relatively positive Immediate Focuses on Need ACF 

fV-B Planning from other reviews proactive action training 

Emphasis More expensive 

than current 

Substantive Title More review Yes Yes Relatively positive Soon Focuses on More complex 

IV-E Reviews funding, may substantive issues reviews 

reduce 

disallowances _—— — 

E-2

— — 1, 

II DETAILED EVALUATION OF IMPLEMENTATION OPTIONS 

IIOption ~ikely Budget May Need May Need Likely State -ikely Possible Major Pros? Major Cons? 

Impact? Legislation? Regulation? Reaction? fiming? 

Section 427 More review Yes Yes Relatively positive bon Focuses on results Requires new 

Incentives [unding Makes 427 a real training for ACF 

incentive program Difficult to make a 

true incentive 

I , 

Focus Program Strongly positive More potential 10 Not as 

Reviews add value comprehensive 

Should be more 

timely — 

F -esa time Yes Yes Strongly positive ;oon Minimize Each plan more 

evicwing plans duplication of complex 

efforts 

Title IV-E -

r Automation

Xvelopment 

Funding 

No Yes Strongly negative 

—— 

.ong term Simplify reviews 

Use stale-of-art 

technology 

iqsenrse 

-0ss of access 10 

.ecords ..—. 

Relatively positive [mmediate More State Lack of direct 

scope expenditures on some 

More appropriate requirements sreview Smaller

disallowances 

Section 427 Less funding Yes Yes Strongly positive Soon Reduce review May miss outliers 

Reviews expcndit ures 

End/reduce use of 

troublesome 

process 

autonomy Federal control _— ...-

Thle IV-E Limited Less funding Yes Yes S1rongty positive Soon Reduce No formal check 

L----- k

Discontinue Less funding Yes Mixed Immediate 

———. 

Reduce review Reduces Federal 

Planning and cxpcndit urcs input on impot-tant 

Program Rcvimvs End usc of SIatc dccisi(ms

I Iroublcsomc No dircci Iixfcral 

process TA process — — 

Limited Minimal No No Relatively positive Immediate Should streamline Reports won’t L____ I I 

I 

Background
 report-writing setve general

Sections information role


E-3

, I 

I 

\ , 

1 

! 

I 

I 

. 

0 

) 

I 

u

.->

.=

$3 0. 

_A 

u 

.->

S 

5 

Lx 

! 

I 

1 

T 

1 

I 

* 

I 
DETAILED EVALUATION OF IMPLEMENTATION OPTIONS 

Option Likefy Budget May Need May Need Likely State Likely Possible Major Pros? Major Cons? 

Impact? Legislation? Regrslation? Reaction? Timing? 

Performance Minimal new No No Relatively positive Immediate Would increase Might not improve 

Reporting funding awareness timeliness 

Streamline Minimal nav No No Miscd S(um Mighl irnprovc Rcgimml office 

Decision-Making funding timeliness resistance 

Clarify authority 

Limit Scope of Minimal new Yes Yes Strongly positive Soon Could improve Might allow some 

Reviews funding timeliness activities to go 

Could reduce “un-reviewed” for 

complexity some time I I — 

E-5

APPENDIX F


NOTES 

1. S. Rep. No. 336, 96th Cong., “Summary” 1450 (1980). 

2. Small amounts of additional Federal money are available through the following 

programs: (l)the1974 Child Abuse Prevention and Treatment Act funds 

adoption opportunities, child abuse State grants, child abuse challenge grants, 

child abuse discretionary programs, family violence programs, and emergency 

child abuse prevention services (in 1991, total funding was about $82 million); 

(2) abandoned infants assistance (in 1991, funding was about $13 million); and 

(3) temporary child care for children with disabilities and crisis nurseries grants 

(in 1991, funding was about $11 million). See J. Rovner, “Under the ChildWelfare Banner Lies a Patchwork of Federal Programs,” Congressional 

Quartedy, 30 March 1991,798-799. 

3.	 In 1992, Title IV-E foster care maintenance, training, and administrative 

expenses made up an estimated 61 percent of Federal child welfare spending; 

Title XX made up 21 percent; Title IV-B made up 7 percent, and Title IV-E 

adoption assistance maintenance, training, and administrative expenses made up 

6 percent. Much of the Title XX funding and Title IV-B funding was likely 

spent by States on foster care maintenance payments for children not eligible 

for AFDC. 

4.	 In 1992, Title IV-E administrative and training expenses made up 32 percent of 

the total Federal funding effort. From fiscal year 1985 to fiscal year 1992, 

foster care administrative expenses rose from $143 million to $981 million. As 

the Office of Inspector General pointed out in an earlier report, it is important 

to understand that States have been given the authority to claim many types of 

services as administrative expenses including pre-placement sewices (see 

Department of Health and Human Services, Office of Inspector General, 

Oppo~nihes for Cost Containment by Modifiing Federal Reimbunement to 

Statesfor Administrative Costs Underthe Foster Care Program, A-07-90-00274, 

August1990.) 

5. The Title IV-E Independent Living program is not open-ended; it is a capped 

entitlement program. For more information on the program, see an upcoming 

OIG report entitled “Independent Living Program for Foster Care Youth: 

Strategies for Improved ACF Management and Program Reporting” (OEI-Ol93-00090). 

6.	 Of the $273 million of Title IV-B claims in 1992, $132 million--less than 4 

percent of all Federal funding of child welfare--was Section 427 funding. 

F-1

7. 

8. 

9. 

10. 

11. 

12. 

13. 

14. 

15. 

On occasion, the Office of Inspector General performs audits of Title IV-E 

funds. These are identical in scope and content to the ACF-conducted reviews. 

The ACF conducts initial reviews after States certify that they are eligible for 

427 funding. The initial review consists solely of the Administrative Procedures 

Review. If the State passes that review, a case record review is conducted the 

following year. If the State passes this subsequent review, it receives funding 

for three years prior to another review (known as a triennial review). At this 

review, ACF conducts another case record review and receives assurances from 

the State about administrative procedures. The standards for the triennial 

review are stricter than for the subsequent review. Once a State has passed 

two consecutive triennial reviews, the triennial reviews are conducted every five 

years. 

Administration for Children and Families, Section 427 Review Handbook, 

August 1988. 

S. Rep No. 118, 10lst Cong., “Foster Care, Adoption Assistance, and Child 

Welfare Services,” 103 (1990). 

Administration for Children and Families, Draft Child We~are Services Program 

Review Manual, December 1990. 

Adoption Assistance and Child Welfare Act of 1980, Pub. L. No. 96-272, 94 

Stat. 517 (1980). 

Office of Human Development Services Task Force on Foster Care and 

Adoption Assistance, “Report on Title IV-E~itle IV-B Programs,” February 6, 

1987, 3. 

H.R. 2264, as introduced in the 103rd Congress, included the following major 

changes to the oversight process: elimination of Section 427 reviews, creation 

of new Title IV-B State plan requirements that mimicked Section 427, and 

establishment of a new review process for Title IV-B. 

For example, see H. R. Rep. No. 395, 10lst Cong., “No Place to Call Home: 

Discarded Children in America,” 79-84 (1990); United States General 

Accounting Office, Foster Care: Incomplete Implementation of the Reforms and 

Unknown Effectiveness, GAOIPEMD-89-17, August 1989; S. Rep. No. 118, 10lst 

Cong., “Foster Care, Adoption Assistance, and Child Welfare Services,” Senate 

(1990); M. Allen, “Crafting a Federal Legislative Framework for Child Welfare 

Reform,” American Journal of Orthop.ychiat~, 61 (October 1991) 4: 610-623; 

and American Public Welfare Association, Report on State Public Child Welfare 

Agencies’ Experiences wirh Title IV-E and Section 427 Reviews, Draft #3, January 

25, 1993. -

F-2

16. 

17. 

18. 

19. 

20. 

21. 

22. 

23. 

24. 

25. 

Family Preservation Act of 1991: Hearing Before the House Subcommittee on 

Human Resources, 102nd Cong., 42 (June 11 and 12, 1991). 

S. Rep., “Foster Care, Adoption Assistance, and Child Welfare Services”, 110. 

The ACF has convened a task force to look at all of its monitoring activities, is 

currently working on evaluating the costs and benefits of a quality control 

system, and is finalizing new guidance on IV-B joint planning. Oversight issues 

were discussed in the prior Administration as well. See, for example, 

Administration for Children and Families, Final Repoti of lhe Section 427 

Revrkion Task Force, Briefing Memorandum, April 16, 1990; Office of Human 

Development Services Task Force on Foster Care and Adoption Assistance, 

Repon on Tide IV-E/Tide IV-B Programs; and Administration for Children and 

Families, Child We~are Monitoring Task Force: Draft Concept Papers (Revked), 

internal HHS document, July 16, 1992. 

Department of Health and Human Services, Office of Inspector General, 

Oppommities to Improve Fos~er Care Eligibili~ Decerrninations, A- 12-93-00022, 

May 1994 (draft). 

For example, see H. R. Rep. No 395, 10lst Cong., No Place to Call Home: 

Discarded Children in America, 39-44 (January 12, 1990); C. W. Dugger, 

“Shortage of Trained Caseworkers imperils Young Victims of Abuse: The 

Cracked Shield, A Child Welfare System Stumbles,” New York Times, December 

28, 1992, Al, B8; “Wronging Children,” Washington Post, February 10, 1991, 1; 

C.W. Dugger, “Troubled Children Flood Ill-Prepared Care System: Shattered 

Lives, When Foster Care Fails,” New York Times, September 8, 1992, Al, B7. 

See H. R. Report, No Place lo Call Home, 33-36; Department of Health and 

Human Services, Office of Inspector General, Crack Babies, OEI-03-89-01540, 

June 1990, and Department of Health and Human Services, Office of Inspector 

General, Trends in Foster Care, OEI-01-90-00490, Januaxy 1992. 

See H. R. Rep., No Place to Call Home, 33-36; and S. Evans, “Desperate 

Parents Cast Unruly Children Into Hands of a Burdened Government, “ 

Washington Post, September 30, 1991, 1. 

Notably, officials from both the American Public Welfare Association and the 

Child Welfare League of America mentioned this. 

The Institutes for Health and Human Services, Inc., Directoy of Child We@e 

Class Action Lawsuits, October 1, 1992. 

Many of these have resulted in States settling consent decrees out of court. 

The consent decrees often have resulted in dramatic changes in State 

procedures and laws. See The Institutes for Health and Human Services, Inc., 

F-3

26. 

27. 

28. 

29. 

30. 

31. 

32. 

33. 

34. 

35. 

36. 

37. 

Directo~ of Child We~are C[am Action Lawsuits, October 1, 1992 and National 

Center for Youth bw, Foster Care Refom:LitigatiotZ Docket, 1989. 

These are the objectives ACF has defined for the reviews. 

Most changes such as these would require revisions to existing statute. 

APW~ Repoti on Experiences with Title IV-E and Section 427 Reviews. 

Our data show that in one State, over $1 million, or almost 6 percent of the 

Federal Title IV-E foster care funding, was disallowed on a Title IV-E review 

solely for reasons that appear to be outside of the control of the child welfare 

agen~, in another State, over 10 percent (more than $500,000) was disallowed. 

These reasons (as stated in the review reports) were: “court order did not 

indicate reasonable efforts, “ “court order did not indicate contrary to the 

welfare of the child,” and “no judicial determination done within 180 days.” 

OIG, Opportunities to lrnprove Foster Care Eligibility Determinations, May 1994 

(draft). 

Of the small number of reviews from which we were able to gather this 

information, this review involved the most people. We suspect that in other 

States, reviews involved large numbers approaching those in this example. 

Four of the 10 regions and 4 of the 13 States responded “No” or “Don’t know” 

to the question about whether Title IV-E reviews are meeting this objective. 

S. Bill No. 1886, 103rd Cong., Social Security Act Amendments of 1993, 

introduced on November 17, 1993 by Senator Daniel Patrick Moynihan. 

This method was used quite successfully by the Public Health Sefice. The 

PHS, in response to a recommendation we made, funded the Federation of 

State Medical Boards to develop performance indicators for State medical 

boards. The system the Federation developed has gained wide acceptance and 

is serving very useful informational purposes for the States (and for PHS). 

The original legislation upon which the OBRA 93 family preservation and 

family support provisions were based included a provision to put in place 

corrective action plans. 

The new Title IV-B Subpart 2 includes funding for grants to State judiciaries to 

assess and improve handling of proceedings related to foster care and adoption 

assistance. 

OIG, Oppotiunities to Improve Foster Care Eli@bili~ Determinations, May 1994 

(draft>. \ / 

F-4

38.	 The initial legislation that resulted in the OBRA 93 child welfare provisions (as 

well as the conference report on OBRA 93) included a requirement that the 

Department conduct a study on reasonable efforts. 

39.	 In addition, we reviewed the content of audits conducted by OIG Office of 

Audit Setices in five States. The Office of Audit Setices conducts audits of 

State programs that are very similar to the Title IV-E reviews conducted by 

ACF. The OIG reports were not included in our analysis of the timeliness of 

reporting or the resources used in reporting. They did, however, contribute to 

our analysis of and understanding of the content of review reports. 

F-5


—. -. —.— .. —..—