United States General Accounting Office

GAO Report to the Chairman, Subcommittee

on Human Resources, Committee on

Ways and Means, House of

Representatives

February 1997 CHILD WELFARE

States’ Progress in

Implementing Family

Preservation and

Support Services

GAO/HEHS-97-34

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-272396 

February 18, 1997

The Honorable E. Clay Shaw, Jr.

Chairman

Subcommittee on Human Resources

Committee on Ways and Means

House of Representatives

In the late 1980s, increases in illegal drug use, homelessness, and poverty

contributed to dramatic increases in the rates of child abuse and neglect

and the number of children in foster care. Intent on improving services for

children and their families as well as reducing foster care costs, states

began to reconsider their approach to child welfare. Rather than waiting

until families reached the crisis stage, they began to focus more on early

intervention and preventive services designed to strengthen and support

families. By the early 1990s, however, the child welfare system was

overwhelmed by the needs of an increasing number of at-risk families and

children.1

 States argued that additional federal funding was needed to

supplement current state and federally funded programs. Therefore, to

assist states in providing services designed to support families and help

keep them together, the Congress enacted legislation as part of the

Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) that authorized

$930 million in federal funds to states over a 5-year period for family

preservation and support (FPS) services. Family preservation services

typically target families already in crisis whose children would otherwise

be removed from home. Family support services are community-based

activities intended to prevent the kinds of crises that family preservation

services are aimed at alleviating. To receive federal funds for these

services, each state had to submit a grant application in 1994 and a 5-year

plan in 1995 that set quantifiable goals and methods for measuring

outcomes.

In response to your request concerning the status of states’ use of funds

for FPS services, this report describes (1) the nature and extent of states’

use of federal funds for new and expanded FPS services and (2) states’

plans to assess the impact of these services on children and their families

and impacts identified to date. This report builds on our prior work that

assessed early federal and state implementation efforts.

1

See our prior reports, Child Welfare: Opportunities to Further Enhance Family Preservation and

Support Activities (GAO/HEHS-95-112, June 15, 1995) and Child Welfare: Complex Needs Strain

Capacity to Provide Services (GAO/HEHS-95-208, Sept. 26, 1995).

Page 1 GAO/HEHS-97-34 Implementing FPS Services
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To collect information on states’ use of federal funds for and the impact of

FPS services, we conducted a nationwide survey of state child welfare

agencies; held in-depth interviews with officials in nine states and five

localities; interviewed Department of Health and Human Services (HHS)

officials in its headquarters office; and reviewed related federal and state

budget, summary, guidance, planning documents, and progress reports.

(See app. I for more details of our scope and methodology.)

Results in Brief All states reported to us that they are using federal funds to increase the

availability of family preservation and family support services either by

creating new programs or expanding existing programs. Forty-four states

said that they introduced new programs. For example, some states

launched new programs in which counselors are available 24 hours a day

to work with families that have a history of child abuse. Forty-seven states

reported enhancing their existing programs or expanding them to serve

more clients. For example, adding a service like childcare could enhance a

family resource center that already provides an array of services, such as

parenting classes, afterschool activities, and family counseling.

As required by the law, our analysis shows that states appear to be

allocating a significant portion of their federal funds to both family

preservation and family support services. In the last 2 years, states

budgeted 56 percent of their service dollars to family support and

44 percent to family preservation. The somewhat greater emphasis on

family support services reflects priorities established through state and

community planning efforts. Moreover, many states already had family

preservation programs in place and decided to bolster family support

services.

To determine whether this infusion of federal funds improves services for

children and families, we identified a number of efforts that are underway

or planned to assess programs providing FPS services. States plan to track

the results of their federally funded services, for example, by measuring

the number of clients served and the extent to which their needs are met,

improvements in parent-child relationships, the degree that services are

coordinated, and indicators of community well-being such as child abuse

rates. Although not required to do so, at least 11 states are also planning

formal evaluations to determine whether the services actually improve

outcomes for families. Further, two federally sponsored evaluations are

underway to assess the effectiveness of family preservation and family

support services.

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Early results from 10 states indicate some successes, such as preventing

child removal and continued maltreatment. While it is too early to

determine the impact of these programs, federal and state officials report

that the extensive community and interagency collaboration required by

the law has resulted in improved identification of service needs, setting of

priorities, and receipt of services by at-risk families otherwise overlooked.

Background We previously reported that states originally funded most FPS services

themselves or with nonfederal funds. As the demand for services

increased and available resources became more constrained, states sought

additional funding from federal sources, such as Title IV-B Child Welfare

Services, Title XX Social Services Block Grant, and Title IV-A Emergency

Assistance. However, funding levels were still insufficient to keep pace

with service needs. By the early 1990s, over half the programs we surveyed

reported that they were not able to serve all families who needed services

primarily due to the lack of funds and staff.

OBRA 1993 created the Family Preservation and Support Services program

under Title IV-B, Subpart 2, of the Social Security Act. Administered by

HHS’ Administration for Children and Families (ACF), OBRA 1993 authorized

$930 million over a 5-year period. Through fiscal year 1997, Congress

appropriated $623 million for grants to states to conduct planning

activities and fund FPS services for the first time.2

 The grants are based on

each state’s percentage of children receiving Food Stamps, a federal food

subsidy program for low-income households. State child welfare agencies

are responsible for administering the FPS program in each of the 50 states

and the District of Columbia.

OBRA 1993 allowed states to use up to $1 million of their grant amount for

planning purposes during the first year, with no required state match.

Funds used for FPS services and other allowable activities, such as

additional planning or evaluation, require a 25-percent state match. The

law also requires states to spend a significant portion of service dollars for

each type of service, which HHS has defined as at least 25 percent each for

family preservation services and for family support services. Further, state

administrative costs are limited to 10 percent.

To receive FPS funds, states submitted grant applications to HHS by

June 1994 and comprehensive plans a year later. These plans were based

2

An additional $52 million was set aside for court enhancement studies; FPS services grants to Indian

tribes; and federal evaluation, research, training, and technical assistance. For fiscal year 1998, OBRA

1993 authorized $255 million, which had not been appropriated at the time of our review.

Page 3 GAO/HEHS-97-34 Implementing FPS Services
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on a needs assessment; developed with community groups; and

coordinated with health, education, and other agencies that serve children

and families. As required, the plans described goals that states expect to

achieve by 1999 and methods that they will use to measure their progress.

Federal guidance also encourages states to continue their collaborative

planning activities, improve service delivery, and leverage additional

funding from other sources for FPS services.

Family preservation programs generally serve families where child abuse

or neglect has occurred or where children have been identified as

representing a danger to themselves or others. These families risk having

their children temporarily or permanently placed outside the home in

foster care, juvenile detention, or mental health facilities. Most family

preservation programs provide specific services tailored to the family’s

needs to help ameliorate the underlying causes of dysfunction. These

services may include, for example, family counseling and training in

parenting skills. The intensity, duration, and packaging of services

differentiates these programs from the traditional delivery of child welfare

services, which also share the goal of placement prevention and family

reunification. Even among family preservation programs, however, service

delivery varies. In the widely used Homebuilders intensive crisis

intervention model, caseworkers typically carry small caseloads of two

families at a time and are available to families on a 24-hour basis for 4 to 6

weeks. In other program models, caseworkers may carry caseloads of up

to 20 families, with one or two personal contacts per week for a period of

7 or more months. (See app. II for a description of various family

preservation program models.)

Family support programs include a broad spectrum of community-based

activities that promote the safety and well-being of children and families.

In general, the purpose is to reach families before child abuse or neglect

occurs. Often provided in a community center or a school, family support

programs may include services outside the traditional scope of the child

welfare agency, such as health care, education, and employment. Some

family support programs offer a comprehensive array of services to an

entire community, including parenting classes, health clinics, and

counseling. Other programs are more narrow in scope and may focus only

on family literacy or provide information and referral services. Compared

to family preservation, eligible participants may be more broadly or

narrowly defined; for example, all families in a community or only teenage

mothers in a community. In practice, the distinction between family

preservation and family support services may be blurred.

Page 4 GAO/HEHS-97-34 Implementing FPS Services
B-272396 

States Are Using

Federal Funds for

Both New and

Existing Services

The federal FPS services legislation provides states with the flexibility to

meet the needs of children and families through family preservation and

community-based family support services. Exercising this flexibility, states

have reported choosing to fund an array of services and, in many cases,

strategies for improving the ways in which services are delivered. Almost

all states appear to be introducing new family preservation and family

support services. Our analysis shows that states are allocating somewhat

more funds to family support services.

New and Expanded

Services Vary

Forty-four states reported that they used federal funds to create new

family preservation programs, family support programs, or both. For

example, Oregon has had one model of a family preservation

program—the Intensive Family Services Program—since 1980; however,

concerns about the high numbers of African-Americans in foster care in

one community prompted this state to initiate a new family preservation

program. This program is based on the Homebuilders service-delivery

model but refined to better meet the cultural needs of this population.3

Although almost all the states reported starting new programs, the size and

service levels of these programs vary across states and programs. Some

are quite small. For example, in a low-income neighborhood in Maryland, a

new family preservation component was added to a community-based

substance abuse treatment program. There, $40,000 pays for one

caseworker to provide family preservation services for as many as five

families at a time to prevent the need to remove children from their homes

while the parents are treated for substance abuse. Another new family

support program in this same community provides information and

coordinates communitywide activities to ensure families have knowledge

of and access to all available community resources. About $75,000 is being

spent for this program that plans to serve 200 persons by telephone or

in-person and make 600 contacts by mail a month.

By contrast, another community in Texas implemented a larger-scale

program spending $971,000 in federal funds over the last 2 years to create

a family resource center in each of three school districts. This new family

support program offers an array of services at each school-based center,

including parent education, counseling, adult education, childcare, some

health care, and family support workers for families in need of more

3

Compared with the Homebuilders model, Oregon’s state family preservation program relies less on

the provision of concrete and supportive services and more on family therapy; moreover, treatment is

less intensive.

Page 5 GAO/HEHS-97-34 Implementing FPS Services
B-272396 

intensive services. As of August 1996, over 3,000 households containing

8,600 individuals had registered since the program’s inception.

In addition to introducing new programs, almost every state used federal

funds to fill gaps in existing FPS services. Forty-seven states reported

expanding existing family preservation services, family support services,

or both by making them available to more clients within existing service

areas, by adding more program sites, or enhancing programs by increasing

the intensity of existing services or adding new services as illustrated by

the following cases:

• Texas expanded its intensive placement prevention program to additional

locations to reach new clients as well as more clients within existing

service areas. This family preservation program is designed to prevent the

need for placing abused and neglected children in foster care. The existing

18 service-delivery units are being expanded to 38 units and about 115 new

workers are being hired to serve an additional 520 families per year.

• Arkansas expanded its Intensive Family Services program from 10 to 20

counties. This family preservation program was also enhanced by adding

emergency cash assistance for participating families. This new service will

enable families in crisis to address some of their immediate needs, such as

covering back rent to avoid becoming homeless.

• One Maryland community enhanced a neighborhood recreation program

by adding new activities and increasing its hours of operation. Community

members voiced concern that the lack of recreational activities was a

factor in the adolescent crime rate. This family support program is

designed to give young people a safe place to congregate and recreate,

especially in the late afternoon and evening hours, to keep them off the

streets and away from the influence of illegal and drug-related activities.

The likelihood of states creating new or expanding existing programs

appeared unaffected by whether states had previously provided family

preservation or family support services, how long states have had service

dollars available, or whether service decisions were made at the state or

local level. Our analysis of state survey responses showed no clear

patterns regarding the circumstances that might result in states funding

certain types of services.

States Place Somewhat

More Emphasis on Family

Support Services

As the law requires, most states are spending a significant portion of their

federal funds for family preservation services and family support services.

Of the federal funds used for services in fiscal year 1996, states allocated

Page 6 GAO/HEHS-97-34 Implementing FPS Services
B-272396 

an average of 56 percent to family support services and 44 percent to

family preservation.4

In 1996, over half the states allocated a majority of their service dollars for

family support services, as shown in table 1. Four of these states are using

all their service dollars for family support activities, which is allowable as

long as the state justifies this distribution.

Table 1: Type of Service Receiving

Majority of Funding, by Number of

States, Fiscal Year 1996

Type of service Number of states

Family support servicesa 29

Family preservation services 11

Equal funding for both services 11

Total 51

aFour states—District of Columbia, Iowa, Massachusetts, and Tennessee—are using all their

service dollars for family support services.

Source: GAO analysis of HHS summary of state budget requests.

While every state is initiating or expanding family support services, family

preservation services, or both, slightly more states are using federal funds

for family support services. Forty-one states reported introducing new

family support programs, while 34 states initiated new family preservation

programs. Forty-three states expanded existing family support services,

compared to 38 states for family preservation.

Several reasons may explain why states have placed somewhat more

emphasis on family support services. According to federal and state

officials, some states had already spent considerable state or other federal

funds for family preservation services and decided—either at the onset or

based on planning results—to place greater emphasis on family support

services. Further, many states delegated to counties or communities the

responsibility for conducting localized planning and making service

decisions. Localities were apt to be more familiar with support services

and to play a larger role in program decisions than the child welfare

agencies familiar with family preservation.

Federally Funded Services

Were Implemented Within

Last 2 Years

States have had 1 to 2 years to initiate or expand family preservation and

family support services, depending on how they used their first year’s

funds. All states spent at least a year doing collaborative community-based

4

Amounts for family preservation and support services are based on budget information that states

submit to HHS each year. Data on actual expenditures are not readily available.

Page 7 GAO/HEHS-97-34 Implementing FPS Services
B-272396 

planning to develop their 5-year plans, in accordance with HHS guidance.

Nineteen states elected to implement services while simultaneously

conducting planning activities resulting in these states having had about 2

years to implement services. The majority of the states, however, began to

implement federally funded services a year later, after they had completed

their 5-year plans.5

For those states that have had a year to initiate or expand services, most

reported that implementation of family preservation and family support

services has been slower than they expected. In total, 25 states indicated

being behind schedule primarily due to the magnitude and complexity of

the implementation effort. Most of these states said that they experienced

delays in designing or developing FPS services. Moreover, the competitive

process to select communities or programs that would receive federal

funds also caused delays in several states. Officials had not anticipated the

time required to solicit and review proposals, respond to challenges, and

award contracts. Many states also reported that an extended period of

time was required to change their service-delivery system to facilitate

implementation, such as training staff on procedural changes and

collaborating with other service providers. In addition to these procedural

factors, many states attributed their receipt of federal funds later than

expected as a reason for being behind schedule.

Other Activities Are

Designed to Improve

Service Delivery

While states appear to be using most of their federal FPS funds to initiate or

expand family preservation or family support services, many states are

also undertaking a variety of activities to enable the service-delivery

system to serve vulnerable children and families more effectively and

efficiently. According to estimates provided by each state at the time of

our study, an average of 83 percent of federal funds had been spent on

direct services, such as the new and expanded family preservation and

family support services already described. The remaining federal dollars

were used for other allowable activities, including additional planning,

administration,6

 and capacity-building such as training and technical

assistance.

Five states dedicated all their FPS funds to the provision of direct services,

while 46 states used a portion of their funds for other activities as well as

5

First-year funds were available to all states by Sept. 1994. The next year’s funds—triggered by states’

submittal of their 5-year plans—were available a year later.

6

According to federal guidance, administrative costs include costs for procurement, payroll

processing, management, data processing and computer services, and other indirect services.

Page 8 GAO/HEHS-97-34 Implementing FPS Services
B-272396 

direct services. Thirty-eight of these states conducted activities designed

to enhance the capacity of state and local agencies to provide family

preservation and support services. These activities included staff training

in cultural awareness or procedural changes, technical assistance to

service providers, research or evaluation activities, and management

information system development and improvement. For example,

Arkansas held two conferences, which were attended by over 1,000

individuals, to educate the public on prevention issues, encourage

collaboration among providers, and provide technical assistance and

training to staff of community-based organizations. Several states

contracted with universities or private research firms to conduct outcome

evaluations. In Idaho, local panels were established to review closed child

protection cases to identify service gaps and improvements to the

service-delivery system responsible for investigating allegations of child

abuse and neglect.

In addition, 17 states reported that planning activities will continue beyond

1995. For example, Maryland is taking more time to allow its 19 local

management boards representing the state’s 24 counties to develop their

own community-based plans. At the time of our study, the state had

provided federal funds to 11 boards for localized planning. Eventually

every local management board in the state will have the opportunity to

develop its own plan.

Results and Impact

Will Be Monitored in

Various Ways

Midway into this 5-year program, it is too early to identify what impact the

federally funded family preservation and family support services have had

on the lives of vulnerable children and their families. Several efforts,

however, are underway to monitor results and assess impact. By law,

states must track results and report on their progress in achieving the

goals set in their 5-year plans. Some states will also conduct formal

evaluations to examine outcomes and processes. To determine the impact

of federally funded services, however, requires rigorous evaluation. Eleven

states plan to conduct such evaluations. In addition, federal efforts are

underway to assess the effectiveness of family preservation and family

support services.

States Will Use Various

Measures and Methods to

Track Results

States plan to track the results of federally funded services by using a

variety of measures. At a minimum, all states report that they will track the

number of children and families served and most will measure the extent

to which their needs are being met. Specifically, 45 states will look for

Page 9 GAO/HEHS-97-34 Implementing FPS Services
B-272396 

evidence of changes in parent-child relationships, family functioning, or

participants’ satisfaction with services delivered. Many states will also

assess the well-being of children by using appropriate measures, such as

the number of infants discharged from community care who receive

follow-up care within 48 hours. More than half the states told us that they

expect to determine the program’s cost effectiveness, the efficacy of

certain services for particular client groups, or both. Finally, at least 45

states plan to monitor traditional indicators of child welfare, such as the

number of child abuse and neglect reports, and changes over time in one

or more aspects of the service-delivery system. For example, one state

plans to examine the extent to which consumers are participating in

service planning groups and services are provided in conjunction with

community and neighborhood organizations.

Having set goals and measurable objectives in their 5-year plans, states are

expected to annually report on outcomes and progress towards achieving

these goals. At the time of this report, HHS and its contractor responsible

for evaluating state implementation were reviewing states’ first progress

reports and expected to complete their initial analyses in December 1996.

In addition, some states will conduct formal evaluations that examine

processes and outcomes, in many cases in conjunction with schools of

social work at state universities. For example, Kentucky has contracted

with the University of Kentucky to develop an evaluation program to

assess the extent to which the state’s FPS services program reaches the

target population, monitor the frequency of service delivery and client

participation, tabulate the cost of implementing the program, and assess

the extent that program goals are achieved. In Arizona, the state’s

evaluation will track multiple child, family, and community outcome

measures over time and compare results to baseline indicators. Data

sources include family questionnaires, agency reports, and worker

assessments.

State plans for monitoring and evaluating FPS programs should yield useful

information on the size, nature, and outcomes of funded activities as well

as changes in the well-being of communities, families, and children.

Because these efforts will not necessarily confirm that the programs

caused improved outcomes, 11 states plan to conduct their own rigorous

evaluations—even though such evaluations are not required—that will

yield more conclusive results. For example, a research contractor will

conduct a 3-year randomized clinical trial of a home visitation program in

San Diego County, California, that is based on Hawaii’s Healthy Start

Page 10 GAO/HEHS-97-34 Implementing FPS Services
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model.7 Researchers will randomly assign 500 families to one of two

groups—about half the families will receive program services and the

other families will not—and evaluate the effectiveness of the program

model as it is implemented in San Diego. Primary study objectives include

testing whether implementation of this model results in improved

outcomes and determining what cost-benefits are derived.

Federal Evaluations Are

Designed to Assess Impact

Two federal evaluations are underway to rigorously assess the impact of

FPS programs on children and families—one for family preservation and

the other for family support services. Each evaluation is comprised of

multiple studies of mature programs—initiated before the federal FPS

services law—that span a range of program models and methods for

targeting services. At the time that we prepared this report, the research

contractors were expected to begin data collection in the fall of 1996 and

issue interim reports a year later.

The family preservation evaluation is reviewing four programs that aim to

prevent out-of-home placement and one program that tries to reunite

foster children with their families.8

 Two of these programs use the

Homebuilders crisis intervention model, while the other three use less

intensive service models. Each program evaluation is designed to assign

families to treatment and control groups. Families in the treatment group

receive services from the family preservation program. Families in the

control group receive services that they would have received if the

program was not available. Outcomes to be measured include changes in

foster care placement rates, recidivism, and duration in stay, as well as

family functioning and subsequent child abuse and neglect.

The family support evaluation consists of multiple studies of eight

different programs, including several comprehensive community family

support programs as well as those that focus on economic self-sufficiency,

family literacy, or preventing substance abuse.9

 Five programs are being

evaluated using treatment and control groups. The remaining three

programs will compare families that receive program services with

7

The Healthy Start model uses home visitors to provide supportive services to families at risk of

becoming abusive. New mothers are screened and interviewed at the hospital and can voluntarily

receive family support services until their children are 5 years old.

8

The family preservations programs are in New York City, Philadelphia, the Louisville area of

Kentucky, the Memphis area of Tennessee, and selected counties in New Jersey.

9

The family support programs are in Albuquerque, New Mexico; San Jose, California; Cleveland, Ohio;

Denver, Colorado; Pensacola, Florida; New York City; several cities in Wisconsin; 11 counties in Iowa;

and 6 school districts in Kentucky.

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families in other programs or similar settings. For example, families that

participate in Florida’s Full Service Schools program will be compared

with families in comparable schools where the program is not offered.10

Outcomes to be measured include family functioning, child and family

well-being, instances of child abuse and neglect, and satisfaction with

services delivered.

Early Results Are Few, but

Service-Delivery

Approaches Have Been

Affected

Although it is too early to identify service impacts on children and

families, 10 states reported that program results were available on

federally funded FPS services. Most of these states collected data on the

number of children and families served, changes in child abuse and

childhood mortality rates, as well as changes in their approaches to

delivering services. For example, Louisiana reported on the results of

federally funded projects after the first year of implementation. To

contribute to future planning efforts related to the configuration of family

preservation and family support services in Louisiana, the evaluation

described the services and population characteristics in three programs

and assessed the relationship between services and short-term outcomes.

In particular, the Intensive Home Based Services program, which is a

family preservation program, met its goal of preventing child removal and

continued maltreatment. A family support program, designed to prevent

child abuse and neglect, resulted in few reports of child maltreatment even

though a majority of cases had had one or two child abuse or neglect

reports before receiving program services. In another example for another

family support program operating at a child development center whose

primary service population is teenage parents and their children,

individual service needs were summarized based on participants’ and

workers’ completion of a new needs assessment form.

While not much is known yet about the impact of federally funded

services, the legislation appears to have affected the ways in which states

and localities develop and administer services for children and their

families. According to federal and state officials, the primary impact to

date has been to forge links between state agencies and the communities

they serve. The process of developing states’ 5-year plans resulted in

public agencies, organizations, service providers, and consumers working

together for the well-being of children and families. Many states departed

from their traditional method of administering child welfare services at the

10The Full Service Schools model is a school-based family support program that integrates education,

medical, and human services for general and certain at-risk populations in predominantly low-income

communities. Primary objectives include helping children to be better prepared for school, reducing

teenage pregnancy rates, and reducing the need for mental health and substance abuse services.

Page 12 GAO/HEHS-97-34 Implementing FPS Services
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state level. In particular, 27 states reported distributing federal funds to

counties and other local entities, such as community groups and local

coalitions, to develop their own plans and make service decisions. Several

states took additional steps to better identify the service needs of children

and families. For example, Michigan is investing an additional $10 million

in state funds to supplement federal funds and enable each of its 83

counties to participate in the process of improving services to better meet

local needs. State officials credit this process with ensuring that at-risk

families now have greater access to needed services and contributing

significantly to the broader goal of positive system reform.

Conclusion Before the enactment of OBRA 1993, FPS programs throughout the country

were unable to meet the demand for services to strengthen and support

families. Since then, states have begun to both initiate and expand

programs of family preservation and support services to achieve the

purpose of the FPS legislation. Early results indicate that these services are

being offered to families and children who might otherwise have fallen

through the cracks and that some programs supported with federal funds

have met their goals of strengthening families and reducing child abuse

and neglect. Information being gathered by states, universities, and

research firms should increase our understanding of the outcomes of

funded activities as well as changes over time in the well-being of

communities, families, and children. Moreover, the community-based

collaborative planning process undertaken seems to be having beneficial

effects on the service-delivery system. While there has been service

innovation and services have been expanded, it is still too early to tell

what will be the ultimate impact of these programs on children and

families.

Agency Comments

and Our Evaluation

In commenting on a draft of this report, HHS agreed with our findings that

implementation has been slower than expected but has achieved several

positive outcomes. In particular, HHS emphasized the availability of new

and expanded programs for both family preservation and support services,

the focus on family support as a balance to family preservation, and the

extension of services to families otherwise overlooked. Further, HHS noted

that the use of FPS funds has encouraged collaboration among programs

and levels of government and has attracted additional funds to meet

community needs.

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We are providing copies of this report to the Secretary of Health and

Human Services, state child welfare directors, and state FPS coordinators.

We will also make copies available to other interested parties upon

request. Should you or your staff have any questions or wish to discuss the

information provided, please call me at (202) 512-7125. Other GAO contacts

and staff acknowledgements are listed in appendix IV.

Sincerely yours,

Mark V. Nadel

Associate Director, Income Security Issues

Page 14 GAO/HEHS-97-34 Implementing FPS Services
Page 15 GAO/HEHS-97-34 Implementing FPS Services
Contents

Letter 1

Appendix I 

Scope and

Methodology

18

GAO Survey Instrument 18

Appendix II 

GAO Survey of State

Child Welfare

Agencies

20

Appendix III 

Comments From the

Department of Health

and Human Services

38

Appendix IV 

GAO Contact and

Acknowledgments

40

Table Table 1: Type of Service Receiving Majority of Funding, by

Number of States, Fiscal Year 1996

7

Abbreviations

ACF Administration for Children and Families

ASPE Office of the Assistant Secretary for Planning and Evaluation

FPS family preservation and support

HHS Department of Health and Human Services

OBRA Omnibus Budget Reconciliation Act

Page 16 GAO/HEHS-97-34 Implementing FPS Services
Page 17 GAO/HEHS-97-34 Implementing FPS Services
Appendix I 

Scope and Methodology

We had previously assessed federal and state efforts to implement the FPS

provisions during the first 18 months after OBRA 1993 was enacted and

highlighted areas in which those efforts could be enhanced.11 To update

this information, we interviewed officials from HHS’ ACF, which is

responsible for overseeing this program, and reviewed related federal

guidelines. Recognizing that it might be too early to identify service

impacts on children and families, we also reviewed several states’ 5-year

plans and first annual progress reports to determine the availability of

information related to our objectives and to document states’ plans for

assessing impact.

To obtain information about the status of federal evaluation efforts, we

interviewed officials from HHS’ Office of the Assistant Secretary for

Planning and Evaluation (ASPE) and ACF who are responsible for

overseeing the three national evaluation contracts that will collectively

assess state implementation and the effectiveness of FPS programs.

GAO Survey

Instrument

We designed a survey instrument to obtain information about states’ use of

federal funds for FPS services, plans for assessing impact, and impacts

identified to date. We discussed development of the instrument with HHS

headquarters staff and several state child welfare agency officials.

We pretested the instrument by telephone with the Title IV-B agency’s FPS

coordinator in two states—Indiana and New Jersey. We chose these states

for our pretest because they had distributed their federal funds in different

ways—one to counties to do their own planning and make service

decisions and the other to programs directly based on state-level

decisionmaking. We revised the instrument based on the results of the

pretest.

In late June and early July 1996, we sent a copy of the instrument to the

appropriate official of the child welfare agency in each of the 50 states and

the District of Columbia. We offered the officials the option of completing

the instrument in writing and returning it to us within 2 weeks. We

interviewed by telephone those officials who did not return a completed

instrument.

We did not verify the information obtained through the survey instrument.

However, we conducted in-depth interviews in nine states to supplement

information collected in the survey. In particular, we obtained additional

11See GAO/HEHS-95-112, June 15, 1995.

Page 18 GAO/HEHS-97-34 Implementing FPS Services
Appendix I 

Scope and Methodology

information about (1) the programs that these states initiated or expanded

with federal funds, (2) how federal funds were distributed within the state,

and (3) plans for rigorous evaluation, if any. We conducted seven

interviews by telephone and two in person—one in Anne Arundel County,

Maryland, and one in Sacramento County, California. In each state, we

interviewed the same state-level individual(s) who responded to our

survey. In five of these states—California, Iowa, Maryland, Texas, and

Wisconsin—we also interviewed knowledgeable staff from a locality that

had received federal funds. We selected these nine states because of their

different size, location, and method for distributing federal funds.12

We conducted our work between May and September 1996, in accordance

with generally accepted government auditing standards.

12We conducted in-depth interviews in Arkansas, California, Iowa, Maryland, New Hampshire, North

Carolina, Oregon, Texas, and Wisconsin.

Page 19 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

This appendix presents our survey of state child welfare agencies

regarding their use of Title IV-B, Subpart 2, funds for services. Each

question includes the summary statistics and the actual number of

respondents that answered the question. In each case, we use the format

that we believe best represents the data, including frequencies, means, and

ranges.

Page 20 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

U.S. General Accounting Office 6/25/96

Interview of State Officials on OBRA 1993 and Family Preservation and Support Services

BACKGROUND INFORMATION (TO BE FILLED OUT BEFORE INTERVIEW AS MUCH AS POSSIBLE.)

A. State: ________________ 51 Respondents

B. Interviewee Information

NAME: _______________________________________________

ADDRESS: _______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

TITLE: _______________________________________________

PHONE #: (________)________-____________ FAX #: (________)________-_______________

DATE OF TIME OF

INTERVIEW: __________/_________/__________ INTERVIEW: _________________________

Mo. Day Yr.

Hello, Mr./Ms. ________________________________, my name is _______________________________________.

I am with the U.S. General Accounting Office (GAO), an agency of the Congress.

The Congress has asked us to study the nature and extent of new family preservation and support services since the

enactment of OBRA 1993, and how states are assessing the impact of these services on families, children and

communities. As part of the study, we are interviewing officials from all 50 states and the District of Columbia.

During the interview we will ask about the ways in which your state has used its Title IV-B Subpart 2 funds and

about recent family preservation and support initiatives in your state. We are also interested in how your state plans

to measure, or is measuring, the impact of family preservation and support services on families and children.

C. This interview should take about 45 minutes. Do you have the time to talk with me now?

1. [ ] Yes (IF "YES," GO TO E.),

2. [ ] No

D. When would be a good time to call you back?

E. O.K., let’s begin.

1

Page 21 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

USE O F OBRA F UNDS

First we'd like to discuss how OBRA funds are being used in your state. Let me clarify that, when we say "OBRA

funds", we mean the federal family preservation and support funds provided by OBRA 1993--that is, Title IV-B

Subpart 2 funds. Also, our focus is on only those OBRA funds that your state received for services--that is, those

funds requiring a state match.

 1. On what date were OBRA funds first made available to your state to use for services? (ENTER DATE.) 

_________/__________/__________ Range-8/1/94 to 6/1/96

Month Day Year n=51

2. Did your state allocate its OBRA funds to family preservation and support programs directly, or did your

state distribute funds to counties or other local governments for them to allocate to family preservation and

support programs? (CHECK ONE.) n=51

1. 24 Family preservation and support programs directly (GO TO QUESTION 7.)

2. 22 Counties or other local governments

3. 5 Both

3. As of now, how many counties have received OBRA funds to use for family preservation and support

services? (ENTER NUMBER.) n=27

1. Range=3-111

No. of counties Mean=27.6

4. Did these counties do localized planning to decide what family preservation and support services to fund? 

(CHECK ONE.) n=27

1. 27 Yes

2. 0 No

5. Did your state retain any of its OBRA funds at the the state level before distributing funds to counties? 

(CHECK ONE.) n=27

 

1. 24 Yes => About what percentage was retained at the state level? _______________________%

(ENTER PERCENTAGE.)

2. 3 No Range=2-77%

Mean=20.3%

6. How many counties are there in your state? n=27

1. Range=3-256

No. of counties Mean=65.4

2

Page 22 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

The next few questions ask about the use of OBRA funds that were available to your state for services. Again, we

mean those Title IV-B Subpart funds requiring a state match.

7. Now I’d like to ask you about the use of OBRA funds in your state for activities that do not involve directly

initiating or expanding family preservation or family support services. The question is, in your state...

(CHECK ONE FOR EACH.)

Have any OBRA funds been used to... Yes

(1)

No

(2)

1. Pay for broad-based planning activities that were not covered by the FY 1994

funds available for developing your state’s 5-year plan--that is, those first-year

funds requiring no state match? n=51

17 34

2. Pay for efforts to increase your state’s capacity to provide family preservation

and support services? Examples of this include training staff in cultural

awareness or process changes; providing technical assistance to individuals,

groups, and organizations that deliver family preservation and support services;

conducting research or evaluation activities; and developing or improving

management information systems. n=51

38 13

3. Fund the reporting of your state’s progress toward achieving the goals set out in

the 5-year plan? n=51

24 27

4. Pay for family preservation and family support administrative costs? These

include costs for procurement, payroll processing, management, data processing

and computer services, as well as other indirect costs. n=51

38 13

5. Pay for or fund any other activity that does not involve directly initiating or

expanding family preservation or family support services? (IF "YES," ASK

RESPONDENT TO PLEASE SPECIFY.) n=51

4 47

(IF ALL ITEMS IN QUESTION 7 ARE CHECKED "NO," GO TO QUESTION 9.)

8. Of the OBRA funds your state has received for services so far, about what percentage has been used for the

activities you just mentioned? And, about what percentage has been used to directly initiate or expand family

preservation and support services? (ENTER PERCENTAGE FOR EACH.) n=46

1. Range=1-84% for activities that do not directly involve initiating or expanding services, as

Mean=19% mentioned in Question 7.

2. Range=16-99% for directly initiating or expanding services.

Mean=81%

100% Total OBRA funds received for services

3

Page 23 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

FAMILY PRESERVATION AND SUPPORT ACTIVITIES

Now we’d like to ask some questions about family preservation and support services that have been initiated or

expanded with OBRA funds. We will begin by asking a series of questions about family preservation services.

Family Preservation Services

9. Before October 1, 1993, were any family preservation services provided in your state? (CHECK ONE.)

n=51

1. 50 Yes

2. 1 No

10. Since your state first received OBRA funds for services, have any of these funds been used to implement any

family preservation services in your state? (CHECK ONE.) n=51

1. 45 Yes

2. 6 No (GO TO QUESTION 16 ON PAGE 7.)

The next few questions ask about the number of family preservation programs that have been funded with OBRA

dollars. Let me clarify that, when we say "program," we mean a type of program or model within which specific

services are provided. Examples of family preservation programs could include the Homebuilders crisis intervention

model, or a less intensive family reunification program. A particular program may be available at multiple sites, or

funds may be distributed to multiple service-providers to implement a particular program. (FOR A MORE

DETAILED DESCRIPTION OF DIFFERENT TYPES OF FAMILY PRESERVATION PROGRAMS OR MODELS,

SEE PAGE 16 AT THE BACK OF THIS SURVEY.)

11. How many types of family preservation programs or models in your state have been funded with OBRA

dollars? (ENTER NUMBER OR CHECK "DON’T KNOW".) n=45

1. _______________ n=36, Range=1-15, Mean=4.1

No. of types of programs or models

2. 9 Don’t know at state level

4

Page 24 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

12. We are interested in learning more about these family preservation services. First, we’d like to know if

OBRA funds have been used to introduce brand new programs, or were OBRA funds used to expand or

enhance existing programs. Second, we’d like to know how many programs were brand new, expanded, or

enhanced. The first question is this: Anywhere in your state, have OBRA funds been used to ... (CHECK

ONE FOR EACH ITEM IN (A); IF "YES" IN (A), THEN CONTINUE TO (B).)

(A)

Have OBRA funds

been used to...

(CHECK ONE FOR

EACH)

(B)

How many types of

family preservation

programs or models are

in this category?

(ENTER NUMBER OR

CHECK "DON’T KNOW")

Don’

t

know

(1)

No

(2)

Yes

(3)

No. of types of

programs or models

(1)

Don’

t

know

(2)

1. Introduce new family preservation programs

that were not used before? n=45

1 10 34 If yes

--->

2. Expand existing family preservation programs

to new locations? n=45

3 14 28 If yes

--->

3. Expand existing family preservation programs

to reach more clients within the same service

areas? n=45

3 12 30 If yes

--->

4. Enhance existing family preservation programs

by providing more of an existing service or

introducing new services to the same number of

clients within the same service areas? n=45

2 11 32 If yes

--->

5. Do anything else regarding family preservation

services? (PLEASE SPECIFY.) n=45

3 39 3 If yes

--->

13. Since your state first received OBRA funds for services, have any clients been served, who would not have

been served, without the provision of OBRA funding for these family preservation programs? (CHECK

ONE.) n=45

1. 43 Yes

2. 2 No

5

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Appendix II 

GAO Survey of State Child Welfare Agencies

14. Consider your state’s schedule for implementing OBRA-funded family preservation services. In general,

would you say that the implementation of family preservation services in your state, as of now, is very much

ahead of schedule, slightly ahead of schedule, on schedule, slightly behind schedule, or very much behind

schedule? (CHECK ONE.) n=45

1. 0 Very much ahead of schedule (GO TO QUESTION 16.)

2. 4 Slightly ahead of schedule (GO TO QUESTION 16.)

3. 19 On schedule (GO TO QUESTION 16.)

4. 16 Slightly behind schedule

5. 6 Very much behind schedule

15. Now, I’m going to mention some reasons why a state’s implementation of family preservation services might

be behind schedule. Please indicate if any of these reasons apply to your state. (CHECK ONE FOR

EACH.)

Is implementation behind schedule because your state... Yes

(1)

No

(2)

1. Received its OBRA funds later than it expected to receive them? n=22 12 10

2. Decided to delay action on family preservation services until federal

welfare reform was complete? n=22

5 17

3. Delayed action on family preservation services until receiving federal

guidance related to the implementation of OBRA 1993? n=22

9 13

4. Experienced delays in developing or producing the 5-year plan? n=22 6 16

5. Experienced delays in designing or developing the "new" family

preservation services? n=22

14 8

6. Required an extended period of time to make changes to the existing

service-delivery system before family preservation services could be

implemented? These changes might include training staff on cultural

awareness or process changes, collaborating with other related service

providers, reorganizing departments, or changing service delivery processes.

n=22

10 12

7. Experienced delays in any other pre-implementation activities? (IF "YES,"

PLEASE SPECIFY.) n=22

14 8

6

Page 26 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

Family Support Services

Now we’d like to ask a series of questions about family support services.

16. Before October 1, 1993, were any family support services provided in your state? (CHECK ONE.) n=51

1. 48 Yes

2. 3 No

17. Since your state first received OBRA funds for services, have any of these funds been used to implement any

family support services in your state? (CHECK ONE.) n=51

1. 50 Yes

2. 1 No (GO TO QUESTION 23 ON PAGE 10.)

The next few questions ask about the number of family support programs that have been funded with OBRA

dollars. Let me clarify that, when we say "program," we mean a type of program or model within which specific

services are provided. Examples of some family support programs that have been replicated around the country

include: comprehensive/community family support programs like the Parents Services Project that originated in the

San Francisco Bay Area; child abuse and neglect prevention programs like Hawaii’s Healthy Start model; and school

readiness programs like HIPPY and Parents as Teachers (PAT). A particular program may be available at multiple

sites, or funds may be distributed to multiple service-providers to implement a particular program. (FOR A MORE

DETAILED DESCRIPTION OF DIFFERENT TYPES OF FAMILY SUPPORT PROGRAMS OR MODELS, SEE

PAGES 16 AND 17 AT THE BACK OF THIS SURVEY.)

18. How many types of family support programs or models in your state have been funded with OBRA dollars?

(ENTER NUMBER OR CHECK "DON’T KNOW".) n=50

1. _______________ n=37, Range=1-35, Mean=7.4

No. of types of programs or models

2. 13 Don’t know at state level

7

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Appendix II 

GAO Survey of State Child Welfare Agencies

19. We are interested in learning more about these family support services. First, we’d like to know if OBRA

funds have been used to introduce brand new programs, or were OBRA funds used to expand or enhance

existing programs. Second, we’d like to know how many programs were brand new, expanded, or enhanced.

The first question is this: Anywhere in your state, have OBRA funds been used to ... (CHECK ONE FOR

EACH ITEM IN (A); IF "YES" IN (A), THEN CONTINUE TO (B).)

(A)

Have OBRA funds

been used to...

(CHECK ONE FOR

EACH)

(B)

How many types of

family support

programs or models are

in this category?

(ENTER NUMBER OR

CHECK "DON’T KNOW")

Don’

t

know

(1)

No

(2)

Yes

(3)

No. of types of

programs or models

(1)

Don’

t

know

(2)

1. Introduce new family support programs that

were not used before? n=50

2 7 41 If yes

--->

2. Expand existing family support programs to new

locations? n=50

2 16 32 If yes

--->

3. Expand existing family support programs to

reach more clients within the same service areas?

n=50

1 14 35 If yes

--->

4. Enhance existing family support programs by

providing more of an existing service or

introducing new services to the same number of

clients within the same service areas? n=50

2 17 31 If yes

--->

5. Do anything else regarding family support

services? (PLEASE SPECIFY.) n=50

5 44 1 If yes

--->

20. Since your state first received OBRA funds for services, have any clients been served, who would not have

been served, without the provision of OBRA funding for these family support programs? (CHECK ONE.)

n=50

1. 49 Yes

2. 1 No

8

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Appendix II 

GAO Survey of State Child Welfare Agencies

21. Consider your state’s schedule for implementing OBRA-funded family support services. In general, would

you say that the implementation of family support services in your state, as of now, is very much ahead of

schedule, slightly ahead of schedule, on schedule, slightly behind schedule, or very much behind schedule?

(CHECK ONE.) n=50

1. 1 Very much ahead of schedule (GO TO QUESTION 23.)

2. 4 Slightly ahead of schedule (GO TO QUESTION 23.)

3. 23 On schedule (GO TO QUESTION 23.)

4. 17 Slightly behind schedule

5. 5 Very much behind schedule

22. Now, I’m going to mention some reasons why a state’s implementation of family support services might be

behind schedule. Please indicate if any of these reasons apply to your state. (CHECK ONE FOR EACH.)

Is implementation behind schedule because your state... Yes

(1)

No

(2)

1. Received its OBRA funds later than it expected to receive them? n=22 9 13

2. Decided to delay action on family support services until federal welfare

reform was complete? n=22

4 18

3. Delayed action on family support services until receiving federal guidance

related to the implementation of OBRA 1993? n=22

7 15

4. Experienced delays in developing or producing the 5-year plan? n=22 5 17

5. Experienced delays in designing or developing the "new" family support

services? n=22

15 7

6. Required an extended period of time to make changes to the existing

service-delivery system before family support services could be

implemented? These changes might include training staff on cultural

awareness or process changes, collaborating with other related service

providers, reorganizing departments, or changing service delivery processes.

n=22

13 9

7. Experienced delays in any other pre-implementation activities? (IF "YES,"

PLEASE SPECIFY.) n=22

13 9

9

Page 29 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

IMPACT OF FAMILY PRESERVATION AND FAMILY SUPPORT SERVICES

Now, I’d like to ask you about any results achieved by OBRA-funded family preservation and support services.

Again, when we say "OBRA funds", we mean Title IV-B Subpart 2 funds.

23. We realize it may be too early to have done this, but has your state gathered any information on the results

achieved so far by OBRA-funded... (CHECK ONE FOR EACH.) n=51

Yes

(1)

No

(2)

1. Family preservation services? 9 42

2. Family support services? 9 42

(IF "NO" TO BOTH family preservation AND family support SERVICES, THEN GO TO QUESTION 28

ON PAGE 13.)

24. Now, I’m going to mention some measures that might be used to assess the impact of family preservation or

family support services. First, we’d like to know if the measure was used. If so, we’d like to know if it was

used to assess the impact of family presevation services, family support services, or both. The first question

is this: For OBRA-funded family preservation or family support services, did anyone in your state

measure... (CHECK ONE FOR EACH ITEM IN (A); IF "YES" IN (A), THEN CONTINUE TO (B).)

(A)

Did anyone

measure...

(CHECK ONE

FOR EACH)

(B)

Was it used for family

preservation (FP)

services, family support

(FS) services, or both?

No

(1)

Yes

(2)

If yes

--->

(ENTER "FP", "FS", OR

"BOTH")

1. The number of children, families, or clients served? n=10 0 10

2. The extent to which the needs of vulnerable or at-risk

children and families were met? n=10

5 5

3. The number of foster care placements prevented or

number of family reunifications? n=10

4 6

4. Changes in the well-being of children, including each

child’s development, school performance or readiness?

n=10

6 4

5. Changes in parent-child relationships, family satisfaction,

or family functioning? n=10

5 5

6. Changes in the community, such as in the number of

child abuse/neglect reports, in poverty rates, in birth rates,

or in childhood mortality rates? n=10

3 7

10

Page 30 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

(A)

Did anyone

measure...

(CHECK ONE

FOR EACH)

(B)

Was it used for family

preservation (FP)

services, family support

(FS) services, or both?

No

(1)

Yes

(2)

If yes

--->

(ENTER "FP", "FS", OR

"BOTH")

7. Changes to the service-delivery system, such as in

caseloads or expenditures? n=10

5 5

8. Other changes to the service-delivery system, such as

changes in the extent of collaboration, coordination, and

inclusiveness? n=10

2 8

9. Still other changes to the service-delivery system, such as

in staffing levels, staff training, number of cases per

worker, or timeliness of services? n=10

6 4

10. Cost effectiveness? n=22 8 2

11. Which types of services work best for certain groups of

clients? n=22

7 3

12. Anything else? (IF "YES," PLEASE SPECIFY) n=10 7 3

25. We would like any information you might have on specific results of OBRA-funded family preservation or

family support services in your state. Could you mail or fax to us any documentation? n=10

1. 7 Yes => I will tell you where to mail or fax this information at the conclusion of this interview.

2. 3 No

11

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Appendix II 

GAO Survey of State Child Welfare Agencies

26. I am going to now mention some ways in which the impact of OBRA-funded family preservation or family

support services might be assessed. To your knowledge, in your state, ... (CHECK ONE FOR EACH.)

Has anyone assessed the impact of OBRA-funded services by... Yes

(1)

No

(2)

1. Monitoring indicators? n=10 9 1

2. Preparing periodic progress reports? n=10 8 2

3. Reviewing individual case records? n=10 2 8

4. Surveying clients? n=10 5 5

5. Reviewing specific family preservation or family support programs? n=10 4 6

6. Reviewing portions or all of your state’s child and family service-delivery

system? n=10

5 5

7. Doing anything else? (IF "YES," PLEASE SPECIFY.) n=10 2 8

27. To your knowledge, has anyone in your state conducted a formal evaluation--that is, an evaluation that utilized

an experimental design--to assess the effectiveness of OBRA-funded... (CHECK ONE FOR EACH.) n=10

Yes

(1)

No

(2)

1. Family preservation services? 1 9

2. Family support services? 0 10

12

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Appendix II 

GAO Survey of State Child Welfare Agencies

Plans to Assess Impact

We are interested in your state’s plans for assessing the impact of family preservation and family support services

on children, families, and communities.

28. Now, I’m going to mention some measures that might be used to assess the impact of family preservation or

family support services. First, we’d like to know if the measure will be used in your state. If so, we’d like

to know if it will be used to assess the impact of family presevation services, family support services, or

both. The first question is this: For OBRA-funded family preservation or family support services, does

anyone in your state plan to measure... (CHECK ONE FOR EACH ITEM IN (A); IF "YES" IN (A), THEN

CONTINUE TO (B).)

(A)

Will anyone

measure...

(CHECK ONE

FOR EACH)

(B)

Will it be used for

family preservation (FP)

services, family support

(FS) services, or both?

No

(1)

Yes

(2)

If yes

--->

(ENTER "FP", "FS", OR

"BOTH")

1. The number of children, families, or clients served? n=51 0 51

2. The extent to which the needs of vulnerable or at-risk

children and families were met? n=51

9 42

3. The number of foster care placements prevented or

number of family reunifications? n=51

16 35

4. Changes in the well-being of children, including each

child’s development, school performance or readiness?

n=51

14 37

5. Changes in parent-child relationships, family satisfaction,

or family functioning? n=51

6 45

6. Changes in the community, such as in the number of

child abuse/neglect reports, in poverty rates, in birth rates,

or in childhood mortality rates? n=51

6 45

7. Changes to the service-delivery system, such as in

caseloads or expenditures? n=51

19 32

8. Other changes to the service-delivery system, such as

changes in the extent of collaboration, coordination, and

inclusiveness? n=51

4 47

9. Still other changes to the service-delivery system, such as

in staffing levels, staff training, number of cases per

worker, or timeliness of services? n=51

21 30

10. Cost effectiveness? n=51 19 32

13

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Appendix II 

GAO Survey of State Child Welfare Agencies

(A)

Will anyone

measure...

(CHECK ONE

FOR EACH)

(B)

Will it be used for

family preservation (FP)

services, family support

(FS) services, or both?

No

(1)

Yes

(2)

If yes

--->

(ENTER "FP", "FS", OR

"BOTH")

11. Which types of services work best for certain groups of

clients? n=51

16 35

12. Anything else? (IF "YES," PLEASE SPECIFY) n=51 42 9

(IF ALL ITEMS IN QUESTION 28 ARE CHECKED "NO," GO TO QUESTION 30.)

29. We are interested in examples of specific measures that will be used to assess the impact of OBRA-funded

family preseravtion or family support services. Does your state’s 5-year plan describe any of the measures

that you just mentioned? (CHECK ONE.) n=51

1. 35 Yes => Please mail or fax us the relevant pages from your state plan. I will tell you where to

send this information at the conclusion of this interview.

2. 16 No

30. I am going to now mention some ways in which the impact of OBRA-funded family preservation or family

support services might be assessed. To your knowledge, in your state, ... (CHECK ONE FOR EACH.)

Will anyone assess the impact of OBRA-funded services by... Yes

(1)

No

(2)

1. Monitoring indicators? n=51 50 1

2. Preparing periodic progress reports? n=51 49 2

3. Reviewing individual case records? n=51 26 25

4. Surveying clients? n=51 45 6

5. Reviewing specific family preservation or family support programs? n=51 46 5

6. Reviewing portions or all of your state’s child and family service-delivery

system? n=51

39 12

7. Doing anything else? (IF "YES," PLEASE SPECIFY.) n=51 12 39

14

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Appendix II 

GAO Survey of State Child Welfare Agencies

31. To your knowledge, will anyone in your state conduct a formal evaluation--that is, an evaluation that will

utilize an experimental design--to assess the effectiveness of OBRA-funded... (CHECK ONE FOR EACH.)

n=51

Yes

(1)

No

(2)

1. Family preservation services? 8 43

2. Family support services? 8 43

REQUEST FOR OTHER DATA

32. For background purposes, we are interested in other data that may be included in your state’s 5-year plan.

Does your state’s plan include any data that portrays either graphically, in tables, or in narrative, any aspect of

child welfare at or before the time the 5-year plan was developed? n=51

1. 38 Yes => Please mail or fax us the relevant pages from your state plan.

2. 13 No

33. (IF "YES" TO QUESTIONS 25, 29, or 32.) You can mail or fax us (1) documentation related to results of

family preservation/family support services in your state, (2) those sections of your state’s 5-year plan related

to measures that will be used to assess the impacts of these services, or (3) those sections of the state plan

related to child welfare data to:

U.S. General Accounting Office

Attn: Ms. Karen Lyons

Federal Office Building

2800 Cottage Way Room W-2326

Sacramento, CA 95825

The fax number is 916-974-1202

If you have any questions, you can call me at 916-974-3341 (California time).

That concludes this interview. Thank you very much for your time and cooperation.

15

Page 35 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

DEFINITIONS

We define family preservation services and family support services as they appear in the Omnibus Budget

Reconciliation Act of 1993:

-- Family preservation services are typically designed to help families at risk or in crisis. Services may be

designed to (1) prevent foster care placement, (2) reunify families, (3) place children in other permanent living

arrangements, such as adoption or legal guardianship, (4) provide followup care to reunified families, (5)

provide respite care for parents and other caregivers, and/or (6) improve parenting skills.

-- Family support services are primarily community-based preventive activities designed to promote the wellbeing of children and families. Services are designed to (1) increase the strength and stability of families, (2)

increase parents’ confidence and competence in their parenting abilities, (3) afford children a stable and

supportive family environment, and (4) otherwise enhance child development.

The terms, family preservation program and family support program, refer to the type of program or model

within which specific services are provided. A particular program may be available at multiple sites, or funds may

be distributed to multiple service-providers to implement a particular program.

Family preservation programs are often distinguished by one of the following theoretical approaches or

models:

-- Crisis intervention technique forms the basis for the Behavioral Science Institute’s Homebuilders

model. Key program characteristics include: contact with the family within 24 hours of the crisis;

caseload sizes of one or two families per worker; service duration of 4 to 6 weeks; provision of both

concrete services and counseling; staff availability to families on a 24-hour basis; and an average of 20

hours of service per family per week.

-- Family systems technique is a model typified by the FAMILIES program, originated in Iowa. Attention

is focused on the way family members interact with one another and seeks to correct dysfunction by

working on the family’s interaction with the community. Teams of workers carry a caseload of 10 to 12

families; families are seen in their own homes for an average of four and one-half months; and both

concrete and therapeutic services are provided.

-- Therapeutic family treatment is a model that relies less on the provision of concrete and supportive

services and more on family therapy. One of the first such programs was the Intensive Family Services

Program which began in Oregon. Treatment is less intensive than the Homebuilders model and can be

delivered in either an office or home setting. Workers carry a caseload of about 11 families and service

duration is 90 days with weekly followup services provided for an average of 3 to 5 1/2 months.

-- Some family preservation programs use slight variations of these existing models or hybrids of several

models.

Family support programs can be categorized by their type, which is closely aligned with their mission.

Common program types are: (with nationally recognized programs and models in parentheses)

-- Comprehensive/community family support programs offer a wide array of services and typically serve

multiple populations, such as teen parents, juvenile offenders, and jobless adults. Programs tend to be

community-based and open to the entire community. Program components may include some of the more

narrowly focused family support programs listed below. (Parent Services Project)

16

Page 36 GAO/HEHS-97-34 Implementing FPS Services
Appendix II 

GAO Survey of State Child Welfare Agencies

-- Child abuse and neglect prevention programs serve at-risk populations and focus on prevention of

abuse and neglect by working to eliminate social isolation. Programs link families to one another and to

services, including homevisiting, parenting education classes, peer support groups, and child-related

services. (The Nurturing Program; Hawaii’s Healthy Start (replicated through Healthy Families America))

-- Economic self-sufficiency programs serve unemployed and/or underemployed parents by offering

extensive job preparation, skills development workshops, training sessions, and job placement services.

Most programs also provide comprehensive services for families, including referral to other community

agencies, mental health services, and tax/legal assistance. (Comprehensive Child Development Program

(federal program))

-- Family literacy programs focus on generating literacy competency in parents and children. Programs

are often linked with community-based organizations, including libraries and family learning centers.

(Parent and Child Education (PACE); Even Start (federal program); FAMILY MATH; National Center for

Family Literacy; SERS Family Learning Centers)

-- Infant and child health and development programs serve families from prebirth until the child reaches

the age of 3. Programs are often home-based and incorporate a strong emphasis on health and nutrition.

Many programs are linked to healthcare facilities, including hospitals, clinics, and community health

facilities. (Maternal Infant Health Outreach Worker (MIHOW) Project)

-- School readiness/achievement programs primarily aim at preparing children for school success. In

addition to cognitive skills, many programs stress the development of children’s competencies in social,

emotional, and physical domains. (Home Instruction Program for Preschool Youngsters (HIPPY); Parents

as Teachers (PAT); Teachers Involve Parents in Schoolwork (TIPS))

-- Situation-specific programs are designed to meet the unique needs of families in specific situations,

including homeless families, rural families, refugee families, military families, families with incarcerated

members, and single-parent families. (Single Parent Resource Center)

-- Special needs programs primarily serve families whose children have special developmental needs or

disabilities. Most programs focus on providing parents with information to enable them to cope with the

additional stresses of nurturing special needs children. (Family, Infant, and Preschool Program (FIPP))

-- Substance abuse prevention programs are sometimes designed for all children and families and are

preventive in orientation; in other cases, programs target children and youth known to be at-risk or live in

substance abusing family situations. Programs aim at strengthening self-esteem and promoting healthy

lifestyles. (Families and Schools Together (FAST))

-- Wellness programs serve families who are dealing with normal stresses of parenting. Programs offer a

wide range of support to families in the area of parenting education. These programs tend to be colocated--at YWCAs, health councils, and religious service organizations--often functioning as a

supplementary service for adults. (Child Rearing Program; Effective Parenting Information for Children

(EPIC); The Mothers’ Center; Parents Place)

17

Page 37 GAO/HEHS-97-34 Implementing FPS Services
Appendix III 

Comments From the Department of Health

and Human Services

Page 38 GAO/HEHS-97-34 Implementing FPS Services
Appendix III 

Comments From the Department of Health

and Human Services

Page 39 GAO/HEHS-97-34 Implementing FPS Services
Appendix IV 

GAO Contact and Acknowledgments

GAO Contact Karen E. Lyons, Evaluator-in-Charge, (916) 486-6442

Acknowledgments In addition to those named above, the following individuals made

important contributions to this report: Patricia L. Elston conducted both

the nationwide survey and in-depth interviews for a portion of the states

and coauthored the report; Deborah A. Moberly performed these same

tasks and conducted computerized analyses of the survey data; and 

Joel I. Grossman assisted in developing, pretesting, and finalizing the

survey instrument.

(105826) Page 40 GAO/HEHS-97-34 Implementing FPS Services
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