United States General Accounting Office

GAO Report to The Honorable Nancy L.

Johnson, U.S. House of Representatives

November 1999 FOSTER CARE

Effectiveness of

Independent Living

Services Unknown

GAO/HEHS-00-13

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-283530 

November 5, 1999

The Honorable Nancy L. Johnson

Chairman, Subcommittee on Human Resources

Committee on Ways and Means

House of Representatives

Dear Madam Chairman:

Each year approximately 20,000 youths exit the foster care system with

the expectation that they will be able to live self-sufficiently.1

 After exiting

the system, many of these youths face serious problems, including

homelessness, lack of employment stability, incarceration, and early

pregnancy. Recently, a congressional subcommittee raised concerns in

hearings that the federal Independent Living Program (ILP), designed to

help foster care youths make the transition to living independently, does

not give youths leaving foster care the necessary life skills to complete

basic education, find and maintain employment, or otherwise live

self-sufficiently after leaving care. The Congress is currently considering

legislation that would double program funds and expand services for

youths in foster care and those who will leave foster care.

All states provide independent living services to youths about to leave the

foster care system. Because of your concerns that little is known about the

level of services offered to these youths and whether the services match

their needs, you asked us to (1) describe the extent of services provided

under ILPs, and (2) discuss what is known about the effect of these

services on youths’ ability to live on their own.2

 In conducting this work,

we reviewed relevant literature and 1998 annual ILP reports submitted by

the states to the Department of Health and Human Services (HHS). We also

interviewed state and federal officials and independent living experts and

visited independent living programs in four locations—Contra Costa

County, California; Baltimore City and County, Maryland; New York, New

York; and the San Antonio region, Texas. In addition, to obtain national

information on additional services offered by state ILPs, we surveyed all 50

states and the District of Columbia. We conducted our work between

January and September 1999 in accordance with generally accepted

1

When youths who have not been reunited with their families or adopted attain age 18, federal

reimbursement is no longer made to states for the youths’ maintenance in foster care. However, some

states allow youths to remain in care, at state expense, until age 21.

2

We testified on these issues in May 1999 and this report expands on that information. See Foster Care:

Challenges in Helping Youths Live Independently (GAO/T-HEHS-99-121, May 13, 1999).

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government auditing standards. (A more detailed discussion of our scope

and methodology appears in appendix I.)

Results in Brief States provide a wide range of services to better ensure that foster care

youths are prepared to live on their own after they leave the foster care

system. Those services—funded by federal, state, local, and private dollars

totalling at least $131.5 million in 1998—include assisting youths in

attaining their educational goals, such as completing high school or

passing the General Educational Development (GED) test and attending

postsecondary schools; as well as assisting youths in finding and

maintaining employment.3

 In addition, youths attend classes in daily living

skills, covering such topics as money management, hygiene,

housekeeping, and nutrition, and receive instruction in areas that help

youths interact successfully with adults, such as conflict management.

Other transitional services, such as supervised practice living

arrangements and after-care services, allow youths to try living on their

own prior to leaving the foster care system and provide temporary

assistance to ease the transition to independence. However, state and local

administrators told us that their ILPs cannot always provide all of the

assistance administrators and youths say is needed to help youths learn to

live on their own. For example, some programs do not have fully

developed links with employers to provide job leads, lack opportunities

for youths to practice skills in real-life settings, and fall short on the

number of supervised practice living arrangements needed for youths to

become more proficient at living self-sufficiently.

Even though the federal ILP was established in 1985, few national or local

studies have been completed to assess the effectiveness of independent

living services in helping youths through the transition to living on their

own after foster care.4

 We identified only one national study that has been

completed to date, which found that services provided by ILPs have the

potential to improve outcomes for youths. In addition, although several

states indicated they have completed studies that measure general youth

outcomes, such as education and employment status, only a few attempted

to measure the helpfulness of ILP services in youths’ ability to attain

self-sufficiency. While HHS is tasked with overseeing implementation of ILP,

it has done little to determine program effectiveness and has no

3

Some states were unable to identify the amount of additional state, local, or private funds spent on

their ILPs.

4

Although ILP was established in 1985, funds for payments to the states were not appropriated until

1987.

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established method to review the states’ progress in helping youths in the

transition from foster care. For example, HHS primarily relies on state

annual program reports for effectiveness information and has no other

monitoring efforts in place. However, the content and quality of the

reports vary and they contain little information on program outcomes. HHS

officials told us they recognize these deficiencies and the need to improve

monitoring efforts. To begin the improvement process, HHS issued a

contract in September of 1998 to analyze 10 years of annual state ILP

reports to determine, among other things, which states are producing good

ILP reports that could be models for other states and what measures HHS

can take to improve state reporting and evaluation. We are making

recommendations to HHS concerning the need to enhance HHS’ and states’

accountability for preparing youths to live on their own.

Background Adolescents in foster care, especially those who have been in care for a

number of years, face numerous challenges in preparing to become

self-sufficient adults once they leave the foster care system. Several

programs help foster care youths in their transition to independent living,

but only one—ILP—is specifically designed to serve this population.

The transition from the foster care system to self-sufficiency can be

difficult. Research has shown that many former foster care youths have

serious educational deficiencies and rely on public assistance. For

example, a 1991 study of foster care youths interviewed 2.5 to 4 years after

they left care found that 46 percent had not finished high school.5

Additionally, almost 40 percent were found to be a cost to the community

through their dependence on such programs as public assistance and

Medicaid. Similarly, the University of Wisconsin recently studied youths

who had been out of care between 12 and 18 months, and found that

37 percent had not finished high school and 32 percent were receiving

public assistance.6

 In addition, former foster care youths often find

themselves lacking adequate housing. The Westat study reported that

25 percent of the youths were homeless at least 1 night, and the University

of Wisconsin study found that, after leaving care, 14 percent of the males

and 10 percent of the females had been homeless at least once. Additional

difficulties may further impede youths’ ability to become self-sufficient.

The Westat study found that 51 percent of the youths were unemployed

5

Westat, Inc., A National Evaluation of Title IV-E Foster Care Independent Living Programs for Youth

(Washington, D.C.: HHS, 1991).

6

Mark E. Courtney and Irving Piliavin, Foster Youth Transitions to Adulthood: Outcomes 12 to 18

Months After Leaving Out-of-Home Care (Madison, Wisc.: University of Wisconsin, 1998).

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and 42 percent had given birth or fathered a child. Likewise, the University

of Wisconsin found that 39 percent of the youths were unemployed, and

that 27 percent of the males and 10 percent of the females had been

incarcerated at least once.

ILP—the primary program designed to help foster care youths become

self-sufficient—authorizes federal funding for states to establish and

implement services to assist youths aged 16 and over in making the

transition from foster care to independent living. Originally authorized in

1985 by P.L. 99-272 for a limited period, the program was reauthorized

indefinitely as part of the Omnibus Budget Reconciliation Act of 1993 (P.L.

103-66), which also increased federal funding to the current level of

$70 million per year. A portion of the federal funds—$45 million—is

distributed to states as an entitlement based on each state’s proportion of

all youths receiving federal foster care maintenance payments in fiscal

year 1984.7

 States are also eligible to receive a proportional share of the

remaining $25 million in federal funds to match the funds they provide.

HHS estimates that almost 77,000 youths aged 16 to 20 were in foster care

as of September 1998. While approximately 40 percent of the youths in this

age range will return to their biological families, almost 20,000 adolescents

per year leave the foster care system and are expected to live

self-sufficiently. Eligible ILP participants include youths aged 16 and over

for whom federal foster care payments are being made.8

 At their option,

states may use ILP funds for foster care youths not receiving federal

assistance and former foster care youths who were in foster care after the

age of 16. Likewise, states may provide services to any of these youths

until the age of 21. Youth participation in ILP services is voluntary.

Other federal programs may also provide some assistance to this

population, but are not designed to specifically provide services to foster

care youths. For example, HHS’ Transitional Living Program for Homeless

Youth provides funds to communities for housing and independent living

services to homeless youths. A variety of other programs may also assist

7

Under Title IV-E of the Social Security Act, federal matching funds are provided to states for foster

care maintenance costs. These funds cover a portion of the food, housing, and incidental expenses for

foster care children from families who would have been eligible for benefits under the former Aid to

Families With Dependent Children program using 1995 eligibility criteria. States are responsible for

any foster care costs they incur for children not eligible for federal support.

8

States can receive federal foster care maintenance payments for eligible children while they are in

foster care family homes, private for-profit or nonprofit child care facilities, or public child care

institutions. Youths become ineligible for federal foster care maintenance payments at age 18 or, at a

state’s option, age 19 if a child in foster care is a full-time student in a secondary school and is

expected to complete the educational program prior to turning 19.

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youths. For example, Job Corps, under the auspices of the U.S.

Department of Labor, enrolls youths aged 16 to 24 who are economically

disadvantaged, in need of additional education or training, and living

under disorienting conditions such as a disruptive homelife. In addition,

other agencies, such as the Departments of Justice, Education, and

Housing and Urban Development, have education and employment

assistance programs targeted to disadvantaged and at-risk youths. Service

agencies in the states may also provide assistance to youths, including

educational, juvenile justice, mental health, public assistance, and

substance-abuse service agencies.

The federal government provides most of the funding for ILP. In addition,

HHS is responsible for assisting state child welfare systems by promoting

continuous improvement in the delivery of child welfare services. In this

regard, HHS central office staff are responsible for developing ILP-related

policies, procedures, and regulations, and for ensuring their

implementation by the states. HHS’ regional office staff serve as the local

ILP contacts for the states, review and approve state applications for ILP

funds, and review the annual state ILP reports. Regional staff also provide

technical assistance to the states and clarification on program

requirements. In addition, the University of Oklahoma’s National Child

Welfare Resource Center for Youth Development, under cooperative

agreement with HHS, is responsible for providing ILP training and technical

assistance to the states in coordination with the regional offices.

HHS issued instructions to states in December 1993 outlining allowable ILP

services including education and employment assistance, instruction in

daily living skills, and other support services to ease youths’ transition to

independent living. In addition, states must provide written transitional

independent living plans based on an assessment of each youth’s needs

and may establish outreach programs to attract individuals eligible to

participate in the program.

Multiple Services

Assist Youths in

Achieving

Independence, but

ILPs Fall Short in Key

Areas

To better ensure that foster care youths are prepared to live on their own,

state ILPs provide an array of services using a combination of federal, state,

local, and private funds. These services include assistance with completing

education and finding employment; instruction in the basic skills needed

to live independently, such as money management, hygiene, housekeeping,

and nutrition; and transitional services, such as supervised practice living

arrangements (see appendix II). However, state and local administrators

told us that their current ILPs fall short in key areas. For example, some

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programs do not sufficiently seek out employment opportunities in the

community and offer few opportunities for youths to participate in real-life

practice opportunities or esteem-building experiences. Moreover, some

programs could not provide enough housing or other transitional

assistance to both youths still in care and those who have left care. To

address these shortcomings, a few locations have added specialized stuff

and programs, such as developing partnerships with local businesses for

part-time youth employment.

ILP Services Supported by

Federal, State, and Other

Funds

To provide ILP services, states use federal annual ILP funds of $70 million,

$25 million in state matching funds, and additional dollars provided by a

variety of sources. For example, our survey showed that 35 states reported

spending additional state, local, and private funding on their ILPs totaling at

least $36.5 million (see table 1).9

 Also, 20 states reported receiving in-kind

ILP donations such as mentoring services, use of facilities for training,

attorney services, drivers’ education training, college scholarships, books,

school supplies, clothing, computers, gift certificates, and household

supplies for youths.

Table 1: Categories of Non-Federal ILP

Funding

Type of funding

Range of funding among

reporting states Total funding reported

State (20 states) $75,000 to $11 million $22.8 million

Local (7 states) $1,000 to $6.5 million $13 million

Private (7 states) $1,500 to $295,000 $0.7 million

Because federal funds can only be used to serve youths aged 16 to 21,

more than one-third of the states reported using some additional funds to

provide services to some youths younger than 16. During federal fiscal

year 1998, the states served a total of 2,169 youths under age 16. Our

review of state annual ILP reports showed that approximately 42,680

youths aged 16 or older—only about 60 percent of all eligible

youths—volunteered to receive ILP services in 1998, and officials in the

states we visited noted that attracting youths to participate in the program

is a challenge.10

9

Thirty-five states reported spending additional dollars beyond the federal funds and state match, but

not all of these states reported the amounts spent in each category.

10Although not all states included participation figures in their annual reports, we determined that at

least 42,680 youths in 40 states received some type of independent living service during 1998.

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Education and

Employment Assistance

Offered, but Few Pathways

From Foster Care

Developed

According to our review of annual state ILP reports, 41 states reported

assisting youths with preparing for, or completing, education or vocational

training.11 Of these 41 states, 26 offered assistance, such as tutoring or

remedial training, to help youths graduate from high school or receive a

GED; 28 states helped youths prepare for vocational school, for instance

through vocational testing or referral; and 33 states helped youths pursue

postsecondary education, such as through educational planning or

assessments, assistance in applying for financial aid or college admission,

or campus tours.12 Further, 21 states awarded some tuition aid or

scholarships for college or vocational schools, and 20 helped pay for other

educational expenses such as books, training materials, uniforms, college

entrance exam fees, or college application fees.

In total, 40 states reported providing employment services to youths. Of

these, 28 states assisted youths with job readiness, including instructing

them in how to write resumes, how to interview for and maintain a job,

and how to complete job applications; and 24 states helped youths with

job search. Moreover, 18 states helped with job placement. For example,

for several youths with negligible work skills, the District of Columbia

contracted for job placement services that included a job coach, on-the-job

assistance with work problems, transportation assistance, mentoring, and

periodic group sessions.

Although all four areas we visited provided assistance with education and

employment, we found that the ILPs did not provide services that fully

matched foster care youths to appropriate employment pathways. For

example, officials in three of the sites told us that vocational opportunities

for youths were limited for several reasons. State and local coordinators in

Texas indicated that few apprenticeship positions are available, while ILP

coordinators in Baltimore City and New York reported a lack of vocational

education programs that youths can afford and a lack of ILP funds to pay

for such programs. These officials also reported that culinary arts and

technology-related programs—two programs popular with foster care

youths—are relatively expensive. Of the four sites we visited, only Texas

11We reviewed 1998 annual state ILP reports from 45 states plus the District of Columbia. However,

because no standard report format exists, states do not consistently report services offered during the

previous year. We counted only those states that specifically mentioned providing a particular service

either throughout, or in some portion of, the state in their 1998 report, although others may have

provided the service but not included this information as part of their program description. According

to an HHS ILP official, annual reports from Alaska, California, New York, South Carolina, and

Wyoming were not available at the time of our review.

12Many of these states reported providing all the educational services mentioned.

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offers statewide tuition waivers for all state-supported vocational,

technical, and postsecondary schools.

Our field visits also revealed that connections between the ILP and

potential employers were not thoroughly developed. For example, ILP

coordinators in one location told us they did not have time to establish

relationships with very many employers and that employment

development efforts in their location are largely informal. State officials in

California and Maryland indicated that they believe more public-private

partnerships are needed to provide youths with employment

opportunities. In addition, New York City officials told us that they are just

beginning to devise ways to link with employers to enhance youths’ job

prospects. Several officials also pointed out that more staff need to be

assigned to this task if it is to be accomplished.

Some locations are attempting to address these training and employment

shortcomings. For instance, Maryland established a partnership between

the ILP, the United Parcel Service (UPS), the Living Classroom Foundation,

and the Annie E. Casey Foundation. This program provides employment

opportunities, according to UPS officials, to expose youths to a significant

and demanding first job that teaches them invaluable, transferable

workplace skills. UPS supervisors work closely with youths to identify

barriers and access other resources if needed (such as mentoring,

counseling, or job readiness programs), and strive to instill leadership

skills and develop the youths’ potential. For example, the youths attend

career and academic goal-setting sessions with a UPS School-to-Work

Specialist. Moreover, UPS supervisors maintain close contact with youths

after they have been hired to ensure their success on the job.

Transportation to the work site is provided and on-site college-level

classes are available, as well as opportunities to combine working for UPS

with working for other area employers such as banks, grocery stores, and

drug stores. UPS planned to hire 75 foster care youths during the first year

of the partnership.

States Provide Assistance

in Learning Daily Living

Skills, but Opportunities to

Practice Skills Are Lacking

In our review of annual state ILP reports, we found that 46 states report

training youths in daily living skills such as money management, health

and safety, nutrition, housekeeping, parenting and sexual responsibility,

and interpersonal and other social skills. The four areas we visited also

offer training in daily living skills. For example, in Contra Costa County,

California, youths attend a series of living skills workshops that cover,

among other topics, how to prepare a budget and how to open and use a

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B-283530 

checking account. Likewise, life skills classes in the San Antonio, Texas,

area meet for 8 weeks and cover core areas, including personal and

interpersonal skills, health and safety, money management, and planning

for the future. In New York City, life skills classes provide instruction on

housekeeping, health care, interpersonal skills, food management,

transportation, and family planning, among others.

Although some daily living skills are taught in a classroom setting, officials

in the four states we visited stressed the importance of experiential

learning, and independent living experts concurred that youths benefit

from activities in which they can practice the skills learned. State and local

program officials acknowledged the importance of activities that allow

youths to perform—and perhaps initially fail at—daily tasks until they

become proficient. According to local officials and service providers,

many foster youths have learned to depend on the child welfare system for

their care and thus may not have been exposed to everyday experiences

other teens take for granted, such as cooking, grocery shopping, driving,

or taking excursions outside their communities. To address this, Texas

and California conduct a program called “Independent City”—a simulated

community in which young persons are assigned an income and must

apply for jobs, sign leases for apartments, arrange for utilities, open

checking accounts, and buy cars.

In addition to the need to gain practical living experience, officials in three

of the locations we visited reported that youths need to learn interpersonal

skills, such as conflict management, communication, and decision-making.

Officials report that youths who do not master these other skills may have

difficulty finding and maintaining employment. To learn these skills,

youths may participate in classroom-based training or in recreational

events. In New York City, for example, one service provider takes youths

to Broadway plays or restaurants to allow them to learn how to interact in

social situations, including how to behave and how to order from a menu.

After the activity, youths meet with the coordinator to discuss lessons

learned. Other opportunities for youths to develop social skills, such as

team-building and leadership, are provided by teen conferences, retreats,

and youth advisory boards. For instance, Maryland holds an annual

statewide teen conference where youths attend workshops on

self-empowerment, conflict resolution, and goal achievement. Texas offers

wilderness challenge and ropes courses to strengthen problem-solving and

team-building abilities. Moreover, according to our review of annual

reports, 22 states have youth advisory boards that work to improve

policies and services affecting foster youths. The Youth Advisory Board in

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Massachusetts, for example, meets with the commissioner of the social

services department quarterly to express concerns and recommendations

regarding agency foster care services and policies.

Further, officials in the four states we visited emphasized that youths need

to be able to form and maintain relationships with others. Establishing a

connection to an adult is so important, according to Texas state officials,

that one goal of the state’s ILP is for every young adult to have a significant

adult in his or her life when he or she leaves foster care. To help youths

receive this type of social support, many states use mentoring programs.

According to a study of 29 child welfare programs’ mentoring services,

these services can take many forms: some link adult mentors to youths to

assist them in making the transition from foster care to adult living, while

other programs involve workplace mentoring where the employer

provides jobs, monitors the work experience, and offers career

development opportunities to young persons.13 Officials in all the locations

we visited viewed mentoring programs as one method to provide youths

with a vocational role model and opportunities to practice independent

living skills, as well as opportunities to form connections to adults who

serve as positive role models.

We found that opportunities to practice daily life tasks and to develop

self-esteem were limited in some of the locations we visited. Program

officials in two locations and foster care youths in three locations told us

that issues such as safety regulations for group homes inhibit or prevent

certain activities, such as practicing cooking. In addition, esteem-building

experiences are often limited to a small number of youths. For example,

local officials in Texas reported that opportunities for foster care youths

to participate in postsecondary school conferences or extended outdoor

activities were limited. In addition, programs offering adult mentors serve

a small number of youths. For example, a foster care service provider in

Texas—contracted by the state specifically to develop mentor

programs—reported difficulty finding mentors.

13Edmund V. Mech and others, “Mentors for Adolescents in Foster Care,” Child and Adolescent Social

Work Journal, Vol. 12, No. 4 (Aug. 1995).

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Housing and Other

Transitional Support

Services Provide Bridges

to Adulthood, but

Obstacles Impede

Self-Sufficiency

Transitional living arrangements allow youths to live on their own and

practice becoming proficient at managing their lives while still receiving

supervision and financial support. Our survey showed that more than

80 percent of the states provided transitional practice living arrangements

to some youths while they are still in foster care to allow them an

opportunity to experience independent living for a period of time. About

37 percent of the states offered housing to some youths after they left the

foster care system. In Baltimore County, Maryland, for example, the

Challengers Independent Living program seeks to provide youths with the

means to cope with independence once they leave foster care. In this

program, foster care youths can reside for 18 to 24 months in apartments

furnished and supervised by the service provider and receive a weekly

stipend to purchase clothing, food, and household supplies. They are also

responsible for cleaning the apartments and doing their own laundry. Each

youth’s foster care payment covers the cost of rent, utilities, and

administration of the program. Program staff also offer educational,

vocational, clinical, and home-life support, including additional

independent living skills training. Similar programs, such as the Real

Solutions Transitional Living Program in San Antonio, Texas, are available

to young adults who have left foster care. This privately funded program

provides youths with a group living arrangement for up to 3 years,

normally from ages 18 to 21, while they adjust to self-sufficiency.

Additional transitional support services provided by the states include

counseling, programs for youths with special needs and disabilities, and

after-care programs for youths who are no longer in the foster care

system.14 Officials in the states we visited said that many youths have

mental health issues that need to be addressed. Some states noted in their

annual ILP reports that individual or group counseling may help address

issues that act as barriers to independent living for the teen population,

such as drug abuse, or may increase the youths’ ability to utilize

independent living skills they were taught. Thirty-one states indicated in

their annual reports that they offer some type of counseling service, such

as individual, group, or peer counseling. In Illinois, for example, support

groups provide a forum for youths to express their feelings about being in

foster care, as well as to identify issues and fears about leaving it. Seven

states offered specialized programs for developmentally disabled youths

and four states offered services for those with emotional or behavioral

problems.

14HHS data for 1998 identified 20 percent of foster youths between the ages of 16 and 20 as having a

disability.

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To assist youths who have exited foster care, our survey showed that, in

federal fiscal year 1998, 30 states provided formal services for a period of

time after foster care, serving a total of 7,830 youths between the ages of

11 and 24. The majority of these states reported providing a full range of

services, including education and employment assistance, training in daily

living skills, and individual and/or group counseling. In addition, 21 states

reported providing other services and assistance such as mentoring,

transportation assistance, medical coverage, and clothing. Our field visits

confirm that some states offer after-care services. For example, Florida

reports serving former foster care youths through tuition assistance,

counseling, opportunities to attend conferences and receive skills training

or to serve as mentors or co-trainers, referrals to other agencies for

assistance in finding a job or housing, transportation assistance, and

opportunities to use the resource library.

However, we noted some concerns about these services. For example, the

number of transitional living arrangements is limited. Our survey showed

that 38 states served 6,320 current foster youths and 12 states served 1,787

former foster youths.15 Officials in the four areas we visited confirmed that

the number of supervised transitional housing sites is very limited and that

they could not provide adequate housing for both youths in care and those

who have left the system. One transitional housing provider in Texas

indicated that the program has space for only 6 youths, while an additional

80 to 100 youths with no place to live upon exiting foster care could

benefit from this type of housing program. A transitional housing provider

in a second location explained that program staff carefully screen youths

for readiness to handle the responsibilities of managing their own place to

live and, because of limited capacity, accept only the most promising teens

into the program. In addition, some officials noted that their after-care

services are limited and that they believe youths could benefit from more

services than they can offer. For example, in Texas, after-care services are

available for only 6 months after the youth exits care. The services consist

mainly of referrals to other service agencies, visits to colleges, and a small

stipend for 4 months. After-care services in Baltimore County and New

York City are limited to referring the youths to other agencies that can

assist them.

15According to our survey, 43 states reported providing transitional housing to current foster care

youths and 19 states reported providing this service to former foster care youths in fiscal year 1998.

Only 38 and 12 states, respectively, provided the number of youths served.

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Information on

Program

Effectiveness Is

Limited

Given the significant challenges that youths face in moving from foster

care to adulthood, it is important to understand how effective the ILP is in

better ensuring outcomes for foster care youths. However, little

information is available to help in understanding the outcomes these

programs achieve. HHS has not taken an active role in identifying whether

state ILPs are providing services that increase youths’ chances of becoming

self-sufficient once they leave the foster care system or in sharing

information among the states.

Few National and Local

Studies on ILP

Effectiveness

Few studies that address ILP effectiveness have been conducted on a

national or local level. Only one national study has been completed since

ILP was established in 1985. This study—conducted by Westat, Inc., with

funding from HHS—found that services provided by ILPs have the potential

to improve outcomes for youths. The study found that skills training in

particular areas led to better outcomes (e.g., health training aided youths

in gaining access to health care), although no one skill area had a

consistent effect across all outcomes assessed. More comprehensive

effects were achieved when youths were taught a combination of skills.

Youths who received training in managing money, obtaining a credit card,

and buying a car, as well as help in how to find a job and gain access to

appropriate education opportunities, were more likely to keep a job for at

least a year.

Two other studies are currently under way; study results are due in fall

1999. The Child Welfare League of America recently developed a state

survey on independent living services to gather comprehensive

information on ILP topics such as the population served, the type of foster

care placement and permanency plan for these youths, fiscal information

on ILP funds, ILP policies, transitional living arrangements, and model

programs. In 1997, the Annie E. Casey Foundation awarded a grant to the

National Child Welfare Resource Center for Organizational Improvement

at the University of Southern Maine and the National Resource Center for

Youth Services at the University of Oklahoma to define the current

knowledge base regarding the transition of youths out of foster care and to

examine effective practices and policies which may improve opportunities

for youths to become fulfilled, productive adults.

In addition, 12 states told us they had conducted follow-up studies of

youths who had left foster care and 14 additional states reported they had

a follow-up study under way or were planning such a study. Eight states

provided a copy of completed studies; only three of these studies asked

Page 13 GAO/HEHS-00-13 Foster Care: Independent Living
B-283530 

former foster care youths about the effectiveness of independent living

services they received while in care. For example, an evaluation of the

Wayne County, Michigan, ILP attempted to contact former ILP participants

to obtain information on their current situations.16 However, none of the

former clients could be located and the study was changed to a survey of

youths currently participating in an ILP or those receiving after-care

services. Of the 61 youths surveyed, over 80 percent indicated that their

quality of life improved after they received independent living services.

Youths judged housing and health care services more effective than other

services, and judged employment services among the least effective. A

study of 26 youths in Nevada about 3 months after leaving foster care

showed that most of the respondents believed the ILP helped prepare them

to some extent for making the transition to living on their own, including

preparing them to find a place to live, prepare meals, budget money, and

locate community resources.17 However, 53 percent of the youths were not

satisfied with their independent living services. Finally, in a 1995 North

Carolina study comparing 44 ILP participants and 32 nonparticipants who

left foster care between 1992 and 1995, 65 to 73 percent of the participants

felt that ILP services were helpful to some extent in preparing them for

independent living, although no specific area of ILP assistance stood out.

Fifty-five percent of the ILP participants started living independently

immediately after leaving foster care, compared to only 12 percent of

nonparticipants. Similarly, 30 percent of the ILP participants were paying

all their housing expenses within 1 to 3 years after leaving foster care, as

compared to 19 percent of nonparticipants. According to the study, these

and other housing-related findings indicate a definite, though gradual,

movement toward independent living that is more pronounced for ILP

participants than for nonparticipants.

We identified three additional local studies that show positive effects of ILP

services and link participation in ILP with improved education, housing,

and other outcomes—from Baltimore County, Harris County (Houston,

Texas), and New York City. In the Baltimore County study, youths who

received ILP services were more likely to complete high school, have an

employment history, and be employed when they left foster care.18 In the

Harris County study, the author found that graduates of the Texas ILP

16Moore & Associates, Inc., Final Report: An Evaluation of the Wayne County Independent Living

Coalition, submitted to the Michigan Family Independence Agency (Sept. 1998).

17Hailu Abatena, “Independent Living Initiative Program: A Follow Up Survey Report of the Youth

Released from Foster Care in Nevada in 1996” (Henderson, Nev.: Nevada Research, Evaluation, and

Planning Consultants, undated).

18Maria Scannapieco and others, “Independent Living Programs: Do They Make A Difference?” Child

and Adolescent Social Work Journal, Vol. 12, No. 5 (Oct. 1995).

Page 14 GAO/HEHS-00-13 Foster Care: Independent Living
B-283530 

achieved full-time employment earlier and were more likely to complete

high school or a GED at a younger age than youths who did not receive

independent living services.19 The New York City study of independent

living services provided by Green Chimneys Children’s Services showed

that 75 percent of the youths had completed high school or a GED,

72 percent had full-time employment when they left care, and 65 percent

had savings accounts.20

HHS Slow in Leading

Efforts to Determine ILP

Effectiveness

A 1994 HHS Office of the Inspector General (OIG) report and a 1995 Harvard

University study both recommended HHS take a stronger role in managing

ILPs. However, HHS has been slow in leading efforts to determine if state

ILPs improve the ability of youths leaving the foster care system to live on

their own.21 The OIG report made two broad recommendations: (1) that

HHS’ Administration for Children and Families (ACF) should restructure its

ILP application and program reporting procedures to more adequately

support state plans and to gain an accurate national picture of

independent living efforts, and (2) that ACF should focus its management

and program reporting efforts on sharing information among the states.

The OIG report noted that the lack of accurate national information on

independent living efforts weakens basic accountability and hinders

efforts to improve programs and to determine effective practices. In

addition, the Harvard study recommended that greater emphasis be placed

on sharing information, with HHS’ regional offices taking the lead in

exchanging information among these offices and the states for which they

are responsible. According to the study, only 3 of the 10 regional offices

provided technical assistance to states beyond policy interpretation.

Currently, HHS has few strategies in place to review the states’ progress in

helping youths in the transition from foster care. HHS primarily relies on

annual state ILP reports and summary statistics from these reports for

information about ILP effectiveness. According to HHS staff, no additional

monitoring strategies are in effect. There are two problems with relying on

the annual reports to determine ILP effectiveness. First, as the OIG report

noted and we confirmed during our review of annual state reports, states’

approaches to program reporting and the quality of their program reports

19Jane T. Simmons, “PAL Evaluation Final Report,” unpublished report submitted to Harris County

(Texas) Children’s Protective Services (Mar. 6, 1990).

20Gerald P. Mallon, “After Care, Then Where? Outcomes of an Independent Living Program,” Child

Welfare, Vol. 77 (Jan./Feb. 1998).

21Office of Inspector General, “Independent Living Programs for Foster Care Youths: Strategies for

Improved ACF Management and Reporting,” HHS (#OEI-01-93-00090, Nov. 1994); and Kari Burrell and

Valeria Perez Ferreiro, Policy Analysis Exercise (Cambridge, Mass.: Harvard University, Apr. 12, 1995).

Page 15 GAO/HEHS-00-13 Foster Care: Independent Living
B-283530 

vary greatly. According to the OIG report, many state reports do not

adequately address the intensity of services or the range of efforts made

for youths in various placement settings. Likewise, states use various

definitions of terms, which the OIG reported can result in duplicate counts

and inconsistent statistics. To illustrate, the term “to be served” can mean

in one state that a youth has received an assessment, while in another

state it means that the youth was enrolled in a formal life skills course.

Second, states are required to report certain information to HHS on the

status of ILP participants 90 days after program completion—such as

whether the youths are employed, have completed high school or a GED, or

are living independent of public assistance. However, states inconsistently

report this information and question the value of the data because they

believe that 90 days may be too soon to judge youths’ independence. For

example, the OIG found that some states provide information on youths 90

days after discharge from foster care, while other states look at youths’

status 90 days after completing the discrete ILP. Our review of 1998 annual

state reports reveals that few reports address the effectiveness of services

and outcomes for youths, making these reports an ineffective means of

consolidating information on program effectiveness across the nation. To

illustrate the difficulty in obtaining this outcome information, our

nationwide survey showed that while 29 states attempt to contact ILP

youths in response to the 90-day requirement, only four states reported

success in contacting more than half of the former foster care youths. The

majority of the states could locate only some or a few.

HHS officials told us that they recognize deficiencies in the annual state ILP

reports, and that the agency needs to improve its monitoring of the

program. However, because no other data currently exist with which to

determine program effectiveness, HHS issued a contract in September 1998

to conduct an analysis of 10 years of annual state ILP reports so it can

begin to fill the data gaps. According to project staff, this analysis

represents HHS’ first attempt since ILP began to summarize what states are

doing with their ILP funds. Project objectives include identifying which

states are producing ILP reports that could be used as models by other

states, as well as what measures HHS can take to improve state reporting

and evaluation.

Conclusions The Congress has identified adolescent foster youths as an important part

of the foster care population and raised questions about whether states are

doing enough to prepare youths to live self-sufficiently. Unfortunately,

serving the population of youths about to leave the foster care system is

Page 16 GAO/HEHS-00-13 Foster Care: Independent Living
B-283530 

difficult. Research has shown that many pitfalls are encountered by these

youths once they are on their own. Information on the services foster care

youths need to help them become independent is critical to the success of

ILPs. However, states do not routinely receive information on what has

worked best in other states and have inconsistently applied HHS

regulations on following up with youths. HHS has not analyzed information

from state ILPs to develop a national perspective on what services are most

needed and which services are less important in preparing youths to live

on their own once foster care ends. We believe HHS should take steps to

build a system of reporting and monitoring tools that would provide

policymakers and program officials with the necessary information to

assess the effectiveness of ILPs.

Recommendations To enhance HHS’ and the states’ accountability in preparing youths to live

on their own after leaving the foster care system, the Secretary of HHS

should develop a uniform set of data elements and a report format for

state reporting on ILP so that analysis of ILP information can be conducted

using consistent data and the results shared with the states; and concrete

measures of effectiveness for assessing state ILPs, such as the number of

youths with stable employment and housing at the time they leave foster

care and at specific intervals thereafter.

Agency and Other

Comments

We requested comments on this report from HHS and state ILP officials in

the four states we visited. HHS, New York, and Texas provided technical

comments, which we incorporated where appropriate. In addition, New

York’s comments mentioned the need for additional incentives to

encourage youths’ participation in the program. California and Maryland

did not comment.

Page 17 GAO/HEHS-00-13 Foster Care: Independent Living
B-283530 

We are sending copies of this report to the Honorable Donna E. Shalala,

Secretary of Health and Human Services; state ILP coordinators; state child

welfare agencies; and other interested parties. Copies will also be made

available to others on request. If you or your staff have any questions

about this report, please call me at (202) 512-7215. Other major

contributors to this report are listed in appendix III.

Sincerely yours,

Cynthia M. Fagnoni, Director

Education, Workforce, and Income Security Issues

Page 18 GAO/HEHS-00-13 Foster Care: Independent Living
Page 19 GAO/HEHS-00-13 Foster Care: Independent Living
Contents

Letter 1

Appendix I 

Scope and

Methodology

22

Appendix II 

Figures From Our

Review of Annual

State Reports

24

Appendix III 

GAO Contacts and

Staff

Acknowledgments

32

Related GAO Products 33

Table Table 1: Categories of Non-Federal ILP Funding 6

Figures Figure II.1: Specific Education Services Reported by States

During 1998

24

Figure II.2: Specific Employment Services Reported by States

During 1998

26

Figure II.3: Specific Daily Living Skills Training Reported by

States During 1998

28

Figure II.4: Specific Financial Assistance Provided by States

During 1998

30

Abbreviations

ACF Administration for Children and Families

GED General Educational Development

HHS U.S. Department Health and Human Service

ILP Independent Living Program

OIG Office of the Inspector General

UPS United Parcel Service

Page 20 GAO/HEHS-00-13 Foster Care: Independent Living
Page 21 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix I 

Scope and Methodology

To identify what is currently known about the services provided by

Independent Living Programs (ILP) and the effect of these services on

youths’ ability to live on their own, we reviewed the relevant literature on

problems former foster care youths face in living independently, 1998

annual ILP reports submitted by the states to the Department of Health and

Human Services (HHS) (see appendix II)22, and studies showing the

effectiveness of ILP services. We also interviewed experts on independent

living services. We obtained the perspectives of representatives of the

National Child Welfare Resource Center for Youth Development, the

National Independent Living Association, the Child Welfare League of

America, and the Casey Family Program. In addition, we interviewed

officials of HHS’ Children’s Bureau and Family and Youth Services Bureau.

We developed a state survey to obtain national information on additional

services offered by state ILPs and on additional funds spent beyond the

federal dollars and required state matching funds. In April 1999, we

surveyed ILP coordinators in each of the 50 states and the District of

Columbia. We received responses from all states and the District of

Columbia, and from these responses we obtained general information on

(1) additional state, local, and private funds spent on ILPs, (2) the number

of youths younger than age 16 served who were served and the services

provided to them, (3) the extent of after-care programs, (4) the states’

ability to follow up with youths after leaving care, and (5) the extent of

transitional housing services. We also obtained information on outcome

studies conducted by the states. We did not verify the information

obtained through the survey. However, we conducted telephone

interviews with state respondents to clarify answers, as needed.

To obtain information on the services offered by states to youths leaving

care and the problems states face in meeting their needs, we visited

independent living programs in four locations—Contra Costa County,

California; Baltimore City and County, Maryland; New York City, New

York; and the San Antonio region, Texas. We chose these four locations

because our analysis of the literature and discussions with key

independent living experts identified these localities as having ILPs that

provide critical services to help youths become self-sufficient, such as

postsecondary tuition waivers and well-developed employment links in the

community. California and New York also have large populations of foster

22We reviewed 45 annual state reports, plus the report from the District of Columbia. At the time of our

review, reports were not available from Alaska, California, New York, South Carolina, and Wyoming.

HHS subsequently received reports from Alaska, California, New York, and South Carolina, but these

were received too late to be included in our analysis. Wyoming did not submit an annual report

because the state did not use federal ILP funds in 1998.

Page 22 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix I 

Scope and Methodology

care youths. In each state, we met with state ILP officials to obtain an

overview of how the program is implemented throughout the state. At the

local sites, we met with a variety of staff and clients, including ILP

coordinators, case workers, private service providers, and current and

former foster care youths. Where available, we met with youth advocacy

organizations.

Page 23 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

Figure II.1: Specific Education Services Reported by States During 1998

Note: Delaware and Missouri provided education services but did not specify the type of services

in their 1998 annual reports.

Page 24 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

aHigh school or General Educational Development (GED) services enable participants to seek a

high-school diploma or its equivalent. Tutoring is an example of such services.

bVocational services enable youths to participate in appropriate vocational training and may

include vocational testing or referral.

cPostsecondary education services enable youths to prepare for or attend college or university.

These services may include educational planning, assistance obtaining financial aid or college

admission, or college testing preparation.

Source: State annual ILP reports for 1998.

Page 25 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

Figure II.2: Specific Employment Services Reported by States During 1998

Note: Louisiana, Nebraska, and Vermont provided employment services, but did not specify

which services.

Page 26 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

aJob readiness services can include information on how to prepare for a job, such as how to

prepare a resume or complete job applications, or how to maintain employment.

Source: State annual ILP reports for 1998.

Page 27 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

Figure II.3: Specific Daily Living Skills Training Reported by States During 1998

aMoney management can include instruction in budgeting or opening a bank or credit card

account.

Page 28 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

bHealth and safety can include information about substance abuse, hygiene, parenting, first aid,

and leisure.

cFood and nutrition can include information about how to shop for groceries or prepare and cook

food.

dCommunity resources can include information about access to resources such as medical care,

legal services, transportation, and recreation.

eSocial skills can include activities to improve self-esteem, interpersonal relationships,

problem-solving, leadership, and sexual responsibility.

f

Montana reported providing daily living skills but did not identify specific training offered.

Source: State annual ILP reports for 1998.

Page 29 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

Figure II.4: Specific Financial Assistance Provided by States During 1998

Page 30 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II 

Figures From Our Review of Annual State

Reports

aFinancial incentives or stipends can include incentives for completing training or units of training

in daily living skills.

bThese services include tuition waivers or scholarships.

cThese services include books, training materials, uniforms, college exam fees, and college

application fees.

dThese expenses can include fares for buses, trains, or airplanes; or gas for youths’ automobiles.

eStart-up assistance includes items such as utility deposits or household items (e.g., furniture,

dishes, and linens).

Source: State annual ILP reports for 1998.

Page 31 GAO/HEHS-00-13 Foster Care: Independent Living
Appendix III 

GAO Contacts and Staff Acknowledgments

GAO Contacts David D. Bellis, Assistant Director, (202) 512-7278

Diana M. Pietrowiak, Evaluator-in-Charge, (202) 512-6239

Staff

Acknowledgments

Ellen Soltow, Suzanne Sterling, Jay Smale, and Joel Grossman also made

important contributions to this report.

Page 32 GAO/HEHS-00-13 Foster Care: Independent Living
Related GAO Products

Youth Mentoring Programs: Fiscal Year 1998 (GAO/HEHS-99-129R, May 28,

1999).

Foster Care: Challenges in Helping Youths Live Independently

(GAO/T-HEHS-99-121, May 13, 1999).

Foster Care: Increases in Adoption Rates (GAO/HEHS-99-114R, Apr. 20, 1999).

Juvenile Courts: Reforms Aim to Better Serve Maltreated Children

(GAO/HEHS-99-13, Jan. 11, 1999).

Child Welfare: Early Experiences Implementing a Managed Care Approach

(GAO/HEHS-99-8, Oct. 21, 1998).

Foster Care: Agencies Face Challenges Securing Stable Homes for

Children of Substance Abusers (GAO/HEHS-98-182, Sept. 30, 1998).

Foster Care: Implementation of the Multiethnic Placement Act Poses

Difficult Challenges (GAO/HEHS-98-204, Sept. 14, 1998).

Child Protective Services: Complex Challenges Require New Strategies

(GAO/HEHS-97-115, July 21, 1997).

Foster Care: State Efforts to Improve the Permanency Planning Process

Show Some Promise (GAO/HEHS-97-73, May 7, 1997).

Child Welfare: Complex Needs Strain Capacity to Provide Services

(GAO/HEHS-95-208, Sept. 26, 1995).

(116033) Page 33 GAO/HEHS-00-13 Foster Care: Independent Living
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