United States General Accounting Office

GAO Report to Congressional Requesters

June 1995 CHILD WELFARE

Opportunities to

Further Enhance

Family Preservation

and Support Activities

GAO/HEHS-95-112

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-257596 

June 15, 1995

The Honorable E. Clay Shaw, Jr.

Chairman

The Honorable Harold E. Ford

Ranking Minority Member

Subcommittee on Human Resources

Committee on Ways and Means

House of Representatives

The Honorable Rick Santorum

United States Senate

In the past 20 years, social, cultural, and economic changes—such as

increases in substance abuse, community violence, and poverty—have

increased the severity of families’ problems and the number of families

coming to the attention of American child welfare agencies. From 1976 to

1992, the rates of child abuse and neglect increased fourfold. And from

1988 to 1993, the number of foster children increased almost one-third, to

nearly 450,000. States have struggled to keep up with the increased

demand for child welfare services, but worsening state fiscal difficulties

have further strained the child welfare system’s ability to serve vulnerable

children and their families.1

To enable states to provide 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) (P.L. 103-66) that

authorized new funding for family preservation and family support

services. More recently, the Congress has considered several proposals

that would incorporate these funds, along with various other child welfare

programs, into a block grant program for states.

This report responds to a request from the Subcommittee on Human

Resources of the House Committee on Ways and Means that we monitor

the implementation of the family preservation and support (FPS) provisions

of OBRA 1993. The report (1) describes the condition of child welfare in

America that precipitated OBRA 1993, (2) assesses federal and state efforts

1

While many public, private, and nonprofit entities provide a range of services to families in need, the

primary governmental responsibility for child and family services rests with the states. Each state has

its own legal and administrative structures and programs that address the needs of children and

families. Traditionally, the child welfare system encompasses services available to all children,

including the disabled, homeless, abused and neglected, and dependent.

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to implement its provisions, and (3) highlights areas in which these efforts

could be enhanced.

To develop information about the state of child welfare before 1993, we

reviewed our past work and related congressional documents. To assess

federal and state implementation efforts and suggest areas where

improvements could be made, we conducted two nationwide surveys, one

of state child welfare agencies2

 and another of 509 FPS program

administrators; interviewed Department of Health and Human Services

(HHS) officials in its headquarters and 10 regional offices; and interviewed

representatives of organizations involved in assisting states with

implementing the new law, such as national associations, child advocacy

groups, national resource centers, and foundations.

Results in Brief Reliance on foster care decreased in the early years following enactment

of the Adoption Assistance and Child Welfare Act of 1980. However, by the

mid-1980s, the incidence of poverty, substance abuse, and child abuse and

neglect began to rise. Greater and greater demands were being made on a

service-delivery system ill-equipped to handle the flow of troubled children

and families coming to its attention. Although states attempted to stem

this tide by focusing on services designed to prevent or remedy family

crises that might result in foster care placement, their efforts were often

constrained by funding limitations and fragmented service-delivery

systems.

Early state implementation of the FPS provisions of OBRA 1993 has

appropriately focused on understanding the law and federal guidelines,

applying for funds, and initiating a comprehensive process designed to

culminate in a long-range plan. HHS’ involvement with the states has been

one of partnership through ongoing consultation and assistance.

While activities implementing the new law appear to be on target,

opportunities exist to further enhance state efforts to develop a viable plan

and monitor results. In particular, states anticipate difficulties in

(1) developing various aspects of their 5-year plans, such as identifying

useful and appropriate baseline information to use in setting goals, making

funding and service decisions, and tracking results, and (2) performing

their own comprehensive program evaluations, which could help ensure

2

State child welfare agencies are responsible for administering Title IV-B of the Social Security Act in

each of the 50 states and the District of Columbia. Examples of child welfare services include child

protection, care of the homeless and neglected, child social and nutritional development, and

out-of-home care.

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that children and families’ needs continue to be met and determine if

intended results are achieved. Whether child welfare programs continue to

exist under the FPS program or as a block grant, states having the ability to

set outcome-based goals and to effectively measure progress towards

achieving these goals is important in ensuring adequate support for our

nation’s vulnerable children and families.

Background The FPS provisions of OBRA 1993 are administered by HHS’ Administration

for Children and Families (ACF). OBRA 1993 authorized $930 million in

funding to states over a 5-year period to initiate or expand family

preservation services and community-based family support services. The

Congress appropriated $60 million for fiscal year 1994, of which $2 million

was reserved for federal evaluation, research, training, and technical

assistance, and $600,000 was earmarked for grants to Indian tribes. The

balance was available for grants to states to fund family preservation and

support services. State grant amounts are to be based on each state’s

percentage of children receiving Food Stamps, a food subsidy program for

low-income households. States may use up to $1 million of their grant

amount for planning purposes during the first year, with no required state

match. States must match the funds used for FPS services.3

FPS funding under OBRA 1993 is limited compared with that of many other

federal programs. There is consensus among child welfare experts and

practitioners that these new dollars can best be used strategically and

creatively to stimulate the broader system reform that is already underway

in many states and communities. For example, about one-half of the states

had initiated a children’s agenda or comprehensive strategy to coordinate

and integrate services for children and families before OBRA 1993 was

enacted. In addition to funding new or expanded FPS services, the law

enables each state to use FPS funds during the first year to broadly review

current strategies for meeting the service needs of children and their

families. The planning period is viewed as especially critical because the

legislation provides a new focus on family-centered services and

community linkages that may require a change in the way that child

welfare services within each state are designed and delivered.

3

Each state may receive federal matching grants for up to 75 percent of the costs to provide FPS

services or an amount equal to the state’s grant amount, whichever is less. Other federal funds may not

be used for the state’s match.

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Family Preservation and

Support Services

Family preservation and family support services emphasize safety; a focus

on the family; and a service-delivery approach that is flexible, accessible,

coordinated, and culturally relevant. The distinction between these two

types of services is sometimes unclear because many service-delivery

models or programs are available and services may overlap. Family

preservation services typically target families in crisis whose members

have experienced child abuse or neglect. Family support services, while

primarily available to the general population, are often aimed at at-risk

populations—those identified as being in increased danger of becoming

abusive, such as families headed by single mothers or low-income families.

Family Preservation Services Family preservation services are typically designed to help families

alleviate crises that, left unaddressed, might lead to the out-of-home

placement of children. Although more commonly used to prevent the need

to remove children from their homes, family preservation services may

also be a means to reunite children in foster care with their families. The

goals of such services are to maintain the safety of children in their own

homes, when appropriate, and to assist families in obtaining services and

other support necessary to address the families’ needs. Examples of family

preservation services include crisis-related services to prevent the need

for out-of-home placement, respite care for parents and other caregivers,

services to improve parenting skills and support child development, and

follow-up services to support adoptive and reunited families.

Family Support Services Family support services are primarily community-based activities designed

to promote the well-being of vulnerable children and their families. The

goals of family support services are to increase the strength and stability

of families, increase parents’ confidence and competence in their

parenting abilities, afford children a stable and supportive family

environment, and otherwise enhance child development. Examples of

such services include respite care for parents and caregivers; early

developmental screening of children; mentoring, tutoring, and health

education for youth; and a range of home-visiting programs and

center-based activities, such as drop-in centers and parent support groups.

During the 104th Congress, legislators have considered several block grant

proposals to replace various child welfare programs, including the FPS

program authorized under OBRA 1993. The largest of these programs are

Title IV-B (Child Welfare Services and FPS) and Title IV-E (Foster Care and

Adoption Assistance). Other categorical programs that could be

incorporated into a block grant include the Abandoned Infants Assistance

Act, Adoption Opportunities program, Child Abuse Prevention and

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Treatment Act, Family Violence Prevention and Treatment Act, and

Temporary Child Care for Children with Disabilities and Crisis Nurseries

Act.

In general, block grants are a form of federal aid authorized for a wider

range of activities than categorical programs, which are usually more

specific in scope. Grantees are given greater flexibility to use funds on the

basis of their own priorities and to design programs and allocate resources

as they deem appropriate, although funding levels are usually lower.

Administrative, planning, fiscal, and other types of reporting requirements

are kept to the minimum amount necessary to ensure that national goals

are being accomplished.

Before OBRA 1993

Child Welfare Was in

Crisis

In 1980, the Congress enacted the Adoption Assistance and Child Welfare

Act (P.L. 96-272) to combat the problems of increasing numbers of

children entering and remaining in foster care for long periods of time. The

primary goals of this act were to prevent the unnecessary separation of

children from their families, improve the quality of care and services to

vulnerable children and their families, and ensure that children did not

languish in foster care.

The 1980 law appeared to have achieved its intended effect as the number

of children in foster care decreased in the first few years after its passage.

By the mid-1980s, however, the foster care population had begun to swell

again. From 1988 to 1993, the number of children in foster care rose 32

percent—from 340,000 to 449,000—according to the American Public

Welfare Association’s Voluntary Cooperative Information System. This

new growth in foster care was fueled in part by an increasing number of

child abuse and neglect cases. According to the American Humane

Association, reports of child abuse and neglect quadrupled from 670,000 in

1976 to 2.9 million in 1992; an estimated 40 percent of these reports were

substantiated. Child welfare experts also attribute the rise in the foster

care population to such trends as the increasing use of illegal drugs,

especially among young mothers in inner-city areas; rising numbers of

homeless families; and growing numbers of children and families living in

poverty.

States faced substantial challenges in containing burgeoning foster care

costs while meeting the needs of the most troubled children and families

under these difficult conditions. Increasingly, these families had multiple

problems that required the intervention of two or more service-delivery

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systems, such as child welfare, mental health, employment, housing, child

care, and drug treatment. Families in these situations were expected to

navigate among the various service-delivery systems in order to arrange

the “package of services” that they needed. Ironically, negotiating these

systems required the greatest effort and sophistication from precisely

those families least capable of responding to this challenge. Furthermore,

services were often more focused on managing crises—such as

investigating allegations of abuse and neglect and removing children from

their families—and less focused on prevention and treatment.

Intent on improving services for children and their families as well as

reducing foster care placements and expenditures, states began to

reconsider their crisis-intervention approach to child welfare; that is, they

began to focus more on prevention and treatment and on providing

services that addressed the causes of family dysfunction before removing

children from their homes became necessary. These services became

known as family preservation and family support services.

Originally, states funded these services themselves or with nonfederal

funds, but fiscal pressures led them to seek additional funding from

federal sources. Funds for FPS services were available from two programs

authorized by the Social Security Act—Title IV-B Child Welfare Services

and Title XX Social Services Block Grant—but funding levels were capped

and insufficient to keep pace with increasing demand for services. So

some states made greater use of uncapped entitlement programs,

including Titles IV-A Emergency Assistance, XIX Medicaid, and IV-E

administration.4

Despite the new focus on prevention, child welfare agencies became

increasingly constrained by insufficient resources, high caseloads, and

overburdened workers. By the time we surveyed FPS programs in 1994,

more than one-half said that they were unable to serve all the eligible

families that requested their services. The child welfare system had

become unable to fully realize the goals of the 1980 law.

OBRA 1993

Implementation Is on

Target

During the first 18 months after OBRA 1993 was enacted, state

implementation activities proceeded according to schedule. All states

obtained funding for the first year and began extensive planning efforts.

Moreover, during that time, HHS worked collaboratively with the states to

4

Foster Care: Services to Prevent Out-of-Home Placements Are Limited by Funding Barriers

(GAO/HRD-93-76, June 29, 1993).

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help them implement the new law. HHS’ contributions to implementation of

OBRA 1993 included working closely with the states to educate and support

them in their implementation and planning efforts and arranging for

evaluation of state efforts.

States’ Implementation

Activities

Within the first year after enactment of OBRA 1993’s FPS provisions, all

states applied for and received first-year funding. They also initiated

planning processes that included conducting needs assessments; including

a diverse group of involved individuals and groups5

 in plan development;

and coordinating with other service systems—such as public health and

mental health. According to HHS officials, states’ planning efforts

progressed at a pace that generally reflected previous or existing state

efforts to provide FPS services, reform child welfare service delivery, or

both. HHS said that it expects all states to meet the June 30, 1995, due date

for their 5-year plans. (See app. II for summary baseline information about

previous state efforts at providing FPS services and reforming child welfare

service delivery.)

During fiscal year 1994, states planned to use $55.5 million in OBRA 1993

grant funds to develop their 5-year plans and provide FPS services, as

shown in table 1. In the 22 states that slated first-year funds for services,

47 percent of the service dollars were allocated for family preservation

services and 53 percent for family support services.6

Table 1: Allocations for Fiscal Year

1994 Grant Funds, by Purpose

Purpose

Dollar amount

(in millions) Percent of total dollars

Services $26.1 47

Planning 23.2 42

Training and technical

assistance 4.0 7

Administration 1.5 3

Other 0.7 1

Total $55.5 100

Source: HHS analysis of state applications.

5

People and groups involved in child and family service delivery include representatives from

public—federal, state, and local—and nonprofit agencies and community-based organizations with

experience in administering programs of services for children and families, including FPS services,

special interest and minority groups, parents, and other care providers.

6

More details about states’ use of funding are available in HHS’ Draft Preliminary Report: Analysis and

Synthesis of First-Year Grant Applications, Family Preservation and Family Support Services

Implementation Study (Washington, D.C.: 1995).

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Furthermore, 25 states planned to contribute additional resources—over

and above their federal allotment and existing funding levels—for planning

and FPS service provision. Eleven of these states planned to add resources

for both planning activities and providing FPS services; 12 states, only for

FPS services; and 2 states, only for planning purposes.

HHS’ Implementation

Contributions

Overall, the federal approach to implementing the new law during its first

18 months was one of open, active collaboration and coordination with the

concerned individuals and groups. To assist in crafting guidelines and

regulations, HHS consulted and held focus groups with experts in FPS and

related programs as well as with public child welfare administrators,

national advocacy and professional organizations, parents, and foster

parents. To familiarize federal and state staff with OBRA 1993’s FPS

requirements, HHS sponsored training and technical assistance conferences

and worked directly with state staff as they applied for first-year funds and

initiated the planning process. In addition, HHS took steps toward

improved coordination at the federal level by exploring and acting on

opportunities for collaboration among the various federal programs that

serve vulnerable children and their families.

HHS also participated in ongoing discussions, consultations, and

negotiations with states to help them develop their 5-year plans. This

process enabled federal staff to monitor state implementation of the FPS

provisions of OBRA 1993 and to identify areas in which additional training

and technical assistance would be useful to the states. For example,

according to HHS officials, states did not always involve all the concerned

groups, particularly community-based organizations, in the planning

process. To ensure that the state planning process was inclusive, HHS

convened monthly conference calls to discuss this issue with regional staff

and continued discussions with state staff.

Finally, HHS began efforts to fulfill the OBRA 1993 requirement of a national

evaluation of the effectiveness of FPS services. In September 1994, HHS

awarded three 5-year contracts to collectively assess state implementation

and the effectiveness of several FPS programs. The state implementation

study will annually analyze all state applications and plans. It will also

develop in-depth case studies on the processes being used and the impact

of the law’s implementation in 10 states and 20 communities. A second

study will synthesize the family preservation research literature and assess

program effectiveness at six family preservation sites. In addition, a third

study will synthesize the family support literature and assess program

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effectiveness at up to 10 family support sites. The family preservation

evaluation, in particular, will use rigorous methodologies, such as

randomly assigned experimental and control groups. At the time that we

prepared this report, these three evaluations were in the planning and

design stage; interim reports are expected by fall 1997.

Opportunities Exist to

Further Enhance

Implementation

Efforts

While implementation of OBRA 1993 has progressed according to schedule,

we identified several areas in which efforts could be enhanced by

additional assistance from HHS. More than one-half of the states reported

that they were experiencing or expected to experience difficulty in certain

areas of implementation. Concerns include developing information that

will enable states to set meaningful goals and measure results. In addition,

states could benefit from further technical assistance from HHS in

evaluating their programs. HHS is aware of states’ concerns and has taken

some general steps to help them address these issues.

States Underscore Areas in

Which Planning Is Difficult

Twenty-nine states reported that developing baseline and trend

information—which should form the basis for developing their plans,

making sound service and funding decisions, and monitoring results—will

not be easy. States must analyze available information on the well-being

and needs of children and families and on the adequacy of existing

services and then identify trends in these areas over time. HHS has

suggested possible measures or indicators of child and family well-being

and the status of service delivery. But the states are still responsible,

although they are inexperienced at using indicators, for selecting the most

meaningful indicators for their unique circumstances.

Receiving additional, individualized guidance in developing appropriate

baseline and trend information should help states overcome several other

areas that they cited as problematic. For example, 27 states reported that

making decisions on targeting their funding will be difficult, given the

limited funding provided under OBRA 1993 and the strong competition

among various state, local, and community entities for service dollars.

Once states identify the vulnerable populations or target areas, they

should be able to select priorities for targeting funding and services.

In addition, states’ inexperience or past difficulties in defining measurable

outcomes and indicators of change have fueled their trepidation about

setting outcome-based goals and measuring progress. Thirty-four states

reported that developing outcome-based goals—an element of the

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required state plan—will be difficult. Goals must be based on improved

outcomes expected for children and families’ safety and well-being.

Further, states’ goals must be realistic, specific, and measurable. Even

once they have set goals, 26 states believe that measuring progress in

accomplishing their goals will be difficult. Again, selecting appropriate

indicators to measure outcomes makes this task challenging.7

States Could Learn From

Evaluating Their FPS

Services as They

Implement OBRA 1993

Another method by which states could measure progress and monitor

results would be to evaluate their FPS programs. While OBRA 1993 mandates

a national evaluation of FPS services, it makes no such requirement of the

states. Nevertheless, conducting their own evaluations of FPS services

could help states manage their programs better. For example, evaluations

could provide information about the economic efficiency of states’ FPS

programs and the impact on the children and families served, the

community, and the service-delivery system itself. Yet 33 states reported

that program evaluations would be difficult for them to do, and 38 states

indicated that HHS has not provided enough assistance in this area.8

Further, the methodologies of previous FPS evaluations limited the ability

of evaluators to draw meaningful conclusions about the long-term

effectiveness of FPS services in helping to keep families together,

improving the well-being of vulnerable children and their families, and

reducing foster care placements and costs. Evaluations employing

rigorous methodologies, such as randomly assigned experimental and

control groups, are needed to determine the effectiveness of FPS services

as compared with other service-delivery strategies. Evaluations are also

needed to provide insight into which methods of intervention work best

for which populations of children and families.9

The national evaluations of state implementation and the effectiveness of

FPS programs are designed to address these issues. Although the national

evaluations have begun and should continue to provide useful information

about the effectiveness of FPS services, states may not have sufficient

information about how well they have implemented OBRA 1993 and how

7

See appendix II for additional information about previous state monitoring efforts.

8

Some states reported that they have evaluated their FPS programs in the past; however, these results

are not yet available. (See app. II for more information about previous state evaluation efforts.)

9

See Foster Care: Services to Prevent Out-of-Home Placements Are Limited by Funding Barriers

(GAO/HRD-93-76, June 29, 1993) and Karl Ensign, “Prevention Services in Child Welfare: An

Exploratory Paper on the Evaluation of Family Preservation and Family Support Programs,” U.S.

Department of Health and Human Services, Office of the Assistant Secretary for Planning and

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

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effective their programs are. States could benefit from additional technical

assistance to enable them to conduct their own program evaluations, if

they wish to do so.

HHS Has Provided States

General Assistance in

These Areas

According to HHS officials, HHS is aware of the difficulties that states face

and is interested in using our report results to enhance its efforts to

identify states’ training and technical assistance needs. Further, HHS is

aware of the varying levels of expertise among the states in areas related

to developing the 5-year plan, providing FPS services, and reforming child

welfare service delivery. To support the states in dealing with these

challenges, HHS awarded a contract in September 1994 to (1) coordinate

efforts among a host of resource organizations, including public agencies

that administer federal programs for children and families, national

resource and research centers, and national organizations and foundations

involved with FPS; (2) support regional conferences for federal and state

staff; and (3) provide direct assistance to individual states, as needed. HHS

has encouraged states to use these resources and is committed to

continuing to assist states through technical assistance and joint planning.

While federal involvement would be minimized if child welfare services

were administered through block grant programs, the Congress and

federal agencies likely would maintain an interest in the use and

effectiveness of federal funds. Current federal efforts to assist states in

implementing the FPS provisions of OBRA 1993 would still be worthwhile

and have long-term ramifications. For example, by the time a block grant

went into effect, the states would have already developed their

comprehensive 5-year plans setting quantifiable goals and methods for

measuring outcomes. These plan elements would help states focus on

accountability for results; that is, ensure the safety and improved

well-being of vulnerable children and their families. As we have previously

reported, accountability is critical to preserving state flexibility and,

hence, reducing the likelihood of increased federal intervention.10 With

continued HHS assistance now, states could have in place the mechanisms

to ensure such accountability under a block grant environment.

Agency Comments

and Our Evaluation

In its May 15, 1995, comments on our draft report, HHS agreed that early

implementation of the FPS provisions of OBRA 1993 was on target and

attributed this initial success to the partnerships established between

federal and state staff. HHS reemphasized its commitment to provide

10Block Grants: Characteristics, Experience, and Lessons Learned (GAO/HEHS-95-74, Feb. 9, 1995).

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technical assistance to states as they develop their plans and monitor

progress; these efforts will also include technical assistance to those states

interested in conducting evaluations. At HHS’ suggestion, we added

language in the report to more fully describe the characteristics of family

preservation services (see pp. 4 and 29). HHS also suggested minor

technical revisions to the draft, which we incorporated as appropriate.

HHS expressed concerns that under a block grant arrangement (1) federal

technical assistance efforts would be curtailed if funds were not

appropriated for this purpose and (2) states may not have sufficient funds

to serve the numbers of children and families who could benefit from FPS

services. A copy of HHS’ comments is included in appendix V.

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

Human Services, state child welfare directors, and state FPS program

administrators. We will also make copies available to other interested

parties upon request. Should you or your staffs have any questions or wish

to discuss the information provided, please call me at (202) 512-7230.

Other GAO contacts and staff acknowledgments are listed in appendix VI.

Jane L. Ross

Director, Income Security Issues

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Page 13 GAO/HEHS-95-112 Family Preservation and Support
Contents

Letter 1

Appendix I 

Scope and

Methodology

16

GAO Survey Instruments 16

Appendix II 

Baseline Information

on Existing FPS

Efforts

19

State Child Welfare Agencies Can Build on Previous Efforts 19

State FPS Programs Varied, but Shared Some Commonalities 25

Appendix III 

GAO Questionnaire to

State Child Welfare

Agencies

34

Appendix IV 

GAO Questionnaire to

FPS Program

Administrators

58

Appendix V 

Comments From the

Department of Health

and Human Services

85

Appendix VI 

GAO Contacts and

Acknowledgments

88

Tables Table 1: Allocations for Fiscal Year 1994 Grant Funds, by Purpose 7

Table II.1: States That Undertook Planning Activities and

Targeted FPS Services Before OBRA 1993

23

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Contents

Table II.2: Most Common Indicators That States Used to Measure

Progress in Accomplishing FPS Goals Before OBRA 1993

25

Table II.3: Percent of Programs That Provided Family

Preservation Services With Goals Similar to Those Under OBRA

1993

27

Table II.4: Percent of Programs That Provided Family Support

Services With Goals Similar to Those Under OBRA 1993

27

Table II.5: Comparison of FPS Programs Administered Within and

Outside the Child Welfare System

29

Table II.6: Characteristics of Three Family Preservation

Service-Delivery Models

31

Table II.7: Characteristics of Selected Family Support

Service-Delivery Approaches, by Service Configuration

32

Table II.8: Characteristics of Selected Family Support

Service-Delivery Approaches, by Service Strategy

33

Abbreviations

ACF Administration for Children and Families

ASPE Assistant Secretary for Planning and Evaluation

FPS Family preservation and support

HHS U.S. Department of Health and Human Services

OBRA 1993 Omnibus Budget Reconciliation Act of 1993

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Appendix I 

Scope and Methodology

To develop information about the condition of child welfare before the

enactment of OBRA 1993, we reviewed our past reports and related

congressional documents.

To obtain information about federal and state implementation efforts, we

interviewed officials from HHS’ ACF, which is responsible for the FPS

provisions of OBRA 1993 at the federal level, in HHS’ headquarters and its 10

regional offices. We also reviewed federal guidelines and proposed

regulations11 related to implementing the FPS legislation, available

literature on existing FPS programs, and national and regional conference

notes and literature related to training and technical assistance provided

to both HHS and state staff. In addition, we interviewed representatives

from several national organizations involved with assisting states in their

efforts to implement OBRA 1993, including national associations, child

advocacy groups, national resource centers, and foundations.

To determine how states plan to use first-year funds, we reviewed HHS

documents that summarized state grant applications and surveyed the

state child welfare agency in each of the 50 states and the District of

Columbia. We did not verify the accuracy of these data; however, we did

review a sample of grant applications and verified some amounts.

To obtain information about 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. We also attended or

reviewed the proceedings from meetings of the national evaluation

advisory panels12 and reviewed drafts of interim products that were

prepared under the national evaluation contracts as well as available

research literature on the effectiveness of FPS programs. Information was

not readily available on current state evaluation efforts.

GAO Survey

Instruments

We designed two questionnaires to obtain baseline information about

existing state efforts related to child welfare service delivery and FPS

services. We developed separate questionnaires to collect information

about state efforts from the following two perspectives: (1) the state child

11Notice of proposed rulemaking pertaining to the implementation of the FPS provisions of OBRA 1993

was issued in October 1994; final regulations are expected in June 1995.

12Each of the three national evaluations has established an advisory panel, which is comprised of

outside experts on related issues, to help guide the work of the project.

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Appendix I 

Scope and Methodology

welfare agency that is responsible for implementing the FPS provisions of

OBRA 1993 and (2) program administrators who are responsible for

operating or administering state FPS programs. In some cases, the state

child welfare agency also administered one or more FPS programs and,

thus, would have received both questionnaires.

We discussed development of the two questionnaires with HHS

headquarters staff; several state child welfare agency officials; staff from

the Subcommittee on Human Resources of the House Committee on Ways

and Means; and representatives from such national organizations as the

American Public Welfare Association, Family Resource Coalition, and

National Resource Center for Family-Based Services. In addition, some of

these individuals reviewed drafts of both questionnaires.

Before mailing the two questionnaires, we conducted two pretests—one in

Georgia and one in Oklahoma—involving the state Title IV-B agency

official responsible for implementing OBRA’s FPS provisions (for the state

questionnaire) and the state program administrator from two different FPS

programs (for the program questionnaire). These officials represented

states and programs of different size, geographic location, and FPS

emphasis. Using the pretest results, we revised the questionnaires to try to

ensure that the questions (1) would be easy for respondents to answer and

(2) were relevant, clear, and free from bias.

We did not verify the information obtained through the questionnaires.

However, we believe that our interviews with federal and state staff and

representatives from other national organizations as well as our review of

the literature reasonably ensure that the information gathered through our

questionnaires fairly represents the described programs.

State Questionnaire

Regarding Child Welfare

Service Delivery

We surveyed the state child welfare agency in each of the 50 states and the

District of Columbia regarding the delivery of state child welfare services,

the role of FPS services, and monitoring efforts before enactment of OBRA

1993. The questionnaire also asked about state implementation of the new

law and federal assistance provided. In late August 1994, we mailed the

questionnaire to the 51 child welfare agencies and received responses

from each one.

Program Questionnaire

Regarding FPS Services

We designed a second questionnaire to obtain information about FPS

programs that were under the auspices of a state government; that is,

Page 17 GAO/HEHS-95-112 Family Preservation and Support
Appendix I 

Scope and Methodology

administered by, operated by, or otherwise affiliated with a state

child-serving agency—and which operated before enactment of OBRA

1993.

13 The questionnaire asked about these FPS programs’ history and

administration, specifications, staffing, goals, funding, and experiences

with monitoring and evaluation.

Before mailing this questionnaire, we asked the child welfare agencies to

identify the universe of state-affiliated FPS programs in their state. We

mailed each state a listing of FPS programs that we were aware of. The

state child welfare agencies corrected our list and added other programs,

thus, identifying our universe of 552 state FPS programs.14

In late August 1994, we mailed the program questionnaire to the 552 FPS

programs. To encourage participation and increase response rates, we

mailed a second copy of the questionnaire to all nonrespondents in early

October and a third copy in early November.

From the 552 questionnaires we mailed, we received 436 responses. Based

on returned questionnaires and telephone contacts from several

respondents, we adjusted our population size to 509 and the number of

valid responses to 393 to exclude 11 programs that did not meet our

selection criteria and 32 programs whose responses were incorporated

with responses from other programs (some agencies operated more than

one FPS program). The 393 valid responses resulted in an overall response

rate of 77 percent.

We conducted our audit work from January 1994 to March 1995 in

accordance with generally accepted government auditing standards.

13Child-serving agencies outside of the child welfare system include mental health, juvenile justice,

education, and other public health agencies.

14We recognized in March 1994 that states were just beginning the grant application process and

generally had not inventoried FPS programs within the states. Until states had conducted this

inventory—a requirement for the state plan due in June 1995—the true universe of state and nonstate

FPS programs would be unknown.

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The underlying principles of FPS services—services that are

family-focused, coordinated, flexible, accessible, and culturally

relevant—are not radically new to most states. Before enactment of OBRA

1993, many state child welfare agencies had begun to change child welfare

service delivery in their respective states and provide FPS services in ways

similar to those promoted under the new law. In addition, every state had

one or more FPS programs operating, although most FPS services were not

available on a statewide basis.

Based on responses to two GAO questionnaires—one to each state child

welfare agency and the other to FPS program administrators—we

established baseline information about state child welfare service delivery

and FPS services before the new law. In the following sections, we describe

• previous efforts on the part of state child welfare agencies, who are

responsible for implementing the new law, to provide FPS services, reform

child welfare service delivery, and monitor results; and

• the characteristics of FPS programs that were affiliated with a state child

welfare agency, another state child-serving agency—such as mental health

or juvenile justice—or both.

Unless otherwise noted, the term state refers to the state child welfare

agency. FPS program refers to a program of FPS services provided under the

auspices of a state child-serving agency, both within and outside the child

welfare system.

State Child Welfare

Agencies Can Build on

Previous Efforts

Many state child welfare agencies had taken steps to provide FPS services

and reform child welfare service delivery before enactment of OBRA 1993.

The extent of these efforts may not have been as widespread or

comprehensive as the new law and proposed federal regulations require,

but can still form a basis from which states can move forward.

The FPS provisions of OBRA 1993 and draft regulations set out requirements

for states as they implement the new law. Before states can use new

federal funds to provide FPS services, they must undertake a planning

process that includes broad consultation and involvement, an assessment

of needs, and joint planning. States are encouraged to develop a child and

family service system that keeps children and families safe; builds on the

resources and strengths of families; offers a continuum of services that is

family-focused, easily accessible, and culturally relevant; and links this

service continuum to other community services and service-delivery

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systems—such as mental health and education—to ensure that families

have access to comprehensive services to meet their individual needs.

From our survey of state child welfare agencies, we provide information

about state efforts in these areas before enactment of OBRA 1993. We did

not assess the adequacy or completeness of the survey information nor did

we determine compliance with applicable laws or how far along states

might be in their planning process; rather, this information provides some

insight into states’ previous experiences that could form a basis for future

planning, service delivery, and monitoring activities. (See app. I for more

details on our survey methodology and app. III for a copy of the state child

welfare agency questionnaire.)

Guiding Principles Provide

a Framework

Both family preservation and family support services are based on a

common set of principles or characteristics that help ensure their

responsiveness and effectiveness for children and their families. These

principles should provide an organizing framework as states plan for new

FPS services, according to proposed federal rules. Before enactment of

OBRA 1993, 45 states had established guiding principles for family

preservation services, family support services, or both. Such principles

were formalized primarily in internal agency documents, such as program

instructions, policy manuals, and plans. In addition, 27 states had

embodied guiding principles in state law. Most states shared similar

principles as those outlined in proposed federal regulations, with primary

emphasis on maintaining the welfare and safety of children, strengthening

and preserving families, focusing on the family as a whole, and delivering

services that were intensive enough to meet family needs.

In addition, 48 states had previously developed initiatives for child welfare

service delivery to meet objectives similar to those promoted by the new

law. Of these states, 44 had initiatives to either begin or expand family

preservation services and improve the well-being of vulnerable children

and their families, particularly those at risk of or experiencing child abuse

and neglect. In addition, 39 states had initiatives to start or expand family

support services and about 37 states had initiatives to develop a

continuum of services that are family-focused, comprehensive, and

coordinated.

States’ initiatives were most commonly the result of state legislation,

initiation or replication of a pilot or demonstration project, or a formal

planning process. However, 12 states had undertaken these initiatives in

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Efforts

response to a court order or consent decree. In addition, 39 states

indicated that their efforts were part of broader state initiatives or reform

efforts, such as reinventing government or welfare reform. About one-half

of the states had initiatives underway to develop a comprehensive

service-delivery strategy for child and family services.

Most States Offered Full

Array of Services

Every state offered most of the types of services that might optimally

comprise a full array of child welfare services. Among elements that would

ideally be part of a child welfare services continuum, according to

proposed federal rules, are FPS services; child welfare services, including

child abuse and neglect prevention, intervention, and treatment services;

foster care; and services to support reunification, adoption, kinship care,

independent living, or other permanent living arrangements. States were

least likely to offer family support services as well as services after a child

had left foster care (although 38 states and 34 states, respectively, offered

these services). Most services were offered statewide; services that were

not, were generally moving in that direction.

Before OBRA 1993, 29 states reported that they emphasized family

preservation services more than family support services. A total of 48

states offered family preservation services compared with 38 states for

family support services. While FPS services were included in most states’

array of available services, FPS services were least likely to be available

statewide. Family preservation services were available statewide in 29

states and family support services in 22 states.

Child Welfare Services

Were Often Linked to

Other Services

In addition to a continuum of services, according to proposed federal

rules, linkages to other services and service-delivery systems, such as

health, mental health, housing, employment, education, and child care,

complete the picture of a responsive service-delivery system. Effective

coordination of a broad spectrum of services provides a holistic approach

to serving children and families and increases the likelihood of matching

families’ needs with appropriate services rather than merely providing

available services.

Many state child welfare agencies were connected to other

service-delivery systems by virtue of their organizational structure and by

establishing formal arrangements. The state child welfare agencies had

various types of formal arrangements or linkages with other state

programs that provide child and family services. Regardless of the state

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program, the most common types of formal arrangements were service

coordination and collaboration, use of other programs’ services, and joint

planning. State child welfare agencies were least likely to have integrated

services or pooled funds with other state programs. Formal arrangements

were most common with juvenile justice and mental health programs—a

situation that may be facilitated by organizational structure because 43

state child welfare agencies were part of an umbrella or consolidated

agency, most commonly with employment, juvenile justice, and mental

health programs. Few states had formal arrangements with state housing

programs.

In addition to connecting with other state service-delivery systems, most

states had established ties at the community level during the 5 years

before enactment of OBRA 1993. In particular, 35 states had initiatives that

drew upon community-based programs for the design, implementation, or

both of the delivery of child welfare services. Furthermore, about 35 states

had established linkages with community-based organizations related

specifically to the delivery of FPS services.

Of the 39 state child welfare agencies that offered both family preservation

services and family support services, the most common linkages between

the delivery of these two services were service collaboration and

coordination. Furthermore, most of these states had ties between the two

services within the state child welfare agency as well as with other

entities, such as other state programs and community-level child welfare

service providers. In 9 states, the delivery of family preservation services

was separate and distinct from family support services.

States Had Previously

Conducted Some Planning

Activities

As states develop their 5-year plan, proposed federal rules require them to

establish baseline and trend information from which to base funding and

service decisions. Such information is needed to help determine target

populations, assess service needs and resources, identify service gaps, and

develop opportunities for bringing about more effective and accessible

services for children and families. Most states had collected some of this

information related to the delivery of FPS services, as shown in table II.1,

before enactment of OBRA 1993. Furthermore, as the table illustrates, more

states undertook these activities for family preservation services than for

family support services. In addition, HHS recommends that FPS services be

targeted towards populations and in locations of greatest need. Before the

new law, most states that offered FPS services targeted these services in

various ways.

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Table II.1: States That Undertook

Planning Activities and Targeted FPS

Services Before OBRA 1993

Family

preservation

services

Family

support

services

Activity

Develop new and more effective approaches to delivering

services 45 31

Identify available resources 38 27

Establish linkages with community-based organizations 35 32

Assess family and community needs 34 29

Identify child welfare service overlaps and gaps 30 22

Targeting

By client population 38 25

At county or local discretion 29 27

At selected locations 29 24

To support collaborative, community-based service-delivery

strategies 21 23

Measuring Progress Was

Difficult

While 40 states monitored results for family preservation services

compared with 29 states for family support services, measuring progress

in accomplishing goals for either type of service was difficult for most of

these states in the 5 years before enactment of OBRA 1993. States

monitored progress towards accomplishing FPS goals, primarily by internal

program reviews and periodic progress reports prepared by program staff.

Fewer states relied heavily on external program evaluations to monitor

progress—20 states for family preservation services and 7 states for family

support services. In addition to monitoring progress in accomplishing FPS

goals, most of these states used the monitoring results to assist in program

development. Furthermore, 34 states had evaluated or reviewed family

preservation services to determine program effectiveness, compared with

18 states for family support services. Information was not readily available

on the scope, methodologies, and results of state evaluations.

Although states undertook a variety of activities to measure the progress

of FPS services in accomplishing goals, most states found these activities

difficult to carry out. Regardless of whether the progress of family

preservation or family support services was tracked, states had difficulties

with or did not conduct the following activities:

• collecting useful and complete data,

• selecting appropriate indicators,

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• measuring cost effectiveness,

• identifying correlates of success or the program or client characteristics

that affect the likelihood of successful outcomes, and

• defining measurable outcomes.

In general, states had not used indicators to monitor results for FPS

services—less than one-half of the states for family preservation services

and less than one-fourth for family support services. Those states that did

used various indicators to measure the progress of FPS services, as shown

in table II.2. Most common were indicators related to expenditures and

child abuse and neglect reports. Beyond that, for family preservation

services, most states focused primarily on indicators related to cost,

systems, and service delivery, and less so on family and child indicators.

For family support services, fewer states used indicators, but those that

did focused more on family indicators. States found these indicators to be

of varying usefulness, leaving little or no clear picture of what indicators

would be most useful for states to set goals, base funding and service

decisions, and track results.

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Table II.2: Most Common Indicators That States Used to Measure Progress in Accomplishing FPS Goals Before OBRA 1993

Family preservation Family support

Indicator Type

Number of

statesa Usefulnessb

Number of

statesa Usefulnessb

Expenditures Systems 33 Moderate/

somewhat

17 Somewhat

Cost effectiveness Cost 31 Spreadc 11 d

Caseloads Systems 29 Moderate 16 Somewhat

Cases per worker Service delivery 27 Spreadc 10 d

Staffing Service delivery 25 Moderate 15 Somewhat

Child abuse and neglect

reports

Community-wide 23 Moderate 17 Somewhat

Timeliness Service delivery 23 Spreadc 11 d

Family functioning Family 22 Moderate 16 Moderate/

somewhat

Child’s well-being Child 21 Very/

moderate

16 Spreadc

Parent-child relationships Family 15 d 15 Moderate/

somewhat

aRepresents number of states that indicated they used the indicator to measure the progress of

family preservation services (based on n≤42) and family support services (based on n≤29) in

accomplishing goals.

bBased on scaled response of “very/moderate/somewhat/not at all useful,” with “very” being the

most useful and “not at all” being the least; level of usefulness determined by majority of

respondents.

cState responses were spread among the “very/moderate/somewhat useful” categories, without

the majority of responses being in any one or two categories.

dInsufficient number of respondents (less than one-half of n).

State FPS Programs

Varied, but Shared

Some Commonalities

While family preservation programs encompass a variety of

service-delivery strategies, family support programs encompass an even

broader array of approaches. As a result, it is difficult to define a typical

program of family preservation or family support services. From our

survey of 393 FPS program administrators, we provide some information

about the characteristics of these programs as they looked before

enactment of OBRA 1993. We especially focus on those aspects that are

highlighted in the new law, such as outcome-based goals and methods for

monitoring progress towards achieving these goals. We did not assess the

adequacy or completeness of the survey data. Furthermore, the

information described below pertains only to the population of FPS

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programs that responded to our questionnaire and cannot be projected to

the universe of such programs. (See app. I for more details on our survey

methodology and app. IV for a copy of the state FPS program

questionnaire.)

About 66 percent of the programs we surveyed provided family

preservation services and 79 percent provided family support services.15

Regardless of whether a program provided family preservation or family

support services, about 35 percent of the programs provided these

services on a statewide basis. Over one-half of those programs that were

not available statewide were moving in that direction.

Some FPS Goals Were

Emphasized More Than

Others

According to federal guidelines, which were based on focus group

discussions and the literature on professional practice, the goals for FPS

services should reflect the underlying principles of family-focus,

accessibility, flexibility, coordination, and cultural relevance. Hence, FPS

services should be directed towards assuring the safety of all family

members; enhancing parents’ ability to create an appropriate home

environment that promotes healthy child development; assisting children

and families with resolving crises and remaining safely together in their

homes whenever possible; and avoiding unnecessary out-of-home

placement of children and helping foster children reunite with their

families or with placement in another planned, permanent living

arrangement, such as adoption or legal guardianship.

Although goals varied among individual programs, most of the FPS

programs we surveyed had goals similar to those articulated in federal

guidelines. Programs that provided family preservation services focused

most often on improving parenting skills and preventing the need for

foster care placement, as shown in table II.3. Family support services were

also designed to improve parenting skills as well as to connect or provide

information to families with other community supports and services, as

shown in table II.4. Regardless of whether family preservation or family

support services were provided, program goals were least likely to include

respite care of children to provide temporary relief to parents and other

caregivers, as shown in both tables.

15The percentages reflect the number of respondents that answered specific questions related to FPS

services; hence, the ratios are not always with respect to the total of 393 programs that responded to

our questionnaire. In addition, programs provided family preservation, family support services, or

both.

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Table II.3: Percent of Programs That

Provided Family Preservation Services

With Goals Similar to Those Under

OBRA 1993

Goal

Percent of

programsa

Improve parenting skills 91

Help children at risk of foster care placement remain with their families 86

Prevent foster care reentry after children have been reunited with their

families 77

Reunite children in foster care with their families 77

Place children for adoption, with a legal guardian, or some other permanent

living arrangement when family reunification is not appropriate 27

Provide respite care of children for parents and other caregivers 25

aRepresents percent of programs that actually responded (n≤171).

Table II.4: Percent of Programs That

Provided Family Support Services

With Goals Similar to Those Under

OBRA 1993

Goal

Percent of

programsa

Strengthen parent-child relationships 92

Connect families with and encourage use of other community supports and

services 92

Improve parenting skills 91

Provide information and referral services 90

Improve family functioning 86

Prevent child abuse and neglect 79

Provide families with opportunities to interact with other families and

program staff 73

Promote family self-sufficiency 70

Assess children’s early developmental needs 60

Prevent out-of-home placement 59

Provide respite care of children for parents and other caregivers 36

aRepresents percent of programs that actually responded (n≤198).

Most FPS Programs Could

Not Fully Meet the

Demand for Services

Almost two-thirds of the FPS programs experienced difficulty in meeting

the demand for their services. Over one-half of the FPS programs were not

able to serve all eligible families who requested services, primarily

because of an insufficient level of funding and number of staff to provide

FPS services. These factors, according to most program administrators,

hindered the program’s ability to achieve its primary goals for FPS services.

Nevertheless, almost 90 percent of the program administrators felt that,

overall, their program of family preservation services was very or

moderately effective in reducing the number of families at-risk or in-crisis

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that might lead to foster care placement. By comparison, almost

80 percent of the questionnaire respondents felt that family support

services were similarly effective in reducing the number of families at-risk

of or experiencing child abuse and neglect.

Progress Monitored

Internally

Most programs monitored the progress of FPS services in accomplishing

program goals primarily by internal program reviews or evaluations and

periodic progress reports prepared by program staff. Less than one-half of

the programs used indicators to measure program outcomes. In addition,

less than one-half of the programs were reviewed or evaluated by an

organization outside of the program. Results from these monitoring efforts

were primarily used to determine program effectiveness and assist in

program development.

In the last 5 years, just over one-half of the programs were formally

evaluated. These evaluations focused primarily on the process of program

implementation, the impact of FPS services, and compliance with

applicable law or regulations. Furthermore, over 40 percent of the family

preservation programs were in the process of being formally evaluated,

compared with just over 50 percent for family support programs.

Information was not readily available on the scope, methodologies, and

results of these evaluations.

Service-Delivery

Characteristics of FPS

Programs

How FPS programs were administered and operated appeared to be related

to the type of service offered. Family preservation services were more

likely provided within the context of the child welfare system, while family

support services were more likely provided under the auspices of other

state child-serving agencies, such as mental health and education, as

shown in table II.5. Moreover, family preservation programs were more

likely operated by other private organizations under contract with a state

or local public agency, while family support programs were most

commonly operated by a community-based organization.

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Table II.5: Comparison of FPS

Programs Administered Within and

Outside the Child Welfare System

Percent of programs

Type of state agency

Family

preservation

services

(n=179)

Family

support

services

(n=207)

Child Welfare 74 43

Nonchild Welfare

Mental Health 19 13

Juvenile Justice 11 4

Education 3 20

Maternal and Child Health 3 11

Other Public Health 1 4

Other 18 32

Total nonchild welfarea 55 84

aMore than one type of agency may be responsible for administering family preservation services,

family support services, or both.

Program approaches to the delivery of family preservation services varied

in many ways. However, the intensity, duration, and packaging of services

commonly differentiates such programs from the traditional delivery of

child welfare services. One way to differentiate among family preservation

programs is to describe them by the type of intervention they employ.

According to the literature, such programs can be classified into three

models—crisis intervention, family systems, and therapeutic family

treatment.16

• The crisis intervention model forms the basis for the Behavioral Science

Institute’s Homebuilders service-delivery approach, which began in 1974 in

Tacoma, Washington. Intervention occurs within 24 hours of a family’s

referral to the program. Services are typically intensive in nature and are

provided in the home so that caseworkers can make accurate assessments

and gain the trust of the family.

• The family systems model is typified by the FAMILIES program originated in

Iowa in 1974. Attention is focused on the family as a whole, not specific

family members, and seeks to correct dysfunction by working on the

family’s interaction with the community. Families actively participate in

their assessment and help establish the treatment goals of improved

16Karl Ensign, “Prevention Services in Child Welfare,” citing K.E. Nelson, M.J. Landsman, and W.

Deutelbaumn, “Three Models of Family-Centered Placement Prevention Services,” Child Welfare, Vol.

LXIX, No. 1 (Jan.-Feb. 1990), pp. 3-21.

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service linkages, perception, and relationships within the family and its

environment.

• Therapeutic family treatment relies less on the provision of concrete,

supportive services and more on family therapy. The treatment is also less

intensive. One of the first such programs was the Intensive Family

Services Program developed in Oregon in 1980. Treatment, which is also

based on family systems theory, is comprised of three distinct

phases—assessment, treatment, and termination.

While these are three models of family preservation service delivery, many

variations of these models as well as other approaches exist.

Over one-half of the programs characterized their service-delivery

approach for providing family preservation services as one of the three

models described above. The remaining programs used either other

approaches or different service-delivery strategies depending on the

jurisdiction or program site. As shown in table II.6, programs that used the

three family preservation service-delivery models had some commonalities

as well as differences.

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Table II.6: Characteristics of Three

Family Preservation Service-Delivery

Models

Model

Characteristic

Crisis

intervention Family systems

Therapeutic

family

treatment

Number of programsa

(percent)

50

(30%)

27

(16%)

9

(5%)

Average caseload per

worker

3 cases per

worker

9 cases per

worker

9 cases per

worker

Percent of programs

using a

team approach

44% 78% 56%

Average duration of

services

1.5 months 5.7 months 5.9 months

Availability of workersb 24 hours a day,

7 days a week

24 hours a day,

7 days a week

24 hours a day,

7 days a week

Types of families

receiving servicesb

Birth; extended;

foster; adoptive

Birth; extended;

foster; adoptive

Birth; extended;

foster; adoptive

Location of service

deliveryb

In family’s home In family’s home In family’s home

Minimum educational

requirementb

Bachelor’s

degree

Bachelor’s

degree

Master’s degree

aOf a total of 169 programs, we describe the characteristics of 86 family preservation programs in

this table; the remaining 83 programs used either other approaches or different service-delivery

strategies depending on the jurisdiction or program site.

bAs determined by the majority of respondents.

Unlike family preservation services, programs that provided family

support services were less likely to follow a particular service-delivery

model. Programs varied greatly in terms of targeted populations and types

of family support services offered. However, according to the literature,

family support programs can be differentiated either by their

service-delivery configuration or by their service strategy. In terms of

service-delivery configuration, family support services are typically

provided in the home or in a center, such as program facilities or a school.

With respect to service strategy, programs can be differentiated by the

areas in which they focus, such as those that promote self-sufficiency or

emphasize child abuse and neglect prevention. In actuality, family support

programs are often not clearly delineated as services may be

multidisciplinary and strategies may overlap.17

17Karl Ensign, “Prevention Services in Child Welfare,” citing F. Farrow, T. Grant, and J. Meltzer,

“Challenges and Opportunities for Public Policies on Family Support and Education,” and G.C.

Christopher, “Community-Based Family Support and Education: Local Program Examples,” papers

delivered at the Colloquium on Public Policy and Family Support (1990).

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Over one-third of the family support programs provided services in the

home and just under one-third were center-based. Some characteristics of

these programs are arrayed in table II.7. The remaining programs’

populations were configured in other ways or configurations varied

depending on jurisdiction or program site.

Table II.7: Characteristics of Selected

Family Support Service-Delivery

Approaches, by Service Configuration

Service-delivery configuration

Characteristics Home-based Center-based

Number of programsa

(percent)

69

(39%)

50

(29%)

Average caseload per worker 18 cases per worker 21 cases per worker

Percent of programs using a

team approach

56% 69%

Targeted servicesb By geographic area;

parents at risk of child

abuse or neglect

c

Average duration of services 10 months 7 months

Availability of workersb c c

Minimum educational

requirementb

c c

aTotal of 175 programs.

bAs determined by the majority of respondents.

cResponses varied with no majority for any one response category.

Over one-half of the family support programs focused on one of three

service strategies—the prevention of child abuse and neglect; family

self-sufficiency; and early child development and school success. These

programs shared many common elements, as shown in table II.8.

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Table II.8: Characteristics of Selected

Family Support Service-Delivery

Approaches, by Service Strategy

Service strategy or program focus

Characteristic

Child abuse and

neglect prevention

Family

self-sufficiency

Early child

development and

school success

Number of programsa

(percent)

139

(67%)

109

(52%)

109

(52%)

Average caseload per

workerb

19 cases per worker 21 cases per worker 23 cases per worker

Percent of programs

using a team

approach

65% 69% 64%

Targeted servicesc By geographic area;

families with

children under age

5; parents at risk of

child abuse or

neglect; pregnant

teens

By geographic area;

parents at risk of

child abuse or

neglect

By geographic area;

families with

children under age

5; parents at risk of

child abuse or

neglect

Average duration of

services

9 months 8 months 10 months

Availability of workersc d d d

Location of service

deliveryc

d d d

Minimum educational

requirementc

d d d

aTotal of 208 programs; however, some programs focused on more than one area.

bOne-half or more of the respondents indicated that workers did not have cases.

cAs determined by the majority of respondents.

dResponses varied with no majority for any one response category.

Page 33 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

In this section, we present our questionnaire to state child welfare

agencies regarding child welfare service delivery before enactment of OBRA

1993. Each question includes the summary statistics and the actual

number of respondents that answered each question. In each case, we use

the format that we believe best represents the data, including frequencies,

means, and ranges.

Page 34 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

U.S. GENERAL ACCOUNTING OFFICE

Survey of States Regarding Child Welfare Service-Delivery

INTRODUCTION

The Congress has asked the U.S. General Accounting Office

(GAO) to monitor the implementation of the family

preservation and support provisions of the Omnibus Budget

Reconciliation Act of 1993 (OBRA). The Congress would

like to know how these provisions will affect children and

families. Although we will be monitoring the

implementation of this law over the next few years, the

Congress has initially asked us to provide information about

existing, or pre-OBRA 1993, delivery of state child welfare

services.

This questionnaire asks about your state’s approach for

delivering child welfare services and the role of family

preservation and support services prior to OBRA 1993.

Specifically, it asks questions about your state’s child

welfare services: the structure of service-delivery, family

preservation and support services, monitoring efforts,

implementation of OBRA 1993, and federal assistance

provided. We will not be assessing your state’s compliance

with any of the Act’s provisions. The questionnaire data

will be used to provide a nationwide picture of how states

provided services before the new law was enacted. We will

not use the data to compare service-delivery among states.

INSTRUCTIONS

The questionnaire should be answered by the person who is

most knowledgeable about your state’s delivery of child

welfare services. If this person is unable to respond to all of

the questions, he or she may wish to seek the help of others

in completing this questionnaire.

Unless otherwise directed, please answer our questions about

your state’s child welfare system as it looked before OBRA

1993, that is, prior to October 1, 1993. In addition, we ask

for some information for federal fiscal year (FFY) 1994

(October 1, 1993 through September 30, 1994). If your

records are not organized by federal fiscal year, please

respond for your state’s fiscal year 1994.

Because terms and their usage may vary across states, we

have provided a glossary of terms that we will be using in

the questionnaire. For your convenience, the glossary listing

the terms in alphabetical order is on the inside cover of this

questionnaire.

Please return your completed questionnaire in the enclosed

self-addressed, stamped envelope within 14 days after

receipt. If you should lose or misplace the stamped

envelope, please send the completed questionnaire to:

Karen Lyons

U.S. General Accounting Office

301 Howard St., Suite 1200

San Francisco, CA 94105

Or, you may fax a copy of your completed questionnaire

marked "Attention Karen Lyons" at 916-974-1202.

If you have any questions, please call Karen Lyons or

Rodina Tungol at 916-974-3341.

Please print the name and telephone number of the

individual completing this questionnaire:

Name:___________________________________________

Title: ____________________________________________

Agency: __________________________________________

Telephone number: ( )____________________________

1. Prior to October 1, 1993, which of the following types

CHILD WELFARE SERVICE-DELIVERY

of organizational structures best characterizes your

state’s agency that provided child welfare services (that

is, the Title IV-B/IV-E agency)? (CHECK ONE)

(n=50)

1. 26 Part of an umbrella agency responsible for

administering a number of human service

programs under separate management

2. 17 Part of a consolidated agency under which

several human service programs or

management functions have been integrated

3. 5 A separate or autonomous agency (SKIP TO

QUESTION 3.)

4. 2 Other (SPECIFY): _______________________

_____________________________________

(SKIP TO QUESTION 3.)

Page 35 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

2. What other types of programs served children and

families under this umbrella or consolidated agency

prior to October 1, 1993? (CHECK ALL THAT

APPLY) (n=42)

1. 2 Education

2. 24 Juvenile justice

3. 21 Drug and/or alcohol abuse

4. 27 Employment/JOBS

5. 3 Housing

6. 23 Mental health

7. 13 Maternal and child health

8. 10 Other public health

9. 29 Other (SPECIFY): ______________________

_______________________________________

3. What was your state’s primary approach for delivering

child welfare services? (CHECK ONE) (n=49)

1. 29 State-administered and state-delivered or statecontracted services

2. 12 State-supervised but county or locallydelivered/contracted services

3. 6 Combination of state and county/locallydelivered/contracted services

4. 2 Other (SPECIFY):_______________________

_______________________________________

4. Whether your state’s approach to delivering child welfare services was state or locally based, prior to October 1, 1993:

(A) Was any portion of each of the following areas of child welfare service-delivery contracted with local provider

agencies?

(B) If yes, about what proportion of services in these areas would you estimate were contracted?

(A)

Was this

contracted?

(CHECK ONE

FOR EACH)

(B)

What proportion was contracted?

(IF YES, CHECK ONE FOR EACH)

SERVICE-DELIVERY

AREA No Yes

If yes

--->

All or Almost

All

More than

Half About Half

Less than

Half

None or

Almost None

1. Direct services

(n=48)

7 41 If yes

--->

5

(n=41)

5 7 20 4

2. Case management

(n=48)

25 23 If yes

--->

1

(n=23)

1 3 13 5

3. Licensing and/or

certification (n=47)

38 9 If yes

--->

0

(n=9)

0 0 4 5

4. Other (SPECIFY):

(n=4)

_________________

_________________

-- If yes

--->

-- -- -- -- --

Page 36 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

5. During the 5 years immediately prior to OBRA 1993,

had your state developed a "Children’s Agenda" for

child and family service-delivery that applied across

state human service programs? (n=50)

1. 24 Yes

2. 26 No

6. During the 5 years immediately prior to OBRA 1993,

OBJECTIVE Yes No

1. Either initiate or expand

family preservation services

(n=50)

44 6

2. Either initiate or expand

family support services

(n=50)

39 11

3. Improve well-being for

vulnerable children and their

families, particularly those

experiencing or at-risk of

abuse and neglect (n=49)

44 5

4. Develop continuum of

comprehensive, coordinated

services (n=49)

37 12

5. Develop continuum of

culturally relevant services

(n=48)

26 22

6. Develop continuum of familyfocused services (n=47)36 11

7. Draw upon community-based

programs for design and/or

implementation of delivery of

child welfare services (n=50)

35 15

8. Other initiatives (SPECIFY)

_________________________

(n=4)

_________________________

--

were any state initiatives developed for child welfare

service-delivery to meet each of the following

objectives? (CHECK ONE FOR EACH)

7. Did you check "yes" to any part of question 6 above?

(n=49)

1. 48 Yes (CONTINUE)

2. 1 No (GO TO QUESTION 10)

8. Consider your response to question 6 related to state

initiatives for child welfare service-delivery. During

the 5 years prior to OBRA 1993, which of the

following factors served as the impetus for these state

initiatives? (CHECK ALL THAT APPLY) (n=49)

1. 33 State legislation

2. 12 Court order or consent decree

3. 16 State reorganization

4. 22 Change in leadership or vision unrelated to

improving delivery of child welfare services

5. 27 Formal planning process designed to improve

delivery of child welfare services

6. 19 State fiscal crisis or escalating costs

7. 29 Either initiation or replication of a pilot or

demonstration project

8. 3 DHHS monitoring or program review

9. 4 Other factor (SPECIFY):__________________

_____________________________________

9. Consider the state initiatives that were developed in the

last 5 years, mentioned in question 6 above. Were any

of these initiatives developed as a part of any of the

following broader issues? (CHECK ALL THAT

APPLY) (n=49)

1. 8 Welfare reform

2. 3 Health care reform

3. 14 "Reinventing Government" effort

4. 18 Child and Adolescent Services System

Planning (CASSP)

5. 26 A comprehensive strategy for child and family

services for the state

6. 11 Other broader initiative (SPECIFY):_________

____________________________________

7. 10 None of the above

Page 37 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

10. Consider the agency that provided your state’s child welfare services (Title IV-B/IV-E agency) prior to October 1, 1993.

Which of the formal arrangements listed across the top, if any, did that agency have with other state programs that provided

child and family services? (FOR EACH STATE PROGRAM, CHECK ALL THE ARRANGEMENTS THAT APPLY)

(n=51)

What type of a formal arrangement did your child welfare agency have with the other state programs?

Other State Programs

(CHECK ALL THAT APPLY)

OTHER STATE

PROGRAMS

Not

ApplicableNo Formal

Arrangements

Service

Collaboration

Service

Coordination Funds Pooled

Use Other

Program’s

Services

Service

Integration

Joint

Planning

Other

(SPECIFY)

1. Education 10 21 27 15 22 7 22 2

2. Juvenile Justice 7 24 30 19 18 13 29 8

3. Alcohol and/or

Drug Abuse

12 21 22 9 18 6 15 4

4. Employment/JOBS 13 14 22 6 20 12 13 1

5. Housing 23 7 5 1 8 1 3 0

6. Mental Health 6 29 30 23 27 13 32 3

7. Maternal and Child

Health

12 20 22 8 18 4 21 0

8. Other Public Health 14 8 17 4 18 3 12 0

9. Other program

(SPECIFY):

________________

5 2 5 2 2 3 2

Page 38 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

11. Listed below are types of services a state child welfare agency might potentially offer. (See glossary for definitions)

(A) Prior to October 1, 1993, was each a child welfare service offered by your state’s Title IV-B/IV-E agency?

(B) If yes, was each service offered statewide, that is, were services available in all counties in your state?

(C) If the service was not offered statewide, is the service moving toward being offered statewide?

CHILD WELFARE SERVICES

(A)

Did your state offer this

service?

(CHECK ONE FOR

EACH)

(B)

Was this service offered

statewide?

(CHECK ONE FOR

EACH)

(C)

Is service moving toward

being offered statewide?

(CHECK ONE FOR

EACH)

No Yes

If yes

---> Yes No

If no

---> Yes No

1. Family support services

(n=49)

11 38 If yes

---> 22

(n=38)

16 If no

---> 16

(n=16)

0

2. Family preservation services

(n=50)

3 47 If yes

---> 29

(n=46)

17 If no

---> 18

(n=18)

0

3. Child protective services

(n=50)

0 50 If yes

---> 50

(n=50)

0 If no

---> 0

(n=0)

0

4. Family foster care (n=50) 0 50 If yes

---> 50

(n=50)

0 If no

---> 0

(n=0)

0

5. Kinship foster care (n=48) 6 42 If yes

---> 41

(n=42)

1 If no

---> 0

(n=0)

0

6. Therapeutic or specialized

family foster care (n=50)

1 49 If yes

---> 33

(n=49)

16 If no

---> 16

(n=16)

0

7. Group home care (n=50) 1 49 If yes

---> 44

(n=49)

5 If no

---> 2

(n=5)

3

8. Residential treatment (n=50) 1 49 If yes

---> 44

(n=49)

5 If no

---> 3

(n=5)

2

9. Family reunification services

(n=50)

2 48 If yes

---> 43

(n=48)

5 If no

---> 5

(n=5)

0

10. Adoption services (n=50) 0 50 If yes

---> 50

(n=50)

0 If no

---> 0

(n=0)

0

11. Other permanent living

arrangements (SPECIFY):

(n=16)

_______________________

-- -- If yes

--->

--

(n=9)

-- If no

--->

--

(n=0)

--

12. Independent living services

(n=50)

1 49 If yes

---> 42

(n=49)

7 If no

---> 6

(n=6)

0

13. Aftercare services (n=44) 10 34 If yes

---> 27

(n=34)

7 If no

---> 7

(n=7)

0

14. Other child welfare services

(SPECIFY):_____________

(n=3)

_______________________

-- If yes

--->

--

(n=2)

-- If no

--->

--

(n=1)

--

Page 39 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

12. Within the context of your state Title IV-B/IV-E

FAMILY PRESERVATION AND SUPPORT

SERVICES

agency’s approach to delivering child welfare services,

were family preservation or family support services

offered prior to OBRA 1993? (CHECK ONE) (n=51)

1. 39 Both family preservation services and family

support services (CONTINUE)

2. 7 Family preservation services only (GO TO

QUESTION 15)

3. 1 Family support services only (GO TO

QUESTION 15)

4. 4 Neither family preservation nor family support

services (GO TO QUESTION 22 ON PAGE 8)

Linkages Between Family Preservation Services and

Family Support Services

13. What types of linkages existed between your state’s

delivery of family preservation services and its delivery

of family support services? (CHECK ALL THAT

APPLY) (n=39)

1. 25 Service collaboration

2. 19 Funding collaboration

3. 24 Coordination

4. 16 Integration of services

5. 22 Information sharing

6. 4 Media

7. 20 Contracting

8. 3 Other (SPECIFY):_______________________

_____________________________________

9. 9 None of the above-- delivery of family

preservation services was separate and distinct

from family support services

14. Prior to October 1, 1993, were there any linkages

between your state’s delivery of family preservation

services and its delivery of family support services in

the following areas: within your child welfare agency

(Title IV-B/IV-E), with other state programs, or with

other local level service providers? (CHECK ONE

FOR EACH)

Linkages between family preservation

services and family support services ... Yes No N/A

1. Within state child welfare agency

(n=37)

33 4 0

2. With other state programs (n=33) 22 11 0

3. With other local, community

level, child welfare service

providers (n=36)

28 6 2

4. Other (SPECIFY):

(n=0)

__________________________

__________________________

--

Guiding Principles

15. Prior to October 1, 1993, had your state established

any guiding principles for family preservation and/or

support services for vulnerable families and children?

(n=47)

1. 45 Yes (CONTINUE)

2. 2 No (GO TO QUESTION 19)

16. In which of the following types of documents, were

your state’s guiding principles for family preservation

and/or support services articulated? (CHECK ALL

THAT APPLY) (n=45)

1. 27 State law

2. 16 State regulations

3. 33 State policy

4. 37 Program or departmental instructions

5. 32 Planning or strategy document

6. 3 Other (SPECIFY): ______________________

_____________________________________

Page 40 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

17. Which of these principles were explicitly addressed in

these documents? (CHECK ALL THAT APPLY)

(n=45)

1. 44 To maintain the welfare and safety of

children

2. 45 To strengthen and preserve the family

whenever possible

3. 33 To support families in order to promote

children’s healthy development

4. 42 To focus on the family as a whole

5. 33 To make services easily accessible

6. 33 To deliver services in a manner that

respects cultural and community

differences

7. 37 To provide services that are flexible and

responsive to family needs

8. 29 To link a wide variety of supports and

services outside the child welfare system

9. 28 To provide services that are communitybased and involve community

organizations and residents in their design

and delivery

10. 39 To provide services that are intensive

enough to meet family needs and keep

children safe

11. 34 To empower families

12. 4 Other (SPECIFY):

___________________________________

___________________________________

18. Consider the principles you checked in question 17.

Please write the corresponding numbers of the five

principles that your state primarily emphasized prior to

October 1, 1993. (n=41)

1. __________

2. __________

3. __________

4. __________

5. __________

Role of Family Preservation and Support Services Within

Child Welfare Service-Delivery System

19. Consider the total funding, regardless of source, for your state’s child welfare services for the 5 years prior to OBRA 1993.

In general, did the proportion for family preservation and support services increase or decrease over that period?

Did the proportion of family preservation and support services change?

(CHECK ONE FOR EACH SERVICE)

Greatly

Increased

Somewhat

Increased

Remained

about the

same

Somewhat

Decreased

Greatly

Decreased Don’t Know

Not

Applicable--

State did not

provide

services

1. Family preservation

(n=46)

14 21 7 2 1 1 0

2. Family support

(n=46)

6 18 15 2 0 1 4

Page 41 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

20. Do you anticipate that the level of funding for family preservation services and family support services as a proportion of

total funding, regardless of source, for all child welfare services in your state will increase or decrease over the next 5 years?

(CHECK ONE FOR EACH)

SERVICE Greatly

Increase

Somewhat

Increase

Remain

the Same

Somewhat

Decrease

Greatly

Decrease Unknown

State Does

Not Provide

Service

1. Family preservation

(n=47)

11 23 10 1 0 2 0

2. Family support (n=47) 14 23 5 1 0 3 1

21. Prior to October 1, 1993, did your state place more emphasis on family preservation services or more emphasis on family

support services? (CHECK ONE) (n=43)

1. 16 Much more emphasis placed on family preservation services than family support services

2. 13 More emphasis placed on family preservation services than family support services

3. 6 About the same emphasis on each

4. 5 More emphasis placed on family support services than family preservation services

5. 2 Much more emphasis placed on family support services than family preservation services

6. 1 Not applicable-- did not offer both types of services

Strategies for Service-Delivery

22. Prior to October 1, 1993, had your state undertaken any of the following activities related to the delivery of family

preservation services and family support services? (FOR EACH TYPE OF SERVICE, CHECK ONE FOR EACH

ACTIVITY; IF SERVICE WAS NOT OFFERED, CHECK "N/A")

ACTIVITIES

Activities for Family

Preservation Services?

(CHECK ONE FOR EACH)

Activities for Family

Support Services?

(CHECK ONE FOR EACH)

N/A Yes No N/A Yes No

1. Developed new and more effective approaches

to delivering services

2

(n=51)

45 4 6

(n=44)

31 7

2. Assessed family and community needs 2

(n=50)

34 14 5

(n=44)

29 10

3. Identified child welfare service overlaps and

gaps

4

(n=49)

30 15 8

(n=43)

22 13

4. Identified available resources 2

(n=49)

38 9 7

(n=44)

27 10

5. Established linkages with community-based

organizations

1

(n=49)

35 13 6

(n=44)

32 6

6. Developed strategies for blended financing 3

(n=49)

23 23 6

(n=45)

20 19

7. Developed common application forms 3

(n=48)

5 40 10

(n=44)

6 28

8. Simplified case management procedures 5

(n=48)

12 31 9

(n=44)

6 29

9. Evaluated or reviewed program to determine

effectiveness

2

(n=48)

34 12 6

(n=43)

18 19

10. Other (SPECIFY):_______________ n=0 n=0

Page 42 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

23. During the past five years,:

(A) Did your state identify a need to change its degree of emphasis on policies regarding family preservation and support

services? (CHECK ONE FOR EACH; IF STATE DID NOT PROVIDE SERVICE, CHECK "N/A")

(B) If yes, was more or less emphasis on each service needed?

(C) Were any steps taken to change this degree of emphasis prior to October 1, 1993?

SERVICE

(A)

Identified need to change

emphasis over last 5 years?

(CHECK ONE FOR EACH)

(B)

What change in degree of emphasis was needed?

(IF YES, CHECK ONE FOR EACH)

(C)

Steps taken

to change

emphasis?

N/A No Yes

If yes

--->

Much more

emphasis was

needed

Somewhat more

emphasis was

needed

Somewhat less

emphasis was

needed

Much less

emphasis was

needed

Yes No

1. Family support

(n=50)

7 7 36 If yes

--->

25

(n=36)

11 0 0 29

(n=

35

6

2. Family preservation

(n=51)

2 3 46 If yes

--->

28

(n=46)

17 1 0 40

(n=

42)

2

24. Prior to October 1, 1993, how, if at all, were family preservation services or family support services targeted? (FOR EACH

TYPE OF SERVICE, CHECK ONE FOR EACH METHOD OF TARGETING; IF SERVICE WAS NOT OFFERED,

CHECK "N/A")

TARGETING

Targeting for family

preservation services?

(CHECK ONE FOR EACH)

Targeting for family support

services?

(CHECK ONE FOR EACH)

N/A Yes No N/A Yes No

1. At county or locality discretion 5

(n=45)

29 11 9

(n=43)

27 7

2. At selected locations 6

(n=45)

29 10 9

(n=41)

24 8

3. By client population 4

(n=48)

38 6 9

(n=41)

25 7

4. To support collaborative, communitybased service-delivery strategies7

(n=43)

21 15 9

(n=42)

23 10

5. Other (SPECIFY):_______________

______________________________

--

(n=1)

-- -- --

(n=1)

-- --

Goals, Monitoring, and Evaluation for Family

Preservation Services

25. Prior to October 1, 1993, did your state’s IV-B/IV-E

agency offer family preservation services? (n=51)

1. 48 Yes (CONTINUE)

2. 3 No (GO TO QUESTION 32 ON PAGE 13)

Page 43 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

26. Prior to October 1, 1993, was each of the following a stated goal for your state’s family preservation services? If yes,

overall, how successful, if at all, was your state in meeting that goal?

STATED GOAL

(A)

A goal of your state?

(CHECK ONE FOR

EACH)

(B)

Overall, how successful in meeting goal?

(IF YES, CHECK ONE FOR EACH)

No Yes

If yes

--->

Very

Successful

Somewhat

Successful

About as

Successful as

Unsuccessful

Somewhat

Unsuccessful

Very

Unsuccessful

1. Help children at risk of foster care

placement remain with their families

2

(n=47)

45 If yes

---> 22

(n=42)

16 4 0 0

2. Prevent children from reentering an

out-of-home placement after they

have been reunited with their families

13

(n=47)

34

If yes

--->

9

(n=30)

17 4 0 0

3. Reunite children with their families 8

(n=47)

39 If yes

---> 10

(n=36)

20 5 1 0

4. Help children who cannot be reunited

with their families to be placed for

adoption, with a legal guardian, or

some other planned, permanent living

arrangement

27

(n=47)

20

If yes

--->

3

(n=19)

12 2 2 0

5. Provide respite care for parents and

other caregivers, including foster

parents

33

(n=47)

14

If yes

--->

2

(n=14)

7 3 2 0

6. Improve parenting skills 10

(n=46)

36 If yes

---> 10

(n=36)

22 4 0 0

7. Other goals (SPECIFY):___________

_______________________________

(n=1) If yes

--->

--

(n=1)

-- -- -- --

27. 1. In the 5 years immediately prior to OBRA 1993,

how was progress towards accomplishing these

goals for family preservation services (listed in

the preceding question) primarily monitored?

(CHECK ALL THAT APPLY) (n=45)

2. 6 U.S. Census Bureau or other published data

sources

2. 29 Periodic progress reports prepared by program

staff

3. 29 Internal program review

4 6 DHHS monitoring or program review

5 11 External program review

6 20 External program evaluation

7 17 Computerized management information systems

8. 20 Use of indicators to measure outcomes

9. 16 Client surveys

10. 6 Other (SPECIFY): ______________________

______________________________________

11. 5 Progress not monitored prior to October 1,

1993 (GO TO QUESTION 32 ON PAGE 13)

28. Of the methods you checked in question 27, please

write the corresponding numbers of the two your state

relied on most to monitor progress towards its goals in

the 5 years before OBRA 1993. (n=40)

1. __________

2. __________

Page 44 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

29. Prior to October 1, 1993, did your state use each of the following indicators to measure the progress of its family

preservation services in accomplishing its goals? If yes, how useful, if at all, was each in measuring the progress towards

these goals?

Did state

use

indicator?

If used, how useful, if at all, was each

indicator?

(IF YES, CHECK ONE FOR EACH)

No Yes

If yes

--->

Very

Useful

Moderately

Useful

Somewhat

useful

Not At All

Useful

Systems Indicators

1. Caseloads (n=42) 13 29 6 (n=27) 14 7 0

2. Expenditures (n=41) 8 33 6 (n=31) 12 12 1

Communitywide Indicators

3. Child abuse and neglect reports

(n=39)

16 23 6 (n=20) 10 4 0

4. Poverty indicators (n=40) 31 9 3 (n=8) 2 3 0

5. Number of births (n=41) 37 4 0 (n=3) 1 2 0

6. Childhood mortality (n=40) 37 3 0 (n=2) 1 1 0

Service-delivery Indicators

7. Staffing (n=42) 17 25 4 (n=23) 13 6 0

8. Amount of training (n=39) 24 15 3 (n=15) 8 4 0

9. Cases per worker (n=42) 15 27 8 (n=25) 10 6 1

10. Timeliness (n=41) 18 23 7 (n=21) 6 8 0

Family Indicators

11. Parent-child relationships

(n=38)

23 15 6 (n=12) 3 3 0

12. Family satisfaction (n=40) 22 18 7 (n=17) 7 3 0

13. Family functioning (n=38) 16 22 7 (n=19) 10 2 0

Child Indicators

14. Child’s well-being (n=40) 19 21 7 (n=15) 7 1 0

15. Child’s development (n=40) 32 8 6 (n=7) 0 1 0

16. School performance or

readiness (n=39)

32 7 5 (n=6) 1 0 0

Cost, Success and Other Indicators

17. Cost effectiveness (n=42) 11 31 7 (n=28) 9 8 4

18. Correlates of success (program

or client characteristics that

affect likelihood of success)

(n=39)

24 15 3 (n=12) 6 3 0

19. Other indicator (SPECIFY):

(n=8)

-- -- (n=7) -- -- --

20. Other indicator (SPECIFY):

(n=1)

-- -- (n=2) -- -- --

Page 45 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

30. In addition to monitoring its progress in accomplishing your state’s goals for family preservation services, in which of the

following ways did your state primarily use the results from its monitoring efforts? (CHECK ONE FOR EACH)

USES FOR MONITORING Yes No

1. To identify training needs (n=39) 31 8

2. To identify technical assistance needs (n=39) 32 7

3. To assist in program development (n=42) 38 4

4. To identify areas needing a change in emphasis

(n=37)

29 8

5. To identify gaps in service-delivery (n=38) 31 7

6. To document program effectiveness (n=40) 35 5

7. To identify areas for further study (n=37) 22 15

8. Other uses for monitoring

(SPECIFY):____________________

(n=3)

______________________________

--

31. The following is a list of activities that a state might have undertaken to measure the progress of its family preservation

services in accomplishing its goals. Prior to October 1, 1993, did your state find this activity easy or difficult to carry out?

ACTIVITIES

How easy or difficult to do?

(CHECK ONE FOR EACH)

N/A

Very

Easy

Somewhat

Easy

Neither

Easy Nor

Difficult

Somewhat

Difficult

Very

Difficult

1. Defining measurable outcomes

(n=42)

2 3 10 5 11 11

2. Selecting appropriate indicators

(n=42)

2 1 9 2 20 8

3. Identifying appropriate data

sources (n=42)

2 3 8 10 14 5

4. Collecting useful and complete

data (n=42)

1 1 3 8 14 15

5. Measuring cost effectiveness

(n=41)

3 1 6 6 13 12

6. Identifying correlates of success

(program or client characteristics

that affect likelihood of success)

(n=42)

8 1 4 4 11 14

7. Other (SPECIFY):

(n=1)

___________________________

___________________________

-- -- -- -- --

Page 46 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

Goals, Monitoring, and Evaluation for Family Support

Services

32. Prior to October 1, 1993, did your state offer family

support services? (n=50)

1. 38 Yes (CONTINUE)

2. 12 No (GO TO QUESTION 39 ON PAGE 17)

33. Prior to October 1, 1993, was each of the following a stated goal for your state’s family support services? If yes, overall,

how successful, if at all, was your state in meeting that goal?

STATED GOAL

(A)

A goal of your state?

(CHECK ONE FOR

EACH)

(B)

Overall, how successful in meeting goal?

(IF YES, CHECK ONE FOR EACH)

No Yes

If yes

--->

Very

Successful

Somewhat

Successful

About as

Successful as

Unsuccessful

Somewhat

Unsuccessful

Very

Unsuccessful

1. Provide information and referral

services (n=37)

9 28 If yes

---> 4

(n=26)

19 2 1 0

2. Assess children’s early developmental

needs (n=35)

17 18 If yes

---> 2

(n=15)

10 1 2 0

3. Strengthen parent-child relationships

(n=37)

2 35 If yes

---> 2

(n=31)

22 7 0 0

4. Improve parenting skills (n=36) 2 34 If yes

---> 3

(n=30)

19 7 1 0

5. Provide respite care for parents and

other caregivers (n=36)

14 22

If yes

--->

2

(n=19)

11 4 1 1

6. Improve family functioning (n=35) 3 32 If yes

---> 2

(n=30)

20 8 0 0

7. Promote family self-sufficiency

(n=37)

8 29 If yes

---> 2

(n=26)

18 6 0 0

8. Provide families with opportunities to

interact with other families and

program staff (n=37)

17 20 If yes

---> 3

(n=18)

13 2 0 0

9. Connect families with and encourage

use of other community supports and

services (n=36)

6 30 If yes

---> 4

(n=28)

19 4 1 0

10. Prevent out-of-home placement

(n=35)

9 26 If yes

---> 6

(n=24)

11 3 4 0

11. Prevent child abuse and neglect

(n=36)

2 34 If yes

---> 4

(n=31)

17 7 3 0

12. Other goals (SPECIFY):___________

(n=1)

_______________________________

-- If yes

---> --

(n=1)

-- -- -- --

Page 47 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

34. In the 5 years immediately prior to OBRA 1993, how

was progress towards accomplishing these goals for

family support services (listed in the preceding

question) primarily monitored? (CHECK ALL THAT

APPLY) (n=37)

1. 4 U.S. Census Bureau or other published data

sources

2. 21 Periodic progress reports prepared by program

staff

3. 20 Internal program review

4. 5 DHHS monitoring or program review

5. 10 External program review

6. 7 External program evaluation

7. 12 Computerized management information systems

8. 8 Use of indicators to measure outcomes

9. 8 Client surveys

10. 3 Other (SPECIFY):_______________________

_____________________________________

11. 8 Progress was not monitored prior to October 1,

1993 (GO TO QUESTION 39 ON PAGE 17)

35. Of the methods you checked in question 34, please

write the corresponding numbers of the two your state

relied on most to monitor progress towards its goals in

the 5 years before OBRA 1993. (n=27)

1. __________

2. __________

Page 48 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

36. Prior to October 1, 1993, did your state use each of the following indicators to measure the progress of its family support

services in accomplishing its goals? If yes, how useful, if at all, was each in measuring the progress towards these goals?

Did state

use

indicator?

If used, how useful, if at all, was each

indicator?

(IF YES, CHECK ONE FOR EACH)

No Yes

If yes

--->

Very

Useful

Moderately

Useful

Somewhat

useful

Not At All

Useful

Systems Indicators

1. Caseloads (n=29) 13 16 0 (n=16) 6 10 0

2. Expenditures (n=29) 12 17 0 (n=16) 6 10 0

Communitywide Indicators

3. Child abuse and neglect reports

(n=29)

12 17 3 (n=16) 4 9 0

4. Poverty indicators (n=28) 20 8 0 (n=8) 4 4 0

5. Number of births (n=28) 21 7 1 (n=7) 3 3 0

6. Childhood mortality (n=28) 21 7 1 (n=6) 2 3 0

Service-delivery Indicators

7. Staffing (n=29) 14 15 0 (n=15) 6 9 0

8. Amount of training (n=29) 18 11 1 (n=11) 3 7 0

9. Cases per worker (n=29) 19 10 1 (n=10) 6 3 0

10. Timeliness (n=29) 18 11 0 (n=10) 5 5 0

Family Indicators

11. Parent-child relationships

(n=29)

14 15 2 (n=14) 6 6 0

12. Family satisfaction (n=27) 15 12 3 (n=11) 4 3 1

13. Family functioning (n=29) 13 16 2 (n=15) 6 7 0

Child Indicators

14. Child’s well-being (n=28) 12 16 4 (n=15) 5 6 0

15. Child’s development (n=27) 18 9 3 (n=8) 2 3 0

16. School performance or

readiness (n=27)

18 9 3 (n=8) 1 4 0

Cost, Success and Other Indicators

17. Cost effectiveness (n=28) 17 11 1 (n=10) 2 7 0

18. Correlates of success (program

or client characteristics that

affect likelihood of success)

(n=26)

18 8 2 (n=7) 1 4 0

19. Other indicator (SPECIFY):

(n=4)

-- -- (n=3) -- -- --

20. Other indicator (SPECIFY):

(n=2)

-- -- (n=1) -- -- --

Page 49 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

37. In addition to monitoring its progress in accomplishing your state’s goals for family support services, in which of the

USES FOR MONITORING Yes No

1. To identify training needs (n=27) 15 12

2. To identify technical assistance needs (n=26) 19 7

3. To assist in program development (n=28) 24 4

4. To identify areas needing a change in emphasis

(n=28)

22 6

5. To identify gaps in service-delivery (n=27) 20 7

6. To document program effectiveness (n=27) 20 7

7. To identify areas for further study (n=26) 12 14

8. Other uses for monitoring

(SPECIFY):____________________

(n=2)

______________________________

--

following ways, if any, did your state primarily use the results from its monitoring efforts? (CHECK ONE FOR EACH)

38. The following is a list of activities that a state might have undertaken to measure the progress of its family support services

in accomplishing its goals. Prior to October 1, 1993, did your state find this activity easy or difficult to carry out?

ACTIVITIES

How easy or difficult to carry out?

(CHECK ONE FOR EACH)

N/A

Very

Easy

Somewhat

Easy

Neither

Easy Nor

Difficult

Somewhat

Difficult

Very

Difficult

1. Defining measurable outcomes

(n=28)

5 0 4 3 6 10

2. Selecting appropriate indicators

(n=28)

4 0 5 3 8 8

3. Identifying appropriate data

sources (n=28)

3 0 3 9 6 7

4. Collecting useful and complete

data (n=28)

3 1 1 4 8 11

5. Measuring cost effectiveness

(n=28)

4 0 3 4 10 7

6. Identifying correlates of success

(program or client characteristics

that affect likelihood of success)

(n=28)

6 0 3 4 6 9

7. Other (SPECIFY):

(n=0)

___________________________

___________________________

-- -- -- -- --

Page 50 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

39. As your state implements OBRA 1993, what

IMPLEMENTATION OF OBRA 1993

proportion of your state’s fiscal year 1994 allocation

will be spent on planning and providing services?

(ENTER PERCENTAGE; IF NONE, ENTER ’O’)

1. Planning (n=41) Range=0-100

Mean=69 %

2. Family preservation services (n=24) Range=0-67

Mean=23 %

3. Family support services (n=24) Range=0-81

Mean=25 %

4. Other (training and technical assistance

for service-delivery, administrative Range=0-100

costs, etc.) (n=24) Mean=13 %

TOTAL 100 %

5. 10 Proportions will not be known until the state

completes its 5-year plan prior to June 30,

1995.

40. Does your state plan to pass through any of its fiscal

year 1994 allocation for family preservation and

support services to community-based organizations?

(CHECK ONE) (n=47)

1. 19 Yes, funds will be passed-through for both

family preservation and support services

2. 1 Yes, funds will be passed through for family

preservation services only

3. 3 Yes, funds will be passed through for family

support services only

4. 15 No, FY94 funds will not be passed-through for

either kind of services

5. 9 Unknown--pass-throughs, if any, will not be

known until the state completes its 5-year plan

prior to June 30, 1995.

41. Consider the amount of your state’s current funding

level plus its OBRA 1993 allocation, excluding any

applicable state match. In FFY 1994, will your state

add any resources over and above this amount to fund

its strategic planning activities or family preservation

and support services? (CHECK ONE) (n=50)

1. 11 Yes, both strategic planning activities and

family preservation and support services

2. 2 Strategic planning activities only

3. 8 Both family preservation and support services

only

4. 2 Family preservation services only

5. 2 Family support services only

6. 6 Neither strategic planning activities nor family

preservation and support services

7. 19 Don’t know

Page 51 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

42. Listed below are activities which states could conduct to implement the family preservation and support provisions of OBRA

1993. How easy or difficult is each activity for your state to conduct? (CHECK ONE FOR EACH; IF STATE NEED NOT

DO THE ACTIVITY, CHECK "N/A")

ACTIVITIES

Is activity easy or difficult to conduct?

(CHECK ONE FOR EACH)

N/A

Very

Easy

Somewhat

Easy

Neither

Easy Nor

Difficult

Somewhat

Difficult Difficult

1. Identify the major stakeholders (n=49) 0 17 25 4 2 1

2. Coordinate with the various state and

local public child-serving agencies (n=49)

0 1 23 6 16 3

3. Coordinate with Indian tribes (n=49) 15 3 13 3 9 6

4. Consult with community groups (n=49) 0 5 24 8 10 2

5. Consult with consumers (n=49) 0 2 9 14 19 5

6. Recruit and retain qualified staff (n=48) 5 2 8 10 17 6

7. Train staff (n=49) 6 2 9 16 14 2

8. Conduct a needs assessment (n=49) 1 2 12 19 11 4

9. Establish baseline and trend information

(n=48)

0 3 6 10 21 8

10. Describe the nature and scope of public

and private family preservation and

support services (n=49)

0 2 14 11 17 5

11. Establish outcome-based, measurable

goals (n=48)

0 1 4 9 26 8

12. Monitor progress in accomplishing goals

(n=49)

0 1 5 17 19 7

13. Design and conduct evaluations (n=48) 0 1 3 11 27 6

14. Decide how to target funding (n=49) 0 2 6 14 17 10

15. Fund state’s share of family preservation

and support services under OBRA 1993

that is, fund the state match, if applicable

(n=47)

1 7 8 17 9 5

16. Other activities (DESCRIBE)

(n=2)

-- -- -- -- --

Page 52 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

43. Listed below are conditions which could affect a state’s ability to implement the family preservation and support provisions

of OBRA 1993.

To what extent, if any, will each condition hinder your state’s ability to implement the family preservation and support

provisions of OBRA 1993?

CONDITIONS

To what extent condition hinders?

(CHECK ONE FOR EACH)

N/A

Very Great

Extent

Great

Extent

Moderate

Extent

Some

Extent

Little or

No

Extent

a. State legislation must be enacted in

order to implement OBRA 1993

and state’s 5-year plan (n=49)

23 1 1 3 3 18

b. Competition within the state exists

for limited funding (n=50)

2 12 18 8 9 1

c. Federal funding streams are

categorical (n=50)

0 21 9 14 4 2

d. Other conditions (DESCRIBE)

(n=6)

-- -- -- -- --

44. Of the activities you checked in question 42 and the conditions in question 43, please write the corresponding

numbers/letters of the three activities/conditions that will be most difficult for your state to conduct/address and will most

hinder your state’s implementation of OBRA 1993. (n=41)

1. ________ 2. ________ 3. ________

45. For each of the three difficulties/hindrances that you identified in the preceding question, if any, please describe your state’s

strategy for addressing them.

1. Strategy for activity/condition #1: (n=43)

14 Unknown

2. Strategy for activity/condition #2: (n=42)

18 Unknown

3. Strategy for activity/condition #3: (n=40)

13 Unknown

Page 53 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

DHHS ASSISTANCE

46. In implementing OBRA 1993, has DHSS provided more or less than enough of each of the following types of assistance?

(CHECK ONE FOR EACH)

TYPE OF ASSISTANCE

How much is DHHS meeting your state’s OBRA 1993 planning needs?

Much More

Than Enough

More Than

Enough Enough

Less Than

Enough

Much Less

Than Enough

1. Training (n=49) 1 5 30 12 1

2. Technical assistance (n=49) 0 12 27 8 2

3. Regulation and guidelines (n=50) 1 8 25 11 5

4. Dissemination of information, such

as program models, research results,

and best practices (n=49)

2 7 30 7 3

5. Program evaluation, including

technical assistance for conducting

state or local evaluations (n=50)

0 2 10 28 10

6. Joint planning (n=50) 0 8 33 9 0

7. Other areas (SPECIFY)

(n=5)

____________________

____________________

-- -- -- -- --

47. Compared to DHHS assistance provided to your state before OBRA 1993, is DHHS assistance currently better or worse?

TYPE OF ASSISTANCE

How does DHHS assistance in implementing OBRA compare to preOBRA 1993? (CHECK ONE FOR EACH)

Much Better

Somewhat

Better

About the

Same

Somewhat

Worse Much Worse

1. Training (n=50) 7 22 20 1 0

2. Technical assistance (n=50) 12 21 15 2 0

3. Regulation and guidelines (n=50) 7 16 23 3 1

4. Dissemination of information, such

as program models, research results,

and best practices (n=49)

9 22 17 1 0

5. Program evaluation, including

technical assistance for conducting

state or local evaluations (n=49)

3 12 30 4 0

6. Joint planning (n=50) 11 20 17 2 0

7. Other areas (SPECIFY)

(n=2)

____________________

____________________

-- -- -- -- --

Page 54 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

48. In implementing OBRA 1993, how involved, if at all,

has the DHHS regional office staff been in your state’s

planning process thus far? (CHECK ONE) (n=51)

1. 23 Very involved

2. 21 Moderately involved

3. 6 Somewhat involved

4. 1 Not involved

49. How satisfied, if at all, are you with the level of

involvement of DHHS regional office staff in your

state’s planning process thus far? (CHECK ONE)

(n=51)

1. 22 Very satisfied

2. 19 Generally satisfied

3. 8 As satisfied as dissatisfied

4. 2 Generally dissatisfied

5. 0 Very dissatisfied

50. Consider your responses to the preceding four questions related to your level of satisfaction with the extent of involvement

and assistance provided by DHHS office staff in your state’s planning process and implementation plans.

Please comment in the space below on the quality of DHHS assistance since October 1, 1993. What factors did you

consider when making your assessment? How does DHHS assistance compare to pre-OBRA 1993? What is DHHS doing

well? Where there is a need for improvement, how can DHHS better meet your state’s needs? (n=42)

COMMENTS

51. Please provide below any additional information about your state’s approach to delivering child welfare services-- such as

information about creative or innovative strategies for delivering, funding, coordinating, or evaluating services. (n=23)

Page 55 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

52. Please provide below any information that you would like the Congress to consider in monitoring and evaluating the impact

of the family preservation and support provisions of OBRA 1993. (n=25)

Thank you for completing our questionnaire.

Page 56 GAO/HEHS-95-112 Family Preservation and Support
Appendix III 

GAO Questionnaire to State Child Welfare

Agencies

GLOSSARY

Child welfare services are services that protect the welfare

of children. Such services encompass a broad range of

activities, including child protection, care of the homeless

and neglected, child social and nutritional development, and

out-of-home care. In addition to family preservation and

family support services, child welfare services include:

child protective services for children who are the

subject of an alleged or substantiated report of child

abuse or neglect. Services may include the receipt,

investigation, and substantiation of maltreatment

reports, direct services and/or service referrals,

assistance related to court proceedings, case

management, and case planning.

family foster care involving the removal of children

from their homes and placement with a foster family.

kinship foster care involving the removal of children

from their homes and placement within the homes of

relatives.

therapeutic or specialized family foster care for

children who are placed in foster family homes as an

alternative to group homes or residential treatment.

Specialized foster parents receive additional support

and are trained to handle the types of problems they

are likely to encounter when caring for children with

special needs.

group home care involving the removal of children

from their homes and placement in a foster care setting

where they receive 24-hour care by paid staff.

Facilities encompass such settings as emergency

shelters, receiving homes, and group homes.

residential treatment involving the removal of

primarily youths from their homes and placement in a

residential facility where they are taught skills and

provided specialized treatment. The youths who are

placed into residential treatment often exhibit multiple

behavior problems, such as poor school performance,

substance abuse, delinquency, and early unprotected

sexual activity.

family reunification services designed to help reunite

families who have had children removed from their

homes and placed into foster care.

adoption services associated with helping a child to

secure an adoptive home and includes assistance

related to terminating parental rights and recruitment

and evaluation of prospective adoptive parents.

independent living services designed to help prepare

youths who would eventually be emancipated from the

foster care system. Services generally fall into the

categories of basic skills training (money management,

health, food and nutrition), education (GED and

college preparation), and employment (job training and

placement).

aftercare services after children leave foster care in

order to prevent their reentry into foster care.

Family preservation services are typically designed to help

families (including adoptive and extended 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. This

definition appears in the family preservation and support

provisions of the Omnibus Budget Reconciliation Act of

1993.

Most family preservation services are tailored to the family’s

needs to help ameliorate the underlying causes of

dysfunction while the child remains at home. The intensity,

duration, and packaging of services differentiates family

preservation programs from the traditional delivery of

children’s services.

Family support services are primarily community-based

preventive activities designed to promote the well-being of

children and families. Services are designed to (1) increase

the strength and stability of families (including adoptive,

foster, and extended 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. This

definition appears in the family preservation and support

provisions of the Omnibus Budget Reconciliation Act of

1993.

Community-based family support services include: (1) inhome visits, parent support groups, and other programs

designed to improve parenting skills; (2) respite care; (3)

structured activities to strengthen the parent-child

relationship; (4) drop-in centers to enable families to

informally interact with other families and with program

staff; (5) information and referral services; and (6) early

developmental screening of children.

Page 57 GAO/HEHS-95-112 Family Preservation and Support
Appendix IV 

GAO Questionnaire to FPS Program

Administrators

In this section, we present our questionnaire to state-affiliated FPS program

administrators regarding FPS services before enactment of OBRA 1993. Each

question includes the summary statistics and the actual number of

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

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

ranges.

Page 58 GAO/HEHS-95-112 Family Preservation and Support
Appendix IV 

GAO Questionnaire to FPS Program

Administrators

U. S. General Accounting Office

Survey of State Family Preservation and Support Programs

INTRODUCTION

The Congress has asked the U.S. General Accounting Office

(GAO) to monitor the implementation of the family

preservation and support provisions of the Omnibus Budget

Reconciliation Act of 1993 (OBRA). The Congress would

like to know how these provisions will affect children and

families. Although we will be monitoring the

implementation of this law over the next few years, the

Congress has initially asked us to provide information about

existing, or pre-OBRA 1993, family preservation and

support programs.

As part of this effort, we are conducting a survey of all

family preservation and support programs in the United

States that are under the auspices of a state government (that

is, administered by, operated by, or otherwise affiliated with

a state child-serving agency) and which operated before

OBRA 1993. Your program was identified as such a

program by your state’s child welfare agency. We will not

be assessing compliance with any of the Act’s provisions.

The survey data will be used to provide a nationwide picture

of state family preservation and support programs as they

looked before the new law was enacted. We will not use

the data to compare programs among states.

This questionnaire asks about your program’s family

preservation and/or family support services. Specifically, it

asks about your program’s history and administration,

program specifications, staffing, goals, funding, and

experiences with monitoring and evaluation.

INSTRUCTIONS

Please complete this questionnaire for the program

named on the label affixed above.

This questionnaire should be completed by the person who is

most knowledgeable about your program’s family

preservation or support services. If this person is unable to

respond to all of the questions, he/she may wish to seek the

help of others in completing this questionnaire

If your program provided only family preservation or

only family support services, you will need to complete

only half of the questionnaire. Otherwise, if your

program provided both services, we ask that you

complete the entire questionnaire.

Unless otherwise directed, please answer our questions about

your program as it looked before OBRA 1993, that is, prior

to October 1, 1993. Some questions ask for information by

federal fiscal year (FFY) 1993 (October 1, 1992 through

September 30, 1993). If your records are not organized by

federal fiscal year, please respond for your state’s fiscal year

1993.

Because some terms and their usage may vary across

programs, we have provided a glossary of terms that we will

be using in the questionnaire. For your convenience, the

glossary, listing the terms in alphabetical order, is on the

inside cover of this questionnaire.

Please return your completed questionnaire in the enclosed

self-addressed, stamped envelope within 14 days after

receipt. If you should lose or misplace the stamped

envelope, please send the completed questionnaire to:

Karen Lyons

U.S. General Accounting Office

301 Howard St., Suite 1200

San Francisco, CA 94105

Or, you may fax a copy of your completed questionnaire

marked "Attention Karen Lyons" at 916-974-1202. If you

have any questions, please call Karen Lyons or Rodina

Tungol at 916-974-3341.

Thank you for your assistance.

Please print the name, title, agency, and telephone

number of the individual completing this questionnaire:

n=352

Name:____________________________________________

Title: ____________________________________________

Agency: __________________________________________

Telephone number: ( )______________________________

Page 59 GAO/HEHS-95-112 Family Preservation and Support
Appendix IV 

GAO Questionnaire to FPS Program

Administrators

1. Prior to October 1, 1993, did your program provide

PROGRAM INFORMATION

either family preservation or family support services ?

(See glossary for definitions.) (CHECK ONE) n=381

1. 31% Both family preservation and family support

services

2. 21% Family preservation services only

3. 34% Family support services only

4. 14% Neither family preservation nor family support

services--->(STOP! PLEASE RETURN

QUESTIONNAIRE.)

2. Was this program either administered or operated by

(for) a state agency prior to October 1, 1993? n=320

1. 87% Yes (CONTINUE)

2. 13% No (STOP! PLEASE RETURN

QUESTIONNAIRE.)

3. Prior to October 1, 1993, did your program provide

FAMILY PRESERVATION SERVICES

family preservation services? n=269

1. 66% Yes

2. 34% No (GO TO QUESTION 53 ON PAGE 14)

History and Administration of Family Preservation

Services

4. In what month and year did your program begin

providing family preservation services? (ENTER

MONTH AND YEAR) n=168

______________________

MONTH/YEAR

5. Prior to October 1, 1993, under what authority did your

program of family preservation services operate?

(CHECK ALL THAT APPLY) n=171

1. 25% Adoption Assistance and Child Welfare Act of

1980 (P.L. 96-272)

2. 14% Child Abuse Prevention and Treatment Act

3. 11% Other federal legislation (SPECIFY NAME

OF LAW):

__________________________________

4. 39% State legislation which specifically authorized

your program

5. 10% Other state legislation

6. 36% State regulation or administrative decision

7. 18% Other authority (SPECIFY):

_____________________________________

_____________________________________

6. What type of state agency was responsible for

administrative oversight of your program’s family

preservation services? (CHECK ALL THAT APPLY)

n=179

1. 74% Child welfare

2. 3% Education

3. 11% Juvenile justice

4. 19% Mental health

5. 3% Maternal and child health

6. 1% Other public health

7. 18% Other (SPECIFY):_______________________

______________________________________

7. What type of agency had primary responsibility for the

day-to-day provision of your program’s family

preservation services ? (CHECK ONE) n=167

1. 23% State public agency

2. 15% Local public agency

3. 23% Community-based organization

4. 29% Other private organization under contract with

a state or local public agency

5. 4% No primary agency-- type of agency varied by

jurisdiction or program site

6. 6% Other type of agency (SPECIFY):__________

______________________________________

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Administrators

8. As of October 1, 1993, was your program a state-wide

program, that is, were family preservation services

available in all counties in your state? n=177

1. 34% Yes (GO TO QUESTION 11)

2. 66% No (CONTINUE)

9. Is your program of family preservation services moving

toward becoming a state-wide program? n=116

1. 60% Yes

2. 40% No

10. As of October 1, 1993, in about what percent of the

counties in your state did your program provide family

preservation services? (ENTER NUMBER) n=97

Range=0-100 % of counties in state

Mean=30.42

11. As of October 1, 1993, what was the status of your

program’s family preservation services? (CHECK

ONE) n=178

1. 11% A pilot or demonstration project

2. 17% A partially implemented program---> When is

full implementation anticipated?

MONTH/YEAR: ___________________

3. 67% A fully implemented program

4. 1% Discontinued or no longer operating as a

distinct program

5. 4% Other (SPECIFY)_______________________

______________________________________

Program Specifications for Family Preservation Services

12. Prior to October 1, 1993, what criteria did children and

families meet to receive family preservation services

from your program? (CHECK ALL THAT APPLY)

n=179

1. 74% Child must be in imminent risk of either initial

or continued out-of-home placement

2. 39% Child is being considered for out-of-home

placement, but is not at imminent risk

3. 1% Both parents must be living at home

4. 19% At least one parent must be living at home

5. 3% Income must not exceed a specific amount

6. 8% Court or court-appointed body must approve

family’s participation

7. 48% Referral must be made by a public childservice agency

8. 20% Program is available to anyone requesting

family preservation services

9. 31% Other (SPECIFY): ______________________

_____________________________________

13. What types of populations, if any, were specifically

excluded from receiving family preservation services

from your program? (CHECK ALL THAT APPLY)

n=179

1. 6% Sexual abuse cases

2. 3% Substance abuse cases

3. 25% Involuntary clients

4. 3% Absent parent families

5. 4% Homeless families

6. 10% Other (SPECIFY):_______________________

______________________________________

7. 74% No specific populations were excluded as long

as the eligibility requirements were met

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14. What types of family preservation services did your

program offer? (CHECK ALL THAT APPLY)

n=179

1. 88% Parenting education

2. 42% Parent or in-home aide

3. 37% Child care (daycare for young children,

before and after school, respite)

4. 28% Aftercare services

5. 35% Services after completing participation in

family preservation program

6. 16% Job training or readiness

7. 40% Emergency financial assistance

8. 21% Housing

9. 63% Transportation

10. 79% Counseling (clinical, family, group)

11. 24% Substance abuse treatment

12. 78% Client advocacy

13. 86% Service referral

14. 45% Mental health services

15. 27% Health services

16. 31% Other types of family preservation

services offered (SPECIFY):

_________________________________

15. Which of the following best characterized the service

delivery model used by your program to provide family

preservation services? (See glossary for definitions.)

(CHECK ONE) n=169

1. 30% Crisis intervention technique, similar to

the Behavioral Science Institute’s

"Homebuilders" approach

2. 16% Family systems technique, similar to the

"FAMILIES" approach originated in Iowa

3. 5% Therapeutic family treatment, similar to

the "Intensive Family Services Program"

in Oregon

4. 22% Service delivery model varied by

jurisdiction or program site

5. 27% Other service delivery model

(SPECIFY):____

______________________________________

16. What was the recommended average number of cases

for a family preservation worker to have at any one

time during FFY 1993? (ENTER NUMBER OF

CASES) n=129

Range=2-150 cases per worker

Mean=9.37

(n=32) Not Applicable-- workers did not have cases

17. Were family preservation services provided using a

team approach? n=177

1. 66% Yes (CONTINUE)

2. 34% No (GO TO QUESTION 19)

18. What types of workers usually formed the team?

(CHECK ALL THAT APPLY) n=117

1. 62% Caseworker

2. 38% Program administrator

3. 51% Therapist

4. 41% Counselor

5. 51% Social worker

6. 32% Teacher

7. 27% Other parent(s)

8. 56% Other

(SPECIFY):_______________________

_____________________________________

19. What was the recommended average number of months

for a family to receive family preservation services at

any one time during FFY 1993? (ENTER NUMBER

OF MONTHS) n=141

Range=1.0-24.0 months per family in program

Mean=4.73

20. Prior to October 1, 1993, at what time(s) were workers

available to work with clients needing family

preservation services? (CHECK ONE) n=167

1. 2% By appointment only

2. 8% During regular business hours

3. 57% 24 hours a day, 7 days a week

4. 2% After school or during the evening

5. 20% Times varied by jurisdiction or program

site

6. 11% Other

(SPECIFY)_______________________

______________________________________

21. What types of families received family preservation

services? (CHECK ALL THAT APPLY) n=176

1. 96% Birth families

2. 88% Extended families (includes grandparents

or other relatives)

3. 53% Foster families

4. 67% Adoptive families

5. 12% Other families

(SPECIFY)________________

______________________________________

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22. Where did families most often receive family

preservation services? (CHECK ONE) n=157

1. 76% In their home

2. 8% In program facilities

3. 1% In a school

4. 0% In a health facility

5. 4% In other community facility

(SPECIFY):_____

_____________________________________

6. 9% Location varied by jurisdiction or

program site

7. 2% Other

(SPECIFY):_______________________

_____________________________________

Staffing for Family Preservation Services

23. How many paid, full-time equivalent (FTEs) family

preservation workers provided direct services during

FFY 1993? Family preservation workers are frontline

program staff who work with families and children on a

day-to-day basis. They may include caseworkers, social

workers, therapists, counselors, teachers, and parents.

(ENTER NUMBER)

n=131

Range=0-251 Paid employee FTEs n=39 Unknown

Mean=25.66

24. How many full-time equivalent (FTEs) unpaid family

preservation volunteers provided direct services during

FFY 1993? (ENTER NUMBER)

n=91

Range=0-75 Volunteer FTEs n=64 Unknown

Mean=1.99

25. What was the minimum educational requirement, if any,

for family preservation caseworkers? (CHECK ONE)

n=155

1. 9% High school diploma or equivalent

2. 3% Associates degree

3. 50% Bachelors degree

4. 21% Masters degree

5. 8% Other minimum educational requirement

(SPECIFY): _________________________

6. 8% No minimal educational requirement

26. Were your program’s family preservation caseworkers

typically required to have had previous work

experience? n=168

1. 79% Yes--->Please describe: (n=125)

______________________________________

2. 21% No

27. Before working with their first client, were your

program’s family preservation caseworkers required to

receive any training related to providing family

preservation services? n=167

(n=85)

1. 75% Yes---> Number of hours: Range=5-128

2. 25% No Mean=33.80

28. Were your program’s family preservation caseworkers

required to complete a minimum number of hours of inservice training related to providing family preservation

services each year? n=169

1. 53% Yes---> Minimum hours of training

hours each year:(n=74)

Range=2-240

2. 47% No Mean=26.76

Participation in Family Preservation Services

29. Since its inception, about how many families and about

how many children have received family preservation

services from your program? If your program did not

count participation by the number of families or

children, please indicate below how participation was

counted and enter the count. (ENTER

UNDUPLICATED COUNTS)

n=96

Number of families:__________ n=68 Unknown

Range=8-40,000

Mean=2,396

n=74

Number of children: __________ n=87 Unknown

Range=8-30,000

Mean=3,116

30. During FFY 1993, about how many families and about

how many children received family preservation

services from your program? If your program does not

count participation by the number of families or

children, please indicate below how participation is

counted and enter the count. (ENTER

UNDUPLICATED COUNTS)

n=125

Number of families: __________ n=34 Unknown

Range=7-139,000; Mean=1,692

n=102

Number of children: __________ n=48 Unknown

Range=4-84,094; Mean=1,877

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31. Prior to October 1, 1993, did your program serve all

eligible families who requested (or were referred for)

family preservation services within its service area?

(CHECK ONE) n=177

1. 28% Yes (GO TO QUESTION 34)

2. 65% No (CONTINUE)

3. 7% Don’t know (GO TO QUESTION 34)

32. Which of the following was a major, moderate, minor,

or not a reason why your program could not serve all

eligible families who requested (or were referred for)

family preservation services in its service area?

(CHECK ONE FOR EACH REASON)

REASON

Major

Reason

Moderate

Reason

Minor

Reason

Not a

Reason

1. Insufficient number of staff

to provide services (n=103)

63% 19% 6% 12%

2. Insufficient amount of

funds to provide services

(n=104)

71 14 6 9

3. Regardless of funds or

staffing, space was full

(n=96)

27 21 16 36

4. Families chose not to

participate in the program

(n=102)

8 9 50 33

5. Other reason(s): (n=7)

-- -- --

33. What most often happened to the eligible families in

your service area needing family preservation services

that could not be served by your program? (CHECK

ONE) n=103

1. 32% Families referred to other less intensive

services

2. 6% Families referred to another family

preservation program

3. 20% Families placed on a waiting list for your

program’s family preservation services

4. 16% Children removed from the families and

placed in an out-of-home placement

5. 6% Other (SPECIFY):

___________________________________

6. 19% Don’t know

34. Prior to October 1, 1993, of those families that

requested (or were referred for) family preservation

services from your program in your service area, to

about how many, if any, were you able to provide these

services? (CHECK ONE) n=116

1. 19% All or almost all

2. 34% More than half

3. 9% About half

4. 13% Less than half

5. 1% None or almost none

6. 24% Don’t know

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Goals for Family Preservation Services

35. Prior to October 1, 1993, was each of the following a stated goal for your program when providing family

preservation services? If yes, how successful, if at all, was your program in meeting that goal?

STATED GOAL

A program goal?

(CHECK ONE

FOR EACH)

How successful was your program in meeting goal?

(IF YES, CHECK ONE FOR EACH)

No Yes

If

Yes

-->

Very

Successful

Somewhat

Successful

About As

Successful As

Unsuccessful

Somewhat

Unsuccessful

Very

Unsuccessful

1. Help children at risk of foster care

placement remain with their families

(n=171)

14% 86% If

yes

--->

67%

n=142

30% 3% 0% 0%

2. Prevent children from reentering an outof-home placement after they have been

reunited with their families (n=165)

23 77 If

yes

--->

53

n=121

40 7 0 0

3. Reunite children with their families

(n=164)

23 77 If

yes

--->

47

n=117

44 9 0 0

4. Help children who cannot be reunited with

their families to be placed for adoption,

with a legal guardian, or some other

planned, permanent living arrangement

(n=150)

73 27

If

yes

--->

37

n=41

51 7 5 0

5. Provide respite care for parents and other

caregivers, including foster parents

(n=150)

75 25 If

yes

--->

67

n=39

26 5 0 3

6. Improve parenting skills (n=170) 9 91 If

yes

--->

47

n=149

48 5 0 0

7. Other goal (SPECIFY): (n=39)

________________

___________________________________

___________________________________

-- If

yes

--->

-- -- -- -- --

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Administrators

36. Prior to October 1, 1993, was each of the following a measurable outcome to determine your program’s

success when providing family preservation services? If yes, how successful, if at all, was your program on

this outcome?

A measurable

outcome for your

program?

(CHECK ONE

FOR EACH)

How successful was your program on this outcome?

(IF YES, CHECK ONE FOR EACH)

OUTCOME

No Yes

Very

Successful

Somewhat

Successful

About as

Successful as

Unsuccessful

Somewhat

Unsuccessful

Very

Unsucessful

1. Family functioning

(n=160)

31% 69% If yes

--->

36%

n=108

54% 9% 1% 0%

2. Recurrences of child

abuse or neglect

(n=159)

34 66 If yes

--->

57

n=101

39 4 0 0

3. Child behavior (n=151) 37 63 If yes

--->

33

n=93

57 10 0 0

4. School performance

(n=143)

59 41 If yes

--->

29

n=56

62 9 0 0

5. Client satisfaction

(n=159)

30 70 If yes

--->

70

n=109

28 2 1 0

6. Cost effectiveness of the

program (n=149)

38 62 If yes

--->

69

n=87

24 3 3 0

7. Placement prevention

(n=158)

20 80 If yes

--->

72

n=122

26 2 0 0

8. Family reunification

(n=150)

39 61 If yes

--->

46

n=84

45 8 0 0

9. Other (SPECIFY):

(n=10)

____________________

____________________

-- If yes

--->

-- -- -- -- --

37. Prior to October 1, 1993, overall, how effective, if at

all, was your program in reducing the number of

families at-risk or in-crisis that might lead to out-ofhome placement of children? (CHECK ONE) (n=161)

1. 54% Very effective

2. 33% Moderately effective

3. 12% Somewhat effective

4. 1% Of little or no effect

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Funding for Family Preservation Services

38. During FFY 1993, did your PROGRAM receive funds

for providing family preservation services from each of

the following sources? (CHECK ONE FOR EACH)

FUNDING SOURCES Yes No

FEDERAL SOURCES

1. Title IV-E Foster Care (n=108) 24% 76%

2. Title XIX Medicaid (n=116) 33% 67%

3. Title IV-A Emergency

Assistance (n=111)

21% 79%

4. Title IV-B Child Welfare

Services (n=117)

44% 56%

5. Title XX Social Services Block

Grant (n=112)

38% 62%

6. NCCAN grant (n=98) 14% 86%

7. Other federal sources (n=30)

(SPECIFY):_________________

--

STATE SOURCES

8. State general revenue (n=134) 69% 31%

9. Reallocation of state funds

(SPECIFY SOURCE):

(n=77)

___________________________

20% 80%

10. State agency discretionary funds

(n=90)

24% 76%

11. Special state appropriation

(n=100)

41% 59%

12. Other state sources (SPECIFY):

(n=17)

___________________________

--

LOCAL SOURCES

13. Local sources (SPECIFY):

(n=116)

__________________________

56% 44%

PRIVATE SOURCES

14. Private sources (SPECIFY):

(n=106)

__________________________

42% 58%

ALL OTHER SOURCES

15. All other sources (SPECIFY):

(n=16)

__________________________

--

39. During FFY 1993, what was the amount of funds your

program received for family preservation services from

each of the following sources? (ENTER DOLLAR

AMOUNTS; IF NONE, ENTER "O")

1. Federal sources (n=119) Range=$0-113,400,000

Mean=$1,967,603

2. State sources (n=133) Range=$0-60,000,000

Mean=$2,672,538

3. Local sources (n=117) Range=$0-13,469,486

Mean=$160,531

4. Private sources (n=112) Range=$0-3,000,000

Mean=$41,367

5. Other sources (n=113) Range=$0-364,148

Mean=$10,078

6. TOTAL FUNDING (n=120) Range=$0-

212,100,100

Mean=$6,085,922

Monitoring and Evaluation of Family Preservation

Services

40. Prior to October 1, 1993, how did your program

monitor the progress of its family preservation services

in accomplishing its goals? (CHECK ALL THAT

APPLY) (n=177)

1. 77% Internal program review or evaluation

2. 44% Program review or evaluation by an

organization outside your program

3. 71% Periodic progress reports prepared by

program staff

4. 29% Internal computerized management

information systems

5. 46% Indicators which measured outcomes

6. 43% Client surveys

7. 11% Other(SPECIFY)_____________________

___

______________________________________

8. 3% Progress was not monitored prior to

October 1, 1993

41. Of the methods you checked in question 40, please

write the corresponding numbers of the two that your

program relied on most to monitor the progress towards

its goals prior to October 1, 1993.

1. n=166__________

2. n=149__________

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42. In addition to monitoring progress in accomplishing program goals related to family preservation services, in

which of the following ways, if any, did your program primarily use the results from its monitoring efforts?

(CHECK ONE FOR EACH)

USES FOR MONITORING Yes No

1. To identify training needs (n=162) 79% 21%

2. To identify technical assistance needs (n=153) 65 35

3. To assist in program development (n=164) 93 7

4. To identify areas needing a change in emphasis

(n=161)

86 14

5. To identify gaps in service-delivery (n=155) 74 26

6. To determine program effectiveness (n=167) 95 5

7. To identify areas for further study (n=143) 59 41

8. Other uses for monitoring (SPECIFY): (n=16)

_______________________

_________________________________

--

43. The following is a list of activities that programs might have undertaken to measure the progress of its

family preservation services in accomplishing its goals.

Prior to October 1, 1993, did your program find this activity easy or difficult to conduct?

ACTIVITIES

How easy or difficult to conduct?

(CHECK ONE FOR EACH)

N/A

Very

Easy

Somewhat

Easy

Neither

Easy Nor

Difficult

Somewhat

Difficult

Very

Difficult

1. Defining measurable outcomes

(n=166)

7% 14% 28% 11% 31% 10%

2. Selecting appropriate indicators

(n=165)

6 13 22 16 34 9

3. Identifying appropriate data

sources (n=163)

9 11 26 19 28 7

4. Collecting useful and complete

data (n=165)

6 5 18 15 41 16

5. Measuring cost effectiveness

(n=164)

12 7 18 15 27 21

6. Identifying correlates of success

(program or client characteristics

that affect likelihood of success)

(n=164)

19 4 15 13 31 19

7. Other (SPECIFY): (n=3)

____________________________

____________________________

-- -- -- -- --

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Administrators

44. Has your program of family preservation services been

formally evaluated in the last 5 years? (n=176)

1. 54% Yes (CONTINUE)

2. 46% No (GO TO QUESTION 49)

45. What types of formal evaluations of family preservation

services have been done in the past 5 years? (CHECK

ALL THAT APPLY) (n=102)

1. 57% Compliance-- which determines if the

program complied with laws or

regulations

2. 72% Process-- which determines if the

program implemention corresponded to

program design

3. 74% Impact-- which gauges the extent to

which the program caused change in the

desired direction

4. 37% Economic efficiency -- which assesses the

cost-benefit or cost-effectiveness of the

program

5. 14% Other type of evaluation (SPECIFY):

___________________________________

___________________________________

46. In what month and year was the most recent formal

evaluation of family preservation services completed?

(ENTER MONTH/YEAR) (n=91)

_______________________

(MONTH/YEAR)

47. Are your program’s family preservation services

currently being formally evaluated? (CHECK ONE)

(n=108)

1. 42% Yes--> Anticipated completion date:

(n=32)

_______________________

(MONTH/YEAR)

2. 58% No

48. Please provide the name, organization, and telephone

number of the person responsible for conducting the

most recent completed or ongoing formal evaluation of

your program’s family preservation services. (n=97)

Name:________________________________________

Organization: __________________________________

Telephone number: ( ) ____________________

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Administrators

49. Listed below are activities that might affect your program’s ability to achieve its primary goals related to family preservation

services. During FFY 1993, did your program find each activity easy or difficult to carry out?

ACTIVITY

Easy or difficult to carry out during FFY93?

(CHECK ONE FOR EACH)

N/A

Very

Easy

Somewhat

Easy

Neither

Easy/nor

Difficult

Somewhat

Difficult

Very

Difficult

1. Identify families "at risk"

(n=168)

7% 37% 30% 10% 14% 1%

2. Recruit or retain qualified

program workers (n=168)

4 9 30 21 33 4

3. Retain qualified service

providers (n=166)

14 13 27 17 27 1

4. Coordinate services with

other public agencies

(n=169)

2 8 32 15 37 5

5. Coordinate services with

private organizations

(n=166)

8 5 30 25 31 2

6. Meet demand for services

(n=168)

1 5 13 17 48 17

7. Tailor services to local

areas (n=168)

5 13 36 26 19 1

8. Target program services

(n=163)

8 15 31 33 11 2

9. Fund or support program

evaluation(s) (n=168)

20 4 8 18 24 26

10. Conduct program

evaluation(s) (n=166)

10 2 14 26 30 18

11. Other state governmentrelated activities:

(Describe): (n=23)

_____________

______________________

______________________

-- -- -- -- --

12. Other activities not related

to state government

(Describe): (n=11)

_____________

______________________

______________________

-- -- -- -- --

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Administrators

50. Listed below are factors that might affect a program’s ability to achieve its primary goals related to family preservation

services. Did your program have more or less than enough of each to provide these family preservation services during FFY

1993?

FACTOR

More or less than enough to achieve primary goal during FFY 1993?

(CHECK ONE FOR EACH)

Much

More than

Enough

More than

Enough Enough

Less Than

Enough

Much Less

Than

Enough

a. Level of funding (n=173) 0% 1% 26% 42% 31%

b. Number of service

providers (n=170)

1 0 35 48 16

c. Amount or number of staff

skills to operate program

(n=169)

0 6 42 43 10

d. Other factors: (n=11)

______________________

______________________

-- -- -- -- --

51. Of the activities in question 49 and factors in question 50 that were checked, please write the corresponding numbers/letters

of the three activities/factors that most hindered your program’s ability to meet its primary objectives for family preservation

services. (ENTER NUMBER FROM QUESTION 49 OR LETTER FROM QUESTION 50 ABOVE)

1. n=150 2. n=145 3. n=134

52. What strategies, if any, does your program have for addressing each of these three hindrances?

1. 18% Unknown (n=148)

82% filled in

2. 22% Unknown (n=126)

78% filled in

3. 29% Unknown (n=114)

71% filled in

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Administrators

53. Prior to October 1, 1993, did your program provide

FAMILY SUPPORT SERVICES

family support services? n=261

1. 79% Yes (CONTINUE)

2. 21% No (GO TO QUESTION 108 ON PAGE

25)

History and Administration of Family Support Services

54. In what month and year did your program begin

providing family support services? (ENTER MONTH

AND YEAR) n=188

______________________

MONTH/YEAR

55. Prior to October 1, 1993, under what authority did your

program of family support services operate? (CHECK

ALL THAT APPLY) n=204

1. 9% Adoption Assistance and Child Welfare

Act of 1980 (P.L. 96-272)

2. 10% Child Abuse Prevention and Treatment

Act

3. 18% Other federal legislation (SPECIFY

NAME OF LAW):

__________________________________

4. 44% State legislation which specifically

authorized your program

5. 14% Other state legislation

6. 24% State regulation or administrative decision

7. 20% Other authority (SPECIFY):

_____________________________________

_____________________________________

56. What type of state agency was responsible for

administrative oversight of your program’s family

support services? (CHECK ALL THAT APPLY)

n=207

1. 43% Child welfare

2. 20% Education

3. 4% Juvenile justice

4. 13% Mental health

5. 11% Maternal and child health

6. 4% Other public health

7. 32% Other

(SPECIFY):_______________________

______________________________________

57. What type of agency had primary responsibility for the

day-to-day provision of your program’s family support

services ? (CHECK ONE) n=199

1. 21% State public agency

2. 20% Local public agency

3. 25% Community-based organization

4. 21% Other private organization under contract

with a state or local public agency

5. 8% No primary agency-- type of agency

varied by jurisdiction or program site

6. 6% Other type of agency (SPECIFY):

______________________________________

58. As of October 1, 1993, was your program a state-wide

program, that is, were family support services available

in all counties in your state? n=206

1. 35% Yes (GO TO QUESTION 61)

2. 65% No (CONTINUE)

59. Is your program of family support services moving

toward becoming a state-wide program? n=125

1. 51% Yes

2. 49% No

60. As of October 1, 1993, in about what percent of the

counties in your state did your program provide family

support services? (ENTER NUMBER) n=109

Range=0-100 % of counties in state

Mean=31.69

61. As of October 1, 1993, what was the status of your

program’s family support services? (CHECK ONE)

n=200

1. 12% A pilot or demonstration project

2. 13% A partially implemented program--->

When is full implementation anticipated?

MONTH/YEAR: ___________________

3. 66% A fully implemented program

4. 1% Discontinued or no longer operating as a

distinct program

5. 8% Other

(SPECIFY):_______________________

______________________________________

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Program Specifications for Family Support Services

62. Prior to October 1, 1993, did your program provide

family support services to anyone who requested its

services? n=206

1. 37% Yes

2. 63% No

63. Prior to October 1, 1993, did your program target

family support services to any specific population of

children and families? n=207

1. 88% Yes (CONTINUE)

2. 12% No (GO TO QUESTION 65)

64. Prior to October 1, 1993, what population of children

and families did your program target its family support

services? (CHECK ALL THAT APPLY) n=184

1. 48% Specific geographic areas, including

communities or neighborhoods

2. 10% Specific ethnic and minority groups

3. 23% Specific income levels

4. 45% Families with children less than 5 years

of age

5. 23% Families with school-aged children

6. 33% Families with a child who is

developmentally disabled, medically

fragile, or seriously emotionally disturbed

7. 32% Public agency referrals

8. 52% Parents at high risk of becoming abusive

or neglectful

9. 37% Pregnant or parenting teens, or teens at

risk of becoming pregnant

10. 27% Pregnant or postpartum women

11. 36% Other (SPECIFY):

______________________

_____________________________________

65. On what areas of family support services did your

program focus? (CHECK ALL THAT APPLY) n=208

1. 52% Family self-sufficiency

2. 39% Families having children with special

developmental needs or disabilities

3. 38% Teen parent support

4. 52% Early child development and school

success

5. 36% Maternal and child health

6. 67% Child abuse and neglect prevention

7. 21% Literacy

8. 29% Other

(SPECIFY):_______________________

66. What types of family support services did your program

offer? (CHECK ALL THAT APPLY) n=209

1. 88% Information and service referral

2. 66% Community outreach

3. 70% Support groups

4. 65% Client advocacy

5. 86% Parenting education

6. 44% Child care

7. 48% Early childhood development services

8. 20% Job training or readiness

9. 20% Literacy training

10. 49% Social services

11. 38% Mental health services

12. 34% Health services

13. 34% Other types of family support services

offered (SPECIFY):

_________________________________

_________________________________

67. What was the recommended average number of cases

for a family support worker to have at any one time

during FFY 1993? (ENTER NUMBER OF CASES)

n=91

Range=4-100 cases per worker

Mean=20.65

(n=93) Not Applicable-- workers did not have cases

68. Were family support services provided using a team

approach? n=202

1. 63% Yes (CONTINUE)

2. 37% No (GO TO QUESTION 70)

69. What types of workers usually formed the team?

(CHECK ALL THAT APPLY) n=129

1. 54% Caseworker

2. 50% Program administrator

3. 32% Therapist

4. 41% Counselor

5. 57% Social worker

6. 49% Teacher

7. 36% Other parent(s)

8. 63% Other

(SPECIFY):_______________________

_____________________________________

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70. What was the recommended average number of months

for a typical family to receive family support services at

any one time during FFY 1993? (ENTER NUMBER

OF MONTHS) n=130

Range=1-60 months per family in program

Mean=8.92

71. Was the delivery of family support services timelimited? n=205

1. 44% Yes

2. 56% No

72. Prior to October 1, 1993, at what time(s) were workers

available to work with clients needing family support

services? (CHECK ONE) n=186

1. 5% By appointment only

2. 16% During regular business hours

3. 20% 24 hours a day, 7 days a week

4. 3% After school or during evenings

5. 41% Times varied by jurisdiction or program

site

6. 15% Other

(SPECIFY):_______________________

______________________________________

73. What types of families received family support

services? (CHECK ALL THAT APPLY) n=206

1. 90% Birth families

2. 82% Extended families (includes grandparents

or other relatives)

3. 58% Foster families

4. 63% Adoptive families

5. 18% Other types of families

(SPECIFY):________________

______________________________________

74. Where did most families receive family support

services? (CHECK ONE) n=175

1. 39% In their home

2. 15% In program facilities

3. 7% In a school

4. 1% In a health facility

5. 6% In other community facility

(SPECIFY):_____

_____________________________________

6. 25% Location varied by jurisdiction or

program site

7. 7% Other

(SPECIFY):_______________________

_____________________________________

Staffing for Family Support Services

75. How many paid, full-time equivalent (FTEs) family

support workers provided direct services during FFY

1993? (ENTER NUMBER) n=124

Range=0-2000

Mean=42.69 Paid employee FTEs n=71 Unknown

76. How many full-time equivalent (FTEs) unpaid family

support volunteers provided direct services during FFY

1993? (ENTER NUMBER) n=78

Range=0-400

Mean=15.26 Volunteer FTEs n=107 Unknown

77. What was the minimum educational requirement, if any,

for family support caseworkers? (CHECK ONE) n=182

1. 19% High school diploma or equivalent

2. 7% Associates degree

3. 41% Bachelors degree

4. 7% Masters degree

5. 12% Other minimum educational requirement

(SPECIFY): _________________________

6. 15% No minimal educational requirement

78. Were your program’s family support caseworkers

typically required to have had previous work

experience? n=185

1. 67% Yes--->Please describe: n=111 (filled in)

__________________

______________________________________

2. 33% No

79. Before working with their first client, were your

program’s family support caseworkers required to

receive any training related to providing family support

services? n=184

(n=81)

1. 68% Yes---> Number of hours: Range=4-200

2. 32% No Mean=31.07

80. Were your program’s family support caseworkers

required to complete a minimum number of hours of inservice training related to providing family support

services each year? n=174

1. 53% Yes---> Minimum hours of training

hours each year: (n=74)

Range=1-160

2. 47% No Mean=26.69

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Participation in Family Support Services

81. Since its inception, about how many families and about

how many children have received family support

services from your program? If your program did not

count participation by the number of families or

children, please indicate below how participation was

counted and enter the count. (ENTER

UNDUPLICATED COUNTS)

Number of families:(n=79) (n=99) Unknown

Range=10-219,883

Mean=10,516.65

Number of children: (n=73) (n=101) Unknown

Range=13-311,128

Mean=13,143.25

82. During FFY 1993, about how many families and about

how many children received family support services

from your program? If your program does not count

participation by the number of families or children,

please indicate below how participation is counted and

enter the count. (ENTER UNDUPLICATED

COUNTS)

Number of families: (n=116) (n=53) Unknown

Range=3-123,000

Mean=5,396.64

Number of children:(n=102) (n=61) Unknown

Range=4-300,000

Mean=7,677.50

83. Prior to October 1, 1993, did your program serve all

eligible families who asked for family support services

within its service area? (CHECK ONE) n=195

1. 38% Yes (GO TO QUESTION 86)

2. 56% No (CONTINUE)

3. 6% Don’t know (GO TO QUESTION 86)

84. Which of the following was a major, moderate, minor, or not a reason why your program could not serve all eligible families

asking for family support services in its service area? (CHECK ONE FOR EACH REASON)

REASON

Major

Reason

Moderate

Reason

Minor

Reason

Not a

Reason

1. Insufficient number of staff

to provide services (n=104)

54% 17% 14% 15%

2. Insufficient amount of

funds to provide services

(n=109)

84 6 5 6

3. Regardless of funds or

staffing, capacity was full

(n=95)

20 14 17 50

4. Families chose not to

participate in the program

(n=101)

8 7 45 41

5. Other reason(s): (n=13)

______________________

______________________

-- -- --

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85. What most often happened to the eligible families in

your service area needing family support services who

could not be served by your program? (CHECK ONE)

n=102

1. 32% Families provided information and

referral services only

2. 21% Families referred to another family

support program

3. 28% Families placed on a waiting list for your

program’s family support services

4. 0% Families were turned away with no

referrals

5. 8% Other (SPECIFY):

6. 12% Don’t know

86. Prior to October 1, 1993, of those families that

requested (or were referred for) family support services

from your program in your service area, to about how

many, if any, were you able to provide these services?

(CHECK ONE) n=112

1. 26% All or almost all

2. 36% More than half

3. 6% About half

4. 12% Less than half

5. 1% None or almost none

6. 19% Don’t know

Goals for Family Support Services

87. Prior to October 1, 1993, was each of the following a stated goal for your program when providing family support services?

If yes, how successful, if at all, was your program in meeting that goal?

STATED GOAL

A program goal?

(CHECK ONE

FOR EACH)

How successful was your program in meeting goal?

(IF YES, CHECK ONE FOR EACH)

No Yes

If

Yes

-->

Very

Successful

Somewhat

Successful

About As

Successful As

Unsuccessful

Somewhat

Unsuccessful

Very

Unsuccessful

1. Provide information and referral services

(n=198)

10% 90% If yes

---> 69%

n=173

25% 4% 1% 2%

2. Assess children’s early developmental needs

(n=182)

40 60 If yes

---> 51

n=105

37 7 2 3

3. Strengthen parent-child relationships (n=191) 8 92 If yes

---> 44

n=170

45 8 2 1

4. Improve parenting skills (n=196) 9 91

If yes

--->

37

n=173

49 12 2 1

5. Provide respite care for parents and other

caregivers (n=173)

64 36 If yes

---> 40

n=60

37 15 8 0

6. Improve family functioning (n=193) 14 86 If yes

---> 26

n=158

56 15 2 1

7. Promote family self-sufficiency (n=183) 30 70 If yes

---> 17

n=122

54 25 2 1

8. Provide families with opportunities to interact

with other families and program staff

(n=187)

27 73 If yes

---> 50

n=133

32 11 5 2

9. Connect families with and encourage use of

other community supports and services

(n=196)

8 92 If yes

---> 44

n=170

46 7 1 2

10. Prevent out-of-home placement (n=183) 41 59 If yes

---> 46

n=101

46 5 2 0

11. Prevent child abuse and neglect (n=184) 21 79 If yes

---> 42

n=136

43 12 3 1

12. Other goals (SPECIFY): (n=29) -- If yes

---> -- -- -- -- --

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88. Prior to October 1, 1993, was each of the following a measurable outcome to determine your program’s success when

providing family support services? If yes, how successful, if at all, was your program on this outcome?

A measurable

outcome for your

program?

(CHECK ONE

FOR EACH)

How successful was your program on this outcome?

(IF YES, CHECK ONE FOR EACH)

OUTCOME

No Yes

Very

Successful

Somewhat

Successful

About as

Successful as

Unsuccessful

Somewhat

Unsuccessful

Very

Unsucessful

1. Child development or

behavior (n=174)

42% 58% If yes

--->

50%

n=97

37% 11% 0% 2%

2. Child health status

(n=172)

58 42 If yes

--->

43

n=70

54 0 0 3

3. Prevention of child

abuse or neglect

(n=179)

37 63 If yes

--->

43

n=109

43 11 2 1

4. School readiness or

performance (n=164)

62 38 If yes

--->

36

n=62

50 14 0 0

5. Prevention of teen

pregnancy (n=164)

76 24 If yes

--->

12

n=40

60 25 2 0

6. Family functioning

(n=177)

33 67 If yes

--->

27

n=115

64 7 1 1

7. Client satisfaction

(n=185)

24 76 If yes

--->

69

n=137

27 2 2 0

8. Prevention of out-ofhome placement

(n=169)

50 50 If yes

--->

50

n=82

40 8 0 1

9. Family self-sufficiency

(n=170)

47 53 If yes

--->

19

n=85

59 19 2 1

10. Other (SPECIFY):

(n=18)

____________________

____________________

-- If yes

--->

-- -- -- -- --

89. Prior to October 1, 1993, overall, how effective, if at

all, was your program in reducing the number of

families at-risk or in-crisis of abusing or neglecting

their children? (CHECK ONE) n=173

1. 38% Very effective

2. 42% Moderately effective

3. 18% Somewhat effective

4. 2% Of little or no effect

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Funding for Family Support Services

90. During FFY 1993, did your program receive funds for

providing family support services from each of the

FUNDING SOURCES Yes No

FEDERAL SOURCES

1. Title IV-E Foster Care (n=138) 8% 92%

2. Title XIX Medicaid (n=148) 20% 80%

3. Title IV-A Emergency

Assistance (n=141)

6% 94%

4. Title IV-B Child Welfare

Services (n=144)

16% 84%

5. Title XX Social Services Block

Grant (n=148)

22% 78%

6. NCCAN grant (n=141) 19% 81%

7. Other federal sources (n=55)

(SPECIFY):_________________

--

STATE SOURCES

8. State general revenue (n=157) 69% 31%

9. Reallocation of state funds

(SPECIFY SOURCE):

(n=88)

___________________________

16% 84%

10. State agency discretionary funds

(n=117)

27% 73%

11. Special state appropriation

(n=129)

44% 56%

12. Other state sources (SPECIFY):

(n=30)

___________________________

--

LOCAL SOURCES

13. Local sources (SPECIFY):

(n=140)

__________________________

61% 39%

PRIVATE SOURCES

14. Private sources (SPECIFY):

(n=131)

__________________________

50% 50%

ALL OTHER SOURCES

15. All other sources (SPECIFY):

(n=29)

__________________________

--

following sources? (CHECK ONE FOR EACH)

91. During FFY 1993, what was the amount of funds your

program received for family support services from each

of the following sources? (ENTER DOLLAR

AMOUNTS; IF NONE, ENTER "O")

1. Federal sources (n=144) Range=$0-

13,000,000.00

Mean=$614,286

2. State sources (n=166) Range=$0-

63,779,715.00

Mean=$2,915,008

3. Local sources (n=142) Range$0-

17,603,200.00

Mean=$284,411

4. Private sources (n=139) Range=$0-

3,100,000.00

Mean=$91,516

5. Other sources (n=131) Range=$0-

67,620,365.00

Mean=$533,952

6. TOTAL FUNDING Range=$0-

(n=133) 87,882,342.00

Mean=$3,425,501

Monitoring and Evaluation of Family Support Services

92. Prior to October 1, 1993, how did your program

monitor the progress of its family support services in

accomplishing its goals? (CHECK ALL THAT APPLY)

n=202

1. 80% Internal program review or evaluation

2. 38% Program review or evaluation by an

organization outside your program

3. 77% Periodic progress reports prepared by

program staff

4. 27% Internal computerized management

information systems

5. 39% Indicators which measured outcomes

6. 50% Client surveys

7. 9% Other(SPECIFY):____________________

____

______________________________________

8. 3% Progress was not monitored prior to

October 1, 1993

93. Of the methods you checked in question 92, please

write the corresponding numbers of the two your

program relied on most to monitor the progress towards

its goals prior to October 1, 1993.

1. n=187

2. n=178

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Administrators

94. In addition to monitoring progress in accomplishing program goals related to family support services, in which of the

following ways, if any, did your program primarily use the results from its monitoring efforts? (CHECK ONE FOR EACH)

USES FOR MONITORING Yes No

1. To identify training needs (n=181) 77% 23%

2. To identify technical assistance needs (n=180) 76 24

3. To assist in program development (n=189) 93 7

4. To identify areas needing a change in emphasis

(n=183)

87 13

5. To identify gaps in service-delivery (n=176) 83 17

6. To determine program effectiveness (n=187) 94 6

7. To identify areas of further study (n=163) 60 40

8. Other uses for monitoring (SPECIFY): (n=14)

_______________________

_________________________________

--

95. The following is a list of activities that programs might have undertaken to measure the progress of its family support

services in accomplishing its goals.

Prior to October 1, 1993, did your program find this activity easy or difficult to conduct?

ACTIVITIES

How easy or difficult to conduct?

(CHECK ONE FOR EACH)

N/A

Very

Easy

Somewhat

Easy

Neither

Easy Nor

Difficult

Somewhat

Difficult

Very

Difficult

1. Defining measurable outcomes

(n=193)

8% 9% 27% 10% 30% 16%

2. Selecting appropriate indicators

(n=193)

7 8 28 11 37 9

3. Identifying appropriate data

sources (n=189)

10 9 26 23 27 5

4. Collecting useful and complete

data (n=192)

6 4 20 17 36 17

5. Measuring cost effectiveness

(n=191)

16 6 14 12 27 26

6. Identifying correlates of success

(program or client characteristics

that affect likelihood of success)

(n=187)

17 4 15 11 34 19

7. Other (SPECIFY): (n=5)

____________________________

____________________________

-- -- -- -- --

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96. Has your program of family support services been

formally evaluated in the last 5 years? n=202

1. 51% Yes (CONTINUE)

2. 49% No (GO TO QUESTION 101)

97. What types of formal evaluations of family support

services have been done in the past 5 years? (CHECK

ALL THAT APPLY) n=109

1. 68% Compliance/monitoring-- which

determines if the program complied with

laws or regulations

2. 80% Process-- which determines if the

program implemention corresponded to

program design

3. 68% Impact-- which gauges the extent to

which the program caused change in the

desired direction

4. 19% Economic efficiency -- which assesses the

cost-benefit or cost-effectiveness of the

program

5. 13% Other type of evaluation (SPECIFY):

___________________________________

___________________________________

98. In what month and year was the most recent formal

evaluation of family support services completed?

(ENTER MONTH/YEAR) n=91

_______________________

(MONTH/YEAR)

99. Are your program’s family support services currently

being formally evaluated? (CHECK ONE) n=114

1. 51% Yes--> Anticipated completion date:

(n=43)_______________________

(MONTH/YEAR)

2. 49% No

100. Please provide the name, organization, and telephone

number of the person responsible for conducting the

most recent completed or ongoing formal evaluation of

your program’s family support services. n=102

Name:_____________________________________

Organization: _______________________________

Telephone number: ( ) __________________

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101. Listed below are activities that might affect your program’s ability to achieve its primary goals related to family support

services. During FFY 1993, did your program find each activity easy or difficult to carry out?

ACTIVITY

Easy or difficult to carry out during FFY93?

(CHECK ONE FOR EACH)

N/A

Very

Easy

Somewhat

Easy

Neither

Easy/nor

Difficult

Somewhat

Difficult

Very

Difficult

1. Identify families "at risk"

(n=196)

15% 38% 30% 8% 8% 1%

2. Recruit or retain qualified

program workers (n=193)

4 11 27 19 35 5

3. Retain qualified service

providers (n=192)

10 15 27 20 24 4

4. Coordinate services with

other public agencies

(n=193)

3 10 37 24 22 5

5. Coordinate services with

private organizations

(n=192)

6 9 29 27 27 3

6. Meet demand for services

(n=198)

2 3 12 20 40 23

7. Tailor services to local

areas (n=196)

4 21 39 21 13 2

8. Target program services

(n=187)

10 18 39 20 11 3

9. Fund or support program

evaluation(s) (n=194)

16 5 10 16 22 31

10. Conduct program

evaluation(s) (n=195)

11 5 13 26 27 20

11. Other state governmentrelated activities: (n=17)

(Describe):_____________

______________________

______________________

-- -- -- -- --

12. Other activities not related

to state government

(Describe): (n=10)

_____________

______________________

______________________

-- -- -- -- --

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102. Listed below are factors that might affect a program’s ability to achieve its primary goals related to family support

services. Did your program have more or less than enough of each to provide these family support services during FFY

1993?

FACTOR

More or less than enough to achieve primary goal during FFY 1993?

(CHECK ONE FOR EACH)

Much

More Than

Enough

More Than

Enough Enough

Less Than

Enough

Much

Less Than

Enough

a. Level of funding (n=194) <1% 0% 12% 50% 38%

b. Number of service

providers (n=191)

<1% 1 27 56 16

c. Amount or number of staff

skills to operate program

(n=192)

2 5 42 43 8

d. Other factors: (n=13)

______________________

______________________

-- -- -- -- --

103. Of the activities in question 101 and factors in question 102 that were checked, please write the corresponding

numbers/letters of the three activities/factors that most hindered your program’s ability to meet its primary objectives for

family support services. (ENTER NUMBER FROM QUESTION 101 OR LETTER FROM QUESTION 102 ABOVE)

1. n=167 2. n=155 3. n=136

104. What strategies, if any, did your program have for addressing each of these three hindrances?

1. 24% Unknown (n=165)

76% filled in

2. 27% Unknown (n=135)

73% filled in

3. 34% Unknown (n=116)

66% filled in

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Administrators

105. Prior to October 1, 1993, did your program provide

LINKAGES BETWEEN FAMILY PRESERVATION

AND FAMILY SUPPORT SERVICES

both family preservation services and family support

services? n=211

1. 45% Yes (CONTINUE)

2. 55% No (GO TO QUESTION 108)

106. What types of linkages existed between your program’s

delivery of family preservation services and family

support services? (CHECK ALL THAT APPLY) n=94

1. 51% Collaboration

2. 60% Coordination

3. 66% Integration of services

4. 58% Information sharing

5. 7% Media

6. 27% Contracting

7. 14% Other

(SPECIFY):_______________________

_____________________________________

8. 14% None of the above--delivery of family

preservation services was separate and

distinct from family support services

107. Prior to October 1, 1993, were there any linkages

between the delivery of family preservation services and

the delivery of family support services within your

program or with other family preservation and support

programs? (CHECK ONE FOR EACH)

Linkages between family preservation services

and family support services ...

Yes No N/A

1. Within your same program (n=84) 89

%

11

%

0%

2. With other family preservation and

support programs (n=81)

67 26 7

3. Other (SPECIFY): (n=2)

__________________________

__________________________

--

COMMENTS

108. What would you say was the greatest accomplishment

achieved by your program’s family preservation and/or

family support services? n=236

109. Please provide any information about your program that

we have missed or would help describe your program

further-- such as information about creative or

innovative strategies for delivering/funding family

support or preservation services, or any other

characteristics or outcomes of your program. n=139

110. Please provide below or on separate sheets any

suggestions you may have to help the Congress identify

factors which should be considered in monitoring and

evaluating the impact of the family preservation and

support provisions of OBRA 1993. n=86

Thank you for completing our questionnaire.

Page 83 GAO/HEHS-95-112 Family Preservation and Support
Appendix IV 

GAO Questionnaire to FPS Program

Administrators

GLOSSARY

Crisis intervention technique is a model of family

preservation service-delivery that forms the basis for the

Behavioral Science Institute’s Homebuilders approach.

Intervention occurs within 24 hours of a family’s referral to

the program. 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. Services are typically intensive

in nature and are provided in the home so that caseworkers

can make accurate family assessments and gain the trust of

the family.

Family preservation services are typically designed to help

families (including adoptive and extended 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. This

definition appears in the family preservation and support

provisions of the Omnibus Budget Reconciliation Act

(OBRA) of 1993.

Most family preservation services are tailored to the family’s

needs to help ameliorate the underlying causes of

dysfunction while the child remains at home. The intensity,

duration, and packaging of services differentiates family

preservation programs from the traditional delivery of

children’s services.

Family support services are primarily community-based

preventive activities designed to promote the well-being of

children and families. Services are designed to (1) increase

the strength and stability of families (including adoptive,

foster, and extended 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. This

definition appears in the family preservation and support

provisions of OBRA 1993.

Community-based family support services include: (1) inhome visits, parent support groups, and other programs

designed to improve parenting skills; (2) respite care; (3)

structured activities to strengthen the parent-child

relationship; (4) drop-in centers to enable families to

informally interact with other families and with program

staff; (5) information and referral services; and (6) early

developmental screening of children.

Family systems technique is a model of family preservation

service-delivery typified by the FAMILIES program,

originated in Iowa in 1974. Attention is focused on the

family as a whole, not specific family members, and seeks

to correct dysfunction by working on the family’s interaction

with the community. Caseworkers carry a caseload of 10 to

12 families, seeing families in their homes for an average of

four and one-half months. Families actively participate in

their assessment and help establish the treatment goals of

improved service linkages, perceptions, and relationships

within the family and its environment.

Family preservation workers and family support workers

are the frontline program staff who work with families and

children on a day-to-day basis. They may include social

workers, therapists, counselors, teachers, and parents.

Program managers, supervisors, and administrative support

staff would generally be excluded unless they provide direct

family preservation or support services to families and

children.

Therapeutic family treatment is a model of family

preservation service-delivery that relies less on the provision

of concrete, supportive services and more on family therapy.

The treatment is also less intensive and can be delivered in

either an office or home setting. One of the first such

programs was the Intensive Family Services Program

developed by Oregon’s Children’s Services Division in

1980. Caseworkers carry a caseload of 11 families. Service

duration is 90 days. The treatment, which is also based on

family systems theory, is comprised of three distinct phases--

assessment, treatment, and termination. Follow-up services

occur weekly for 3 to 5 1/2 months.

Page 84 GAO/HEHS-95-112 Family Preservation and Support
Appendix V 

Comments From the Department of Health

and Human Services

Page 85 GAO/HEHS-95-112 Family Preservation and Support
Appendix V 

Comments From the Department of Health

and Human Services

Page 86 GAO/HEHS-95-112 Family Preservation and Support
Appendix V 

Comments From the Department of Health

and Human Services

Page 87 GAO/HEHS-95-112 Family Preservation and Support
Appendix VI 

GAO Contacts and Acknowledgments

GAO Contacts Karen E. Lyons, Evaluator-in-Charge, (916) 974-3341

Robert L. MacLafferty, Assistant Director, (415) 904-2000

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

important contributions to this report: Rodina S. Tungol led the data

analyses related to the FPS program questionnaire and coauthored the

report; Luann M. Moy assisted in developing, pretesting, finalizing, and

distributing the questionnaires; and Leonard J. Hamilton and Wayne J.

Turowski conducted the computerized analyses of the questionnaire data.

(105820) Page 88 GAO/HEHS-95-112 Family Preservation and Support
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