Foster Care: Most Tribes Do Not Anticipate Challenges with Case Goal Changes, but HHS Could Further Promote Guardianship Assistance
Published: 2016-08-08T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The Preventing Sex Trafficking and Strengthening Families Act, enacted in 2014, limited the use of APPLA as a case goal to children aged 16 and older. The Act made this provision effective 3 years after enactment for children under tribal responsibility. Some experts raised concerns that tribes may use the APPLA case goal to retain tribal connections for hard-to-place children, such as younger children with special needs. GAO was asked to explore tribes' views on these matters.
This report examines: (1) data comparing Indian and non-Indian children in foster care; (2) challenges selected tribal child welfare agencies may face in addressing changes to APPLA and establishing permanent homes for children in tribal foster care; and (3) HHS assistance to tribes in implementing the APPLA change and addressing any challenges to establishing permanent homes. GAO reviewed relevant federal laws, regulations, and HHS guidance; analyzed HHS's fiscal year 2014 data on child welfare agencies' foster care case plans; and interviewed officials from 36 tribes that receive federal child welfare funding from six states with high numbers of tribes receiving this funding. GAO also interviewed HHS officials and officials at six state child welfare agencies.
section_title: What GAO Found
paragraphs: To receive federal child welfare funding, state and tribal child welfare agencies must comply with certain requirements, including developing a permanency plan for the child that identifies how the child will exit the foster care system to a permanent home (“case goal”). If other case goals, such as reunifying with parents, adoption, or guardianship are not possible or appropriate, a child may be assigned “another planned permanent living arrangement” (APPLA) as a case goal. Unlike other case goals, children assigned an APPLA case goal are normally expected to remain in foster care until they reach adulthood, which could result in young children remaining in foster care for many years. Because available foster care data do not include a measure for the APPLA case goal, GAO used long-term foster care and emancipation as proxy measures for this case goal. These data show that in 2014 about 6.1 percent of Indian children had APPLA as a case goal, compared to 8.3 percent of non-Indian children. Of the approximately 1,200 Indian children who were assigned an APPLA case goal, 41 percent were younger than 16, while of the approximately 33,000 non-Indian children with this case goal, 23 percent were younger than 16. These data also show, on average, that Indian and non-Indian children with APPLA as a case goal moved among foster homes about the same number of times.
Most tribal officials GAO interviewed reported that they did not anticipate challenges in implementing the limitation on the use of APPLA to children age 16 and older, but many reported other challenges to establishing permanent homes for children in tribal foster care. Some organizations expressed the view that the APPLA age restriction would compel tribes to pursue other arrangements with non-Indian homes if they could not allow a child to remain in foster care with an Indian family. However, tribal officials GAO interviewed said that they rarely use APPLA and instead pursue reunification with family members or other case goals, such as guardianship. At the same time, tribal officials reported challenges with licensing foster family homes and resource constraints that may make establishing permanent homes—including guardianships—difficult.
The Department of Health and Human Services (HHS) has provided information on APPLA through a listserv and information memoranda and some assistance to tribes in establishing permanent homes for children in foster care. However, many tribes GAO interviewed indicated that they were not receiving Guardianship Assistance Program funds under title IV-E of the Social Security Act which provide support for children exiting foster care to relative guardianships. Guardianship can be a useful alternative to APPLA when reunification and adoption are not viable options. Of the 36 tribes that GAO contacted, 14 reported that they did not participate in the program because it was not included in their title IV-E tribal-state agreements or the tribe faced challenges at the state level, among other reasons. One of HHS's strategic goals is to work with tribes to increase their capacity to promote child safety, permanent homes, and well-being. By taking actions to support tribes' participation in the Guardianship Assistance Program, HHS could help them receive funds to help establish permanent homes for children in tribal foster care, including those who might be affected by the APPLA change.
section_title: What GAO Recommends
paragraphs: GAO recommends that HHS explore the reasons for low tribal participation in the federal guardianship program and identify actions to increase tribal participation. HHS agreed with our recommendation.

section_title: Letter
paragraphs: To receive federal child welfare funds, states and tribes must meet certain  requirements that promote the safety, permanency, and well-being of  children in state or tribal foster care. The Department of Health and  Human Services (HHS) is responsible for overseeing states’ and tribes’  implementation of these and other federal requirements related to child  welfare services. One requirement is that each child in foster care must  have a case plan including, among other components, (1) a description of  the type of home or institution in which the child is to be placed while in  foster care—referred to in this report as their “placement setting”—and (2)  a permanency plan for how the child will exit the foster care system,  either by returning to their home or to an alternative permanent  placement—referred to in this report as the child’s “case goal.” Since  1997, if other case goals (reunification with the child’s parents, adoption,  legal guardianship, or placement with a fit and willing relative) are  determined not to be in the best interests of a child, the court may  designate “another planned permanent living arrangement” (APPLA) as  the child’s case goal. Frequently this occurs when these other case  goals have been deemed to not be possible or appropriate. Child welfare  experts expressed the view that APPLA is being used too frequently and  children are remaining in foster care, particularly in group care  arrangements, rather than exiting to a permanent, family-like setting.  Unlike other case goals that involve a child exiting the foster care system,  in practice, children assigned an APPLA case goal are normally expected  to remain in foster care until they reach adulthood and are no longer  eligible for services, known as aging out of foster care.
The Preventing Sex Trafficking and Strengthening Families Act, enacted  in 2014, restricted the use of APPLA as a case goal to children aged 16  and older. According to some organizations that work on tribal child  welfare issues, the APPLA age restriction might lead tribes to place some  younger tribal children in settings with no tribal connections. These  organizations noted that some tribes might be using the APPLA case goal  to place younger children with serious special needs in family-based  homes within the tribe when reunification or adoption is not available or  appropriate, ensuring that the child retains their connection to their tribe  and extended family. These organizations also said that without the  option of an APPLA case goal for younger children, tribes might need to  pursue case goals of adoption or guardianship—possibly with non-Indian  homes—rather than allowing a child to be assigned APPLA and remain in  foster care with an Indian family until aging out of foster care. The Act  made the APPLA provision effective 3 years after enactment for children  in foster care who are under the responsibility of an Indian tribe, allowing  tribes to continue to use the APPLA case goal for children under age 16  until September 2017. You asked us to review how, if at all, the  restriction on the use of APPLA may affect tribes’ efforts to achieve  permanency for children in their care.
This report examines (1) what available data show about Indian children  in foster care compared to all other children in foster care; (2) the extent  to which selected tribal child welfare agencies face challenges in  addressing recent changes to APPLA and in establishing permanent  homes for children in tribal foster care; and (3) the extent to which HHS  has assisted tribal child welfare agencies in implementing the APPLA  change and addressing any challenges to establishing permanent homes.
To determine what available data show about Indian children in foster  care compared to all other children in foster care, we analyzed data on  foster care case plans from HHS’s Adoption and Foster Care Analysis  and Reporting System (AFCARS) for fiscal year 2014, the most recent  year for which data were available. Because AFCARS does not include a  measure for the APPLA case goal, we used long-term foster care and  emancipation as proxy measures for APPLA. Through interviews with  HHS officials, documentation review, and electronic data testing, we  found the data reliable for the purposes of this report. To obtain the  perspectives of tribal officials, we conducted semi-structured interviews  with tribal officials from 15 federally recognized tribes and convened six  group interviews with representatives from 21 other federally recognized  tribes. We selected the 15 tribes for individual interviews from six states  that have high numbers of tribes receiving funding under title IV-E or title  IV-B of the Social Security Act: Arizona, Michigan, Montana, New Mexico,  Oklahoma, and Washington. The information obtained in our interviews is  not generalizable to the population of federally recognized tribes, but it  provides examples of tribes’ experience using the APPLA case goal and  their views on any challenges they may face when the changes go into  effect. In addition, we reviewed relevant federal laws, regulations and  HHS guidance. We also interviewed state child welfare officials from the  six selected states, as well as officials from the Administration for  Children and Families’ (ACF) Children’s Bureau at HHS; officials from the  five HHS regional offices that cover our selected states; and the Center  for Tribes, an HHS-funded technical assistance provider. See appendix I  for more information on our scope and methodology, including a detailed  description of the AFCARS data elements we analyzed.
We conducted this performance audit from June 2015 to August 2016 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: A federally recognized tribe is an American Indian or Alaska Native tribal  entity that is recognized as having a government-to-government  relationship with the United States. Federally recognized tribes and their  members are eligible for programs and services the federal government  provides to Indians because of their status as Indians.
subsections: section_title: Federal Title IV-E and IV-B Funding for Tribal Child Welfare Programs
paragraphs: Eligible tribes and certain tribal entities have access to federal resources  for child welfare programs under programs administered by HHS. Federal  funding provided under titles IV-E and IV-B of the Social Security Act  covers a portion of costs for states and participating tribes of operating  their foster care, adoption assistance, and kinship guardianship  assistance programs (title IV-E) and funding for child welfare services,  such as parent support and counseling for children and families (title IV- B). Approximately 20,000 of the 415,000 children in foster care at the  end of fiscal year 2014 were identified as American Indian or Alaska  Native alone or American Indian or Alaska Native in combination with one  or more races.
subsections: section_title: Title IV-E Funding
paragraphs: Title IV-E of the Social Security Act is the largest single federal source of  child welfare funding, providing nearly $7.5 billion in fiscal year 2015 to  child welfare agencies to support foster care and transitional independent  living programs for eligible children, adoption assistance for children with  special needs, and kinship guardianship assistance. Both states and  tribes seeking to operate a title IV-E program must have an approved title  IV-E plan. The title IV-E plan provides documentation that state or tribal  law, regulations, and policies comply with program requirements. Among  other things, the title IV-E program requires that states and tribes: make reasonable efforts, consistent with the health and safety of the  child, to preserve and reunify families (1) prior to a child’s placement  in foster care, to prevent the need for removing the child; and (2) to  make it possible for the child to safely return home; prepare a written case plan for each child receiving foster care  maintenance payments and ensure periodic court or administrative  review of each such case; and,  regularly hold a permanency hearing to determine the case goal for  the child (to be held at least every 12 months) and make reasonable  efforts to finalize the case goal—reunification, adoption, legal  guardianship, placement with a fit and willing relative, or, where  appropriate, another planned permanent living arrangement. Case  goal options under title IV-E are shown in table 1.
Title IV-E funds reimburse participating states and tribes for a portion of  their eligible costs of providing foster care, adoption assistance, or kinship  guardianship assistance on behalf of eligible children:
Title IV-E Foster Care Program: The title IV-E Foster Care Program  provides federal funding for state and tribal title IV-E agencies to  support out-of-home care for children until the children are safely  returned home, placed permanently with adoptive families or placed in  other planned arrangements for permanency. Federal funds are  available for a portion of monthly maintenance payments for the daily  care and supervision of eligible children; administrative costs to  manage the program; training of staff and foster care providers;  recruitment of foster parents; and costs related to the design,  implementation and operation of a state-wide data collection  system.
Title IV-E Adoption Assistance Program: The Adoption Assistance  Program provides funds to state and tribal title IV-E agencies to  facilitate the timely placement of children, whose special needs or  circumstances would otherwise make placement with adoptive  families difficult. Federal funds are available for a one-time payment  to families to assist with the costs of adopting an eligible child, and for  a portion of monthly subsidies to assist with the care of an eligible  adopted child, as well as for certain administrative and other program  costs.
Title IV-E Guardianship Assistance Program: The Guardianship  Assistance Program (GAP) is an optional program under title IV-E that  provides funds to support the care of children discharged from foster  care to legal guardianship who meet the program’s eligibility  requirements. Under the program, state and tribal title IV-E agencies  who opt to provide guardianship assistance payments to relatives who  have assumed legal guardianship of eligible children receive partial  reimbursement from the federal government for the cost of providing  these payments. In general, eligible children include those who have  been eligible for title IV-E foster care maintenance payments during at  least a 6 consecutive month period during which the child resided in  the home of the prospective relative guardian who was licensed or  approved as meeting the licensure requirements as a foster family  home, among other criteria.
The reimbursement rate varies by type of expense. The federal share of  foster care maintenance payments, adoption assistance payments, and  guardianship assistance payments is between 50 percent and 83 percent  of costs, with higher federal support going to states and eligible tribes with  lower per capita incomes. The federal share of training and  administrative costs is 75 percent and 50 percent, respectively.
Eligible tribes may receive federal title IV-E funds either by (1) directly  operating a foster care title IV-E program pursuant to an approved title IV- E plan; or (2) administering all or part of a title IV-E program on behalf of  a state pursuant to a tribal-state agreement.
Tribal-state agreements: Tribes may enter into cooperative  agreements with their state child welfare agency to administer part of  the state’s title IV-E program. Through tribal-state agreements, title IV- E funds are generally passed through the state to the tribes. Whether  tribes or states have responsibility for activities such as developing a  case plan for the child’s placement and care, or reviewing the case  plan on a regular basis, can vary depending on the agreement. HHS  considers the state to be the grantee for title IV-E funding and as a  result, the state has ultimate responsibility for ensuring compliance  with title IV-E program requirements.
Direct title IV-E programs: The Fostering Connections to Success and  Increasing Adoptions Act of 2008 (Fostering Connections Act)  authorized tribes to directly operate a title IV-E program and obtain  federal reimbursement for eligible program costs pursuant to an  approved title IV-E plan. As of October 2015, there were seven  tribes approved to directly operate a title IV-E program. The provisions  of title IV-E apply to tribes that operate their own programs in the  same manner as they apply to states, with limited exceptions. HHS  is responsible for oversight and monitoring of states and tribes that  are approved to directly operate a title IV-E program.
section_title: Title IV-B Funding
paragraphs: Tribes also have access to federal funding provided under title IV-B,  subparts 1 and 2 of the Social Security Act for various child welfare  services—$664 million in fiscal year 2015. These programs fund a  range of child welfare services and activities generally aimed at  preventing abuse and neglect; preserving and reunifying families; and  promoting safety, permanency, and well-being of children in foster or  adoptive placements. To receive title IV-B funding, states and tribes must  submit a 5-year plan—the Child and Family Services Plan—that sets forth  the vision and goals to be accomplished to improve the state’s or tribe’s  coordinated child and family service delivery system. It also includes,  among other things, the state’s or tribe’s plans for use of funding from title  IV-B. Tribes that receive title IV-B funding and operate foster care  programs must also comply with certain title IV-E requirements, including  those related to case goals. State and tribal title IV-B agencies must  submit annual updates—Annual Progress and Service Reports—on the  progress made toward accomplishing the goals and objectives in the  Child and Family Services plan, which are reviewed by HHS regional  office staff. Tribes must also be operating a program under title IV-B,  subpart 1 to be eligible to directly administer a title IV-E program. The  main mechanism for oversight of title IV-B tribal agencies is HHS’s review  of the tribe’s Child and Family Service Plan and annual updates. This  review is conducted by HHS regional office staff as part of the joint  planning process.
In addition, tribes or families involved with tribal child welfare programs  may receive other state or federal funding outside of titles IV-E or IV-B to  support child welfare services, or they may be supported only through  tribal funds.
section_title: Another Planned Permanent Living Arrangement as a Case Goal
paragraphs: The Adoption and Safe Families Act of 1997 (ASFA) added APPLA as an  option for a child’s case goal if none of the other case goals enumerated  in the statute would be in the best interests of the child. In addition,  ASFA removed language allowing a child to be “continued in foster care  on a permanent or long-term basis” because of his or her special needs  or circumstances. Under title IV-E, APPLA is permitted as a case goal in  cases where the child welfare agency has documented to the court a  “compelling reason” for determining that the other case goals would not  be in the best interests of the child. The Preventing Sex Trafficking and  Strengthening Families Act, enacted in 2014, restricted the use of APPLA  as a case goal to children age 16 and older, although it delayed  implementation for children in foster care under the responsibility of an  Indian tribe. For older children with a case goal of APPLA, the Act  places additional requirements on states and tribes. Among other  things, at each permanency hearing (to be held at least every 12 months),  the child welfare agency is required to (1) document its intensive,  ongoing, and unsuccessful efforts to return the child home or secure a  placement with a relative, legal guardian, or adoptive parent; and (2)  implement procedures to ensure that the court re-determines whether  APPLA is the appropriate case goal for the child and asks the child about  his or her desired permanency outcome.
section_title: HHS Assistance for Tribes on Titles IV-E and IV-B
paragraphs: ACF’s Children’s Bureau is responsible for providing program guidance  under titles IV-B and IV-E to grantees. ACF is also responsible for pro-  viding technical assistance to tribes on title IV-B and IV-E program  requirements through nine of its regional offices. In 2014, HHS  consolidated its training and technical assistance provided to states and  tribes. The Center for Tribes (the Center), one of the three centers in  HHS’s Child Welfare Capacity Building Collaborative, serves as a  technical assistance resource for tribes. All tribes that receive title IV-E  or title IV-B funds are eligible to receive assistance from the Center. The  Center also develops products that all tribes can access from the  Children’s Bureau website, including ones that have information on  practices such as customary adoption and family group decisionmaking. It  also offers services to tribes that are tailored to their particular needs;  tribes are responsible for requesting these services from the Center.
section_title: Data Show That the Use of APPLA Was Lower for Indian Children than Non- Indian Children and Children in Both Groups Had A Similar Number of Foster Care Placements
subsections: section_title: A Lower Percentage of Indian Children Had APPLA as a Case Goal Compared to Non-Indians, though a Higher Percentage of Indians Were Younger than 16
paragraphs: Available data from HHS show that a lower percentage of Indian children  were assigned APPLA as a case goal at the end of fiscal year 2014  compared to non-Indian children. According to AFCARS data, about 6.1  percent of Indian children were assigned APPLA as a case goal  (approximately 1,200 children) compared to 8.3 percent of non-Indian  children (approximately 33,000 children). The percentage of Indian and  non-Indian children assigned other case goals also differed (see table  2). However, in part because these children could be in either state or  tribal foster care, these data cannot be used to identify children covered  by the 3-year delay for the APPLA age restriction. While data on all  children in foster care under the responsibility of a state agency are  included in AFCARS, data on some children under the responsibility of a  tribal agency are not included in AFCARS. In addition, children identified  as Indian in AFCARS are not necessarily enrolled members of a  federally-recognized tribe.
While a slightly lower percentage of Indian children were assigned  APPLA as a case goal than non-Indian children, a higher percentage of  Indian children than non-Indian children who were assigned this case  goal were younger than 16. Specifically, about 41 percent of Indian  children with APPLA were younger than 16 (about 500 children), while  about 23 percent of non-Indian children with this case goal were younger  than 16 (about 7,500 children) (see fig. 1).
Of Indian children assigned APPLA as a case goal, about 9 percent were  ages 6 through 10, while 29 percent were ages 11 through 15, compared  to approximately 3 percent and 19 percent of non-Indian children  assigned APPLA, respectively. A much smaller percentage of both Indian  and non-Indian children assigned this case goal were age 5 or younger  (see fig. 2).
section_title: Indian and Non-Indian Children with APPLA as a Case Goal Had a Similar Number of Placements while in Foster Care, but a Lower Percentage of Indian Children Were Placed in Institutional Care
paragraphs: On average, Indian and non-Indian children with APPLA as a case goal  moved among foster care homes about the same number of times (see  table 3). Both Indian and non-Indian children who were assigned  APPLA as a case goal had an average of about six different placements  during their most recent stay in foster care. In contrast, both Indian and  non-Indian children who were assigned other case goals had an average  of around three placements. In AFCARS the number of placements is  defined as the number of places the child has lived, including the current  setting, during the current removal episode and does not include the  number of places a child may have lived during a previous episode in  foster care or trial home visits.
Our analysis shows that a higher percentage of all children with APPLA  as a case goal were placed in either institutions or group homes (about  30 percent) than children with other case goals (between 7 and 11  percent). However, some differences exist between Indian and non-Indian  children with APPLA. Although Indian and non-Indian children with  APPLA moved among foster homes about the same number of times, a  slightly lower percentage of Indian than non-Indian children with APPLA  as a case goal were placed in institutional care. While 13.1 percent of  Indian children with this case goal were placed in institutional care, 16.8  percent of non-Indian children with APPLA were placed in institutions.  Some additional differences exist between the percentage of Indian and  non-Indian children placed in group homes, but these differences were  small (13.5 percent of Indian compared to 13.9 percent of non-Indians).  Data also showed that a higher percentage of Indian children with APPLA  were placed in family-style foster homes, either with relatives or non- relatives, than non-Indian children with APPLA (see fig. 3).
section_title: Most Selected Tribes Did Not Anticipate Challenges Implementing APPLA Changes, yet Some Reported Other Challenges in Establishing Permanency
subsections: section_title: Most Selected Tribes We Interviewed Did Not Anticipate Challenges in Limiting APPLA to Older Children and Reported Using APPLA Infrequently
paragraphs: Most tribal officials we interviewed reported that they did not anticipate  challenges associated with limiting the use of the APPLA case goal to  children aged 16 and older. Specifically, officials from 27 of 32 tribes said  they did not anticipate that the restriction would pose challenges for their  foster care programs. Tribal officials we interviewed also did not  anticipate challenges with implementing the related provisions in the  Preventing Sex Trafficking and Strengthening Families Act that  introduced additional case review requirements for foster children to  whom the APPLA case goal is assigned.
Of the 27 tribes that said they did not anticipate challenges with limiting  the use of the APPLA case goal to children aged 16 and older, 17 tribes  told us they use APPLA as a case goal for some children under tribal  custody. However, these tribes told us that they assign APPLA rarely  and only after determining that other case goals, such as reunification,  adoption, or guardianship—which are required to be considered before  APPLA is used—were not possible or appropriate. Tribal officials  reported that most children in their foster care programs are initially  assigned reunification as a case goal and are often reunified with their  parents. These officials told us that if they determine that reunification is  not possible, they will assign adoption or guardianship as a case goal,  depending on the specific case. However, some tribal officials also  noted certain instances in which these case goals were not possible or  appropriate and that they had determined that APPLA was the most  appropriate goal. These examples included:
Older children—Officials from 8 tribes said they use APPLA as a case  goal either primarily or exclusively for older children or teenagers in  foster care. Tribes reported that it was often more difficult to achieve  permanency for older children due to a number of challenges, such as  a lack of services tailored to older children or greater difficulty in  recruiting adoptive families. Some tribes reported that they use  APPLA as a last resort when they cannot find a permanent home for  older children in foster care; officials told us that they use APPLA to  allow the child to continue to receive foster care maintenance  payments while preparing to age out of the system. The challenges  facing older children in foster care in general are well-documented.
Children who do not want to be adopted or placed into  guardianships—Officials from 5 tribes reported assigning APPLA as a  case goal in cases in which older foster children indicated that they  did not want to be adopted or placed into guardianships. For  example, 1 tribe reported assigning APPLA in the case of two children  who were under age 16 for whom reunification was unlikely, but who  did not want to be adopted. According to tribal officials, the children  were initially placed in a family-like foster care home, briefly  transferred to a residential facility, and ultimately placed in an  independent living arrangement.
Children with severe health issues—Officials from 4 tribes reported  using APPLA as a case goal primarily for foster children with  significant mental, behavioral, or physical health issues. For example,  officials from one tribe told us that they sometimes assign APPLA as a  case goal while providing additional services to help foster children  through a crisis due to behavioral or mental health issues. These  cases could include foster children who might need to stay in  residential care for a certain amount of time. These tribal officials told  us that APPLA is sometimes used for children who are placed in  therapeutic foster homes where they receive specialized care. Some  other tribes reported that they believe this case goal could be, in some  cases, an appropriate case goal for younger children who need long- term, intensive medical treatment in therapeutic foster homes or  residential facilities. Another tribe told us the tribe has recently  experienced an influx of tribal children entering the child welfare  system who have a number of significant health issues due to  prenatal exposure to drugs, for whom APPLA could be the most  appropriate case goal.
Some tribes we contacted—5 of 32—said they anticipated that the  APPLA change would present challenges for their foster care programs.  Of these tribes, two reported using the APPLA case goal extensively for  children in tribal foster care. One tribe reported that the majority of  children in foster care under their custody, most of whom are younger  than 16, are assigned long-term foster care as a case goal. A tribal official  told us that while some of these children are in family-like foster homes,  most move around between residential facilities based on their behavioral  needs or that have specific age or gender restrictions. This official noted  that the tribe was concerned about the impact of the APPLA age  restriction given the number of their children in long-term foster care  arrangements. However, this official said that tribal officials had not  discussed the restriction in detail with their tribal attorney, given the 3- year delayed implementation period. The second tribe told us that of the  approximately 50 children under tribal custody, the majority are assigned  long-term foster care and are placed in stable, family-like foster care  homes in the care of extended family members. The tribal official we  spoke with said that when the APPLA restriction takes effect, they will  have to pursue guardianships for children younger than 16 who had  previously been assigned an APPLA case goal. However, the official said  that the tribe has faced challenges establishing guardianships. She told  us that guardianships limit families’ ability to access other resources, such  as educational and training vouchers in some cases, and that the tribe  has a number of foster families who would participate in guardianship  arrangements but do not want to be licensed for a variety of reasons.
section_title: Many Tribes We Interviewed Reported Other Challenges in the Course of Establishing Permanency
paragraphs: While most tribes we contacted did not anticipate challenges in limiting  the use of APPLA as a case goal to older children in foster care, many  tribal officials reported other challenges that made finding permanent  homes for children under tribal custody difficult. Specifically, tribes  reported facing challenges regarding cultural opposition to termination of  parental rights and differences between state and tribal definition of a  relative; licensing requirements; and resource constraints (see fig. 4).  Each of these challenges potentially limits the use of adoption, living with  a relative, and guardianship as alternative case goals for younger children  who have been assigned APPLA when the age limitation on APPLA takes  effect.
Several tribes we contacted reported that the federal foster care  requirements related to termination of parental rights were in conflict with  their cultural values and presented challenges to their efforts to establish  permanency for children in foster care. Specifically, 7 tribes we spoke  with reported that termination of parental rights is not acceptable in their  tribal culture. We previously reported that tribes developing title IV-E  plans encountered challenges associated with incorporating required  language on termination of parental rights into their tribal codes or  policies, which made it difficult to obtain internal approval and  successfully complete the title IV-E plan. HHS officials acknowledged  that termination of parental rights may not align with Indian tribes’ cultural  values and in April 2015, HHS updated its Child Welfare Policy Manual to  modify its interpretation of the statute to clarify that tribal title IV-E  agencies may develop an alternative to termination of parental rights,  such as a modification of parental rights, so long as the alternative  satisfies other applicable requirements. Several tribes we interviewed  practice tribal customary adoptions, which, unlike traditional adoptions,  modify but do not terminate parental rights and also maintain family  connections. Of the 29 tribes that discussed their use of customary  adoption, 9 tribes reported using such adoptions, 12 tribes reported that  they did not, and 8 tribes reported that they did not practice customary  adoptions currently but might pursue them in the future. HHS officials told  us that they support customary adoption as a culturally-appropriate  method of achieving permanency for children. According to HHS officials,  families that adopt a child through customary adoption are eligible for title  IV-E adoption subsidies.
subsections: section_title: Definition of a Relative
paragraphs: Several tribal officials we contacted told us that another challenge facing  their foster care programs were state definitions of who is considered a  “relative” for purposes of foster care; these definitions can contradict  tribes’ cultural traditions. Specifically, officials from 9 tribes we spoke with  in individual and group interviews said their tribes broadly defined the  term relative and that the tribe’s definition was not always compatible with  state definitions. For tribes administering title IV-E on behalf of the state  pursuant to a tribal-state agreement, this difference could affect tribes’  use of the case goal of “placement with a fit and willing relative” or  whether tribal guardianships with relatives would qualify for GAP  payments under a state’s definition of “relative.” For example, officials  from one tribe told us that tribal children are born into an extensive clan  system and that a tribal member’s “extended family” is very large, and  their clan affiliation is a permanent and necessary component to their  identity. Another tribe reported that nearly all of their children in foster  care are placed with individuals who are considered to be relatives under  the tribe’s broad definition, which encompasses not only blood relatives  but also fictive kin—tribal members who may not be blood related but who  have a close relationship with the child. Tribal officials told us that they  believed federal title IV-E requirements did not provide for such a broader  definition of “relative” and that some tribal members who would be  considered relatives under the tribe’s definition may not qualify for certain  services, such as GAP. According to HHS policy, there is no federal  definition of “relative” for the purpose of the title IV-E GAP. Tribes that  administer title IV-E on behalf of the state pursuant to a tribal-state  agreement generally follow the state title IV-E plan. HHS officials  acknowledged that tribes frequently define “relative” differently than  states. However, in some cases, a state’s definition of a relative could be  more restrictive than a tribe’s, and this narrower definition could be  included in the tribe’s title IV-E agreement with the state. According to  HHS, tribes approved to directly operate a title IV-E program have  discretion to define the term relative for the purposes of the title IV-E  GAP. HHS officials told us that HHS will accept a title IV-E plan or  amendment that contains a reasonable interpretation of a relative,  including a plan that limits the term to include biological and legal  familial ties or a plan that more broadly includes tribal kin, extended  family and friends, or other “fictive kin”.
More than one-third of tribes we contacted—15 of 36 tribes—told us that  satisfying federal and state licensing requirements often made it more  difficult to license potential foster care homes and in some cases also  prevented tribes from establishing potential permanent placements for  their children. For example, in order to be eligible for GAP payments, a  child must have resided with a licensed relative foster caretaker for at  least 6 continuous months. Several tribal officials we interviewed said that  licensing requirements regarding the number of family members living in  a home, the size of the home, or the availability of separate bedrooms  presented challenges when attempting to license potential foster homes,  given the prevalence of multi-generational homes in tribal communities.  An official from one tribe also told us that background checks conducted  as part of the licensing process will sometimes disqualify otherwise  suitable relatives from becoming licensed and therefore a possible  permanent caregiver. For example, some tribal officials noted that an  otherwise qualified relative may not pass a background check because of  a past drug offense. Participants in a 2011 survey by the National Child  Welfare Resource Center for Tribes reported that substance abuse not  only contributed to difficulties some families had when they tried to reunify  with their children but also created challenges in finding suitable foster  homes.
However, other tribes we interviewed reported that they have been able  to incorporate some flexibility into their tribal licensing requirements to  address licensing challenges or account for other circumstances unique  to tribal communities. For example, some tribes we interviewed said that  their tribe’s licensing requirements provide more flexibility with regard to  the size of a home or the number of bedrooms available. The Fostering  Connections Act authorized states to waive, on a case-by-case basis,  non-safety licensing standards for relative foster family homes and gave  states discretion to determine what constitutes a non-safety standard.  According to HHS officials, tribes approved to directly operate title IV-E  programs are allowed to define and waive non-safety standards for  relative foster family homes, as are states. However, some officials we  spoke with from tribes approved to directly operate title IV-E programs  were not aware that they were able to waive non-safety licensing  standards. In addition, two of the six states we reviewed for our study— Michigan and New Mexico—were not among those that reported in 2014  allowing waivers of non-safety licensing standards for relative foster  family homes and defining such standards in state law, regulations, or  agency policy, while four states—Arizona, Montana, Oklahoma, and  Washington—reported in 2014 that they did allow such waivers.  According to HHS, tribes operating programs under title IV-E tribal-state  agreements are bound by the terms in those agreements, which could  include licensing requirements. HHS officials we spoke with said that  tribes have not expressed to them any questions or concerns about  challenges they have experienced with non-safety licensing standards.
section_title: Resource Constraints
paragraphs: More than half of tribes we spoke with—21 of 36 tribes—told us that  resource constraints presented challenges for their foster care programs  and for establishing permanency for children under their custody. These  constraints include a lack of foster care homes, limited availability of  needed services, and limited financial support for permanent  guardianships. Officials from 7 tribes reported that a significant challenge  for their programs is a shortage of licensed foster care homes, particularly  those that are willing and capable of caring for children with special  needs. Similarly, officials from 4 tribes told us that they had limited access  to therapeutic foster homes or inpatient care facilities because their tribes  were located in rural areas far from these homes and facilities or because  these resources were already being used by state foster care programs.  Tribal officials also reported that the financial assistance available to  foster care providers or permanent caregivers for children in foster care is  often insufficient to fully cover all of the associated costs. Officials from  one tribe reported that the majority of tribal members struggle to make  ends meet and feed members of their current households. While the tribe  offers financial assistance to foster families, tribal officials said that  amount is insufficient to fully cover the costs of fostering a child. In  addition, several tribes told us that tribal foster care programs generally  do not have access to the range of services available to states, such as  independent living services that can help children in foster care transition  to permanency or resources and services for children with special needs.  HHS officials we spoke with acknowledged that there is great demand  among tribes for resources for these high-needs children. Some tribal  officials also told us that families entering into guardianships did not  receive any financial assistance, such as title IV-E GAP, which, according  to tribal officials, made it more difficult to establish permanency through  guardianships.
section_title: HHS Has Provided Information and Some Assistance to Tribes on APPLA and on Establishing Permanent Homes, but Tribes Reported Low Participation in GAP
paragraphs: HHS has provided information and some assistance to tribes on  implementing the change to APPLA, including policy guidance and  technical assistance through HHS regional offices, and some support for  establishing permanency for children in tribal foster care. Despite  reporting resource constraints, however, most tribes we interviewed  reported that they did not participate in title IV-E GAP to receive federal  funding to support their use of guardianship as a permanent placement.  Without greater tribal participation in GAP, tribes may not be receiving  available funding that could help them encourage the use of and support  guardianship, particularly for older children or those with special needs for  whom finding permanent placements may be difficult.
subsections: section_title: HHS Has Provided Information to Tribes on Changes to APPLA and Technical Assistance to Develop Permanency Options
paragraphs: The Children’s Bureau has sent guidance to regional offices, state child  welfare agencies, and tribal organizations concerning the provisions in  the Preventing Sex Trafficking and Strengthening Families Act, including  the change to the APPLA case goal. For example, the Children’s Bureau  used a listserv to disseminate program instructions and information  memoranda on changes related to the Act. Staff in the five regions that  serve the tribes we interviewed told us that they discussed the guidance  with their respective tribal child welfare agencies. Staff in three of these  regions reported that because of frequent changes in tribal staff, they  maintain an up-to-date listserv of tribal social services directors, who will  be responsible for implementing the APPLA change. They used the  listserv to disseminate guidance, including program instructions and  information memoranda about the change in APPLA. Some tribal officials  told us that they were aware of the APPLA change and had received  information from HHS, while others were uncertain whether they had  received information, and some in our group interviews did not specify  whether they had received it.
The regional offices and the Center for Tribes also provide technical  assistance to tribes that can include help in implementing the APPLA  change and developing other permanency options. Staff in the five  regional offices reported that as part of the joint planning process for  assisting tribes with developing their 5-year title IV-B plans, regional  officials worked with the tribes on how the tribes could address the  change in APPLA. An official with the Center for Tribes told us that as of  March 2016, one tribe had requested assistance with incorporating all of  the elements of the Preventing Sex Trafficking and Strengthening  Families Act into their policies and procedures. In addition, officials from  one regional office and the Center told us that they help tribes with  developing other permanency options such as kinship guardianship  (which may be supported by title IV-E GAP) and customary adoption. One  regional official reported helping tribes develop provisions on customary  adoption that could be added to their tribal code. A Center official also  said that they have received inquiries about GAP and have had requests  for assistance with customary adoption and licensing.
section_title: Most Tribes We Interviewed Reported They Did Not Participate in Title IV-E GAP
paragraphs: Despite the resource constraints reported by many of the tribes we  interviewed, most tribal officials we spoke with that use guardianship as a  case goal reported that their tribes do not participate in title IV-E GAP,  which provides federal funding for a portion of assistance payments paid  to relative guardians on behalf of eligible children. Of the 27 tribes that  reported using guardianship as a case goal, 20 tribes reported that they  do not participate in GAP and do not receive federal funding to support  those guardianships. Of these 20 tribes, 6 do not participate because  they are located in states that do not offer the program. According to HHS  officials, tribes in states that do not offer GAP would need to directly  operate a title IV-E program in order to receive federal guardianship  assistance. As of March 2016, 33 states and 6 tribes had been approved  to operate GAP, according to HHS (see fig. 5).
However, 14 tribes who use guardianship as a case goal are in states  that offer GAP, but tribal officials told us they did not participate in GAP  for several reasons. Officials from 5 tribes reported that because GAP  was not included as an option in their title IV-E tribal-state agreements,  families with guardianship arrangements do not receive GAP payments.  Officials from 3 other tribes said they did not receive title IV-E funding so  their tribes were not eligible for GAP payments. Officials from an  additional 5 tribes told us that they did not participate due to access  challenges at the state level, such as age restrictions or difficulty meeting  state requirements. For example, in one state, according to tribal officials,  a child must be 12 years old before a guardianship would be approved.  Finally, officials from 1 tribe said that they were unaware of title IV-E GAP  (see fig. 6). Given that tribes cited different reasons for not participating in  GAP, HHS, states, and tribes may need to take different actions to  address those reasons. In addition, there may be other reasons why  tribes that we did not interview may not be participating in GAP.
HHS officials said that because the program provides additional support  for foster children’s transition to permanency, participating in title IV-E  GAP and providing tribes GAP payments is in a state’s interest. However,  we previously reported that some states opted not to participate in GAP  because of limited funding for the state’s portion of the GAP payment to  relative guardians. HHS officials told us that they were not aware of any  instances in which a state participated in GAP but did not provide access  to tribes through title IV-E agreements. However, officials also noted that  HHS generally does not have information on the contents of title IV-E  tribal-state agreements, as these agreements are not required to be  submitted as part of a state’s title IV-E plan. Officials said that it is the  responsibility of tribes and states to discuss GAP and whether to include  the program in their IV-E agreements. They noted that Title IV-E calls on  states to negotiate in good faith with tribes to develop a tribal-state  agreement to administer the IV-E program, including GAP assistance  payments. They also told us that the lack of guardianship funding to  tribes means that tribes may be forced to rely on long-term foster care to  fund permanent placements.
ACF’s strategic plan provides a basis for the Children’s Bureau to support  tribes’ participation in GAP. As part of its overarching goal to support  underserved and underrepresented populations, ACF’s 2015-2016  strategic plan includes a goal for working with tribes to increase their  capacity to promote child safety, permanency, and well-being. It also  includes a goal to promote and facilitate improved tribal-state relations  and policy at the regional and state levels to improve outcomes for Indian  children. In addition, federal standards for internal control state that an  agency’s management system should assure that monitoring is  performed continually as part of agency operations. Without more  awareness by HHS on why tribes may not be participating in GAP,  including why some tribal-state agreements do not include GAP as an  option for tribes, some tribes that could benefit from GAP may not  participate in the program. The limited participation in GAP among the  tribes selected for our study suggests that tribes may not be making use  of available financial support for guardianships that could assist them in  establishing permanency for their children and preventing them from  remaining in long-term foster care. In 2012, a collaborative project of six  child welfare organizations identified title IV-E GAP as one method of  helping child welfare agencies establish permanency for children in foster  care, particularly for older or other children for whom finding permanent  placements may be difficult. Several states surveyed by the project  mentioned that they were targeting, although not exclusively, special  groups of children through GAP, including children with the APPLA case  goal. The project report noted that financial assistance for guardians  raising children who were in foster care is an essential component of the  supports relatives need to offer these children permanent families. By  taking steps that might increase tribal participation in GAP, HHS could  better support tribes’ efforts to find secure and stable homes for their  children in foster care.
section_title: Conclusions
paragraphs: Changes made by the Preventing Sex Trafficking and Strengthening  Families Act to the use of the APPLA case goal were expected by child  welfare advocates to help ensure permanent adult connections for older  children. While most tribal officials we spoke with did not consider the  restriction on the use of APPLA to older children as a challenge, more  than half noted that they faced resource constraints—including limited  financial resources—which affect their ability to find permanent  placements for children under their care. In 2008, title IV-E GAP was  established to provide federal dollars to assist states and tribes with  payments to relatives who are willing to provide permanent homes for  children. However, most tribes we interviewed were not participating in  the program. Some reported that their tribal-state title IV-E agreements  did not include access to GAP while other tribes faced access challenges  at the state level. Others did not receive any title IV-E funding or were  unaware of the program, and tribes may have additional reasons for not  participating. Guardianship arrangements can be a useful case goal to  pursue in situations where reunification is not possible and adoption  conflicts with tribal cultural values. GAP could help tribes by providing the  financial assistance that tribal relatives need in order to provide a home  for a child in their care. When the APPLA restriction takes effect, it can  also provide an alternative to APPLA for those tribes trying to place a  younger child who has special needs and requires more resources for  care and for whom other permanency goals are not viable. As our  analysis of the fiscal year 2014 AFCARS data indicated, some of these  younger children may now be in institutional care and may need  placement in a family setting if they are assigned a new case goal instead  of APPLA. In addition, the program can provide needed resources for  relatives willing to provide a stable home for children over the age of 16  who might otherwise be assigned APPLA. Without greater tribal  participation in title IV-E GAP, some tribes may not have critical financial  support to help children exit foster care to homes with relatives. By taking  steps to increase participation in GAP, HHS could better support tribes’  efforts to care for their children.
section_title: Recommendation for Executive Action
paragraphs: To help improve tribes’ ability to maintain safe, stable, and permanent  care for children, the Secretary of Health and Human Services should  direct the Children’s Bureau to explore the reasons for low tribal  participation and identify actions to increase this participation in the title  IV-E Guardianship Assistance Program.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to HHS for review and comment. HHS  provided written comments that are reproduced in appendix II. HHS also  provided technical comments that we incorporated, as appropriate.
HHS concurred with our recommendation that the Children’s Bureau  explore the reasons for low tribal participation and identify actions to  increase participation in the title IV-E GAP. HHS noted that some tribal- state agreements might predate 2008, when GAP was established. HHS  also said that regional office staff participate annually in joint planning for  the title IV-B and IV-E programs with their respective states and tribes  and that participation in GAP is a topic covered in joint planning activities.   In addition, HHS said that regional office staff are available to assist  states and tribes with discussions about GAP participation when tribal- state agreements are renegotiated and that technical assistance is  available to tribes, if needed.  According to HHS, the agency plans to add  information to the Children’s Bureau website about direct federal funding  for tribal title IV-E agencies and about tribal-state partnership agreements  and plans to distribute issue briefs on GAP and best practices for tribal- state agreements.
We agree that HHS has the planning process, technical assistance  resources, and regional staff in place to discuss GAP participation with  title IV-E state and tribal agency officials. However, our review found that  tribal participation in GAP remains low, which suggests that HHS needs  to identify actions to increase participation in this program. We believe  that the additional actions HHS plans to take—providing information on  the Children’s Bureau website about direct funding and distributing issue  briefs on GAP and best practices for tribal-state partnerships and  agreements—could support tribes’ participation in GAP either by helping  tribes to directly operate a title IV-E program or to negotiate a tribal-state  agreement that includes a provision for GAP participation. Because some  tribes reported challenges at the state level to participating in GAP and  several tribes reported that the state where they are located does not  participate in the program, we encourage HHS to engage title IV-E state  agency officials in discussions about tribal participation in GAP during the  annual review of the their title IV-E state plan. As HHS noted in its  response, regional office staff are a resource to states and tribes as they  renegotiate agreements to help them explore participation in GAP.  Through such discussions, HHS could identify ways that regional office  staff might help state agencies resolve any challenges to GAP  participation that tribes experience at the state level. HHS has taken  several steps over the past few years to help tribes with their title IV-E  programs, including hiring a tribal coordinator to facilitate communication  between regional offices and tribal title IV-E agencies. Taking additional  steps to ensure that tribes have the opportunity to participate in GAP  could go a long way toward helping tribes gain more resources for  children under their care and better support tribes’ efforts to care for  children exiting foster care to permanent homes.
As agreed with your offices, unless you publicly announce the contents of  this report earlier, we plan no further distribution until 30 days from the  report date. At that time, we will send copies of this report to the  appropriate congressional committees, the Secretary of the Department  of Health and Human Services, and other interested parties. We will also  make copies available to others on request. In addition, the report will be  available at no charge on GAO’s website at http://www.gao.gov. If you or  your staff have any questions about this report, please contact me at  (202) 512-7215 or brownke@gao.gov. Contact points for our Office of  Congressional Relations and Public Affairs can be found on the last page  of this report. GAO staff who made major contributions to this report are  listed in appendix III.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: This report examines: (1) what available data show about Indian children  in foster care compared to all other children in foster care; (2) the extent  to which selected tribal child welfare agencies face challenges in  addressing recent changes to APPLA and in establishing permanent  homes for children in tribal foster care; and (3) the extent to which HHS  has assisted tribal child welfare agencies in implementing the APPLA  change and addressing any challenges to establishing permanent homes.
To determine what available data show about Indian children in foster  care compared to all other children in foster care, we analyzed relevant  national data on foster care case plans from HHS’s Adoption and Foster  Care Analysis and Reporting System (AFCARS) for fiscal year 2014, the  most recent year for which data are available. Through AFCARS, state  title IV-E agencies are required to report to HHS semi-annually data on  (1) all children in foster care for whom the agency has responsibility for  placement, care, or supervision, and (2) all adopted children who were  placed by the agency or for whom the agency is providing adoption  assistance, care, or services. HHS in 2012 issued regulations that  generally apply the same requirements for data collection and reporting to  tribal title IV-E agencies. AFCARS contains information on placement  settings, case plans, and length of time in foster care, among other  information. Currently, AFCARS provides the following options for  reporting the child’s most recent “case plan goal” (referred to in this report  as a “case goal”):  reunify with parent(s) or principal caretaker(s);  live with other relative(s);  long-term foster care;  Options for reporting the child’s current placement setting in foster care  include:  foster family home (relative);  foster family home (non-relative);  trial home visit.
Specifically, we reviewed AFCARS data for the 415,129 children who  were in foster care on the last day of the fiscal year. Our analysis included  a number of key data elements, including sex, whether the child was an  American Indian/Alaska Native, number of placement settings during  current foster care episode, current placement setting, case goal, and  length of stay of latest removal episode. For the purposes of our data  analysis discussion, we used the term Indian for children identified as  American Indian/Alaska Native in AFCARS. Because the fiscal year 2014  AFCARS dataset does not have a measure for the APPLA case goal, we  used long-term foster care and emancipation as proxy measures for  APPLA. The AFCARS regulations were first issued in 1993, and HHS  published a proposed rule in February 2015 to revise AFCARS to, among  other things, incorporate statutory changes made since then.
AFCARS contains data on children under the responsibility of tribal title  IV-E agencies operating under tribal-state title IV-E agreements but does  not yet contain data for the 7 tribes approved to directly operate title IV-E  programs. Therefore, some children under the responsibility of tribal title  IV-E agencies—and covered by the 3-year delayed implementation  period for the APPLA restriction—are not represented in AFCARS. Data  for certain other children under the care and custody of tribal child welfare  agencies are not submitted into AFCARS. In addition, while AFCARS  provides data on most children in foster care in the United States, there  are several limitations to using the data available to study Indian children  in foster care, particularly those under the care and placement  responsibility of Indian tribes. In general, in AFCARS a person’s race is  determined by how they define themselves or by how others define them;  in the case of young children, parents determine the race of the child. In  AFCARS, “American Indian or Alaska Native” (AI/AN) is defined as “a  person having origins in any of the original peoples of North or South  America (including Central America), and who maintains tribal affiliation  or community attachment.” Children identified as Indian in AFCARS are  not necessarily enrolled members of a federally-recognized tribe or  eligible for enrollment.
Before deciding to use the data provided by HHS, we conducted a data  reliability assessment. We assessed the reliability of the data file that  HHS provided by (1) performing electronic data testing for obvious errors  in accuracy and completeness, (2) reviewing existing information about  the data and the system that produced the data, and (3) interviewing  agency officials and child welfare experts knowledgeable about these  data. We determined that the data were sufficiently reliable for the  purposes of this report.
To obtain the perspectives of tribal officials, we conducted semi- structured interviews (2 in person and 13 by telephone) with tribal child  welfare officials from 15 federally recognized tribes and held six group  interviews with representatives from 21 other federally recognized tribes.  We selected the 15 tribes for individual interviews from six states that  have high numbers of tribes receiving title IV-E or title IV-B funding:  Arizona, Michigan, Montana, New Mexico, Oklahoma, and Washington.  Tribes in these states were selected to achieve variation in tribal  population under age 21 and type of title IV funding—via a direct title IV-E  program, a title IV-E tribal-state agreement, or a title IV-B program only.  We conducted one telephone group interview and convened five in- person group interviews with officials from 21 additional tribes who were  assembled for regional or national meetings at the following venues:
Session convened by Casey Family Programs prior to a tribal  consultation session with the Administration for Children and Families,  Washington, D.C., September 2015.
Oklahoma Indian Child Welfare Association Conference, Norman, OK,  November 2015 - two discussion groups.
Casey Family Programs National Title IV-E Summit, Denver, CO,  December 2015.
Michigan Quarterly Tribal-State Partnership meeting, Lansing, MI,  January 2016.
All tribes in attendance at these events were invited to participate in our  group interviews. In total, our tribal interviewees included representatives  of 6 tribes that were approved to operate a title IV-E program directly  through HHS; representatives of 15 tribes that received title IV-E funding  through a tribal-state agreement as well as title IV-B funding; and  representatives of 13 tribes that received title IV-B funding only. The  information obtained in our interviews is not generalizable to the  population of federally recognized tribes, but provides examples of tribes’  experience using the APPLA case goal and any challenges they may face  establishing permanency for children in their care when the changes go  into effect.
In addition, in the report we use qualifiers, such as “some” and “several”  in some cases to quantify responses from tribal officials across our  individual and group interviews with officials from 36 tribes in total. These  qualifiers are defined as follows:  “Most” more than 18 tribes  “Many” represents 11-17  “Several” represents 6-10  “Some” represents 2-5  We also reviewed relevant federal laws, regulations and HHS guidance to  states and tribes. In addition, we interviewed state child welfare officials  from the six selected states, as well as officials from the Administration on  Children and Families’ (ACF) Children’s Bureau at HHS; officials from five  of HHS’s regional offices that work with the states where the selected  tribes were located; and the Center for Tribes, an HHS-funded technical  assistance provider.
section_title: Appendix II: Comments from the Department of Health and Human Services
section_title: Appendix III: GAO Contact and Staff Acknowledgements
subsections: section_title: GAO Contact
paragraphs: Kay E. Brown, Director, (202) 512-7215 or brownke@gao.gov.
section_title: Staff Acknowledgements
paragraphs: In addition to the contact named above, Elizabeth Morrison (Assistant  Director), Sara Edmondson (Analyst-in-Charge), Kelly Snow, and Kate  Blumenreich made key contributions to this report. Also contributing to  this report were Ed Bodine, James Bennett, David Chrisinger, Sarah  Cornetto, Jean McSween, and Daren Sweeney.