Child Welfare: Improved Federal Oversight Could Assist States in Overcoming Key Challenges
Published: 2004-01-28T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Title IV-B of the Social Security Act, comprised of two subparts, is the primary source of federal funding for services to help families address problems that lead to child abuse and neglect and to prevent the unnecessary separation of children from their families; however, a number of challenges exist that impair states' ability to deliver and track these services. This testimony is based on findings from three reports issued in 2003 and addresses the following: (1) states' use of Title IV-B funds in providing a wide array of services to prevent the occurrence of abuse, neglect, and unnecessary foster care placements, as well as in providing other child welfare services; (2) factors that hinder states' ability to protect children from abuse and neglect; and (3) the Department of Health and Human Services' (HHS) role in helping states to overcome these challenges. Findings are based on multiple methodologies, including a survey to child welfare directors on states' use of Title IV-B funds; an analysis of nearly 600 exit interview documents completed by staff who severed their employment from 17 state, 40 county, and 19 private child welfare agencies; and a survey of all 50 states and the District of Columbia regarding their experiences in developing and using information systems and their ability to report data to HHS. In each case, GAO also conducted multiple site visits to selected states and interviewed child welfare experts and HHS headquarters and regional officials.
section_title: What GAO Found
paragraphs: States use of Title IV-B funds to provide a wide variety of services to prevent the occurrence of abuse, neglect, and foster care placements, as well as to provide other child welfare services. According to GAO's Title IV-B survey data for fiscal year 2002, states spent about 60 percent of subpart 1 funds on the salaries of child welfare agency staff, administration and management expenses, and child protective services, while about 10 percent were used to provide family support and family preservation services. In comparison, states spent about 62 percent of their subpart 2 funds on family support and preservation services. Child welfare agencies face a number of challenges related to staffing and data management that impair their ability to protect children from abuse and neglect. Low salaries hinder agencies' ability to attract potential child welfare workers and retain those already in the profession. According to caseworkers GAO interviewed, high turnover rates and staffing shortages leave remaining staff with insufficient time to establish relationships with families and make the necessary decisions to ensure safe and stable permanent placements. States also face challenges developing appropriate information systems needed to track abuse or neglect reports and monitor children in foster care. In addition, several factors affect states' ability to collect and report reliable adoption, foster care, and child abuse and neglect data, including insufficient caseworker training, inaccurate and incomplete data entry, and technical challenges reporting the data. HHS plays a role in helping states overcome some of the challenges they face in operating their child welfare programs, but additional oversight or technical assistance could assist states in meeting the needs of children served by child welfare agencies. HHS's oversight of Title IV-B focuses primarily on states' overall child welfare systems and outcomes, but the agency provides relatively little oversight specific to Title IV-B subpart 1. In addition, HHS plays a limited role in states' workforce activities by offering partial reimbursement for training expenses and managing discretionary grant programs. The agency monitors states' information systems development and data reporting, but despite the availability of technical assistance, states reported ongoing challenges reporting reliable data. In the related reports, GAO made several recommendations to HHS. GAO recommended that HHS provide the necessary guidance to ensure that regional offices monitor states' use of Title IV-B subpart 1 and to consider gathering additional information on its use. GAO also recommended that HHS take actions that may help child welfare agencies address recruitment and retention challenges. Last, GAO recommended that HHS consider ways to enhance the guidance and assistance offered to help states overcome key data challenges. HHS generally agreed with GAO's findings and recommendations, except that it noted that its level of oversight of Title IV-B was commensurate with the program's scope and intent.

section_title: Letter
paragraphs: Thank you for inviting me here today to discuss several issues related to  the oversight of child welfare programs across the nation. As you are  aware, state child welfare agencies determined that over 900,000 children  had been the victims of abuse or neglect by their parents or other  caretakers in 2001. Additionally, more than 800,000 children are estimated  to spend some time in foster care each year, with the federal government  allocating approximately $7 billion each year to investigate abuse and  neglect, provide placements to children outside their homes, and deliver  services to help keep families together. Title IV-B of the Social Security  Act, comprised of two subparts, is the primary source of federal funding  for services to help families address problems that lead to child abuse and  neglect and to prevent the unnecessary separation of children from their  families. Funding under Title IV-E of the Social Security Act is used  primarily to pay for the room and board of children in foster care. Since  1994, designated federal matching funds have been available to states to  develop and implement comprehensive case management systems— statewide automated child welfare information systems (SACWIS)—to  manage their child welfare cases as well as to report child abuse and  neglect, foster care, and adoption information to the federal government.
In addition to this funding, the Department of Health and Human Services’  (HHS) Administration for Children and Families (ACF) monitors states’  compliance with key federal goals, specified in part by the Adoption and  Safe Families Act (ASFA) of 1997, to keep children safe and ensure their  placement in stable and permanent homes. Through its formal review  process, known as the Child and Family Services Review (CFSR), HHS  uses specific assessment measures, such as agencies’ ability to conduct  timely abuse and neglect investigations and regularly visit children in their  homes, to assess the performance of states’ child welfare systems.
My testimony today will focus on three key issues: (1) states’ use of Title  IV-B funds in providing a wide array of services to prevent the occurrence  of abuse, neglect, and foster care placements, as well as other child  welfare services; (2) factors that hinder states’ ability to protect children  from abuse and neglect; and (3) HHS’s role in helping states to overcome  the challenges they face in protecting children from abuse and neglect. My  comments are based primarily on the findings from three reports: U.S.  General Accounting Office, Child Welfare: HHS Could Play a Greater Role  in Helping Child Welfare Agencies Recruit and Retain Staff. GAO-03-357.  Washington, D.C.: March 31, 2003; Child Welfare: Most States Are  Developing Statewide Information Systems, but the Reliability of Child  Welfare Data Could Be Improved. GAO-03-809. Washington, D.C.: July 31,  2003; and Child Welfare: Enhanced Federal Oversight of Title IV-B Could  Provide States Additional Information to Improve Services. GAO-03-956.  Washington, D.C.: September 12, 2003. Those findings were based on  multiple methodologies, including a survey of child welfare directors on  states’ use of Title IV-B funds; an analysis of 600 exit interview documents  completed by staff who severed their employment from 17 state, 40  county, and 19 private child welfare agencies; and a survey of all 50 states  and the District of Columbia regarding their experiences in developing and  using information systems and their ability to report data to HHS. In each  case, we supplemented these surveys and analyses by conducting multiple  site visits to selected states and by interviewing child welfare experts and  HHS headquarters and regional officials.
In summary, we found that states use Title IV-B funds to provide a wide  variety of services to prevent the occurrence of abuse, neglect, and foster  care placements, as well as to provide other child welfare services.   Subpart 1 dollars were most frequently used to fund staff salaries, with  almost half of these funds designated for the salaries of child protective  services (CPS) social workers. In comparison, states spent half of their  subpart 2 funds on family support or prevention programs and another 12  percent on family preservation services. CFSR results for the past 2 years,  however, indicate that states have not performed strongly in terms of  assessing the services families need and providing those services. Child  welfare agencies face a number of issues related to staffing and data  management that impair their ability to protect children from abuse and  neglect. In particular, low salaries hinder agencies’ ability to attract  potential child welfare workers and to retain those already in the  profession. Our analysis of CFSRs in 27 states indicated that large  caseloads and worker turnover delay the timeliness of investigations and  limit the frequency of worker visits with children, hampering agencies’  attainment of some key federal safety and permanency outcomes.  Furthermore, states face challenges developing appropriate information  systems needed to track abuse or neglect reports and monitor children in  foster care, with many states reporting development delays. In addition,  several factors affect the states’ ability to collect and report reliable  adoption, foster care, and child abuse and neglect data, including  insufficient caseworker training, inaccurate and incomplete data entry,  and technical challenges reporting the data. Although HHS plays a role in  monitoring child welfare programs, additional oversight or technical  assistance could assist states in meeting the needs of children served by  child welfare agencies. For example, HHS’s oversight of Title IV-B focuses  primarily on states’ overall child welfare systems and outcomes, but the  agency provides relatively little oversight specific to the services provided  under Title IV-B subpart 1. In addition, HHS plays a limited role in states’  workforce activities by offering partial reimbursement for training  expenses and managing discretionary grant programs. The agency  monitors SACWIS development and data reporting, but despite the  availability of technical assistance, states reported ongoing challenges  reporting reliable data.
subsections: section_title: Background
paragraphs: ACF is responsible for the administration and oversight of federal funding  to states for child welfare services under Titles IV-B and IV-E. HHS  headquarters staff are responsible for developing appropriate policies and  procedures for states to follow in terms of obtaining and using federal  child welfare funds, while staff in HHS’s 10 regional offices and 10 national  resource centers provide guidance and technical assistance to improve  child welfare services nationwide. HHS compiles state-reported child  welfare data in two databases: the Adoption and Foster Care Analysis and  Reporting System (AFCARS) and the National Child Abuse and Neglect  Data System (NCANDS). HHS relies on the information available in its  databases to analyze and track children’s experiences in the child welfare  system, to determine states’ performance on federal child welfare outcome  measures, and to report to Congress on children’s well being and child  welfare experiences. However, the monitoring of children served by state  child welfare agencies is the responsibility of the state agencies that  provide the services to these children and their families. Child welfare  caseworkers at the county or local level are the key personnel responsible  for documenting the wide range of services offered to children and  families, such as investigations of abuse and neglect; treatment services  offered to families to keep them intact and prevent the need for foster  care; and arrangements made for permanent or adoptive placements when  children must be removed from their homes. Most states and counties  provide some child welfare services directly and provide others through  contracts with private agencies. National survey data confirm that both  state and private child welfare agencies are experiencing similar  challenges recruiting and retaining qualified caseworkers. For instance,  turnover of child welfare staff has been estimated at between 30 percent  and 40 percent annually nationwide, with the average tenure for child  welfare workers being less than 2 years.
In 2000, HHS established a new federal review system to monitor state  compliance with federal child welfare laws. One component of this system  is the CFSR, which assesses state performance in achieving safety and  permanency for children, along with well-being for children and families.  The CFSR process includes a self-assessment by the state, an analysis of  state performance in meeting national standards established by HHS, and  an on-site review by a joint team of federal and state officials. Based on  the results of this process, HHS determines whether a state achieved  substantial conformity with (1) outcomes related to safety, permanency,  and well-being, such as keeping children protected from abuse and neglect  and achieving permanent and stable living situations for children and (2)  key systemic factors, such as having an adequate case review system and  an adequate array of services. States are required to develop program  improvement plans to address all areas of nonconformity.
subsections: section_title: Federal Funding of Child Welfare Services and Programs
paragraphs: Two titles of the Social Security Act provide federal funding targeted  specifically to foster care and related child welfare services. Title IV-E  provides an open-ended individual entitlement for foster care maintenance  payments to cover a portion of the food, housing, and incidental expenses  for all foster children whose parents meet certain federal eligibility  criteria. Title IV-E also provides payments to adoptive parents of eligible  foster children with special needs. To qualify for federal IV-E funding for  SACWIS, states must prepare and submit an advance planning document  (APD) to ACF’s Children’s Bureau, in which they describe the state’s plan  for managing the design, development, implementation, and operation of a  SACWIS that meets federal requirements and state needs in an efficient,  comprehensive, and cost-effective manner. Since the administration and  structure of state child welfare agencies vary across the nation, states can  design their SACWIS to meet their state needs, as long as states meet  certain federal requirements.
Title IV-B of the Social Security Act, established in 1935, authorizes funds  to states to provide a wide array of services to prevent the occurrence of  abuse, neglect, and foster care placements. In 1993, the Congress created  a new program as subpart 2 of Title IV-B (now known as Promoting Safe  and Stable Families), which funds similar types of services but is more  prescriptive in how states can spend the funds. No federal eligibility  criteria apply to the children and families receiving services funded by  Title IV-B.
Title IV-B subpart 1 provides grants to states for child welfare services,  which are broadly defined. Subpart 1 funds are intended for services that  are directed toward the accomplishment of the following purposes: (1)  protect and promote the welfare of all children; (2) prevent or remedy  problems that may result in the abuse or neglect of children; (3) prevent  the unnecessary separation of children from their families by helping  families address problems that can lead to out-of-home placements; (4)  reunite children with their families; (5) place children in appropriate  adoptive homes when reunification is not possible; and (6) ensure  adequate care to children away from their homes in cases in which the  child cannot be returned home or cannot be placed for adoption.
In 1980, the Congress enacted legislation that limited the total subpart 1  funds states could use for three categories of services: foster care  maintenance payments, adoption assistance payments, and child care  related to a parent’s employment or training. The total of subpart 1 funds  used for these purposes cannot exceed a state’s total 1979 subpart 1  expenditures for all types of services. The intent of this restriction,  according to a congressional document, was to encourage states to devote  increases in subpart 1 funding as much as possible to supportive services  that could prevent the need for out-of-home placements. However, this  restriction applies only to the federal portion of subpart 1 expenditures, as  the law notes that states may use any or all of their state matching funds  for foster care maintenance payments.
Subpart 2 authorizes grants to states to provide four categories of services,  which are defined below:    Family preservation services: Services designed to help families at risk or  in crisis, including services to (1) help reunify children with their families  when safe and appropriate; (2) place children in permanent homes  through adoption, guardianship, or some other permanent living  arrangement; (3) help children at risk of foster care placement remain  safely with their families; (4) provide follow-up assistance to families  when a child has been returned after a foster care placement; (5) provide  temporary respite care; and (6) improve parenting skills.
Family support services: Community-based services to promote the safety  and well-being of children and families designed to increase the strength  and stability of families, to increase parental competence, to provide  children a safe and supportive family environment, to strengthen parental  relationships, and to enhance child development. Examples of such  services include parenting skills training and home visiting programs for  first time parents of newborns.
Time-limited family reunification services: Services provided to a child  placed in foster care and to the parents of the child in order to facilitate  the safe reunification of the child within 15 months of placement. These  services include: counseling, substance abuse treatment services, mental  health services, and assistance to address domestic violence.
Adoption promotion and support services: Services designed to encourage  more adoptions of children in foster care when adoption is in the best  interest of the child, including services to expedite the adoption process  and support adoptive families.
section_title: States Spend IV-B Funds on A Variety of Services, With Subpart 2 Focusing More on Prevention
paragraphs: In our September 2003 report on Title IV-B, we found that states use these  funds to provide a wide variety of services to prevent the occurrence of  abuse, neglect, and foster care placements, as well as services to help  children in foster care and their parents; however, relatively few subpart 1  dollars are used to provide family support and family preservation  services, while the majority of subpart 2 funds are used for these purposes.  According to our survey data for fiscal year 2002, states spent subpart 1  funds most frequently on the salaries of child welfare agency staff,  administration and management expenses, CPS services, and foster care  maintenance payments. In comparison, states spent half of their subpart 2  funds on family support or prevention programs and another 12 percent on  family preservation services. CFSR results for the past 2 years, however,  indicate that states have not performed strongly in terms of assessing the  services families need and providing those services.
subsections: section_title: States Use Subpart 1 Funds Primarily for Staff Salaries
paragraphs: Relatively few subpart 1 dollars were used for family support or family  preservation services; instead, they were most frequently used to fund  staff salaries, with almost half of these funds designated for the salaries of  CPS social workers. Another 20 percent of these funds were used for the  salaries of other social workers. During a site visit to the state of  Washington for the Title IV-B report, child welfare officials told us that  they used over 50 percent of the state’s subpart 1 funds for salaries of staff  providing direct services, including CPS social workers, other types of  social workers, social work supervisors, and clerical support staff.  Administration and management comprised the second largest category of  service, accounting for almost 17 percent of subpart 1 dollars. This  category included rent and utilities for office space, travel expenses for  agency staff, and staff training.
CPS represents the third largest category of services that states funded  with subpart 1. States used about 16 percent of their subpart 1 funds to  provide a variety of CPS services, such as telephone hotlines for the public  to report instances of child abuse and neglect, emergency shelters for  children who needed to be removed from their homes, and investigative  services. During our site visit to California, for example, officials reported  using about 40 percent of their subpart 1 dollars to fund staff salaries and  operating expenses associated with a variety of shelter care services  provided by counties, such as emergency shelters and foster homes. A  child is placed in one of these shelters when no other placement option is  immediately available—for example, when an investigation in the middle  of the night determines that the child is at immediate risk of harm. States  also used nearly 11 percent of their subpart 1 funds to make recurring  payments for the room and board of foster children who are not eligible  for reimbursement through Title IV-E. About 10 percent of subpart 1  dollars were used to provide family support and family preservation  services.
section_title: Subpart 2 Most Frequently Funds Family Support and Family Preservation Services
paragraphs: In contrast to subpart 1, states used over 80 percent of their subpart 2  dollars to fund services in its four mandated service categories—family  support, family preservation, family reunification, and adoption promotion  and support services (see app. I for additional information on states’  comparative expenditures on subparts 1 and 2). For example, states  reported using half of their subpart 2 dollars to fund family support and  prevention services. These services included mentoring programs to help  pregnant adolescents learn to be self-sufficient; financial assistance to low- income families to help with rent and utility payments; and parenting  classes, child care, and support groups provided by a community-based  resource center. Washington funded a network of public health nurses and  social service agencies to provide support services to families that are the  subject of a report of abuse or neglect—these services are provided in lieu  of, or following, a formal investigation when the level of risk to the child is  not considered high.
Family preservation services—designed to keep families together and  prevent the need to place a child in foster care—represented the second  largest service category funded by subpart 2. Washington used subpart 2  funds for its statewide family preservation program, which offers  counseling and parent training services for up to 6 months to families with  children who are at risk of being placed in foster care.
In addition, states reported using about 11 percent of their subpart 2 funds  for adoption support and preservation services. With these funds, states  provided services such as counseling for children who are going to be  adopted, family preservation services to adoptive families, and respite  care for adoptive families. Officials in Ohio reported using almost half of  its subpart 2 dollars for adoption services, including post adoption  services and services to recruit families for children in need of adoptive  homes.
Finally, states spent about 9 percent of their subpart 2 dollars on family  reunification services. States funded a diverse array of family reunification  programs, such as supervised visitation centers for parents to visit with  their children and coordinators for alcohol and drug treatment services for  families whose primary barrier to reunification is substance abuse. New  Jersey funded a supervised visitation program that offers parenting  education, counseling, transportation, and support groups and is located  in a private home, allowing families to visit together in a homelike setting  and engage in more natural interactions.
section_title: CFSRs Find States Are Weak in Assessing Families’ Service Needs
paragraphs: While states are using Title IV-B funds to provide this array of services,  CFSR results for the past 2 years indicate that states have not performed  strongly in terms of assessing the services families need and providing  those services. When HHS reviewed case files it determined that 31of the  32 states that underwent a CFSR in 2001 or 2002 needed improvement in  terms of assessing family needs and providing services to meet those  needs. While 21 of the 32 states were considered to have an appropriate  array of services for families, HHS found that the accessibility of services  was a particular weakness in that many services were either not available  statewide or had long waiting lists or other barriers to accessibility.
section_title: Staff and Data Issues Affect States’ Ability to Protect Children From Abuse and Neglect
paragraphs: Child welfare agencies face a number of issues related to staffing and data  management that impair their ability to protect children from abuse and  neglect. In particular, low salaries hinder agencies’ ability to attract  potential child welfare workers and to retain those already in the  profession. Additionally, caseworkers in the four states we visited for the  March 2003 child welfare workforce report cited high caseloads and a  lack of supervisory support as issues impacting their ability to work  effectively. According to these caseworkers, high turnover rates and  staffing shortages leave remaining staff with insufficient time to establish  relationships with children and families and make the necessary decisions  to ensure safe and stable permanent placements. Furthermore, our July  2003 report found that states face challenges developing appropriate  information systems needed to track abuse or neglect reports and monitor  children in foster care. While 47 states are developing or operating a  SACWIS, many states reported that the development of their SACWIS is  delayed. Most states responding to our survey faced challenges to SACWIS  development, such as obtaining state funding and developing a system that  met the child welfare agency’s needs statewide. In addition, several factors  affect states’ ability to collect and report reliable adoption, foster care, and  child abuse and neglect data, including insufficient caseworker training,  inaccurate and incomplete data entry, and technical challenges reporting  the data.
subsections: section_title: Recruitment and Retention Challenges May Hamper Agencies’ Attainment of Federal Child Welfare Outcomes
paragraphs: In our report on the child welfare workforce, we found that public and  private child welfare agencies face a number of challenges recruiting and  retaining qualified caseworkers and supervisors. Low salaries, in  particular, hinder agencies’ ability to attract potential staff and to retain  those already in the profession. For example, caseworkers in each of the  four states we visited said that many of their former child welfare  colleagues pursued positions in the education field where they could not  only make more money but also work with children without risking their  own safety. For example, the Bureau of Labor Statistics’ national wages  survey reports that elementary and middle school teachers earn, on  average, about $42,000 annually while social workers earn about $33,000.
Additionally, high caseloads, administrative burdens, limited supervision,  and insufficient training reduce the appeal of child welfare work.  Caseworkers and supervisors in all four states we visited cited demanding  and complex caseloads and related administrative requirements, such as  casework documentation, as factors affecting retention. Some of the  caseworkers we interviewed handled double the number of cases  recommended by advocacy organizations, and one study found that  caseloads for individual child welfare workers ranged from 10 to 110  children, with workers handling an average of about 24 to 31 children  each. Furthermore, some of the caseworkers we interviewed told us that  they spent between 50 and 80 percent of their time completing paperwork,  thereby limiting their time to assist children and families.
Caseworkers told us that their desire to stay in the child welfare  profession was influenced by high-quality supervision and adequate on- the-job training; however, these elements were often lacking. According to  supervisors in one city we visited, about half of new trainees left their jobs  before completing 1 year, in part, because these newly hired caseworkers  were not sufficiently trained to do their jobs. Furthermore, some newly  promoted supervisors have requested demotions because they felt  unprepared to meet job demands, and the caseworkers they supervised  complained of poor management and insufficient support.
There is some evidence to suggest how recruitment and retention  challenges affect the safety and permanency of children in care, but the  magnitude of this effect is unknown. Caseworkers in the four states that  we visited said that high turnover rates and staffing shortages leave  remaining staff with insufficient time to conduct the types of home visits  necessary to assess children’s safety and to make well-supported decisions  to ensure safe and stable permanent placements. For example, when staff  change, caseworkers may have to reestablish information to update the  case record and families may become hesitant to work with unfamiliar  caseworkers, making it difficult to learn the history of the case. Worker  turnover also disrupts the continuity of services, particularly when newly  assigned caseworkers have to conduct or reevaluate educational, health,  and safety assessments due to poor or insufficient information in case files  left behind by others. Furthermore, caseworkers explained that high  caseloads require them to limit the number and quality of the home visits  they conduct, forcing them to focus only on the most serious  circumstances of abuse and neglect. One caseworker in Texas noted that  when she does make a home visit, the visit is quick and does not enable  her to identify subtle or potential risks to the child’s well-being.
Our analysis of federal CFSRs corroborated caseworker accounts,  showing that large caseloads and worker turnover delay the timeliness of  investigations and limit the frequency of worker visits with children,  thereby hampering agencies’ attainment of some key federal safety and  permanency goals. Although identifying workforce deficiencies is not an  objective of the CFSR process, in all 27 CFSRs we analyzed, HHS explicitly  cited workforce deficiencies—high caseloads, training deficiencies, and  staffing shortages—that affected the attainment of at least one assessment  measure. While the number of affected assessment measures varied by  state, we found that HHS cited these factors for an average of nine  assessment measures per state, with more than half of the 27 states  exceeding this average. For example, in New Mexico’s CFSR, reviewers  cited staff turnover and vacancies as impairing workers’ ability to  investigate child maltreatment reports, provide appropriate services for  families, and establish timely permanency goals. Furthermore, the District  of Columbia’s CFSR describes heavy workloads, high staff turnover, and a  climate in which supervisors often call new workers out of training to  handle ongoing caseload activities.
section_title: Delays in SACWIS Completion and Challenges with Data Collection Affect States’ Ability to Ensure Reliable Data on Children’s Experiences
paragraphs: In addition to performing a wide range of services to protect children,  child welfare caseworkers are the key personnel who collect and  document information on children and families served by children welfare  agencies. Case file documentation is generally captured in state computer  systems. In our July 2003 report, HHS reported that 47 states are using  targeted federal funds to develop or operate their child welfare computer  systems—known as SACWIS—but many continue to face challenges  completing their systems. In our November 2003 testimony on SACWIS,  we reported on the costs associated with developing SACWIS and the  associated barriers, such as development delays and difficulties in  receiving state funding approval, creating a system that reflects child  welfare work processes, and securing contractors knowledgeable about  child welfare. Many state officials said that they recognize the benefit their  state will achieve by developing SACWIS, such as contributing to the  timeliness of child abuse and neglect investigations. In Oklahoma, for  example, caseworkers and state officials noted that they believe their  children are safer since the implementation of SACWIS simply because the  information on the children is easily accessible to the caseworkers and  their supervisors. According to our survey results, automated systems  provided easier access to data and allowed caseworkers to better monitor  children in their care, which may contribute to additional child welfare  and administrative benefits, such as decreased incidences of child abuse  and neglect, shortened length of time to achieve adoption, timeliness of  payments to foster families, and timeliness of payments to foster facilities.
Some of the data captured in case file records are reported to two HHS  databases that compile child welfare data—AFCARS and NCANDS. We  found that several factors affect states’ ability to collect and report reliable  data to HHS on children served by state child welfare agencies. Almost all  of the states responding to our survey reported that insufficient  caseworker training and inaccurate and incomplete data entry into their  information system affect the quality of AFCARS and NCANDS data.  Although most states reported these as separate factors, HHS and the  states we visited found that insufficient training and inaccurate and  incomplete data entry are often linked. Caseworkers, supervisors, and  managers in the five states that we visited reported that additional factors,  such as difficulties balancing data entry with the time that they spend with  the families and children, contributed to inaccurate or incomplete data  entry. Supervisors in Iowa explained that since caseworkers are  responsible for ensuring that children and their families receive the  services they need, the caseworkers tend to initially limit data entry to the  information that is necessary to ensure timely payment to foster care  providers, and complete all other data elements when the caseworkers  have time. In addition, caseworkers in Colorado said that they are between  30 and 60 days behind in their data entry, so the information in the  automated system may not accurately reflect the current circumstances of  children in care.
We also reported in our July 2003 report and November 2003 testimony  that many states experienced technical challenges reporting their data to  HHS. The problems reported by states are typically a result of challenges  associated with data “mapping”—matching state data elements to the  federal data elements. For example, 36 states reported in our survey that  matching their state-defined data to HHS’s definitions affected the quality  of the data reported to NCANDS and AFCARS. In addition to the  challenges reported in our survey, HHS reported that transferring data  from older data systems into SACWIS affects the quality of the data  reported to AFCARS and NCANDS.
section_title: Improvements in HHS’S Oversight of Child Welfare Programs Could Help States Overcome Some Challenges
paragraphs: HHS plays a role in helping states implement their child welfare programs,  but in some cases, additional federal oversight or technical assistance  could help states provide more effective services. In terms of child welfare  funding, HHS focuses its programmatic oversight on the overall child  welfare system in each state and provides relatively little oversight specific  to Title IV-B subpart 1. HHS’s role in assisting states overcome the child  welfare workforce challenges is limited to partial federal reimbursement  for training expenses and management of discretionary grant programs,  such as the Child Welfare Training Program. HHS also monitors SACWIS  development and data reporting and provides assistance to states to  address some of the associated challenges; however, states reported  ongoing challenges, such as the lack of clear and documented guidance on  how to report child welfare data, despite the availability of this assistance.
subsections: section_title: HHS Focuses Oversight on the Overall Child Welfare System, but Has Limited Knowledge about States’ Use of Subpart 1 Funds
paragraphs: HHS focuses much of its programmatic oversight on the overall child  welfare system in each state, rather than focusing specifically on subpart 1  or any other federal funding source. A major component of HHS’s subpart  1 oversight is having the regional offices actively work with states to  develop appropriate goals for their child welfare systems and ensure that  available funds are used to support those goals. To receive Title IV-B  funding, HHS requires states to submit a Child and Family Services Plan,  which covers a 5-year period and describes the state’s goals and objectives  toward improving outcomes related to the safety, permanency, and well- being of children and families, as well as the services and programs the  state will pursue to achieve these goals. In addition to the 5-year plan, HHS  requires states to submit an update each year to discuss their progress in  meeting the goals outlined in their plans. Some regional officials noted  that states are still struggling to use these documents appropriately for  planning purposes and frequently just describe their current programs,  rather than focusing on outcomes and collecting data to measure progress  toward those outcomes.
The CFSR process is an additional tool HHS uses to ensure that states  conform to federal child welfare requirements and to help states improve  their child welfare services. Staff at one regional office described the  CFSR as a thorough review of the services funded by different federal  programs, such as Title IV-B, providing an opportunity to determine  whether states are providing the services they report in their planning  documents and whether those services are adequate and appropriate to  meet the needs of the state’s children and families. When asked about  HHS’s role in guiding states’ use of subpart 1 funds to address weaknesses  identified by the CFSRs, an HHS official told us that the agency provides  technical assistance to states to help them determine the most effective  use of their resources, while giving states much latitude to determine the  most appropriate use of their subpart 1 funds.
HHS does not require states to provide any data about their use of subpart  1 funds, such as their subpart 1 expenditures for specific services. As a  result, several regional offices noted that they have no way of knowing  how states actually spend their subpart 1 funds. Instead, HHS requires  states to submit annual estimates of the amount of subpart 1, subpart 2,  and other federal funds the state plans to spend in the upcoming year on  different categories of services (such as family support or CPS). However,  these estimates may not provide reliable data as to how states are using  subpart 1 funds. HHS officials explained that states’ actual expenditures  may vary from these estimates, as they address unforeseen circumstances.
In addition, HHS requires states to submit their estimates before the final  spending amounts have been appropriated.
The descriptions provided by regional office staff of their review of these  estimates indicate that they review them for relatively limited purposes. As  a result, most HHS regional offices do not review the annual estimates for  compliance with the statutory limits. In addition, HHS’s annual program  instruction, which details what information states must include in their  estimates and serves as the basis for the regional offices’ review of subpart  1 spending, does not mention the subpart 1 limits.  Five regional offices  were unaware that any limits on the use of subpart 1 funds existed. Four  other regional offices were aware of the limits, but did not ensure that  states complied with the limits.
This lack of review led HHS to approve spending plans for 15 states that  reported fiscal year 2002 planned subpart 1 expenditures for foster care  maintenance and adoption assistance payments that exceeded the  statutory limits. The dollar amounts by which the subpart 1 spending  estimates surpassed the limits were small in some cases, but large in  others. For example, Georgia reported that it planned to spend $1,497,000  of subpart 1 funds for these purposes in 2002, which would exceed its  statutory limit by $1,558. At the other extreme, Florida’s estimate indicated  that it planned to spend over $9 million, which was more than $7 million  over the maximum allowable spending of $1.9 million. In total, these 15  states submitted planned subpart 1 spending estimates for foster care  maintenance and adoption assistance payments that would exceed the  statutory limits by over $30 million.
Several regional offices said that they are not concerned about a state  planning to spend significant proportions of its subpart 1 funds on foster  care maintenance and adoption assistance payments if they believed the  state had a strong child welfare system with an appropriate array of  services. Regional office staff said that they would, however, ask a state to  reconsider its funding strategy if the state were performing poorly.  However, many of the states with approved subpart 1 estimates above the  statutory ceilings did not achieve strong outcomes on their CFSR  evaluations with regard to providing needed services and having an  appropriate array of services. HHS has conducted CFSRs on 13 of the 15  states with approved annual estimates over the subpart 1 spending limits  and determined that appropriately assessing family needs and providing  services to address those needs was an area needing improvement in 12 of  the 13 states. In addition, 7 of the 13 states were also determined to need  improvement in terms of having an appropriate array of services to meet  the needs of families in the state.
In discussing the current structure of Title IV-B, officials in all of HHS’s  regional offices told us that they believe states need some flexibility to use  Title IV-B funds to address state-specific child welfare needs as is  currently the case under subpart 1. At the same time, officials in 8 of HHS’s  10 regional offices also stressed the importance of subpart 2 to ensure that  states use some funds on family support services and prevention activities  to help preserve families and keep children from entering foster care.  Several regional offices expressed concern that, in the absence of the  minimum spending requirements outlined in subpart 2, states would  neglect preventive services, while using Title IV-B funds for more urgent  services, such as CPS or foster care. State and local child welfare officials  in one state we visited, along with officials at 2 HHS regional offices, said  that states need more federal funds to provide services to prevent foster  care placements, such as an increase in funds available under Title IV-B or  more flexibility to use Title IV-E funds to provide services. HHS is  currently developing a legislative proposal to give states more flexibility in  using Title IV-E foster care funds for such preventive services.
section_title: HHS’s Involvement with States’ Child Welfare Workforce Is Limited
paragraphs: HHS’s primary connection to the child welfare workforce has been  through partial federal reimbursement—75 percent—of states’ training  funds to implement educational programs for current child welfare staff  and to enhance the child welfare curriculum of undergraduate and  graduate social work programs to better educate and prepare potential  caseworkers. This funding may also be used for curriculum development,  materials and books, support for current workers to obtain a social work  degree, and incentives to induce entry to the child welfare field. During  fiscal year 2002, 49 states received $286 million in title IV-E training  reimbursements. These reimbursements ranged from a low of  approximately $10,400 in Alaska to a high of more than $79 million in  California, with the median reimbursement approximating $2.7 million.
In addition, ACF’s Children’s Bureau manages six discretionary grant  programs through which it funds various activities related to  improvements in the child welfare system. One of these programs—the  Child Welfare Training Program, authorized by Section 426 of Title IV of  the Social Security Act—awards grants to public and private nonprofit  institutions of higher learning to develop and improve the education,  training, and resources available for child welfare service providers. This  is the only program of the six with a specific emphasis on staff training;  however, in fiscal year 2003, it received the second smallest share—8  percent—of the Children’s Bureau’s total discretionary funds.
According to HHS officials, HHS has no authority to require states to  address caseload issues in their CFSR-related program improvement plans  or to enforce any caseload standards. Furthermore, HHS officials said that  states have made few requests of HHS’s national resource centers for  assistance with child welfare staff recruitment and retention. Although  HHS officials told us that they plan to examine the CFSRs to better  understand the relationship between recruitment and retention and safety  and permanency outcomes across the states, the agency is still conducting  these reviews and is not expected to complete them until March 2004.
section_title: HHS Offers Assistance to Help States Develop SACWIS and Improve Their Data, but States Report Ongoing Challenges with Some of HHS’s Efforts
paragraphs: In response to some of the challenges states face in developing SACWIS  and collecting and reporting child welfare data, HHS has conducted on-site  reviews of information systems and provided technical assistance from a  variety of sources. For example, at the time of our review, HHS had  conducted on-site reviews in 26 states with operational SACWIS to ensure  that the systems met all federal requirements and to offer assistance to  states that faced challenges completing the development of their SACWIS.  Few systems have been determined complete after an on-site review  because of unresolved issues, such as not being able to build links to other  state information systems or not implementing certain eligibility  determination functions. To help states address some of these  development challenges, the SACWIS review team provides the state with  recommendations for complying with SACWIS requirements and  schedules a conference call with the state officials to walk through the  system’s deficiencies and offer guidance on how the state can move  forward. In addition, in an attempt to help states comply with the  reporting standards and address some of the factors that contribute to  data quality problems, HHS performs comprehensive reviews of state  information systems’ ability to capture AFCARS data to identify problems  associated with data collection and reporting and to ensure that the  information in the automated system correctly reflects children’s  experiences in care.
Other technical assistance is available to states in a variety of formats.  HHS facilitates the sharing of information between states developing  SACWIS through an automated system users’ group that allows state and  federal officials to exchange information, ideas, and concerns. In addition  to the users’ group, HHS officials sponsor a Listserv—an electronic  mailing list—that allows state officials to exchange information, a monthly  conference call with state information technology directors, an annual  technical assistance meeting, and an NCANDS state advisory group. The  National Resource Center for Information Technology in Child Welfare,  which opened in 1999, also provides assistance to states on SACWIS  development and data issues.
HHS has also made available to states the software it uses to examine  states’ AFCARS and NCANDS submissions for inconsistencies and invalid  data. Officials in all the states that we visited said that they regularly use  this software, and an HHS official said that nearly every state has used the  software at least once. HHS officials reported that these tests help them to  identify some data quality errors, such as missing data, and said that they  believe that, in general, data have improved in recent years. However, the  officials indicated that the tests cannot pinpoint the underlying problems  contributing to these errors. Furthermore, one official reported that no  specific efforts have been conducted to track the individual data elements  and, therefore, HHS cannot report on how data quality has changed over  time.
Although the states we visited appreciated some of HHS’s efforts to assist  with improving state data quality, they and most states responding to our  survey agreed that the assistance is not always consistent or easily  accessible. The primary concerns reported by the states we visited were  delays in receiving clear written guidance on defining and reporting  certain data elements and the lack of state input in suggesting changes to  AFCARS. Despite the written guidance available to states in the form of  regulations and an online policy manual, states reported that the variation  in state policies and practices makes it difficult to interpret how to apply  the general guidance. As a result, states consult with HHS to ensure they  are applying the regulations appropriately. However, in commenting on a  draft of the July 2003 report, officials in Oklahoma told us that a common  concern among the states is the lack of timely response from HHS when  seeking guidance on how to report data. In commenting on a draft of the  same report, HHS explained that it first refers states to its Web site for  information and believes that the available guidance addresses states’  concerns in most instances. In addition, the states that have had an  AFCARS review experienced delays in obtaining guidance on how to  proceed following the on-site review. An HHS official told us that since the  review process is relatively new, the agency is still developing a process to  respond to the states and recognizes that it has not been responsive to the  states already reviewed. In addition, HHS is taking steps to gather  feedback from states and other users of AFCARS data to determine how to  improve the system to make the data more accurate and usable. As a part  of these efforts, HHS has published a Federal Register notice soliciting  comments and held focus group meetings at national conferences. The  difficulties states face in receiving federal guidance and assistance, as well  as the other challenges they face in reporting data, may negatively affect  the reliability of the data available in AFCARS and NCANDS.
section_title: Concluding Observations
paragraphs: Despite its relatively small funding level compared to other funding  sources for child welfare services, Title IV-B represents an important  federal commitment to states’ efforts to protect children from abuse and  neglect. However, HHS does not provide in-depth oversight specific to  Title IV-B subpart 1. Two key issues further compound states’ ability to  prevent abuse and neglect. For example, given the difficulties that public  and private child welfare agencies are experiencing in hiring, training, and  retaining their workforces, these agencies’ ability to provide services to  children is threatened. In addition, states face challenges in completing  their SACWIS systems and in ensuring that caseworkers input complete  and accurate case data in a timely manner.
We recommended in our September 2003 report on Title IV-B that the  Secretary of HHS provide the necessary guidance to ensure that HHS  regional offices monitor states’ use of Title IV-B subpart 1 funds for  compliance with statutory restrictions on the use of these funds. We also  recommended that the Secretary consider the feasibility of collecting basic  data on states’ use of these funds to facilitate its oversight of the program  and to provide guidance to help states determine appropriate services to  fund. In commenting on a draft of that report, HHS agreed with our first  recommendation but noted that the statutory limitations on Title IV-B  funds no longer serve a useful purpose and are incompatible with its  current proposal to offer states much more flexibility in using other  federal child welfare dollars. HHS disagreed with our second  recommendation, stating that it believes that its level of oversight is  commensurate with the scope and intent of the program and minimizes  states’ reporting requirements.
We recommended in our March 2003 report on child welfare worker  recruitment and retention that, because of the reported impact staffing  shortages and high caseloads have on the attainment of federal outcome  measures, that the Secretary of HHS take actions that may help child  welfare agencies address the recruitment and retention challenges they  face. In commenting on a draft of that report, HHS generally agreed with  our findings and concurred with our recommendation, saying that it has  begun to explore the effectiveness of child welfare training programs, with  an emphasis on lessons learned and best practices. However, HHS  stressed that it has no authority to require states to address caseload  issues in their CFSR program improvement plans or to enforce any  caseload standard.
To improve the reliability of state-reported child welfare data, we  recommended in our July 2003 SACWIS report that the Secretary of HHS  consider, in addition to HHS’s recent efforts to improve AFCARS data,  ways to enhance the guidance and assistance offered to states to help  them overcome the key challenges in collecting and reporting child  welfare data. HHS generally agreed with our findings and, in response to  our recommendation, noted that the data definitions need to be updated  and revised and said it is currently in the process of revising the AFCARS  regulations to further standardize the information states are to report.  More recently, HHS said that it would be creating policy guidance that will  delineate what will happen if a state fails to complete its SACWIS within a  reasonable time frame.
Mr. Chairman, this concludes my prepared statement. I would be pleased  to respond to any questions that you or other members of the  Subcommittee may have.
section_title: GAO Contact and Acknowledgments
paragraphs: For further information regarding this testimony, please call Cornelia M.  Ashby at (202) 512-8403. Individuals making key contributions to this  testimony include Diana Pietrowiak, Joy Gambino, Sara Schibanoff, and  Michelle St. Pierre.
section_title: Related GAO Products
paragraphs: D.C. Family Court: Progress Has Been Made in Implementing Its  Transition. GAO-04-234. Washington, D.C.: January 6, 2004.
Child Welfare: States Face Challenges in Developing Information  Systems and Reporting Reliable Child Welfare Data. GAO-04-267T.  Washington, D.C.: November 19, 2003.
Child Welfare: Enhanced Federal Oversight of Title IV-B Could Provide  States Additional Information to Improve Services. GAO-03-956.  Washington, D.C.: September 12, 2003.
Child Welfare: Most StatesAre Developing Statewide Information  Systems, but the Reliability of Child Welfare Data Could be Improved.  GAO-03-809. Washington, D.C.: July 31, 2003.
D.C. Child and Family Services: Key Issues Affecting the Management of  Its Foster Care Cases. GAO-03-758T. Washington, D.C.: May 16, 2003.
Child Welfare and Juvenile Justice: Federal Agencies Could Play a  Stronger Role in Helping States Reduce the Number of Children Placed  Solely to Obtain Mental Health Services. GAO-03-397. Washington, D.C.:  April 21, 2003.
Foster Care: States Focusing on Finding Permanent Homes for Children,  but Long-Standing Barriers Remain. GAO-03-626T. Washington, D.C.:  April 8, 2003.
Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare  Agencies Recruit and Retain Staff. GAO-03-357. Washington, D.C.: March  31, 2003.
Foster Care: Recent Legislation Helps States Focus on Finding  Permanent Homes for Children, but Long-Standing Barriers Remain.  GAO-02-585. Washington, D.C.: June 28, 2002.
District of Columbia Child Welfare: Long-Term Challenges to Ensuring  Children’s Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000.
Child Welfare: New Financing and Service Strategies Hold Promise, but  Effects Unknown. GAO/T-HEHS-00-158. Washington, D.C.: July 20, 2000.
Foster Care: States’ Early Experiences Implementing the Adoption and  Safe Families Act. GAO/HEHS-00-1. Washington, D.C.: December 22, 1999.
Foster Care: HHS Could Better Facilitate the Interjurisdictional  Adoption Process. GAO/HEHS-00-12. Washington, D.C.: November 19,  1999.
Foster Care: Effectiveness of Independent Living Services Unknown.  GAO/HEHS-00-13. Washington, D.C.: November 5, 1999.
Foster Care: Kinship Care Quality and Permanency Issues. GAO/HEHS- 99-32. Washington, D.C.: May 6, 1999.
Juvenile Courts: Reforms Aim to Better Serve Maltreated  Children. GAO/HEHS-99-13. Washington, D.C.: January 11, 1999.
Child Welfare: Early Experiences Implementing a Managed Care  Approach. GAO/HEHS-99-8. Washington, D.C.: October 21, 1998.
Foster Care: Agencies Face Challenges Securing Stable Homes for  Children of Substance Abusers. GAO/HEHS-98-182. Washington, D.C.:  September 30, 1998.
This is a work of the U.S. government and is not subject to copyright protection in the  United States. It may be reproduced and distributed in its entirety without further  permission from GAO. However, because this work may contain copyrighted images or  other material, permission from the copyright holder may be necessary if you wish to  reproduce this material separately.