Child Welfare: Steps Have Been Taken to Address Unregulated Custody Transfers of Adopted Children
Published: 2015-09-16T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Parents have the legal responsibility to protect and care for their children. However, recent media reports have illuminated a practice involving unregulated custody transfers of adopted children. Commonly referred to as “rehoming,” this practice involves parents who turn to the internet or other unregulated networks to find a new home for their child. These media reports found instances in which adopted children were placed in dangerous situations where they were harmed by the adults who received them. GAO was asked to review issues related to unregulated transfers of adopted children.
GAO examined (1) the reasons adoptive families consider unregulated child custody transfers, and services that exist to support these families before they take such an action; (2) what is known about the prevalence of these transfers; and (3) actions selected states and federal agencies have taken to address such transfers. GAO reviewed relevant federal laws, regulations, and policies and selected state laws and proposed legislation. GAO also interviewed officials from federal agencies, 19 child welfare and adoption organizations, 15 adoption agencies, and 7 states selected primarily because of legislative activity on unregulated transfers. GAO also searched online activity on selected social media sites to find illustrative examples of families who may be considering unregulated transfers.
The Departments of Health and Human Services, Homeland Security, and State provided technical comments. The Department of Justice had no comments.
section_title: What GAO Found
paragraphs: Some adoptive families may consider giving their children to another family outside of the courts and child welfare system—an “unregulated child custody transfer”—because of a crisis within the adoptive family and difficulties accessing support services, according to officials GAO interviewed from selected states, child welfare and adoption organizations, and adoption agencies. Children adopted internationally or from foster care may need special care or counseling because of a history of institutionalization and trauma. Some parents, particularly those who adopted internationally, may not be prepared to deal with their adopted child's complex needs. Federal regulations require agencies facilitating international adoptions to provide parents with at least 10 hours of pre-adoption training. In contrast, about half of the states require agencies facilitating foster care adoptions to provide at least 27 hours of training, according to data obtained from Department of Health and Human Services (HHS) officials in May 2015. Many officials said adoptive parents may experience challenges finding mental health services for their families, such as therapists familiar with adoption issues. Many officials also said parents who adopt children with more severe needs may have difficulty finding and paying for intensive services such as residential treatment, which can cost thousands of dollars per month. Officials said these challenges may lead families to seek out unregulated transfers.
Little is known about the prevalence of unregulated transfers. Because they happen without any oversight, these transfers are difficult to track and no federal agency keeps statistics on their occurrence. GAO's observations of social media sites found that some parents have been using online forums to seek new homes for their adopted children. During a 15-month period, GAO identified 23 instances in which a parent posted that they were seeking a new family for their child. Because GAO did not investigate these posts and because discussions between online participants can be continued privately, GAO was unable to determine whether these participants intended to pursue a legal placement or an unregulated transfer, or whether such a transfer actually took place.
Selected states and federal agencies have taken some steps to address unregulated transfers. GAO identified at least 15 states in which there was legislative and other activity in recent years intended to address these transfers. Seven of the 15 states had enacted legislation and 3 made changes to state child welfare programs as of July 2015. The most common approaches were criminalizing unregulated transfers or actions that may lead to these transfers, and restricting the advertisement of children for placement. In addition, activity in several states involved improving post-adoption services, which many officials said was a key need for families who resort to unregulated transfers. However, federal officials and others said addressing service needs can be difficult and time-consuming, and funding for these services is limited. At the federal level, several agencies established an interagency working group on unregulated transfers in October 2013. Officials from the Department of State said they plan to revise international pre-adoption training requirements that may include an increased number of minimum hours. HHS issued a memorandum in May 2014 encouraging states to promote post-adoption services and to review their policies to address unregulated transfers.

section_title: Letter
paragraphs: Recent media reports have illuminated a practice involving transfers of  adopted children to new homes outside of the courts or child welfare  system. Commonly referred to as “rehoming,” this practice involves  parents who turn to the internet or other unregulated networks to find new  homes for their children. These media reports highlighted cases of  parents of adopted children who engaged in these unregulated child  custody transfers because they were unable or unwilling to meet the  complex emotional and behavioral needs of their children. The reports  found that unregulated transfers occurred without background checks of  the new families, and that in some instances, children were placed in  dangerous situations without the knowledge of child welfare officials or  other authorities. For example, one media report found that a child was  placed in a home with an adult convicted of possessing child  pornography. Another media report described a case where two young  girls adopted from foster care were placed by their adoptive parents in the  home of a family friend. One of the adults in the new home was  subsequently convicted of sexually assaulting one of the girls, according  to the media report.
In some instances, parents used online forums on social media sites to  seek new homes for their children, according to media reports. For  example, Reuters News reported following a bulletin board on such a site  for 5 years during which new homes were sought for 261 adopted  children. It found that at least 70 percent of these children had been  adopted internationally. The remaining children were adopted  domestically from foster care or through private adoption agencies and  other means, such as private attorneys.
Parents have a legal responsibility to protect and care for their children,  and unregulated transfers can put children in dangerous situations when  they are placed with unfit adults. While many requirements related to child  welfare and adoptions are determined by states, federal law requires  states to establish systems for reporting and responding to cases of child  abuse and neglect. Several federal agencies may also play a role with  respect to children who could be subject to unregulated transfers. The  Department of State (State Department) conducts some oversight  activities for international adoptions (also called intercountry adoptions),  including serving as the U.S. Central Authority for the Hague Adoption  Convention, collecting data on children adopted into the United States,  and setting requirements for agencies that want to be accredited to  conduct international adoptions. The Department of Homeland Security’s  U.S. Citizenship and Immigration Services (USCIS) issues federal  regulations, forms, and policy guidance related to international adoption  and adjudicates immigration applications. The Department of Health and  Human Services (HHS) oversees federal programs that support child  welfare services, including adoption support, and provides some financial  assistance for certain adoptions, primarily from foster care. HHS also  collects some data on children adopted from or relinquished to the child  welfare system. However, requirements for domestic adoptions, including  those from foster care, are generally set by individual states. The  Department of Justice (Justice) is involved in enforcing applicable federal  criminal laws to protect children and supporting law enforcement  agencies in investigating child exploitation, internet crimes against  children, or other relevant crimes.
You asked us to explore issues related to unregulated child custody  transfers. This report examines:  1.  the reasons adoptive families consider unregulated child custody  transfers, and services that exist to support these families before they  take such an action;  2.  what is known about the prevalence of these transfers; and  3.  actions selected states and federal agencies have taken to help  address such transfers.
To address our objectives, we reviewed relevant federal laws,  regulations, and policies; conducted a search of related literature; and  conducted interviews with 45 agencies, states, and organizations to  acquire a range of perspectives on this topic. Those we interviewed  included officials from the State Department, USCIS, HHS, and Justice;  representatives from 19 organizations that work on child welfare and  adoption issues; officials from state child welfare and other relevant  offices in 7 selected states; and representatives from 15 international and  domestic adoption agencies. The 7 states selected for in-person and  phone interviews were chosen based on factors such as the presence of  legislative activity within the state related to unregulated transfers and a  state’s post-adoption programs. These states are Colorado, Florida,  Illinois, Louisiana, Ohio, Virginia, and Wisconsin. We reviewed relevant  documents to corroborate information obtained in our interviews. In  addition, we searched online forums on selected social media sites to find  illustrative examples of families who may be considering unregulated  transfers. These online forums focused on dissolutions of adoptions,  behavioral challenges of adopted children, and related issues. We  identified online activity on these forums, and reviewed materials that  were posted over a 15-month period (January 1, 2014, through April 1,  2015). The online posts we identified did not provide sufficient information  to determine whether the posters intended to pursue an unregulated  transfer, or to pursue an adoption or other legal placement. We did not  further investigate or otherwise attempt to verify the accuracy of these  posts. Because of our methodology for reviewing these forums and  because discussions between online participants can be continued  privately, we were unable to determine whether a child was actually  transferred to another family and, if so, whether it was done through a  court-approved process or through an unregulated transfer.
Through our interviews with representatives from child welfare and  adoption organizations and others, we identified at least eight additional  states that had legislative activity related to unregulated transfers since  we began our review: Arkansas, Maine, Maryland, Massachusetts,  Nebraska, New York, North Carolina, and South Carolina. We reviewed  information on relevant laws and other activity provided by child welfare  and other agency officials in our seven selected states as well as these  eight identified states. Since we did not attempt to identify all relevant  activity in all states, there may be other states with legislative or other  activity that are not included in our review. To examine federal efforts  related to unregulated transfers, we reviewed relevant documents  obtained in our interviews with federal officials. We also reviewed relevant  federal laws, regulations, and policies as well as GAO criteria on internal  controls. Because children adopted domestically as infants and those in  biological families may be less likely to have mental health issues due to  trauma and institutionalization, and reports of unregulated transfers have  primarily pertained to children adopted internationally or from foster care,  our report will focus on international and foster care adoptions. See  appendix I for additional information on our objectives, scope, and  methodology.
We conducted this performance audit from October 2014 to September  2015 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
subsections: section_title: Unregulated Child Custody Transfers
paragraphs: An unregulated child custody transfer, commonly referred to as rehoming,  is not an adoption. It is a practice in which parents seek new homes for  their children and place them without the safeguards and oversight of the  courts or the child welfare system. This practice does not pertain  exclusively to adopted children; biological children may also be subject to  unregulated transfers. However, media reports and child welfare and  adoption organizations have focused on unregulated transfers of adopted  children that involve families who may be unable or unwilling to deal with  the emotional and behavioral challenges that may be caused by a child’s  pre-adoption conditions. For example, some adopted children may have  histories of long-term institutionalization (e.g., orphanages), abuse, or  other traumatic experiences that affect their behavior.
An adoption may be terminated as a result of a disruption, which occurs  before the adoption is finalized, or a dissolution, which occurs after the  adoption has been finalized, generally in a legal proceeding. Under these  circumstances, the child would go into the child welfare system or be  legally adopted by another family. In contrast, unregulated transfers  occur when parents intend to permanently transfer custody of their child  to a new family without following these steps. Sometimes the parents will  use a document called a power of attorney to delegate to the new family  certain authority for the care and control of the child, although such  documents do not terminate the legal relationship between the adoptive  parents and the child. Because power of attorney arrangements are  generally not overseen by any state or federal agency, information on the  whereabouts of a child subject to an unregulated transfer using a power  of attorney can be limited or unknown. In addition, because families who  engage in an unregulated transfer do not follow the steps required for a  legally recognized adoption, there may be no checks to ensure that the  new home is an appropriate place for the child.
section_title: The Adoption Process and Roles of Federal, State, and Other Agencies
paragraphs: There are different ways that a child can be adopted in the United States.  International adoptions involve a child who was born in another country.  Domestic adoptions can be adoptions from foster care, which involve  children in the child welfare system whose biological parents have had  their parental rights terminated. Other domestic adoptions include those  conducted through private adoption agencies, attorneys, and others. Most  domestic adoptions handled through private adoption agencies,  attorneys, and others primarily involve infants or adoptions by a  stepparent.
Unregulated transfers do not follow the adoption process, which generally  involves many steps to help ensure that the child is legally adopted and  placed in an appropriate and permanent home. While the adoption  process can be different depending on the state and type of adoption, it  typically consists of: a home study performed by a licensed professional to assess the  suitability of the prospective parents, such as their health, finances,  and criminal history; an immigration application and petition, in the case of an international pre-adoption training for prospective parents, either online or in- person, for a specified number of hours on topics such as the  adoption process and issues related to attachment and bonding; final approval of the adoption by a court, either in the United States or  the child’s country of origin; and post-placement or post-adoption services, in some cases, which can  range from information and referral services and peer support groups  to more intensive services for children with severe behavioral needs.  For example, these intensive services can include mental health  counseling, respite care programs to provide temporary relief for  caregivers by placing children in short-term accommodations outside  the home, and residential treatment, which involves extended  treatment services to children while they reside outside the home.
Multiple federal, state, and other agencies can be involved in different  stages of the adoption process, depending on the type of adoption. Fees  also vary by type of adoption; while foster care adoptions may not have  any fees, international adoptions can involve substantial financial  investments from families.
International adoptions. As required under federal law and State  Department regulations, international adoptions are generally conducted  through accredited adoption agencies or approved persons. USCIS is  involved in adjudicating immigration petitions for these children as well as  setting federal home study requirements for international adoptions and  determining the suitability and eligibility of prospective adoptive parents.  The State Department also sets requirements for pre-adoption training  that international adoption agencies and approved persons must provide  for prospective parents. There are no federal requirements for post- adoption monitoring for international adoptions, according to State  Department officials. However, officials said some countries of origin  require adoptive families to provide periodic reports (e.g., according to the  State Department’s website, one country requires families to provide  reports every 6 months for 2 years following an international adoption).  Individual states may also have separate licensing requirements for  international adoption agencies operating in their state.
Foster care adoptions. Foster care adoptions are typically conducted by  state, county, and local child welfare agencies or private adoption  agencies with which they contract. For these adoptions, states set  requirements for home studies, pre-adoption training, and post-adoption  services.
Private domestic adoptions. States also set requirements for home  studies, pre-adoption training, and post-adoption services for private  domestic adoptions, generally through state licensing standards and other  requirements for private adoption agencies, attorneys, and others.
section_title: Federal Funding That States May Use for Adoption Services
paragraphs: Some federal funding is available for adoption services, in addition to any  funding from state, local, or other sources. Funding appropriated for Title  IV-E of the Social Security Act makes up the large majority of federal  funding dedicated to child welfare, comprising about 89 percent of federal  child welfare appropriations (approximately $7.4 billion of nearly $8.3  billion) in fiscal year 2015, according to the Congressional Research  Service. While the majority of these Title IV-E funds support children in  the foster care system, the Title IV-E Adoption Assistance program  provides grants to states for a portion of their costs to support families  who adopted children with special needs, generally from foster care. For  example, states provide ongoing monthly Adoption Assistance payments  (subsidies) to eligible families that can be used to help pay for the costs of  care for the child, which might include therapy and other post-adoption  services. Funds appropriated for this program totaled about $2.5 billion in  fiscal year 2015, comprising about 34 percent of Title IV-E program  funding.
In addition, Title IV-B of the Social Security Act, which is the primary  source of federal child welfare funding available for child welfare services,  also provides funds that states can use to support adoptions by any  family. For example, states may use funds to support pre- and post- adoption services, although funds can also be used for a variety of other  purposes to keep children safe and in stable families. Federal  appropriations for Title IV-B comprised about 8 percent of dedicated  federal child welfare appropriations (approximately $664 million of nearly  $8.3 billion) in fiscal year 2015. Table 1 provides a summary of federal  child welfare funding that states can use for adoption services, including  programs under Title IV-E and IV-B of the Social Security Act.
In addition to these programs, states may use savings generated from  changes made to the eligibility criteria for the Title IV-E Adoption  Assistance program for adoption services. These changes made  additional children eligible for federal Title IV-E Adoption Assistance  payments, thereby potentially freeing up state funds previously used for  this purpose. The Preventing Sex Trafficking and Strengthening  Families Act requires states to use 30 percent of these savings for post- adoption and related services. In addition, states may use different  combinations of federal funds not specifically dedicated to child welfare to  support adoption services, such as funds available under the Temporary  Assistance to Needy Families block grants, Medicaid, and Social Services  Block Grants. While states can use federal funds to support adoption  services for families, we reported in January 2013 that federal funding for  services designed to prevent children from entering foster care—such as  adoption support services—can be limited.
HHS does not collect information on how much states spend in federal  funds specifically for post-adoption services. In addition, our prior work  has shown that some states may not have information on the extent to  which they use these federal funds for adoption services. Although states  are to use savings generated from changes to the Title IV-E Adoption  Assistance program for child welfare services, we reported in May 2014  that only 21 states reported calculating these savings for fiscal year 2012,  and 20 states reported difficulties performing the calculations. In 2014,  the Donaldson Adoption Institute attempted to collect information on  states’ annual post-adoption service budgets, excluding Title IV-E  Adoption Assistance program subsidies. However, it reported that some  states were unable to distinguish this budget item, especially when the  primary programs that served adoptive families also served other families.  It also reported that states with county-administered child welfare  programs were unable to report total state budgets for post-adoption  services. The Institute reported that annual budgets for these services  ranged from $85,000 to $11.2 million in the 21 states that provided  responses to the survey it conducted.
section_title: Characteristics of Children Adopted Internationally and from Foster Care
paragraphs: International adoptions in the United States have changed over time from  a system that predominantly involved the adoption of infants and toddlers  to one that has involved an increasing proportion of older children and  those with special needs. According to State Department data, less than  8 percent of children adopted internationally in fiscal year 2013 were  younger than 1 year compared to over 40 percent in fiscal year 2004. In  addition, one study reported in 2013 that nearly half of more than 1,000  parents surveyed who adopted internationally said their children had  diagnosed special needs.
The State Department, HHS, and others have reported that the changing  landscape of international adoptions is attributable to many different  factors, including positive cultural factors and socio-economic conditions  in other countries that have made it easier for biological families to take  care of their children or to adopt domestically—decisions that have  impacted the number of children eligible for adoption by U.S. families.  About 7,000 children were adopted internationally in fiscal year 2013  compared to nearly 23,000 in fiscal year 2004 (see fig. 1).
Children in foster care may also be more likely to have special needs than  children in the general population. According to a national survey  conducted in 2008 and 2009, more than 42 percent of children ages 18  months to 17 years who were placed in a foster family home following an  investigation of abuse and neglect were found to be at risk for an  emotional or behavioral problem and potentially in need of mental health  services.
Multiple studies have shown that abuse and other maltreatment can  cause changes in the brain development of children, and these changes  may leave them more vulnerable to depression, post-traumatic stress  disorder, and other behavioral or mental health issues. Studies show  that children who are institutionalized—for example, in orphanages prior  to being adopted by a family—are often subject to deprivation and  neglect. Young children with a history of institutional care often show poor  attention, hyperactivity, difficulty with emotion regulation, elevated levels  of anxiety, and increased rates of attachment disorders. For example,  they may develop Reactive Attachment Disorder, which is characterized  by serious problems in emotional attachments to others. The physical,  emotional, and social problems associated with this disorder may persist  as the child grows older.
Families who adopt children with severe behavioral or mental health  issues may face situations which can put the family in crisis. For example,  the adopted child may be violent toward siblings or parents. One study  reported in 2014 that in 23 percent of cases where adoptions were  dissolved, the adopted child was a threat to the safety of other children in  the home.
section_title: Families May Choose an Unregulated Child Custody Transfer Due to an Adoption in Crisis and Challenges Accessing Services
subsections: section_title: Families May Be Unprepared for the Challenges of Adopting Children with Special Needs, Particularly for International Adoptions
paragraphs: Families may choose an unregulated child custody transfer because they  were not sufficiently prepared for the challenges they experienced in their  adoption, according to many child welfare and adoption stakeholders we  interviewed. This lack of preparation may include inadequate  information about the child’s health, an insufficient home study to make a  good match, and minimal pre-adoption training for parents.
Many stakeholders we interviewed—including officials from selected  states, child welfare and adoption organizations, and adoption agencies— expressed concern with the adequacy of the information provided to  prospective parents on the behavioral and mental health conditions of a  child adopted internationally. Access to accurate information is critical to  ensuring that a family is aware of the type of ongoing support they may  need for the child. However, officials from 11 of 19 child welfare and  adoption organizations and 5 of 15 adoption agencies said families who  adopt internationally often do not receive complete information on a  child’s medical and behavioral needs before adopting. State Department  officials explained that some low-income countries lack sufficient mental  health care providers, making it difficult for international adoption  agencies to ensure that children are accurately evaluated prior to  adoption. USCIS officials also said some countries do not allow  prospective adoptive parents to review medical history documents until  after an adoption is finalized for privacy reasons.
Many stakeholders also expressed concern that families may not have  undergone an adequate home study to ensure they are a good match for  their adopted child, and several noted that the home study is a critical  point in the pre-adoption process, when social workers or adoption  agency staff try to determine how families will handle challenges when  parenting their adopted child. According to HHS officials, requirements for  what should be assessed during a home study are determined by  individual states for foster care adoptions. Home study requirements are  determined by USCIS and the State Department for international  adoptions. However, officials from 4 of 7 selected states and 8 of the 15  adoption agencies we interviewed expressed concerns about  inconsistencies in the quality of home studies conducted by child welfare  and adoption agencies across states. For example, Ohio officials said all  child welfare and adoption agencies in their state are required to use a  detailed home study format. They said they may not accept home studies  conducted in other states that have less stringent requirements unless  additional supporting documentation is provided, such as a background  check and safety check of the home.
Families also may not have received sufficient or targeted pre-adoption  training to ensure they were prepared for their child’s specific needs,  particularly for international adoptions, according to most stakeholders we  interviewed. For foster care adoptions, states each set their own training  requirements for prospective parents, according to HHS officials. About  half of all states require agencies facilitating these adoptions to provide  prospective parents with at least 27 hours of training, according to data  obtained from HHS officials in May 2015. Our seven selected states have  requirements of 18 to 47 hours of training for foster care adoptions with  some in-person required training in each state, according to state officials.  Many of our selected states also use similar training models for foster  care adoptions, including Parent Resources for Information,  Development, and Education (PRIDE) and Model Approach to  Partnerships in Parenting (MAPP), which were developed by various child  welfare organizations. In contrast, State Department regulations require  10 hours of training for international adoptions, all of which can be online.  This training must cover topics defined by the federal regulations.  Officials we interviewed from 5 of our selected states, 12 child welfare  and adoption organizations, and 11 adoption agencies told us that this  training may be insufficient, particularly since an increasing proportion of  children adopted internationally are older and have special needs due to  an extensive history of institutionalization and trauma. State Department  officials told us they are considering revisions to pre-adoption training  requirements for international adoptions, which we discuss later in the  report.
States may set training requirements for international adoptions above  the 10-hour minimum or may have required training topics. Two of our  seven selected states require more than 10 hours of training, according to  state officials. For example, Wisconsin officials told us the state requires  18 hours of training, and the same topics are required for international  and foster care adoptions. This training covers issues such as attachment  in adoptive placement, the effects of abuse and neglect, and cultural  sensitivity. In addition, this training includes opportunities to cover issues  specific to the individual child (see table 2).
State Department officials said international adoption agencies may also  have their own training requirements beyond those of federal and state  agencies. For example, officials from one international adoption agency  said they require 30 hours of training for parents wishing to adopt abroad.  This includes training on grief and loss, the child’s country of origin and  cultural differences, the impact of institutionalization, and potential  challenges and service needs. These officials said this expanded training  is more costly for both the agency and prospective parents, and that  some prospective parents thought the training was too cumbersome or  expensive.
section_title: Families May Have Difficulties Accessing Needed Post-Adoption Services
paragraphs: Officials in most of the selected states, child welfare and adoption  organizations, and adoption agencies we interviewed expressed concern  that families may choose an unregulated transfer when they cannot  access post-adoption services to help them cope with or avoid reaching a  crisis point in their adoption. Several of these stakeholders explained that  an adopted child may deal with continuing issues of attachment, identity,  and loss of previous caregivers or biological parents. While services to  help adoptive families can include information, referrals, and peer support  groups, families who adopted children with severe behavioral needs may  need more intensive services, such as mental health counseling, respite  care, and residential treatment. Many stakeholders we interviewed  suggested that families considering unregulated transfers may particularly  need these intensive services.
All seven of our selected states provide some kind of post-adoption  services for families who adopted from foster care and internationally.  For example, Wisconsin officials said the state provides parent training, a  24-hour information hotline, referral services, and mechanisms to link  families to support groups and mentors, which are available to all  adoptive families. Other types of services these selected states provide  include lending libraries, newsletters, and brochures for parents.  However, the seven selected states offered limited intensive services,  particularly for international adoptions, according to our analysis of the  information gathered from selected state officials. Officials from three  states said their state offers counseling and other intensive services, such  as case management and crisis intervention, to both families who  adopted from foster care and internationally. However, officials from the  six states that offer respite care and the four states that provide  residential treatment told us their states provide these services  exclusively to families who adopted from foster care. Some of these  services have maximum time limits or are offered on a case-by-case  basis. For example, Louisiana officials said their state offers respite care  for up to 1 month, and Florida and Illinois officials said their states offer  residential treatment services to families who adopted from foster care on  a case-by-case basis.
In addition, our seven selected states provide varying levels of financial  support to eligible adoptive families through subsidies and cash  assistance programs, according to the information gathered from selected  state officials. For example, Ohio officials described a state program  that uses Title IV-B and state revenue funds to provide up to $10,000 per  child per year to pay service providers in 2014, with an additional $5,000  available per year if the child is recommended for residential treatment by  a mental health provider. In addition, all of our selected states received  federal funds under the Title IV-E Adoption Assistance program to provide  subsidies to eligible adoptive families; the maximum subsidy amounts  ranged from $400 to $2,700 per month in 2014. However, they are  generally only available to eligible families who adopted children with  special needs from foster care, and information is limited on how much  families use their subsidies for services, such as counseling, versus other  expenses for their adopted child, such as food, clothing, and day care.  The Donaldson Adoption Institute reported in April 2014 on a variety of  post-adoption services provided by 49 states that responded to survey  questions about such services. It found that about one-third of these  states offered almost no post-adoption services other than a subsidy for  adoptive families. In addition, the report found that the majority of these  states had services that were open exclusively to families who adopted  from foster care.
Officials in four of our seven selected states told us that the need for post- adoption services exceeded the funding available from state and federal  programs. Our prior work has shown that child welfare agencies have  struggled to meet the service needs of families. Our 2013 report found  that local child welfare officials in four states we reviewed reported  service gaps in multiple areas, including counseling and mental health  services. We also reported that state and local child welfare agencies  may face difficult decisions when determining which activities—aimed at  preserving families and preventing a child from entering foster care—to  prioritize and fund, particularly in light of the ongoing fiscal challenges  these agencies face.
Similar to our selected states, officials from 12 of the 15 adoption  agencies we interviewed said they provide some level of post-adoption  services to families, such as information and referrals. Officials in 4 of the  15 adoption agencies said they provide intensive services, ranging from  trauma-focused therapy to a weekend respite care program. Officials from  six adoption agencies noted that resource constraints have affected their  ability to provide post-adoption services. Officials from the Council on  Accreditation—the organization responsible for accrediting agencies for  international adoptions—said some international adoption agencies have  struggled to maintain their businesses due to the decrease in the number  of international adoptions overall (a decrease of 70 percent between fiscal  years 2003 and 2014). They said while some larger agencies have been  better able to provide services because they are financially stable, this  can be a challenge for other agencies.
Another limitation to accessing post-adoption services that many  stakeholders expressed concern about was the cost of intensive services,  which can be expensive for all families. Officials in 3 of 7 selected states,  6 of 19 child welfare and adoption organizations, and 5 of the 15 adoption  agencies we interviewed said services can be expensive, particularly  intensive services such as mental health counseling and residential  treatment. We have previously reported that the cost to support a youth in  a residential setting can amount to thousands of dollars per month.
In addition to cost, adoptive families may have challenges finding mental  health providers that are “adoption competent”—that is, knowledgeable  about adoption-related issues, according to officials from five selected  states, seven child welfare and adoption organizations, and eight  adoption agencies. These stakeholders said mental health providers who  do not understand issues unique to adoptive families will likely be less  effective in helping these families work through issues. For example, one  official told us adoptive families need therapists who can distinguish  between normal adolescent behavior and a child acting out due to grief  and loss resulting from his or her adoption. Several stakeholders also  noted that families in rural areas may have even more difficulty accessing  effective mental health providers. We reported in 2013 that a Florida  behavioral health service provider had been advertising a child  psychiatrist position for 5 years without success. In a 2011 report, we  found that child psychiatrists and psychologists were among the most  difficult specialist referrals to obtain for children in low-income families  covered by Medicaid and the Children’s Health Insurance Program, both  of which can cover children adopted from foster care and internationally.
Lastly, families may not know about available services from their child  welfare or adoption agency, and therefore do not seek help when needed,  according to officials from four selected states and five adoption  agencies. For example, Virginia officials said families that did not adopt  from foster care may not know about support services they can access  through their local child welfare agency. Wisconsin officials also said they  struggle to find sufficient resources to provide outreach to all adoptive  parents about state resources. Officials from two selected states also  raised concerns that families may not remember whether their adoption  agency provides post-adoption services. They explained that some  families may not need services for years after an adoption is final  because issues may not arise until the child reaches adolescence. By that  point, families may no longer have contact with their adoption agency.
section_title: Families May Be Reluctant to Seek Help for Fear of Repercussions and Associated Stigma
paragraphs: Families in need of help may be reluctant to ask child welfare agencies  for assistance, according to officials from three child welfare and adoption  organizations and four adoption agencies. For example, these officials  noted that there is a stigma associated with contacting child welfare  agencies since those agencies are also generally responsible for  investigating cases of child abuse. A few of these officials further noted  that families, including those who adopted from foster care and  internationally, may fear that contacting an agency will prompt an  investigation into how they care for all of their children. They also said  families may be afraid that they will not be able to adopt again if they are  involved with a child welfare agency.
Officials in five of our seven selected states acknowledged the dilemma  that families face if they contact child welfare agencies for services. In  addition, officials in one selected state said parents cannot voluntarily  relinquish custody of a child in their state (e.g., for care or services)  without being charged with child abandonment. Officials in all seven  selected states said families who decide to relinquish custody to the state  may be required to pay ongoing child support.
Similarly, families who adopted internationally may also be hesitant to  reach out to their adoption agency. Representatives from 9 of the 15  adoption agencies we interviewed told us that families may be ashamed  or embarrassed to contact the agency to discuss problems.  Representatives from one adoption agency explained that families have  gone through a rigorous home study process to prove that they will  provide a good home to an adopted child. Thus, they said these families  may be reluctant to contact their agency and admit that that they are  facing challenges in their adoptions.
section_title: Little Is Known about the Prevalence of Unregulated Transfers
subsections: section_title: Unregulated Child Custody Transfers Are Difficult to Track
paragraphs: Because unregulated child custody transfers are an underground practice  that happens outside the purview of the courts and the child welfare  system, they are difficult to track, and no federal agency keeps statistics  on their occurrence. These transfers may involve an exchange of a  power of attorney that may not be filed with or approved by a court of law,  although it may be signed by both parties and notarized. State laws vary,  but generally a parent may use a power of attorney to temporarily grant  another person certain powers regarding their child’s care and physical  custody, such as the authority to make medical and educational  decisions. For example, a military service member may sign a power of  attorney to allow a family member or friend to take care of and make  medical decisions for his or her child while he or she is deployed.  However, because a power of attorney does not terminate the legal  parent-child relationship, the adoptive parent still retains certain rights and  responsibilities. For example, according to HHS, delegating responsibility  for a child through a power of attorney does not insulate adoptive parents  from state laws regarding imminent risk of serious harm.
State laws determine any time limits (e.g., 1 year) for grants of power of  attorney, and also establish the procedures required to make such an  arrangement effective. For example, officials in three of our seven  selected states told us their state laws do not require power of attorney  documents to be approved by a court, and officials in one selected state  said their laws require court approval in certain circumstances.  However, officials in three of these selected states said they were not  aware of any mechanisms in their states to track expired power of  attorney documents to determine if families are attempting to use them to  permanently transfer custody.
Unregulated transfers are also difficult to track because many adoptions  are not monitored after the adoption is finalized. For those international  adoptions subject to reporting requirements set by individual countries,  reporting may occur for a limited time. For example, according to the  State Department website, one country requires adoptive parents to  provide information about the adoption at certain time intervals for the first  2 years. Officials from the State Department and several adoption  agencies we interviewed told us that while parents may sign a contract  when they adopt a child saying they will report the required information to  the adoption agency, parents may not comply with post-adoption  reporting requirements, and agencies have little leverage to enforce  compliance. In addition, officials in our seven selected states said their  state does not specifically monitor whether adopted children remain with  their families after the adoption is finalized.
section_title: Observations of Social Media Sites Found Families Seeking New Homes for Their Adopted Children
paragraphs: Our observations of forums on social media websites indicate that some  parents have been using these venues to seek new homes for their  children. We observed posts in five social media forums and found a total  of 23 posts in which a person wrote that they were seeking a new family  for their child. Among the 9 posts that included information on a child’s  age, those ages ranged from 7 to 16. Generally, parents in these forums  who said they wanted to transfer a child indicated that they were in  distress or crisis, and most often said they were seeking a new home  because of the child’s behavioral issues or severe mental illness. These  children included those who were adopted from foster care and  internationally. For example, one post asked for a new home for a 7-year- old boy who had been diagnosed with numerous mental illnesses,  including Reactive Attachment Disorder, Oppositional Defiance Disorder,  and autism, and who was physically abusive to his siblings and family  pets. Several posters responded with information about their family and  location or said that they had sent the poster a private message. Another  poster wrote that her son, who she adopted internationally, had been  diagnosed with multiple mental illnesses and was currently hospitalized  for psychiatric reasons, and she was seeking a new home for him.
In addition, we found 40 cases in which a person posted that they wanted  to adopt a child. In some cases, posters wrote that they had successfully  completed a home study. In other cases it was not clear whether they had  undergone a home study. For example, only a third of the posts we  observed in one online forum referenced a home study—either that the  person seeking to adopt had completed one or the person seeking a new  home for the child required one. Some posters said they had adopted  children already in the home, and some wrote they had adopted a  previously adopted child, although it was unclear whether they had legally  adopted the child or whether the child was transferred without court  oversight.
It is possible that conversations on the specifics of transferring a child  were held either through private messages within the social media  platform or by another means, such as email or phone. Because we did  not investigate these posts further and because discussions between  online participants can be continued privately, we were unable to  determine whether a child was actually transferred to another family.  Similarly, we were unable to determine, if such a transfer occurred,  whether it was done through official means or an unregulated transfer.
section_title: Selected States and Federal Agencies Have Taken Some Steps to Address Unregulated Transfers
subsections: section_title: Activity in the 15 States GAO Reviewed Mainly Involved Efforts to Deter Unregulated Transfers
paragraphs: We identified 15 states in which laws were enacted, proposed legislation  was introduced, or recent changes had been made to child welfare  programs that were intended to safeguard children who may be subject to  unregulated transfers. These included the seven states we selected for  interviews as well as eight states recommended by representatives from  child welfare and adoption organizations because of legislative activity  initiated in these states during the course of our review. Of these 15  states, 7 enacted legislation and 3 made changes to child welfare  programs. In addition, legislators in 10 of the 15 states introduced  proposed legislation that had not been enacted as of July 2015 (see table  3).
These selected laws, proposed legislation, and other actions within the 15  states reflect a variety of approaches to addressing unregulated  transfers. The most common approaches were to criminalize  unregulated transfers or actions that may lead to these transfers, and to  restrict the advertising of children or potential homes for placement. Other  approaches may deter unregulated transfers by requiring that parents or  certain other individuals report cases in which custody of a child may  have been transferred. Some approaches may help prevent transfers  from occurring. These included revising requirements for preparing  prospective parents for adoption and increasing outreach about services  available to families after adopting (see table 4).
The five states that enacted laws to criminalize unregulated transfers or  actions that could lead to these transfers made the following changes:
Arkansas and Louisiana enacted laws that define the practice of “re- homing” and impose criminal penalties for those engaging in it. The  laws provide that those who commit the offense of re-homing, which  each state defines differently but generally includes transferring  physical custody of a child to a non-relative without court approval  with the intent of avoiding permanent parental responsibility (or  assisting in such a transfer), will be subject to a fine of up to $5,000  and imprisonment for up to 5 years.
Similarly, Florida enacted a law establishing the crime of “unlawful  desertion of a child,” which provides that a caregiver who deserts a  child (leaves the child with a non-relative with the intent to not return  and provide for the child’s care) under circumstances in which the  caregiver knew or should have known that the child would be exposed  to unreasonable risk of harm commits a third degree felony.
Maine also enacted a similar law, modifying its definition of  “abandonment of a child.” This law provides that a person is guilty of  child abandonment if they transfer physical custody of a child to a  non-relative without court approval with the intent to avoid or divest  themselves of permanent parental responsibility. The law specifies  that violation of this provision constitutes different classes of crimes,  depending on the age of the child.
Wisconsin enacted a law that placed parameters on parental  delegations made through a power of attorney, and established  criminal penalties for unauthorized transfers of children across state  lines. This law provides that delegations to a non-relative of a child’s  care and custody under a power of attorney may be effective for no  longer than 1 year unless approved by a juvenile court, and those who  violate this provision are subject to a fine of up to $10,000 and/or  imprisonment for up to 9 months. In addition, the law states that any  person who sends a child out of the state, brings a child into the state,  or causes such actions to occur for the purpose of permanently  transferring physical custody of the child to a non-relative is guilty of a  misdemeanor.
Six states enacted laws to restrict the advertising of children or potential  homes for adoption or other permanent placement. Specifically,  Arkansas, Colorado, Florida, Louisiana, Maine, and Wisconsin created or  expanded prohibitions on who can place such advertisements, limited the  purposes for which these advertisements can be placed, restricted the  public media that can be used (e.g., the internet), and/or provided  penalties for violations.
Officials from selected states, child welfare and adoption organizations,  and adoption agencies we interviewed discussed some trade-offs and  considerations in implementing these approaches to deterring  unregulated transfers. For example, several stakeholders said a power of  attorney can be used for legitimate purposes, such as a military parent  transferring custody of their child to a trusted friend while on deployment.  They noted that placing additional conditions on power of attorney  transfers can create a burden for these families. In addition, officials from  three selected states and three child welfare and adoption organizations  questioned how states could enforce the use of a power of attorney.  Officials from one national organization specializing in adoption law said  courts that may be involved in approving power of attorney agreements  have other priorities and may not have time to monitor these agreements.  Several stakeholders also said families often go online to access adoption  resources and peer support forums. They said states need to consider  the information that these online forums provide to adoptive families when  considering laws related to the internet.
In addition to approaches that would deter unregulated transfers, 4 of the  15 states we reviewed enacted laws or made changes to child welfare  programs to improve post-adoption services for families. Specifically:
Arkansas enacted a law that directed the state child welfare agency to  adopt rules to ensure that post-adoptive services are provided to all  parents who seek assistance to prevent their adoptions from being  disrupted.
Virginia enacted a law and made changes to its state child welfare  programs to improve post-adoption services based on  recommendations from a study it conducted on unregulated  transfers. The law requires the state registrar to issue, along with  new adoptive birth certificates, a list of available post-adoption  services, and requires the state child welfare agency to provide a list  of such services to the registrar and publish it on its website. In  addition, Virginia officials said the state child welfare agency plans to  modify the solicitation for its post-adoption services contracts to allow  services to be provided by multiple regional providers rather than one  statewide provider. Virginia officials said the intent of this change is to  increase access to services for families statewide.
Illinois and New York also made changes to their child welfare  programs to increase outreach specifically to new parents who  adopted from foster care, although these states did not make statutory  changes. Illinois developed a pilot project for agencies facilitating  foster care adoptions to host celebrations and social events to build  relationships with these families and connect them with other families.  New York developed a brochure for adoption agencies to provide to  new adoptive parents that includes information on unregulated  transfers and possible sources of help with post-adoption needs.
While many stakeholders we spoke with highlighted families’ challenges  with accessing pre- and post-adoption services as key reasons for  unregulated transfers, they also commented on possible challenges in  implementing certain policy options to improve access to and availability  of such services. For example, officials from nearly half of the child  welfare and adoption organizations we spoke with said building a strong  infrastructure for adoption services can be a lengthy and costly task. They  said states have been trying to bolster services, but have had limited  success. Given limited funding, officials from most selected states, child  welfare and adoption organizations, and adoption agencies we  interviewed expressed concern about the level of support for post- adoption services. Many of these stakeholders said families experiencing  difficulties in their adoptions need services, and unregulated transfers are  a last resort for desperate families who feel they have no other option.  They also stated that improving access to effective services may  ultimately help all families meet the needs of their adopted children.
section_title: Federal Agencies Have Taken Steps to Improve Adoption Services and Share Information on Unregulated Transfers with States
paragraphs: Federal agencies have made some collaborative and individual efforts to  address unregulated transfers, mainly by raising awareness of the need  for improved pre- and post-adoption services and by sharing information  with states (see table 5). In some instances they have also collaborated  with non-governmental organizations that have relationships with state  child welfare and law enforcement agencies, such as the Association of  Administrators of the Interstate Compact on the Placement of Children  and the National Association of Attorneys General.
As shown in table 5, the State Department established an interagency  working group in October 2013 to develop a coordinated federal response  to unregulated transfers. Other federal agency participants are USCIS,  HHS, and Justice. With input from the group, the State Department began  work to revise regulations regarding international pre-adoption training  requirements. State Department officials said the revisions may  potentially include an increased number of minimum required hours and  additional required content, drawing from training curriculum used by child  welfare agencies for prospective parents in foster care adoptions. In  addition, the revisions may include required in-person components for  training. State Department officials said they plan to provide proposed  revisions to the Office of Management and Budget by the end of 2015 for  review, and the proposed regulations will be subject to a public comment  period before being finalized. In addition, in February 2015, USCIS issued  revised immigration applications and petitions which are used by certain  families applying to adopt from certain countries. The revisions included  a requirement that families disclose whether they have previously filed  international adoption applications or petitions and the result of the filings  (i.e., approval, denial, withdrawal). Additionally, the revisions require  families to disclose if they have experienced a disruption or dissolution of  an international adoption in the past.
HHS has also taken a number of actions to help improve access to  adoption services. For example, it issued a memorandum in May 2014 to  states that encouraged them to promote services to all adoptive families  and outlined various sources of available federal funds. The memo also  shared information on how unregulated transfers may violate state laws  and encouraged states to review their laws and policies. In addition, HHS  awarded two cooperative agreements with 5-year project periods in  October 2014 to national organizations to improve post-adoption services.  The National Adoption Competency Mental Health Training Initiative aims  to build a web-based training curriculum for child welfare professionals  and mental health practitioners to meet the mental health needs of  adopted children, develop a national certification process for those  completing it, and evaluate its outcomes and effectiveness. The National  Quality Improvement Center for Adoption/Guardianship Support and  Preservation aims to develop evidence-based pre- and post-adoption  interventions and services for prospective and current adoptive families.  Interventions and services will be evaluated at six to eight selected sites  (e.g., state, county, or tribal child welfare agencies). Both projects are  expected to be completed in September 2019. HHS officials also noted  that information on pre-adoption requirements and post-adoption  services, by state, is available on HHS’s Child Welfare Information  Gateway, a website that provides information, resources, and tools on  child welfare, child abuse and neglect, out-of-home care, adoption, and  other topics. In addition, they said HHS has been involved in  discussions with states regarding post-adoption services over the years.  For example, HHS hosted a conference on the needs of adopted  children—including post-adoption services—in August 2012, and was  involved in a forum on unregulated transfers and services for adoptive  families in February 2014 through the National Association of State  Adoption Programs, Inc.
Because states are responsible for much of the work to improve adoption  services, the interagency working group has collaborated with national  organizations to share information with states. Specifically, Justice  worked with the National Association of Attorneys General to gather  information on existing state laws and pending legislative proposals to  address unregulated transfers. Research fellows at the National  Association compiled this information for all states. The organization also  requested information from all state attorneys general offices, and  received responses from six states and the District of Columbia. The  organization completed this work in June 2015, and Justice officials said  they are reviewing the study and will work with the interagency working  group to determine next steps, if any, to be taken. In addition, the  Association of Administrators of the Interstate Compact on the Placement  of Children is working to develop a national outreach campaign to raise  awareness about unregulated transfers and provide information on  alternatives to this practice. Officials from the Association said they are in  the process of soliciting funds from private and non-profit organizations to  support such a campaign.
Despite these efforts, federal officials acknowledged that gaps in services  for adoptive families remain, and determining how to provide them is a  difficult task for public and private agencies working with these families.  For example, HHS officials noted limitations to the federal government’s  ability to support post-adoption services. They said that while all adopted  children will need some level of support after an adoption is final, the  main source of federal support—the Title IV-E Adoption Assistance  program—is limited, and is generally available only to families who  adopted eligible children from foster care. Consistent with our findings in  previous reports, HHS officials said funds from other federal programs  that states can use to support services for private adoptions, including  international adoptions, are limited. Officials said families who cannot  afford services on their own must often rely on services supported by  state and local funding or those provided by private adoption agencies,  and funds from these sources are also limited. HHS officials told us that  the administration included in its fiscal year 2016 budget request a  legislative proposal that would provide an increase of $587 million over 10  years for pre- and post-adoption services. They said this funding would  target services to families with children who may be subject to  unregulated transfers as well as those at risk of entering foster care due  to an adoption in crisis.
Federal officials said they will continue to examine ways to address  unregulated transfers. For example, the State Department has developed  a charter to outline its goals and plans for future work. State Department  officials said they will use this charter to facilitate future efforts with the  interagency working group.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to the Secretaries of Health and Human  Services, Homeland Security, and State and the Attorney General of the  United States for review and comment. The Departments of Health and  Human Services, Homeland Security, and State provided technical  comments that were incorporated, as appropriate. The Department of  Justice had no comments.
We are sending copies of this report to relevant congressional  committees, the Secretaries of Health and Human Services, Homeland  Security, and State, the Attorney General of the United States, and other  interested parties. In addition, this report will be available at no charge on  GAO’s website at http://www.gao.gov.
If you or your staffs have any questions about this report, please contact  me at (202) 512-7215 or brownke@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. GAO staff that made key contributions to this  report are listed in appendix II.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: GAO examined (1) the reasons adoptive families consider unregulated  child custody transfers, and services that exist to support these families  before they take such an action; (2) what is known about the prevalence  of these transfers; and (3) actions selected states and federal agencies  have taken to help address such transfers. To address these objectives,  we used a variety of methods. Specifically, we   conducted interviews with 45 agencies and organizations, including  officials from federal and selected state agencies, child welfare and  adoption organizations, and adoption agencies, to acquire a range of  perspectives on this topic;  reviewed relevant federal laws and regulations, selected state laws,  and federal and selected state policies;  reviewed and analyzed documentation provided by officials we  interviewed;  conducted a search of related literature and reviewed relevant  articles; and  searched online forums on selected social media sites to find  illustrative examples of families who may be considering unregulated  transfers.
Because children adopted domestically as infants and those in biological  families may be less likely to have mental health issues due to trauma  and institutionalization, and reports of unregulated transfers have  primarily pertained to children adopted internationally or from foster care,  our report focuses on international and foster care adoptions.
subsections: section_title: Interviews of Child Welfare and Adoption Stakeholders
paragraphs: To understand why families consider unregulated child custody transfers,  what training and services are available to adoptive families, and actions  selected states and federal agencies have taken to help address such  transfers, we conducted interviews with 45 agencies, states, and  organizations, including federal officials, representatives from national  child welfare and adoption organizations, officials from selected states,  and representatives from adoption agencies. Federal officials we  interviewed included those from the Department of State (State  Department), the Department of Homeland Security’s U.S. Citizenship  and Immigration Services (USCIS), the Department of Health and Human  Services (HHS), and the Department of Justice (Justice).
We interviewed representatives from 19 organizations that work on child  welfare and adoption issues. The 19 organizations we interviewed were  selected to represent a variety of views on adoption and child welfare- related policy, training, and research. For example, these organizations  specialized in certain aspects of adoption, including adoption law, home  studies, pre-adoption training, and post-adoption services. We  interviewed the following child welfare and adoption organizations and  experts: American Academy of Adoption Attorneys; American Bar  Association’s Center on Children and the Law; Association of  Administrators of the Interstate Compact on the Placement of Children;  Center for Adoption Policy; Center for Adoption Support and Education;  Child Welfare League of America; Coalition for Children, Youth, and  Families; Congressional Coalition on Adoption Institute; Council on  Accreditation; the Donaldson Adoption Institute; Joint Council on  International Children’s Services; Madeline Freundlich; Maureen Flatley;  National Center for Missing and Exploited Children; National Center on  Adoption and Permanency; National Conference of State Legislatures;  North American Council on Adoptable Children; Spaulding for Children;  and Voice for Adoption.
In addition, we interviewed officials from state child welfare agencies and  other relevant offices in seven selected states: Colorado, Florida, Illinois,  Louisiana, Ohio, Virginia, and Wisconsin. These states were chosen  based on factors such as legislative activity related to unregulated  transfers in the state, as identified by representatives from child welfare  and adoption organizations during our initial interviews, and the state’s  post-adoption programs. These states also provided variety in numbers  of adoptions in relation to the state’s population. Interviews with officials  were conducted through site visits to Florida and Wisconsin, and phone  calls to the remaining states. In the states selected, the team conducted  interviews with officials from state child welfare agencies and other  relevant offices, such as those from state attorney general offices,  departments of justice, and adoption agency licensing offices.
Finally, we interviewed representatives from 15 international and  domestic adoption agencies. The adoption agencies we interviewed were  selected from those either recommended by national organization  representatives or those licensed or accredited in the states we visited in- person to achieve variation in agency size, including budget and staff and  types of adoptions facilitated. For example, 11 of the 15 adoption  agencies facilitate international adoptions. The remaining 4 agencies  facilitate domestic adoptions only, such as through the child welfare  system (through a contract with the state child welfare agency) or  privately.
In the report we refer to different types of organizations when reporting  information from our interviews with the 7 selected states, 19 child welfare  and adoption organizations, and 15 adoption agencies. References to  “stakeholders” include responses from officials in all three of these  groups. In our interviews with stakeholders, we used a semi-structured  interview protocol that included open-ended questions about reasons that  families may consider unregulated transfers, types of services adoptive  families may need to prevent them from resorting to these transfers, and  types of services that are available to adoptive families. Information was  volunteered by officials in each interview in response to these open- ended questions. Thus, the counts of organizations citing such responses  vary. “All” stakeholders represents 41  “Most” stakeholders represents 21-40  “Many stakeholders” represents 10-20  “Several” stakeholders represents 4-9  “A few” stakeholders represents 2-3  We reviewed relevant documents to corroborate information obtained in  our interviews.
section_title: Review of Federal and Selected State Laws, Regulations, and Policies
paragraphs: To examine federal efforts related to unregulated transfers, we reviewed  relevant documents obtained in our interviews with federal officials. We  also reviewed relevant federal laws, regulations, and policies on agency  roles and responsibilities as well as GAO criteria on internal controls.
To examine selected state efforts related to unregulated transfers, we  reviewed information on recently enacted laws, proposed legislation, and  other documents provided by child welfare and other agency officials in  our seven selected states. Through our interviews with representatives  from child welfare and adoption organizations and others, we identified at  least eight additional states that had initiated legislative activity related to  unregulated transfer since we began our review: Arkansas, Maine,  Maryland, Massachusetts, Nebraska, New York, North Carolina, and  South Carolina. For these eight identified states, we also reviewed  relevant laws, proposed legislation, and other documents provided by  child welfare and other agency officials in these states. For proposed  legislation, we reviewed only the version confirmed by the state officials.  We did not do further research on the status of these proposals;  therefore, additional changes may have been made that are not reflected  in this report, and some proposed legislation included in the report may  no longer be pending. We asked officials in the 15 selected and identified  states to confirm whether their state had enacted a law, introduced  proposed legislation, or took other relevant activity as of July 2015. We  did not report on such activity after this date. Since we did not attempt to  identify all activity related to unregulated transfers in all states, there may  be other states with relevant legislative or other activity not included in our  review.
section_title: Literature Search
paragraphs: We conducted a search of literature related to unregulated child custody  transfers in order to gather information about why families may consider  these transfers, what policies exist to safeguard children who might be  subject to such transfers, what training is required to adopt, and what  services are available to adoptive families. While our search resulted in  some literature on adoption dissolutions and disruptions as well as  services for adoptive families, we were unable to locate academic  literature regarding unregulated transfers.
section_title: Searches of Online Forums on Selected Social Media Sites
paragraphs: We searched online forums on selected social media sites to find  illustrative examples of families who may be considering unregulated  child custody transfers. Using keywords such as “rehoming” and  “adoption disruption,” we searched selected social media sites to locate  online forums—such as groups and message boards—that parents might  use to seek new homes for their children. For example, these forums  were characterized on the sites as support groups for parents who wish to  dissolve an adoption or whose children have behavioral issues. The  results of our searches were not exhaustive as we were unable to  ascertain whether we identified most or all social media sites and forums  with online activity that may relate to unregulated child custody transfers.
We observed posts by participants in eight forums on two websites over a  15-month time period (January 1, 2014, through April 1, 2015). We  analyzed posts on two of the eight forums that involved individuals who  posted that they were seeking a new family for their child or who posted  that they wanted to adopt a child. We did not find posts involving  individuals seeking a new family for their child in the remaining six  forums. The online posts we identified did not provide sufficient  information to determine whether the posters intended to pursue an  unregulated transfer, or to pursue an adoption or other legal placement.  Since we did not investigate individual cases, our approach did not allow  us to determine whether the information posted by online participants was  accurate. Moreover, because discussions between online participants can  be continued privately, we were unable to determine whether a child was  actually transferred to another family and, if so, whether this was done  through a court-approved process or through an unregulated transfer.  One of the eight forums we observed was shut down in March 2015 by  the social media site that hosted it.
We conducted this performance audit from October 2014 to September  2015 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.
section_title: Appendix II: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact name above, the following staff members made  key contributions to this report: Elizabeth Morrison, Assistant Director;  Elizabeth Hartjes; Nhi Nguyen; and Amy Sweet. Also contributing to this  report were: Susan Aschoff; Laurel Beedon; Maurice Belding; Sarah  Cornetto; Sara Edmondson; Kirsten Lauber; Ashley McCall; Mimi  Nguyen; Brynn Rovito; and Almeta Spencer.