Child Welfare: Enhanced Federal Oversight of Title IV-B Could Provide States Additional Information to Improve Services
Published: 2003-09-10T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: In 2001, states determined that over 900,000 children were the victims of abuse or neglect. In fiscal year 2003, subparts 1 and 2 of Title IV-B of the Social Security Act provided $697 million in federal funding for services to help families address problems that lead to child abuse and neglect. This report describes (1) the services provided and populations served under subparts 1 and 2; (2) federal oversight of subpart 1; and (3) existing research on the effectiveness of services unique to subpart 1--that is, when states used subpart 1, but not subpart 2, to fund programs in a particular service category. The report focuses primarily on subpart 1 because little research exists on this subpart, while studies have been conducted on subpart 2.
section_title: What GAO Found
paragraphs: On a national level, GAO's survey showed that the primary emphases of subparts 1 and 2 vary somewhat, but the range of services offered and the types of families served overlap significantly. No single category of service was funded solely by either subpart. In fiscal year 2002, states used subpart 1 funds most frequently for the salaries of child welfare agency staff, administrative and managerial expenses, child protective services, and foster care maintenance payments. Subpart 2 primarily funded family support, family preservation, family reunification, and adoption support services. Programs funded by the two subparts served similar types of populations--predominantly children at risk of being abused or neglected and their parents, as well as children in foster care and their parents. HHS's oversight focuses primarily on states' overall child welfare systems and outcomes, but the agency provides relatively little oversight specific to subpart 1. For example, HHS works with states to establish goals to improve the safety and well-being of children and measure progress toward those goals. However, HHS has limited knowledge about how states spend subpart 1 funds. States submit an annual estimate about how they plan to use their subpart 1 funds in the upcoming year, but provide no data on actual expenditures. HHS reports that it reviews these estimates for relatively limited purposes. We also found that HHS regional offices pay little attention to statutory limits on the use of subpart 1 funds for foster care maintenance and adoption assistance payments. For example, 9 of the 10 HHS regional offices do not monitor states' compliance with these limits. As a result, HHS approved projected 2002 spending plans for 15 states that reported estimated spending amounts that exceeded the limits by over $30 million in total. While GAO's survey data revealed no unique service categories funded by subpart 1 on a national level, 37 states reported unique subpart 1 service categories within their state. Little research is available on the effectiveness of the services in these categories, such as hotlines to report child abuse and emergency shelter services. No states conducted rigorous evaluations of these services, although several states provided some information on outcomes.

section_title: Letter
paragraphs: In 2001, child protective services (CPS) staff in state child welfare  agencies determined that over 900,000 children had been the victims of  abuse or neglect by their parents or other caretakers. Title IV-B of the  Social Security Act 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. Title  IV-B is divided into two parts. States can use subpart 1 funds on almost  any child welfare activity. Subpart 2 provides grants to states for similar  types of child welfare services, such as family support services to enhance  family stability and services to help parents reunify with a child in foster  care, but is more restrictive in how the funds can be spent. In fiscal year  2003, appropriations were $292 million for subpart 1 and $405 million for  subpart 2.
Title IV-B represents a small percentage of total federal spending on child  welfare activities. Most federal funding for these activities comes from  Title IV-E of the Social Security Act and is devoted primarily to paying for  the room and board of children in foster care—known as foster care  maintenance payments. Title IV-B dollars can also be used for foster care  maintenance payments, but are more frequently used for other types of  services. As the Congress has enacted various pieces of legislation to help  move children from foster care into permanent homes more quickly, it has  emphasized the need for states to use Title IV-B funding to provide  supportive services needed to preserve and reunify families. In 1980, for  example, the Congress increased appropriations for subpart 1, but enacted  limits on the use of these funds for foster care maintenance payments and  adoption assistance payments to encourage states to use the additional  funding for services to families. In addition, while states could already use  subpart 1 funds for services targeted in the new subpart 2 program, the  creation of subpart 2 was motivated in part by the fact that few states used  a significant share of their subpart 1 funds for these types of services. The  Department of Health and Human Services’ (HHS) Administration for  Children and Families is currently developing a child welfare option that  would allow states to use Title IV-E funds for the same range of services  allowed under Title IV-B.
Because of your interest in the services states are providing to meet the  needs of families, you asked us to examine the following: (1) How do the  services provided and populations served under subpart 1 compare with  those under subpart 2? (2) What has the federal government’s role been in  overseeing the use of Title IV-B subpart 1 funds? (3) What does the  research say about the effectiveness of services unique to subpart 1?
To answer these questions, we sent two surveys to child welfare directors  to obtain information on how they use Title IV-B funds. To obtain a  breakdown of state spending for subparts 1 and 2, we sent the first survey  to all 50 states and the District of Columbia and received responses from  47 states. We sent the second survey to the 30 states that provided  sufficient data on their first survey within the timeframe that allowed us to  conduct the second survey. We received responses from 17 states,  providing detailed information on the 3 services they reported as receiving  the most subpart 1 funding and the 3 services they reported as receiving  the most subpart 2 funding. Because the data from these states may not be  representative of all states, we have used data from the second survey to  provide examples of the types of children and families served by   Title IV-B. We also conducted site visits in California, New Jersey, Ohio,  and Washington, where we interviewed state and local officials and  service providers to obtain more in-depth information on the services  provided and the types of children and families served. These states  represent both geographic diversity and diversity in how states used  subpart 1 funds. In addition, these states were identified as using  innovative CPS tools or processes. Further, we reviewed applicable laws  and regulations; interviewed HHS central and regional office officials  about their oversight activities with regard to Title IV-B; reviewed results  from HHS’s assessments of state child welfare agencies, known as Child  and Family Services Reviews (CFSR); reviewed the literature assessing the  effectiveness of child welfare services; and interviewed child welfare  experts.
subsections: section_title: Background
paragraphs: 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. The amount of subpart 1 funds a state receives is based on its  population under the age of 21 and the state per capita income, while  subpart 2 funding is determined by the percentage of children in a state  who receive food stamps.
In fiscal year 2003, the Congress appropriated $292 million for subpart 1  and $405 million for subpart 2. These federal funds cover 75 percent of  states’ total Title IV-B expenditures because states must provide an  additional 25 percent using nonfederal dollars. Title IV-B funding is  relatively small compared with the other federal and state funds used for  child welfare services. According to the most recent data available, states  spent an estimated $10.1 billion in state and local funds for child welfare  services in state fiscal year 2000, while federal Title IV-E expenditures in  federal fiscal year 2000 were $5.3 billion. In comparison, Title IV-B  appropriations in federal fiscal year 2000 were $587 million. 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. States may choose to use Title IV-B  funds to provide foster care maintenance or adoption assistance payments  for children without regard to their eligibility for these payments under  Title IV-E.
The Administration for Children and Families within HHS 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 are responsible for providing direct  oversight of state child welfare systems.
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 a  review of statewide data, interviews with community stakeholders and  some families engaged in services, and a review of a sample of cases, 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: Subpart 1
paragraphs: 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:    protect and promote the welfare of all children;    prevent or remedy problems that may result in the abuse or neglect of  children;    prevent the unnecessary separation of children from their families by  helping families address problems that can lead to out-of-home  placements; reunite children with their families;   place children in appropriate adoptive homes when reunification is not    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.
When the Congress enacted the Adoption Assistance and Child Welfare  Act of 1980, it established a dollar cap on the amount of subpart 1 funds  that states could use for certain services and created Title IV-E of the  Social Security Act. This legislation 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. While appropriations for subpart 1  increased from $56.5 million in 1979 to $163.6 million in 1981, the law  requires that the total of subpart 1 funds used for foster care maintenance,  adoption assistance, and child care payments 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.
section_title: Subpart 2
paragraphs: In 1993, the Congress established the family preservation and family  support program under Title IV-B subpart 2, authorizing grants to states to  provide two categories of services: family preservation and community- based family support services. The Adoption and Safe Families Act of   1997 reauthorized the program, renaming it Promoting Safe and Stable  Families and adding two new service categories: adoption promotion and  support services and time-limited family reunification services. Through  fiscal year 2006, the Congress has authorized $305 million in mandatory  funding for subpart 2 and up to $200 million annually in additional  discretionary funding. In fiscal year 2002, the Congress appropriated   $70 million in discretionary funding for the program.
The definitions of the four subpart 2 service categories are:    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.
These services are similar to those allowed under subpart 1, although the  range of services allowed under subpart 2 is more limited in some cases.
For example, time-limited family reunification services can only be  provided during a child’s first 15 months in foster care, while no such  restriction is placed on the use of subpart 1 funds. In addition, states must  spend a “significant portion” of their subpart 2 funds on each of the four  service categories. HHS program instructions require states to spend at  least 20 percent of their subpart 2 funds on each of the four service  categories, unless a state has a strong rationale for some other spending  pattern. By statute, states can spend no more than 10 percent of   subpart 2 funds on administrative costs. A congressional document notes  that states already had the flexibility to use subpart 1 funds for family  support and family preservation services, but that few states used a  significant share of these funds for these services. In creating   subpart 2, the Congress did not revise any components of subpart 1.
section_title: State Plan Requirements for Subparts 1 and 2
paragraphs: To receive Title IV-B funds, states are required to submit a 5-year child and  family services plan to HHS. These plans have a number of specific  reporting and procedural requirements. While several of the requirements  are similar for subparts 1 and 2, states are required to provide information  about more aspects of their child welfare systems under subpart 1. Some  of the major requirements are outlined in table 1.
section_title: Alternative Financing Mechanisms for Child Welfare Services
paragraphs: Federal child welfare funding has long been criticized for entitling states  to reimbursement for foster care placements, while providing little funding  for services to prevent such placements. HHS is currently developing a  legislative proposal to give states more flexibility in using Title IV-E foster  care funds for such preventive services. Under this new proposal, states  could voluntarily choose to receive a fixed IV-E foster care allocation  (based on historic expenditure rates) over a 5-year period, rather than  receiving a per child allocation. The fixed allocation would be an estimate  of how much a state would have received in Title IV-E foster care  maintenance funds. States could use this allocation for any services  provided under Titles IV-B and IV-E, but would also have to fund any  foster care maintenance payments and associated administrative costs  from this fixed grant or use state funds.
Since 1994, HHS has also been authorized to establish child welfare  demonstrations that waive certain restrictions in Titles IV-B and IV-E and  allow states a broader use of federal funds. States with an approved  waiver must conduct a formal evaluation of the project’s effectiveness and  must demonstrate the waiver’s cost neutrality—that is, a state cannot  spend more in Title IV-B and IV-E funds than it would have without the  waiver. Projects generally are to last no more than 5 years. HHS’s authority  to approve these waivers is scheduled to expire at the end of fiscal year  2003.
section_title: The Primary Emphases of These Subparts Vary Somewhat, but the Range of Services and Types of Families Served Overlap Significantly
paragraphs: On a national level, our survey showed that the primary emphases of  subparts 1 and 2 vary somewhat, but the range of services offered and the  types of families served overlap significantly. According to our survey data  for fiscal year 2002, states spent subpart 1 funds most frequently on the  salaries of child welfare agency staff—primarily social work staff who can  provide a variety of services, such as CPS investigations, recruiting foster  parents, and referring families for needed services. The next three largest  categories—administration and management expenses, CPS services, and  foster care maintenance payments—accounted for about 43 percent of  subpart 1 funding. Subpart 2 funds, in comparison, were used primarily to  fund programs within its required service categories—family support,  family preservation, family reunification, and adoption promotion and  support services. Some social work staff whose salaries were funded with  subpart 1 may provide similar services to families as the staff in these  programs funded by subpart 2. On a national basis, however, no service  category was solely funded by either subparts 1 or 2. The programs funded  by subpart 1 and 2 dollars served similar types of children and families.  States used the majority of funds from each subpart to provide services to  children at risk of abuse and neglect and their parents, as well as foster  children and their parents. Officials in most HHS regional offices said that  they believe that the current structure of Title IV-B offers a good balance  in allowing states some flexibility to address state needs and targeting  some federal funds toward services to keep families together and prevent  children from entering foster care.
subsections: section_title: While the Distribution of Funds Differs Somewhat, Some Overlap in Service Categories Exists
paragraphs: Although no category of service is funded solely by either subparts 1 or   2 dollars, somewhat different spending patterns emerged with regard to  the distribution of these funds among the categories. The states  responding to our survey reported spending about 28 percent of subpart 1  funds in fiscal year 2002 on the salaries of child welfare agency staff, with  an additional 43 percent used for administration and management  expenses, foster care maintenance payments, and direct CPS services (see  table 2). In comparison, states used over 80 percent of subpart 2 dollars to  fund services in its mandated service categories—family support, family  preservation, family reunification, and adoption promotion and support  services. However, neither subparts 1 nor 2 funded a unique category of  service at the national level. For example, states typically reported using  subpart 1 to fund CPS programs; however, 5 states used subpart 2 dollars  to fund programs in this category.
Subpart 1 dollars 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 (see fig. 1). During our site visit, Washington 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, social workers who provide ongoing case  management and support services to families involved with the child  welfare agency due to concerns about abuse or neglect, social work  supervisors, and clerical support staff. While states also reported using  subpart 2 funds for staff salaries, only 2 percent of subpart 2 dollars were  used for this purpose. This comparison may underestimate the overlap in  services funded by subparts 1 and 2, however, because much of the costs  of programs funded by subpart 2 is likely attributable to staff salaries.  Similarly, some social work staff whose salaries are funded by subpart 1  likely provide a variety of services, such as family preservation services,  recruiting foster families, and referring families for needed services, some  of which may be similar to services funded by subpart 2.
Percentages do not total to 100 due to rounding.
Administration and management comprised the second largest category of  service, accounting for almost 17 percent of subpart 1 dollars. These  services included rent and utilities for office space, travel expenses for  agency staff, and staff training. Ohio, for example, used most of its  subpart 1 dollars to fund state and county child welfare agency  administrative expenses. In contrast, states spent less than 5 percent of  their subpart 2 funds on administration and management.
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 or when  a child runs away from a foster home. In comparison to states’ use of  subpart 1 funds, states reported using less than 1 percent of their   subpart 2 dollars to fund programs within this service category.
States 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. For instance, New Jersey officials  reported spending over 50 percent of the state’s subpart 1 funds on foster  care maintenance payments. Seventeen states spend subpart 1 funds on  foster care maintenance payments, while only 2 states reported using  subpart 2 funds for this purpose, accounting for less than 1 percent of total  subpart 2 expenditures.
States reported using half of their subpart 2 dollars to fund family support  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.  One California county we visited used subpart 2 to fund a network of  family support services with the goal of strengthening communities and  keeping families from becoming involved with the child welfare system.  Funds were granted to community groups to provide support and improve  the healthy development of families for different populations, such as  grandparent caregivers and adolescent mothers. 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.  Over one-third of the states responding to our survey also reported using  subpart 1 funds to provide family support services similar to those funded  by subpart 2, although family support services only accounted for   8 percent of subpart 1 expenditures. For example, New Jersey transferred  about 27 percent of its subpart 1 funds to local child welfare agencies to  provide family support services, which included parent education classes,  transportation, and mentoring for children.
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  some cases, services provided in this category were similar to those in the  family support category, but were intended to help keep families together.  For example, Florida funded several neighborhood resource centers,  which provide child care, parenting classes, adult education and training  opportunities, mental health services, transportation services, and a food  pantry. Although states primarily used subpart 2 dollars to provide these  services, states also reported using approximately 2 percent of subpart 1  funds on family preservation services.
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 parents. 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.  Similarly, Florida funded adoption support services for children with  special needs who are awaiting adoption, including counseling, behavior  modification, tutoring, and other services to expedite the adoption  process. In contrast, less than 1 percent of subpart 1 dollars were used to  provide adoption support and preservation services.
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. One county we visited in  California used subpart 2 funds for a shared family care program, in which  the parent and child are placed together in a mentor home. The mentor  provides a role model for good parenting behavior and provides hands-on  parenting guidance to keep the family together, while a case manager  ensures that family members receive services to address problems that  could lead to the removal of the child, such as substance abuse or  homelessness. Subpart 1 funds were used much less frequently for family  reunification services; states reported using 1 percent of subpart 1 funds  for these services.
section_title: Significant Overlap Exists among the Types of Children and Families Served by Subparts 1 and 2
paragraphs: Significant overlap exists among the types of children and families served  by these subparts, although certain populations are more closely  associated with a particular subpart. Services funded by each subpart  predominantly targeted children at risk of abuse or neglect and their  parents, as well as children in foster care and their parents. States  responding to our survey reported that services funded by subpart 1 in  fiscal year 2002 most frequently served children living in foster care and/or  their parents, while 9 percent of subpart 2 funds are used for services that  target the same population (see table 3). Similarly, while subpart 2  services most commonly targeted children at risk of abuse and neglect  and/or their parents, about 17 percent of subpart 1 funds were also used  for services aimed at this population. In addition, 9 percent of subpart 1  funds and 11 percent of subpart 2 funds were used to fund services  intended for both of these types of families.
The overlap in populations observed at the national level can also be seen  when looking at the children and families targeted by individual states. We  found that individual states frequently funded programs with each subpart  that served the same types of children and families. For example, all   20 states that used subpart 1 dollars to fund services for children at risk of  abuse or neglect and/or their parents also used subpart 2 dollars to fund a  program serving this same population type (see table 4). Alaska, for  instance, used subpart 1 dollars to fund a broad family support program,  which provided services to children at risk of abuse and neglect and their  parents. The state also used subpart 2 funds to provide another family  support program, which provides similar services to the same types of  children and families. In addition, 17 states funded one or more individual  services with funds from both subparts, so that subparts 1 and 2 were  serving the same children and families.
In our second survey, we requested more detailed information about the  populations served by programs funded by subparts 1 and 2, such as  demographic and socioeconomic characteristics. However, few of the   17 states responding to the second survey were able to provide this kind of  data. When asked about selected subpart 1 services, 10 of the 17 states  were able to estimate the extent to which the same children and families  receiving the identified service funded by subpart 1 also received services  funded by subpart 2. Of children and families receiving the identified  subpart 1 service,  four states reported that generally none or almost none of the recipients  also received a service funded by subpart 2, three states reported that generally less than half of the recipients received  subpart 2 services,    one state reported that all or almost all recipients received subpart 2  two states provided varying estimates for different subpart 1 services.
While none of the states we visited were able to provide data about the  extent to which the same children and families were receiving services  funded by both subparts 1 and 2, state officials in each of these states  recognized some overlap among the types of populations participating in  these services. Officials in California and New Jersey told us that they use  subpart 1 for services to families that are involved with the child welfare  agency due to a report of abuse or neglect, while services funded by  subpart 2 target a broader population, including families who are at risk of  abusing their children. However, while some of the subpart 2 programs  these officials described focused on this at risk population, many of them  were targeted to families who were already involved with the agency.  Officials at a California child welfare agency told us that all of the services  provided by subparts 1 and 2 are targeted toward the same high-risk  communities in which many people are involved with the agency, and they  considered it likely that families receiving subpart 1 services have also  received subpart 2 services in the past or will at some time in the future.  Washington officials noted that children and families involved with the  child welfare agency may receive multiple services, some of which may be  funded by subpart 1 and some of which may be funded by subpart 2.  Finally, although Ohio does not track clients served, one state official  estimated that the types of children and families served by the programs  funded by subparts 1 and 2 overlap by 100 percent.
One New Jersey state official described the services funded by subparts 1  and 2 as part of a continuum of child welfare services, such that some  population overlap is to be expected. In New Jersey, services funded by  subpart 1 target families who are experiencing difficulties that may  jeopardize the safety and well-being of their children. Programs funded by  subpart 2 may also serve these families. However, they also target families  who are not currently having difficulties, but who could become involved  with the child welfare agency in the future. In addition, some subpart 2  programs serve adopted children, many of whom were previously involved  with the child welfare agency and received services funded by subpart 1.  None of the states we visited could provide data on the numbers of  children and families who participated in services funded by subparts 1  and 2 dollars.
section_title: HHS Officials Believe Title IV-B Offers Flexibility While Targeting Prevention Activities, and States Emphasize the Need for Flexibility
paragraphs: Given the overlap observed between the two subparts, we discussed the  potential advantages and disadvantages of consolidation with HHS  regional officials and asked states for their perspective on our survey.  Officials in almost all of HHS’s regional offices said that Title IV-B should  maintain its current balance between allowing states some flexibility and  targeting some resources toward prevention. Officials in all 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. One regional office noted that subpart 1 gives states  the flexibility to address unexpected circumstances affecting the child  welfare system—for example, by developing substance abuse treatment  programs to address the needs of parents affected by the cocaine epidemic  of the 1980s. Similarly, officials in three states we visited felt strongly that  the flexibility to direct the use of subpart 1 funds for state priorities was  important and they would not want to lose this flexibility in any  consolidated program. Our survey results also indicate that the flexibility  to use subpart 1 to meet the needs of their child welfare systems is  important to states. For example, when asked about their preference  between subparts 1 and 2 with regard to different program components,   24 and 26 states, respectively, reported that they preferred subpart 1 when  considering (1) spending restrictions on the percentage of funds that can  be used for specific services and (2) allowable spending categories (see  fig. 2). When asked about the advantages and disadvantages of Title IV-B’s  current structure, several states cited the spending restrictions of subpart  2 as a disadvantage, while a couple of states mentioned the flexibility  associated with subpart 1 as an advantage.
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. One  state we visited expressed opposition to consolidation for this reason,  arguing that keeping a separate subpart 2 was important to ensure that  states fund some prevention services. State and county officials in this  state noted that subpart 2 represents an important federal investment in  prevention services and expressed concern that states would use all  available funds to provide services to families already involved with the  child welfare agency unless funds were specifically targeted for services to  support families at risk of abusing or neglecting their children. In addition,  on our survey, several states cited the prevention focus of subpart 2 as an  advantage of Title IV-B’s current structure.
Officials in 8 of HHS’s regional offices said that they believe that the  current structure of Title IV-B offers a good balance between flexibility  and targeting resources toward prevention. Officials in the other   2 regional offices told us that Title IV-B provides a good mix of flexibility  and a focus on services considered to be federal priorities. One regional  office noted that a consolidated Title IV-B program could be structured to  offer this balance. For example, a consolidated program could require  some minimum spending levels for the current subpart 2 categories, but  also set aside some funds that states could use for a broader array of child  welfare services. In addition, most of the regional offices did not believe  that consolidation would lead to any significant administrative savings.  For example, several regional offices explained that consolidating the  subparts would not reduce HHS’s oversight responsibilities, while another  noted that consolidation would have little impact on HHS regional or state  offices, which are staffed and organized to manage multiple sources of  funding. Another regional office noted that the planning and reporting  requirements for the two subparts are already consolidated in the planning  documents states submit to HHS.
State and local child welfare officials in one state, along with officials at   2 HHS regional offices, commented that increasing the funds available for  service provision was more critical than consolidating the two subparts.  They believe 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, rather than paying primarily for foster care maintenance  payments as it currently does. Since 1994, states have been able to apply  for demonstration waivers to use federal child welfare funds to test  innovative foster care and adoption practices without regard to certain  restrictions in Titles IV-B and IV-E. For example, four states are using  demonstration waivers to create fixed Title IV-E budgets for counties  within the state in which funds can be used more flexibly for prevention  and community-based services not traditionally reimbursed by Title IV-E.
However, HHS’s authority to approve such waivers is scheduled to expire  at the end of fiscal year 2003. States may soon have another mechanism to  use Title IV-E funds to provide preventive services through the child  welfare option HHS is currently proposing.
section_title: HHS Focuses Oversight on Overall Child Welfare System, but Has Limited Knowledge about States’ Use of Subpart 1 Funds
paragraphs: HHS’s oversight focuses primarily on states’ overall child welfare systems  and outcomes, but the agency provides relatively little oversight specific to  subpart 1. For example, HHS regional offices work with states to establish  overall goals to improve the safety, permanency, and well-being of  children and measure progress toward those goals. However, HHS has  limited knowledge about how states use their subpart 1 funds. HHS does  not collect data on subpart 1 expenditures and instead requires states to  submit annual estimates about how they plan to use their subpart 1 funds  in the upcoming year. HHS regional offices reported that they review these  estimates for relatively limited purposes, with several HHS officials noting  that they do not review the spending plans for subpart 1 as closely as  subpart 2 because subpart 1 has few restrictions as to how these funds can  be used. We also found that HHS regional offices pay little attention to  statutory limits on the use of subpart 1 funds for foster care maintenance  and adoption assistance payments. As a result, HHS approved projected  2002 spending plans for 15 states that reported planned spending amounts  that exceeded these spending limits. In response to our survey, 10 states  reported actual 2002 subpart 1 expenditures that exceeded the spending  limits by over $15 million in total.
subsections: section_title: HHS Focuses Much of Its Oversight on States’ Overall Child Welfare Systems and Outcomes
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. In discussing their oversight of  subpart 1, several HHS officials at headquarters and in the regional offices  emphasized the importance of reviewing the overall child welfare system  and the outcomes achieved, rather than scrutinizing individual programs  outside of that context. 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, including subpart 1, 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. This 5-year plan  includes a description of services and programs the state will pursue to  achieve these goals.
In addition to the 5-year plan, HHS requires states to submit an Annual  Progress and Services Report (APSR) each year to discuss their progress  in meeting the goals outlined in their plans and revise the goals as  necessary. Regional HHS staff review this planning document to ensure  that they meet all the technical requirements outlined in the annual  program instructions issued by HHS. For example, states must certify that,  in administering and conducting services under the 5-year plan, the safety  of the children to be served shall be of paramount concern. In addition,  some regional offices reported that they review the state’s objectives and  goals to determine if they are reasonable, assess the progress the state has  made in achieving these goals and objectives, and determine whether child  welfare services are coordinated with the efforts of other agencies serving  children. Some regional officials noted that states are still struggling to use  these documents appropriately for planning purposes. These officials told  us that instead of focusing on outcomes and collecting data to measure  progress toward those outcomes, frequently states simply describe their  current programs.
In addition to reviewing planning documents, all of the regional offices  consult regularly with states to discuss child welfare issues and provide  technical assistance. For example, the regional office may provide  guidance on how to comply with specific program regulations or how to  develop a 5-year plan that will function as a strategic plan for the state’s  child welfare agency. Two regional offices told us that they also conduct  site visits to states as part of their oversight. One regional office reported  visiting states in its region to gain a better understanding of each state’s  child welfare services. This allows the regional office to share good ideas  with other states and to ensure that states are working on areas the  regional office has identified as in need of improvement. Other regional  offices reported that they would like to conduct site visits to states under  their purview, but a lack of travel funds prevented them from doing so.
The CFSR process is an additional tool HHS uses to ensure that states  conform with 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. They consider the CFSR an important  complement to a state’s planning documents—it gives them 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.
CFSR results for the past 2 years indicate that states have not performed  strongly in terms of assessing families to determine what services they  need and providing those services. While 21 of the 32 states that  underwent a CFSR in 2001 or 2002 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. When  HHS reviewed case files, however, it determined that 31 of these states  needed improvement in terms of assessing family needs and providing  services to meet those needs. 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. However, the official also pointed out that HHS gives states a  lot of latitude to determine the most appropriate use of their subpart 1  funds and that the agency cannot become too involved in state budget  decisions given the complexities of the budget processes for states.
section_title: HHS Has Little Information about States’ Use of Subpart 1 Funds
paragraphs: HHS has little information about states’ use of subpart 1 funds. Each year,  HHS requires states to submit a form CFS-101, which includes state  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). The descriptions provided by  regional office staff of their review of these estimates indicate that they  review them for relatively limited purposes. Officials in 4 of the regional  offices told us that they generally use the CFS-101 data to ensure that  states request the total amount of subpart 1 funds to which they are  entitled and that they comply with the requirement to match 25 percent of  subpart 1 funds with state funds. Most regional offices indicated that their  reviews of the CFS-101s focus more on subpart 2 than subpart 1. For  example, they reported that they review states’ planned subpart 2  spending more closely to ensure that states are meeting the requirement  that they spend at least 20 percent of funds on each of the service  categories and spend no more than 10 percent of funds for administrative  purposes. Several HHS officials reported that they do not monitor the use  of subpart 1 funds as closely as other federal child welfare funds due to  the relatively small funding amount and the lack of detailed requirements  about how the funds can be used.
Moreover, the CFS-101 estimates may not provide reliable data as to how  states are using subpart 1 funds. HHS officials explained that the   CFS-101 data are estimates and that states’ actual expenditures may vary  from these estimates, as they address unforeseen circumstances. The  timing for submitting the CFS-101 also affects how well states can  estimate their planned subpart 1 spending. HHS requires states to submit  their initial CFS-101 for the upcoming fiscal year by June 30, which forces  states to estimate their planned spending before the final spending  amounts for Title IV-B and other federal funds have been appropriated.  Some regional officials indicated that they did not know how well states’  CFS-101 estimates reflect their actual subpart 1 spending. We did not  conduct a review of the reasonableness of the data states submit on their  CFS-101s, but we did identify a few instances that suggested that the data  are not always accurate. Two states with county-administered child  welfare systems told us that they do not have reliable data to allow them  to accurately estimate planned spending. A child welfare official in one of  these states told us that its CFS-101 data represented its “best guess” as to  how subpart 1 funds will be used, because the state distributes these funds  to county child welfare agencies and does not collect any data on how the  counties use these funds. The other state told us that its current   CFS-101 data are most likely based on county data from several years   ago and that counties may now be spending subpart 1 funds on different  services.
HHS does not require states to provide any additional 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. An official  from one regional office explained that the only way to determine how a  state actually uses its Title IV-B funds is to review its financial accounts,  which HHS does not do. Some regional officials suggested that it would be  helpful to have actual expenditure data for both Title IV-B subparts,  especially to determine if states were actually using 20 percent of their  subpart 2 funds for each of the four required service categories. Three  regional offices indicated that they have begun asking states to provide  Title IV-B expenditure data.
section_title: HHS Regional Offices Are Unaware of Subpart 1 Spending Limits or Do Not Enforce Them
paragraphs: Given that HHS’s subpart 1 oversight focuses primarily on a state’s overall  child welfare goals and outcomes, the regional offices pay little attention  to the statutory limits on the use of federal subpart 1 funds for foster care  maintenance and adoption assistance payments. Most HHS regional  offices do not review the CFS-101s for compliance with the statutory  limits. In addition, HHS’s annual program instruction, which details what  information states must include in their CFS-101 submittals and serves as  the basis for the regional offices’ review of subpart 1 spending, does not  mention the subpart 1 limits.
Only 1 of HHS’s 10 regional offices told us that it compares states’ planned  subpart 1 spending reported on the CFS-101 with the actual dollar limit for  each state to ensure that states observe the statutory limits. This office  used an HHS program instruction for 1979 listing each state’s subpart 1  allocation to determine the ceiling on foster care maintenance and  adoption assistance payments. In contrast, 5 regional offices were  unaware that any limits on the use of subpart 1 funds existed, although   1 of these offices indicated that it generally did not consider it appropriate  for states to use subpart 1 funds for foster care maintenance payments  because subpart 1 should be used to fund services for families.  Nonetheless, this office approved a CFS-101 for 1 state that exceeded the  statutory limits. Four other regional offices were aware that some  limitations with regard to foster care maintenance and adoption assistance  payments existed, but did not ensure that states complied with the limits.
These 4 regional offices provided several reasons for why they did not  monitor states’ planned spending for compliance with the subpart 1 limits.  Two regional offices indicated that HHS had provided no guidance as to  how such limits should be enforced or that no data were available to  calculate subpart 1 limits for each state. The third regional office reported  that it did not have the specific ceiling amounts for each state. However,  officials in this office said they reviewed planned subpart 1 spending for  foster care maintenance and adoption assistance payments on the   CFS-101 to determine if they had increased from the previous year. If the  amounts had not increased, the regional office assumed that someone had  checked the amounts previously and that they were within the limits. This  regional office approved CFS-101s for 2 states in the region that reported  planned subpart 1 spending for foster care maintenance and adoption  assistance payments in excess of the limits. The fourth regional office told  us that, in the past, it had a list of the maximum spending limits for each  state in its region and that it had previously checked states’ CFS-101s to  ensure that planned spending did not exceed the limits. However, the  regional office no longer conducts such reviews; regional officials said that  they consider the limits to be meaningless because state funds spent on  child welfare services greatly exceed subpart 1 funds. In other words, any  attempt to enforce the limits would only lead to changes in how states  accounted for their funds—if a state was spending $1 million in state funds  on CPS investigations and $1 million in subpart 1 funds for foster care  maintenance and adoption assistance payments, the state could simply  switch state and subpart 1 funding so that state funds paid for the foster  care maintenance and adoption assistance payments, while subpart 1  funding paid for CPS investigations.
This lack of review led HHS to approve CFS-101s 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 (see fig. 3). 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 CFS- 101 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. Moreover, 13 of these   15 states submitted fiscal year 2003 CFS-101s with planned subpart 1  spending above the statutory ceiling, which were approved by HHS.
Several regional offices noted that they judge the appropriateness of  subpart 1 spending on foster care maintenance and adoption assistance  payments in the context of a state’s overall child welfare system. For  example, these 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 they would, however, ask a state to  reconsider its funding strategy if the state were performing poorly.  However, many of the states with approved CFS-101 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 12 of the   15 states with approved CFS-101s 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 11 of  the 12 states. In addition, 6 of the 12 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.
We also compared our survey data on states’ fiscal year 2002 subpart 1  expenditures for foster care maintenance and adoption assistance  payments with the statutory limits and found that 10 states reported  spending subpart 1 funds on these payments that exceeded the legal limits  (see fig. 4). As with their planned spending estimates, states’ subpart 1  actual spending for foster care maintenance and adoption assistance  payments exceeded the statutory limits by varying amounts. Michigan, for  example, reported on our survey that it spent over $6 million on foster  care maintenance payments in fiscal year 2002—well over its $2.2 million  limit for such payments—while New Hampshire’s use of subpart 1 for  foster care maintenance and adoption assistance payments was only about  $27,000 above its limit. In total, these 10 states reported subpart 1  expenditures for foster care maintenance and adoption assistance  payments that exceeded the statutory limits by over $15 million. Our  survey results may underestimate the number of states with subpart 1  spending over the statutory limits, because several states reported on our  survey that they used subpart 1 for foster care maintenance or adoption  assistance payments, but were not able to identify the specific dollar  amount of subpart 1 funds used for these purposes.
Four of these 10 states with subpart 1 expenditures over the statutory  limits were also part of the 15 states with CFS-101s that indicated planned  spending above the limits.  The remaining 6 states did not report  estimated subpart 1 spending over these limits.  For example, Colorado  did not report any planned subpart 1 spending for foster care maintenance  or adoption assistance payments. On our survey, however, the state  reported using over $3 million in subpart 1 funds for these purposes, well  over its $700,000 limit.
section_title: Some Unique Subpart 1 Service Categories Exist at the State Level, but Little Research Exists on the Effectiveness of These Services
paragraphs: Little research is available on the effectiveness of unique services funded  by subpart 1 because few states have evaluated these services. While our  survey data revealed no unique categories of services funded by subpart 1  on a national level, 37 states reported categories of services that were  uniquely funded by subpart 1—that is, the individual state used subpart 1,  but not subpart 2, to fund services in a particular category. For example,  Delaware funded two CPS programs with subpart 1—assessments of a  caregiver’s parenting ability and legal services to represent the child  welfare agency in court cases—but did not use any subpart 2 funds for this  service category. We contacted the states with unique service categories in  their states (other than administration, staff salaries, adoption assistance  payments, or foster care maintenance payments) and none of these states  had conducted rigorous evaluations of these services, although several  states provided some data on the effectiveness of services included in  these categories. Our literature review on the effectiveness of child  welfare practices identified research for some of these unique service  categories, such as certain types of family preservation programs. With  two exceptions, however, it did not identify any evaluations of the specific  services included in these categories.
The most common service categories for which individual states used only  subpart 1 funds were CPS, foster care maintenance payments, and staff  salaries. The 37 states generally reported 1 or 2 unique categories, with   14 states reporting 1 unique category and 1 state reporting a high of   6 categories. Examples of unique subpart 1 services in the CPS category  include specialized investigations of reports of child abuse or neglect,  telephone hotlines to report incidents of child abuse or neglect, and  temporary shelter services for children removed from their homes at times  when no other placement option is available, such as evenings and  weekends. States also provided other types of services that were funded  uniquely by subpart 1. For example, Minnesota provided intensive in-home  services to prevent children from being placed in foster care, North  Carolina contracted for legal services with the state’s Attorney General’s  office, and Maine helped adopted youth pay for post-secondary education  costs.
Our review of child welfare literature and Internet sites that identified  promising child welfare practices found few studies that evaluated the  effectiveness of the specific services that states funded uniquely with  subpart 1 funds. Based on the information provided on our survey, we  identified evaluation research on two of these services. Texas used  subpart 1 to fund its Home Instruction For Parents of Preschool  Youngsters (HIPPY) Program. The goal of HIPPY is to prevent academic  underachievement of children when they enter school. HIPPY works with  parents in their homes or in parent group meetings to increase the degree  and variety of literacy experiences in the home. The program also seeks to  prevent child abuse by enhancing parent-child interactions and focuses on  economically disadvantaged parents who may not be involved in parenting  programs. While Texas has not formally evaluated this program, the model  has been evaluated in other states. Strengthening America’s Families, a  Web site about effective family programs to prevent juvenile delinquency  funded by the Office of Juvenile Justice and Delinquency Prevention, cites  HIPPY as a model program for which evaluations have shown positive  effects on children’s measured competence and classroom behavior at the  end of second grade for children who participated in HIPPY compared  with children with no formal preschool experience. In addition, a   1999 article summarizing research on the HIPPY program found mixed  results. For example, an evaluation in New York found that children  whose parents participated in HIPPY in 1990 outperformed control group  children on measures of classroom adaptation and reading scores 1 year  later, but children whose parents participated in HIPPY in 1991 had similar  outcomes as children in the control group. The article suggested that  variability in how the program is implemented and in parental  commitment to the program may explain the mixed results.
Missouri funded an alternative response system with subpart 1 funds,  which offers assessment services (rather than an investigation) for  families that are the subject of a report of abuse or neglect when the risk  to the child is not considered high to determine if the family needs  services to reduce the risk of harm to the child. By responding to low risk  reports of abuse or neglect in a nonaccusatory manner, the goal is to  encourage families to collaborate in identifying their needs and cooperate  with supportive services. A 1998 evaluation of Missouri counties testing  the state’s alternative response system found that the safety of children  was not compromised by the lack of an investigation and that, compared  to counties that were not using the alternative response system, needed  services were delivered more quickly, subsequent reports of abuse or  neglect decreased, and the cooperation of families improved. An  evaluation of Minnesota’s alternative response systems has also shown  promising results. For example, initial results from the randomized  experimental evaluation showed an increase in the use of community  services with no increase in subsequent reports of abuse or neglect.
Of the 37 states that reported unique subpart 1 service categories, we  asked the 22 states with unique subpart 1 service categories other than  foster care maintenance payments, adoption assistance payments, staff  salaries, or administration, whether they had evaluated the effectiveness  of the programs included in their unique categories. None of these states  had conducted rigorous evaluations of the effectiveness of these services  using randomly selected control groups. One official explained that few  states can afford to divert resources from providing direct services to  conducting formal evaluations of programs, given the tremendous service  needs of families involved with the child welfare system.
However, 5 states provided some information on the outcomes of the  services they funded uniquely with subpart 1. North Dakota used subpart 1  dollars to uniquely fund a component of its family preservation program— family focused services—which the state characterized as a family  reunification service. The state provided us with a draft evaluation report  of its family preservation program, which includes this specific service.  The family preservation program is intended for families with children at  risk of being placed in foster care and offers a range of services, including  parent aides who provide hands-on parenting education and therapists  who are available 24 hours a day to work with the family in the home to  address the issues that may result in the children being removed from the  home. The evaluation of its total family preservation program found that  families receiving services and the social worker involved with the families  both reported improved family functioning upon completion of the  services compared to their functioning prior to the services. The study also  found that fewer children were at risk of being placed in foster care upon  completion of services. However, the evaluation did not include any  control group to determine if these results would have been achieved if  families had not received these services.
Massachusetts used some of its subpart 1 funds to pay for a contractor to  operate a telephone service for reports of child abuse or neglect that are  received in the evenings and on weekends. Officials from Massachusetts  provided an internal study conducted in February 2000 that discussed  problems with this telephone service, most notably limited staff and  resources to handle an increasing volume of calls. The report  recommended several actions to improve the operation of the telephone  service, including an increase in staff to field telephone calls, upgrading  the telephone system so that fewer people receive a busy signal, and  increasing the number of beds available for emergency placements in the  evenings and on weekends. Arizona also funded its child abuse telephone  hotline uniquely with subpart 1 funds and provided the following statistics.  In fiscal year 2003, 69 percent of calls to the hotline were answered  without any wait. Of the calls that were not answered directly, the average  wait time was 3.5 minutes and about 13 percent of calls were abandoned.  In addition, quality assurance staff reviewed over 17,000 calls for which it  was determined that the report did not meet the state’s criteria for a CPS  report requiring investigation and changed only 15 of these to a CPS  report.
Missouri funded several CPS services with subpart 1 funds, including  intensive in-home services for children at imminent risk of removal from  the home- and family-centered services for families for whom an  investigation determined services are needed to eliminate the risk of harm  to the child. Missouri provided two annual reports for fiscal year 2002 that  provide some data on the outcomes of these services. Consumer surveys  indicated that many families found the intensive in-home services useful,  and the annual report on the intensive in-home services indicated that   88 percent of at-risk children were still with their families when services  ended after approximately 6 weeks. In addition, 79 percent of children  who exited the program in 2001 were still at home 1 year after services  ended. With regard to family centered services, the annual report indicated  that over 70 percent of families had achieved their goals at the time their  case was closed. Wisconsin used subpart 1 to fund a Youth Aids Program,  in which the state provides grants to counties to provide services to  prevent the placement of children in correctional facilities and other out- of-home care. The state has not evaluated services provided by the  counties, but a 1995 report notes that in the first several years of  operation, this program produced major reductions in institutional  placements and helped encourage the development of community-based  resources. Over time, however, an increase in youth crime has led to  large increases in institutional and out-of-home care, so that much of  Youth Aids funding at the time was reported to be used for out-of-home  placements.
section_title: Conclusions
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 providing supportive services to help preserve and  reunify families. The primary emphases of the two subparts vary  somewhat, but the range of services offered and the types of families  served overlap significantly. In part because of the relatively small funding  involved and the flexible nature of the funding, HHS does not provide in- depth oversight specific to Title IV-B subpart 1. Instead, HHS focuses  much of its oversight efforts on states’ progress toward the overall goals of  their child welfare systems and the outcomes achieved by these systems.  While this type of oversight is appropriate, HHS could provide valuable  assistance to states by obtaining more concrete data about states’ use of  these funds and synthesizing these data with CFSR data on states’  outcomes with respect to properly identifying the service needs of  children and families and providing needed services. Such analyses could  allow HHS to develop information on how investments in certain types of  services correlate to improved outcomes for children, which could be  shared with states to help them more effectively target their spending.
HHS could also use this enhanced knowledge of Title IV-B to help develop  an appropriate accountability strategy for its newly proposed child welfare  option. If enacted, the additional spending flexibility proposed—given the  size of the Title IV-E allocations that would become available for spending  on a variety of child welfare services—could have a significant impact on a  state’s child welfare system. Given the limited information available about  the services funded with subpart 1 and the effectiveness of these services,  as well as HHS’s findings about the ability of states’ to meet families’  needs, ensuring that states use this flexibility to provide effective services  will be critical to the success of this option. Opportunities also exist for  HHS to continue to encourage states to conduct evaluations of the  programs the states implement.
section_title: Recommendations
paragraphs: We recommend 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. In addition, we recommend 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. For example, an analysis of how  states’ spending patterns correlate to outcomes—both positive and  negative—from the CFSRs could yield useful information for this purpose.
Given that HHS is currently developing the new child welfare option that  would allow states to use Title IV-E dollars for services similar to those  provided under Title IV-B subpart 1, we further recommend that the  Secretary use the information gained through enhanced oversight of  subpart 1—as well as information it may have on states’ use of subpart 2  funds—to inform its design of this option. For example, HHS could use  this information to help states determine the most appropriate services to  provide under this option.
section_title: Agency Comments
paragraphs: We provided a draft of this report to HHS for comment. The Department’s  Administration for Children and Families provided comments. These  comments are reproduced in appendix II. ACF also provided technical  clarifications, which we incorporated when appropriate.
ACF agreed with our recommendation 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. ACF agreed to provide guidance to the regional  offices to enable them to enforce the statutory limits on subpart 1 funds.   However, ACF also noted that this limitation no longer serves a useful  purpose and is incompatible with the current proposal to offer states  much more flexibility in using other federal child welfare dollars. ACF said  that it plans to explore ways to provide states flexibility with respect to  the subpart 1 limits.
ACF disagreed with our recommendation to consider the feasibility of  collecting basic data on states’ use of subpart 1 funds. ACF said that it  believes that its level of oversight is commensurate with the scope and  intent of the program and minimizes states’ reporting requirements.   Rather than using information on Title IV-B expenditures to help states  most effectively use their resources, ACF believes that its oversight is  more appropriately focused on the CFSR process, which requires states to  develop actions in response to weaknesses identified by the CFSR and  which measures the impact of these actions on actual outcomes. In ACF’s  opinion, analyzing how states’ spending patterns correlate to CFSR results  is not useful, given the lack of a direct relationship between the relatively  small Title IV-B funding levels and the broad outcome areas of safety,  permanency, and well-being. In addition, ACF noted that any data  collected on subpart 1 expenditures would be outdated because states  have 2 years to spend Title IV-B expenditures and are not required to  report final expenditures until 90 days after the 2-year period has ended.
We believe, however, that assessing the feasibility of collecting some basic  data on states’ subpart 1 expenditures could enhance ACF’s overall  oversight of states’ child welfare operations and outcomes. While the  impact of states’ program improvement efforts under the CFSR process is  unknown because states are just getting these efforts underway, the  service deficiencies identified by the CFSRs suggest that states could  benefit from some guidance on the services that are associated with  positive CFSR outcomes. An analysis of how states’ spending patterns  correlate to CFSR outcomes need not be limited to subpart 1 spending;  such an analysis could help to identify effective services (regardless of  funding source) that are associated with positive CFSR outcomes and help  states target their subpart 1 and other funding sources more effectively.   Furthermore, we do not believe that 2-year old data on subpart 1  expenditures are necessarily outdated; rather, we believe such data would  provide better information on states’ use of subpart 1 funds than states’  current estimates of planned spending. In addition, ACF could request  expenditure data for a shorter period, such as a year or a quarter or  whatever time period best fits states’ other reporting requirements.
ACF did not comment on our recommendation that it use the information  gained through enhanced oversight to inform its design of its child welfare  option. However, we believe that guidance on services associated with  positive CFSR outcomes could also help states that choose to participate  in the proposed child welfare option to manage their fixed Title IV-E  funding. ACF also commented on our finding that the services provided  and families served under subparts 1 and 2 overlap to some extent.   Specifically, ACF noted that by not permitting the funds, services, and  families to overlap, ACF would significantly impede the functionality of  the continuum of child welfare services funded by Title IV-B and other  federal funding streams and possibly lead to families not receiving needed  services. While we described the overlap in services provided and families  served, we did not state or imply that such overlap was inappropriate or  unnecessary.
We also provided a draft of this report to child welfare officials in the   4 states we visited (California, New Jersey, Ohio, and Washington).  Officials from California and Washington provided a few technical  clarifications that we incorporated, while New Jersey and Ohio did not  have any comments. In addition, Washington expressed concern that our  recommendations for HHS to (1) ensure that the regional offices monitor  states’ use of subpart 1 funds for compliance with the statutory limits and  (2) consider collecting data on states’ use of these funds will add to the  reporting burden of states without providing additional funds to offset that  burden. We recommended that HHS consider the feasibility of collecting  such data and would expect HHS to take into account the burden placed  on states in making this decision.
We are sending copies of this report to the Secretary of HHS, appropriate  congressional committees, state child welfare directors, selected county  child welfare directors, and other interested parties. We will also make  copies available to others upon request. In addition, the report will be  available at no charge on GAO’s Web site at http://www.gao.gov.
If you have any questions, or wish to discuss this report further, please call  me at (202) 512-8403 or Diana Pietrowiak at (202) 512-6239. Key  contributors to this report are listed in appendix III.
section_title: Appendix I: Scope and Methodology
paragraphs: To determine how the services provided and populations served under  subpart 1 compare with those under subpart 2, we surveyed child welfare  directors in all 50 states and the District of Columbia. We sent a survey to  all states to obtain information on how they use Title IV-B funds. We also  sent a second survey to certain states that responded to the first survey.  We pretested both survey instruments in New Hampshire, Rhode Island,  and Wisconsin and obtained input from several other states and from a  Department of Health and Human Services (HHS) official. In January   2003, we mailed a copy of the first survey to the states, asking for specific  data on state spending and populations served for subparts 1 and 2, as well  as their opinions about the current structure of Title IV-B. To address  differences in the administrative structure and reporting systems of state  child welfare agencies, a different version of this survey was sent to states  with county-administered child welfare systems. We received responses  from 47 states, although some states were unable to provide complete  information. To encourage as many states as possible to complete the  survey, we conducted follow-up telephone calls to states that did not  respond to our survey by the initial deadline. After a state responded to  the first survey, we mailed the second survey, requesting more detailed  information on the three services receiving the largest portions of subpart  1 funding and the three services receiving the largest portions of subpart 2  funding. The second survey also asked for copies of any existing  evaluations of the effectiveness of these services. We sent the second  survey to the 30 states that provided sufficient data on their first survey by  mid-April 2003 and received responses from 17 states.
We did not independently verify the information obtained through either  survey. The responses of the 47 states to the first survey can be used to  explain how the 50 states and the District of Columbia in general used  Title IV-B funds. Since we received responses from only 17 states for our  second survey, they may not be representative of all states. Consequently,  we have used these data only as examples or for illustrative purposes. As a  result, we based our analyses of the populations of children and families  served on data from our first survey. However, states that completed the  county-administered version of the survey did not provide data on the  types of children and families who received services funded by Title IV-B  and were not included in these analyses. As a result, the data on  populations served by subparts 1 and 2 cannot be generalized to states  with county-administered child welfare systems.
Data from both surveys were double-keyed to ensure data entry accuracy,  and the information was analyzed using statistical software. On the first  survey, we asked states to describe the nature of each service and select  one service category that best characterized each program funded by Title  IV-B, using the following choices: child protective services (CPS), family  support/prevention programs, parent training programs, health programs,  educational programs, substance abuse programs, counseling and mental  health services, domestic violence programs, formal family preservation  programs, family reunification programs, recruitment and training for  foster/adoptive parents, adoption preservation services, administration  and management, foster care maintenance payments, adoption subsidy  payments, and other.
The data were analyzed using states’ self-identified categories except in  the following situations: (1) if a state clearly described a program as  funding salaries for staff at the child welfare agency, we included these  data under the staff category; (2) if a state used the “other” category for a  service that clearly fell into one of the existing categories (writing in  “foster care maintenance payments,” for example), we revised the survey  response to reflect the actual category; (3) if it appeared that a state  mistakenly checked the wrong box; for example, we changed the category  from CPS to family reunification if the program was described as a family  reunification service; (4) if a state checked multiple categories, we  reported these programs separately under “multiple responses;” (5) if a  state did not check any categories, we selected a service category that best  fit the description of the program and used “other” if the description did  not clearly fall into one of our categories; and finally (6) if a state clearly  described the use of Title IV-B funds as administrative, but categorized it  in another category, we revised the survey to indicate that the funds were  used for administration and management. Some states explained that Title  IV-B funds were used to cover administrative expenses for a particular  program and characterized the use of these funds based on the nature of  the program. For example, a state might have selected family preservation  program when Title IV-B funds were used for administrative expenses for  that program.
As noted earlier in the report, we recognize that some states may not have  separately identified administration or management expenses associated  with a program and may have included these expenses in the program  costs. For reporting purposes, we combined several service categories for  which states reported spending small percentages of Title IV-B funds, such  as parent training and substance abuse services, and reported these  dollars in the “other” category.
We recognize that the service categories used are not necessarily mutually  exclusive. For example, several HHS officials told us that the delineation  between family support and family preservation services is not clear, so  that 2 states providing the same services to the same types of children and  families may report them in different categories. In addition, because the  survey for states with state-administered child welfare systems asked  them to choose one service category for each program, the reported  service categories may not fully capture all relevant programs that fall into  more than one service category. Inconsistencies in how states categorized  services could have an effect on any measured differences between  service categories.
To obtain more in-depth information on the services provided and the  types of children and families served under Title IV-B, we conducted site  visits in California, New Jersey, Ohio, and Washington. We selected these  states to represent a range of geographic locations and subpart 1 spending  patterns. In addition, because preliminary data indicated that significant  subpart 1 funds were devoted to CPS, we selected states that used  innovative CPS tools or processes. However, the experiences of these  states are not necessarily representative of the experiences of any other  state. During these site visits, we interviewed state and local child welfare  officials and service providers and reviewed relevant documentation.
To learn about the federal government’s role in overseeing subpart 1, we  reviewed applicable laws and regulations and interviewed HHS central  office officials. We also conducted interviews with HHS officials in all   10 HHS regional offices to discuss their oversight activities and reviewed  results from HHS’s CFSR reports. In addition, we reviewed states’ CFS- 101s for fiscal year 2002 and compared states’ planned subpart 1 spending  for foster care maintenance, adoption assistance, and child care payments  with states’ final subpart 1 allocations for fiscal year 1979 as reported on  an HHS program instruction from that year. States are required to submit  the CFS-101 by June 30 of the preceding year—June 30, 2001, for fiscal  year 2002. At that time, federal appropriations for Title IV-B and other  federal child welfare funds often are not yet finalized, so states base their  estimates on the previous year’s allocation. States must submit a revised  CFS-101 by June 30, 2002, to request any additional fiscal year 2002 Title  IV-B funds that might be available to them once appropriations are  finalized. In addition, states can request additional Title IV-B funds if other  states do not use the total funds to which they are entitled. In most cases,  we reviewed the final revised CFS-101s approved by HHS. For one state,  we used the initial CFS-101 approved by HHS because it included planned  subpart 1 expenditures that exceeded the limits for foster care  maintenance and adoption assistance payments, but the revised   CFS-101 did not. Although the revised CFS-101 did not show the state  planned to exceed the limit, we used the initial CFS-101 to show that   HHS had previously approved a spending plan that did not comply with  the statutory limits.
We used our survey results to identify services unique to subpart 1—that  is, categories of services funded by subpart 1 that are not funded by  subpart 2. While no category of service was unique to subpart 1 at the  national level, some states funded unique categories of services within  their state with subpart 1. In our second survey, we asked states to provide  a copy of any evaluations they had conducted of the three largest services  funded by subpart 1. If we did not have survey data for one of the  identified services, either because we did not send a second survey to the  state or because the second survey did not ask for data on the particular  service, we contacted the state directly to ask if any evaluation had been  conducted.
In addition, to identify other evaluations on the effectiveness of the  services in these unique categories, we conducted a literature review and  interviewed child welfare research experts. The reports and Internet sites  we reviewed included the following:    Strengthening America’s Families: Effective Family Programs for the  Prevention of Delinquency  (http://www.strengtheningfamilies.org/html/programs_1999/programs_list_ 1999.html).
Child Welfare League of America’s Research to Practice Initiative  (http://www.cwla.org/programs/r2p/).
Casey Family Programs: Promising Approaches to Working with Youth  and Families (http://www.casey.org/whatworks/).
Promising Practices Network on Children, Families, and Communities  (http://www.promisingpractices.net/).
U. S. Department of Health and Human Services, “Emerging Practices In  the Prevention of Child Abuse and Neglect” (Washington, D.C.: n.d.).
We conducted our work between August 2002 and July 2003 in accordance  with generally accepted government auditing standards.
section_title: Appendix II: Comments from the Department of Health and Human Services
section_title: Appendix III: GAO Contacts and Acknowledgments
subsections: section_title: GAO Contacts
section_title: Acknowledgments
paragraphs: In addition to those named above, Melissa Mink and J. Bryan Rasmussen  made key contributions to the report. Anne Rhodes-Kline, Alison Martin,  Luann Moy, and George Quinn, Jr., provided key technical assistance.
section_title: Related GAO Products
paragraphs: 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.
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.
Foster Care: HHS Should Ensure That Juvenile Justice Placements Are  Reviewed. GAO/HEHS-00-42. Washington, D.C.: June 9, 2000.
Juvenile Courts: Reforms Aim to Better Serve Maltreated Children.  GAO/HEHS-99-13. Washington, D.C.: January 11, 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.
Child Welfare: States’ Progress in Implementing Family Preservation  and Support Services. GAO/HEHS-97-34. Washington, D.C.: February 18,  1997.
Child Welfare: Opportunities to Further Enhance Family Preservation  and Support Activities. GAO/HEHS-95-112. Washington, D.C.: June 15,  1995.