Foster Care: HHS Needs to Improve Oversight of Fostering Connections Act Implementation
Published: 2014-05-29T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Approximately 400,000 children were living in foster care in fiscal year 2012, according to the most recent data available. HHS oversees states' implementation of federal child welfare requirements under title IV-E of the Social Security Act. In 2008, the Fostering Connections Act amended title IV-E to improve the outcomes for children in foster care, such as maintaining family and school connections. GAO was asked to review implementation of the act.
GAO examined (1) steps states have taken to implement selected provisions of the act and challenges they have faced, and (2) the extent to which HHS has monitored states' efforts. GAO reviewed relevant federal laws, regulations, and guidance and surveyed 52 state child welfare agencies, achieving a 100 percent response rate. GAO also interviewed HHS officials and state and local child welfare and educational agency officials; caseworkers; court officials, and foster youth and parents in four states, selected to ensure variety of program characteristics and geographic dispersion.
section_title: What GAO Found
paragraphs: To implement the Fostering Connections to Success and Increasing Adoptions Act of 2008 (Fostering Connections Act), many states GAO surveyed (which included the District of Columbia and Puerto Rico) reported requiring caseworkers to employ multiple practices to improve outcomes for children in foster care; however, states continue to face challenges that can undermine progress. Among the practices that the Department of Health and Human Services (HHS) and others suggested states use, survey respondents reported requiring caseworkers to use group decision-making to maintain family connections, consult with schools, and facilitate adult connections for older youth. At the same time, a majority of surveyed states reported facing challenges, especially related to foster placements (see fig. below).
Note: Responses do not sum to 52 if states selected “do not know/not applicable” or did not respond.
Further, the Fostering Connections Act made additional children eligible for federal adoption assistance payments thereby potentially freeing up state funds previously used for this purpose. Although states are required to spend any resulting savings on child welfare services, only 21 states reported calculating these savings for fiscal year 2012, and 20 states reported difficulties performing the calculations. HHS has not provided states guidance in this area, and without it states may continue to struggle with the calculations, leading to potential lost program funding.
HHS approved states' plans to implement the Fostering Connections Act; however, the agency has not yet monitored states' actions. HHS regulations specify that states must undergo a complete review of child welfare programs every 5 years, yet HHS's last review cycle began in 2007—using a tool developed before the act was passed. Internal control standards emphasize using timely data for effective monitoring, but data collected by HHS do not reflect the act's provisions. In March 2014, HHS announced plans to begin a review cycle in fiscal year 2015, but details about how it would address changes from the act were unavailable. Without adequate monitoring or updated data, HHS lacks information about the implementation of the act and the effectiveness of states' actions.
section_title: What GAO Recommends
paragraphs: GAO recommends that HHS (1) provide guidance on how states could calculate savings resulting from changes to federal adoption assistance eligibility criteria, (2) systematically monitor states' implementation of the act, and (3) update data reporting requirements related to the act. HHS concurred with our recommendations. HHS also provided technical comments that were incorporated, as appropriate. The Department of Education had no comments.

section_title: Letter
paragraphs: At the end of fiscal year 2012, approximately 400,000 children were living  in foster care, mostly as a result of having experienced neglect or abuse  by their parents. Nearly half of these children were placed in non-relative  foster family homes and more than a quarter were placed in a relative’s  home. Child welfare agencies generally try to place children with family  members when possible; however, in many cases, agencies lack  information on relatives’ whereabouts. Even when relatives are available  to care for the child, they may need financial help to do so. An experience  in foster care may disrupt other family connections important to the child’s  well-being, such as ongoing relationships with siblings. Children in foster  care face other challenges, such as lower academic achievement and  higher dropout rates than their peers who are not in foster care.  Moreover, youth who remain in foster care until adulthood are more likely  to be homeless, unemployed, and incarcerated compared to the general  population.
The Fostering Connections to Success and Increasing Adoptions Act of  2008 (Fostering Connections Act) made a number of changes to part E of  title IV (title IV-E) of the Social Security Act, which authorizes federal  support for state foster care and adoption assistance programs. According to its co-sponsors, the legislation was intended to address  shortcomings in the existing foster care system that disconnected foster  children from family and school, leaving them ill-prepared to transition out  of care at age 18. The Department of Health and Human Services (HHS)  is responsible for overseeing the states’ implementation of federal  requirements for child welfare services, including those established by the  Fostering Connections Act.
You asked us to review the implementation of the Fostering Connections  Act. This report examines: (1) the actions states have taken to implement  selected provisions of the Fostering Connections Act, and what  challenges, if any, states face; and (2) how HHS has provided technical  assistance to help states implement selected provisions of the Fostering  Connections Act and the extent to which HHS has monitored  implementation.
We reviewed selected provisions of the Fostering Connections Act  pertaining to family connections, school stability, support for older youth,  and states’ savings from the change in income eligibility criteria for  adoption assistance payments, and used several methodologies to  address our objectives. See appendixes I-III for more information on the  specific provisions in this review. First, we reviewed relevant federal laws  and regulations, HHS guidance to states, and other publications. Second,  to obtain information on states’ implementation of the selected provisions  of the Fostering Connections Act, we conducted a survey of state child  welfare agencies from the 50 states, the District of Columbia, and Puerto  Rico, achieving a 100 percent response rate. The survey included  questions about the practices states employed to implement the  provisions, challenges they faced, and their use of HHS-funded technical  assistance. Third, we conducted site visits to four states and two localities  in each state to obtain further information on implementation of these  provisions from state and local child welfare agency officials and  caseworkers, state and local educational agency officials, court officials,  and current and former foster youth and foster parents. We selected the  four states—California, Massachusetts, Texas, and Virginia—to represent  a mix of factors including: type of child welfare agency (state- or county- administered); number of children in foster care; amount of federal title IV- E funds received; whether the state had implemented either of two  optional provisions in the Fostering Connections Act (establishing a title  IV-E guardianship assistance program or extending eligibility for title IV-E  assistance beyond age 18); and geographic dispersion. The localities  were a mix of large cities, smaller cities, and rural areas. The results from  the site visits are not generalizeable, but provide illustrative examples of  how states are implementing the provisions of the Fostering Connections  Act. We also interviewed officials from HHS’s Administration for Children  and Families, including the four regional offices serving the states we  visited, as well as selected HHS-funded technical assistance providers  that have provided assistance to states to implement the Fostering  Connections Act. A more detailed explanation of our methodology can be  found in appendix IV.
We conducted this performance audit from April 2013 to May 2014 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
subsections: section_title: Background
subsections: section_title: Title IV-E and the Fostering Connections Act
paragraphs: Title IV-E of the Social Security Act authorizes federal funding to states to  help cover the costs of operating their foster care and adoption  assistance programs. This funding primarily provides financial support for  the care of eligible children who have been removed from their homes  due to abuse or neglect, as well as to families who adopt eligible children  with special needs from the foster care system. In 2008, the Fostering  Connections Act was enacted, which amended title IV-E. According to  two co-sponsors of the legislation, it was intended to address  shortcomings in the existing foster care system that disconnected foster  children from family and school, leaving them ill-prepared to transition out  of care at age 18. These shortcomings are rooted in longstanding  challenges, such as finding appropriate foster homes; coordinating  between child welfare agencies, schools, and other service providers; and  ensuring housing for foster youth transitioning to independence. The  Fostering Connections Act established requirements for states operating  title IV-E programs as well as options states may elect to pursue to  improve outcomes for youth in and leaving foster care. See table 1 for a  complete list of the required and optional provisions included in our  review.
In addition, the Fostering Connections Act modified a requirement related  to eligibility for adoption assistance. Specifically, the Fostering  Connections Act changed the eligibility criteria for federal adoption  assistance for children with special needs to eliminate income  requirements for the family from which the child is removed. This  change is being phased in over time based on the child’s age at adoption  (becoming applicable to children age 16 and older in fiscal year 2010, 14  and older in fiscal year 2011, 12 and older in fiscal year 2012, and so on  until fiscal year 2018 when the criteria will apply to children of all ages).  As a result, more children may be eligible for federal adoption assistance  payments and states may no longer bear the entire cost of adoption  assistance payments on behalf of eligible children with special needs  removed from families that did not meet the previous income  requirements. The Fostering Connections Act also required states to  spend any savings in state expenditures resulting from the changes to the  adoption assistance eligibility criteria on child welfare services that may  be provided under title IV-E or IV-B (referred to in this report as  “reinvesting savings”). As a result of a subsequent amendment, states are  also required to document how such amounts are spent annually.
section_title: Oversight and Monitoring
paragraphs: Promoting the well-being of children and families has traditionally been  understood as a primary responsibility of state governments, and state  and local governments are the primary administrators of child welfare  programs designed to protect children from abuse or neglect. Most states  administer their child welfare programs centrally, but in some states,  county agencies administer their own child welfare programs with state  supervision. At the federal level, HHS’s Children’s Bureau within the  Administration for Children and Families (ACF) is responsible for  administering and overseeing states’ implementation of title IV-E,  including the provisions added by the Fostering Connections Act. The  ACF regional offices are responsible for reviewing and approving state  title IV-E plans for states in their regions. Title IV-E plans include  information on how states have implemented or plan to implement title IV- E, including the provisions of the Fostering Connections Act. In 2000,  HHS issued regulations that established a systematic review process to  monitor states’ child welfare programs to determine whether the programs  are in compliance with federal law, regulations, and the relevant approved  state plan. These regulations specify that states must undergo a  complete review of their child welfare programs—including title IV-E— every 5 years. This systematic review process, known as the Child and  Family Services Review (CFSR), involves a statewide assessment, a  case-file review, and stakeholder interviews. Two rounds of the CFSRs  have been conducted to date—the second round started in 2007, before  the enactment of the Fostering Connections Act. HHS also compiles,  validates, and reports data on children in foster care and children who  have been adopted from state child welfare agencies in the Adoption and  Foster Care Analysis and Reporting System (AFCARS). Twice a year,  states are required to submit data on the characteristics of children in  foster care, foster parents, adopted children, and adoptive parents.
section_title: Guidance and Technical Assistance for States
paragraphs: ACF is responsible for developing and distributing program guidance to  all states, and issued a comprehensive Program Instruction to state child  welfare agencies in July 2010, with guidance on implementing the various  provisions of the Fostering Connections Act. Some of the provisions of  the Fostering Connections Act are general in nature and allow states  discretion in determining how to implement them. For example, one  provision requires states to make reasonable efforts to place siblings who  are removed from their home in the same foster care placement, but it  does not define what constitutes “reasonable efforts.” ACF’s Program  Instruction described ACF’s expectations for implementation of selected  provisions and in some cases encouraged states to consider certain  practices that could facilitate implementation. For example, the guidance  encouraged notification of relatives via several different methods such as  in writing and orally, and also explained ACF’s expectation that siblings  not placed together should be in contact at least monthly. ACF issued  subsequent Program Instructions on targeted issues and updated its  online Child Welfare Policy Manual to provide additional guidance on  implementing the act.
States receive additional training and technical assistance through  regional ACF offices and the Children’s Bureau’s Training and Technical  Assistance Network. This network is comprised of 28 technical assistance  centers that provide training, technical assistance, research, information  and referral, and consultation. Members of the network include 10 topic- oriented national resource centers; a Training and Technical Assistance  Coordination Center; the Child Welfare Information Gateway, which  provides information, resources, and tools covering child welfare topics;  and 16 other organizations dedicated to providing states training and  technical assistance. Several of these organizations, as well as other  child welfare-focused organizations, have issued toolkits and other  material suggesting practices for states to consider in implementing  Fostering Connections Act provisions.
section_title: States Reported Implementing Suggested Practices but Continue to Face Challenges with Certain Requirements
subsections: section_title: States Reported Requiring Caseworkers to Employ Multiple Practices to Implement the Fostering Connections Act
paragraphs: According to our survey, to implement the various provisions of the  Fostering Connections Act, many states required child welfare workers to  employ multiple practices suggested by HHS and other child welfare- focused organizations. In general, these practices were not specifically  required by the Fostering Connections Act, but stakeholder organizations  recommended states consider them to ensure the act results in better  outcomes for children and youth in foster care. To help ensure that  certain requirements were implemented, most states reported that they  required case workers to document certain key efforts.
subsections: section_title: Family Connections
paragraphs: For the required family connections provisions, states reported  formalizing prior efforts and requiring or recommending practices aimed  at identifying relatives, notifying relatives of the need for foster care  placement, and keeping siblings together or in contact. Figure 1 shows  the top three practices states reported in our survey within each of these  areas. (See app. I for additional practices.) During our visits, states  reported formalizing their prior efforts to identify and notify relatives. For  example, according to officials, Massachusetts began requiring  notification in writing, and California added a timeframe for notification to  its state law. We also learned of specific ways that states are carrying out  some of these practices. For example, in Virginia, state child welfare  agency policy requires that a copy of a written notice to relatives be kept  in the child’s case file and that the date the written notice was sent and of  any relatives’ response be recorded in the state’s child welfare agency  data system. Reasons for not notifying specific relatives—such as  involvement in domestic violence—must be documented as well. To  ensure that siblings not placed together maintain contact, Texas officials  explained that if siblings are placed more than 100 miles apart, the  agency must ensure that the children have access to a phone and video- conferencing. Current and former foster youth we met with in  Massachusetts said the state child welfare agency created a Sibling Bill of  Rights, which has helped youth advocate for their right to remain in  contact with siblings.
Among the optional family connections provisions, HHS data show that  32 states have been approved to operate a title IV-E guardianship  assistance program. Of these states, 21 had previously operated a  guardianship assistance program using state funds or through a title IV-E  waiver demonstration project. In response to our survey, 43 states  reported that they now allow waivers of non-safety licensing standards for  relative foster family homes, up from 33 prior to the enactment of the  Fostering Connections Act. In addition, 32 states reported requiring or  recommending the use of the Federal Parent Locator Service to identify  adult relatives.
section_title: School Stability
paragraphs: States reported establishing new approaches to implement the school  stability requirements. Figure 2 shows the top three practices reported in  our survey. (See app. II for additional practices.) During our visits, we  learned that the state child welfare and educational agencies in Virginia  drafted joint guidance for localities to guide implementation of the school  stability provisions. The guide identified factors to consider in determining  whether the school placement is in the best interest of the child and  clarified responsibilities for funding transportation. We learned of a similar  effort under way in Massachusetts. In three of the four states we visited— California, Texas, and Virginia—state law or agency policy requires  school districts to designate “foster care liaisons” or points of contact at  the district or school level who can assist caseworkers or foster parents  with issues such as immediately enrolling foster youth in a new school in  the event of a school change.
In addition, 36 states reported using title IV-E foster care maintenance  funds to pay for transportation so that children in foster care could remain  in their schools—as authorized by the Fostering Connections Act.
section_title: Older Youth
paragraphs: For the provisions related to older youth, states reported adding to  existing policies to incorporate requirements related to the development  of a transition plan in the 90-day period prior to a youth aging out of care.  Figure 3 shows the top three practices reported by states in our survey.  (See app. III for additional practices.) Officials in Massachusetts reported  that their existing policies already addressed many of the specific  elements of transition plans required by the Fostering Connections Act.  To carry out its planning practices, Texas requires in its manual for  caseworkers that youth be provided a Youth Transition Portfolio at least  90 days before turning 18. The portfolio is to contain key documents such  as the birth certificate, Social Security card, immunization records,  education records, additional health records, and an “Almost 18?”  checklist that lists the 14 required items youth should receive. Texas child  welfare agency policy also requires group decision-making meetings  called Circles of Support to enable youth age 16 or older to develop a  transition plan and to connect with supportive and caring adults who can  help the youth after they leave foster care.
HHS data show that 19 states have approved plan amendments to  implement the option to extend title IV-E assistance to eligible youth ages  18 to 21. Of these states, 9 had previously extended the age for foster  care with other funding sources, at least under limited circumstances.
In addition to providing information on specific practices, states reported  that the legislative and regulatory actions they took, if any, to implement  the selected Fostering Connections Act provisions varied. For each of the  selected provisions in our review, some states reported making changes  to their laws and regulations to implement the provision, while others  reported that their state laws and regulations were already consistent with  the act. For example, three of the four states we visited reported that  they enacted or revised laws or regulations to implement some of the  family connections provisions. State officials indicated that these laws or  regulations largely made minor changes to existing child welfare policy in  this area. For instance, officials in California explained that county child  welfare agencies were already required by state law to look for family  members and consider them for placement prior to the Fostering  Connections Act, but the state amended its law to conform to the  requirements of the act, such as by adding a timeframe—child welfare  workers are to identify and notify relatives within 30 days of a child’s  removal from the home. In addition, in response to our survey, many  states indicated that their existing laws or regulations were consistent with  the Fostering Connections Act and that no changes were needed. Some  states reported that they have undertaken efforts that are reflected in  agency policy or practice guidance, but did not change their laws or  regulations. For example, in our survey, Massachusetts reported making  no changes to laws or regulations to implement the school stability  requirements, but officials we interviewed there told us about new school  stability efforts reflected in joint agency guidance from the state’s child  welfare and educational agencies. Similarly, Texas officials reported  adding a Circles of Support transition planning meeting in the 90 days  before youth turn 18 or exit care without revising state law or regulation.
section_title: States Reported Challenges, Especially Related to Lack of Available Foster Placements
paragraphs: Most states reported in our survey that they face major challenges, some  of which are rooted in difficulties finding sufficient or appropriate living  placements for foster youth or appropriate housing for youth after  transitioning from foster care, along with other challenges.
subsections: section_title: Family Connections
paragraphs: States reported major difficulties identifying appropriate placements for  sibling groups, specifically finding available placements for large sibling  groups (42 states), or sibling groups with exceptional needs (30 states) or  with a wide age range (18 states). Although states do not collect uniform  data on sibling placement, caseworkers and youth we met with in one  state and foster parents in another reported that siblings are frequently  separated. One director of a local child welfare agency we interviewed  explained that some foster families and treatment facilities specify an age  range for children they are willing to accept, and siblings may not fall  within these age ranges. A case worker in another state explained that  some families do not want to take older siblings who are more likely to  have a higher level of trauma than younger children. In addition, 15 states  identified competing priorities—specifically the tension among the  priorities to place siblings together, keep a child at their school of origin,  and place a child with a family member— as a major challenge. Local  child welfare agency officials in two of the localities we visited told us they  tend to give higher priority to placement with a family member than to  placement near the school of origin. Fewer states (no more than 15)  reported major challenges related to identifying or notifying relatives  within 30 days of a child’s removal. Child welfare officials we interviewed  in all four of the states we visited indicated that they had prioritized  identifying relatives for placements prior to enactment of the Fostering  Connections Act.
section_title: School Stability
paragraphs: States reported that finding foster placements was a major impediment to  implementing the school stability provisions as well. Specifically, finding  foster placements near a student’s current school was identified as a  major challenge by 38 states. Officials or child welfare workers we  interviewed in six of the eight localities we visited—representing both  urban and rural areas—told us that children are frequently placed in  homes that are far from their current school. Child welfare workers in  urban locations reported that in some cases older youth may be able to  take public transportation back to their school. However, it is more difficult  to transport younger children since they are more dependent on the foster  parent for transportation in these cases, and foster parents may not be  able to provide transportation due to their work schedules. Issues with  arranging transportation back to the child’s school of origin upon  placement outside of the district—both determining what entity should be  responsible for transportation costs and identifying funds for  transportation—were each raised as a major challenge by 20 states.  Former and current foster youth we spoke with in three different states  reported frequent school changes upon placements, and discussed the  detrimental effects of these changes on their academic progress and  social development. For example, new schools may not recognize credits  they have earned elsewhere, and it can be emotionally difficult to leave  old friends behind and make new ones. Further, 19 states reported in our  survey that the lack of a requirement for educational agencies to  coordinate with child welfare agencies is a major challenge they face in  ensuring school stability for foster youth. In our site visits, we also heard  concerns about coordination from child welfare and school officials in five  of the eight localities we visited.
section_title: Older Youth
paragraphs: Thirty-one states reported identifying appropriate housing for youth after  they transition out of foster care as a major challenge. Finding appropriate  housing for older youth who remain in foster care beyond age 18 was  also cited as a challenge by the two states we visited that had extended  foster care. Officials from one locality noted that young adults may  voluntarily leave foster care and re-enter the program, but finding housing  for these youth can be a challenge. Child welfare workers in another  locality explained that finding a home that welcomes older youth with  behavioral problems is especially problematic. In discussions with former  and current foster youth, we heard examples of youth who were  homeless and living in shelters upon transitioning out of care. In addition,  21 states reported additional difficulties with transition planning; that is,  with both identifying and engaging supportive adults from the youth’s life  in the transition planning efforts, and the same number of states reported  a lack of staff training or time to effectively engage youth in their transition  planning. Some case workers we interviewed also explained that  sometimes youth left care unexpectedly which made it difficult to  complete the 90-day transition plan.
These challenges to maintaining family connections, ensuring school  stability, and assisting older youth are not new; states have faced many of  them since before the Fostering Connections Act was enacted. We heard  examples of new approaches to try to address these challenges, such as  the use of social media to locate relatives and telecommunications  options to keep siblings connected. (See apps. I-III for additional  examples of state practices.) However, many challenges remain  unresolved, hindering states’ abilities to effectively meet the needs of  children in foster care.
section_title: Only Twenty-One States We Surveyed Reported Calculating Savings From Adoption Assistance Income Eligibility Changes for Fiscal Year 2012
paragraphs: Regarding implementation of the Fostering Connections Act provision  directing states to reinvest any savings due to the elimination of income  eligibility criteria for adoption assistance payments, only 21 states we  surveyed reported performing calculations of these savings from this  change for fiscal year 2012, and 20 states reported performing the  calculations for fiscal year 2011. Three states reported they were  developing a methodology to calculate the savings. States that did  calculate savings reported using these funds for a range of services,  including state-funded subsidy payments, post-adoption staff and  services, mental health services, and other child welfare uses.
Examples provided do not sum to 20 because some states reported more than one  challenge and other states reported challenges not discussed here. a mechanism to automate the calculations. Four states reported  challenges with developing a methodology to determine savings, and  three states discussed the challenge of calculating the savings given the  gradual phasing-in of more eligible youth by age or other changes in the  eligible population. Few states identified challenges related to reinvesting  the savings. Specifically, three states reported difficulty in planning for the  use of the funds given the uncertainty about how much the state will have  to spend each year. Two other states reported facing challenges  obtaining approval within the state for their spending plans.
HHS officials attributed the low number of states that reported calculating  savings in our survey to the lack of a reporting requirement, confusion  over the requirement for states to document and use any savings, and the  low number of youth eligible under the new eligibility criteria to date.  While the Fostering Connections Act did not specifically require states to  report the amount saved as a result of the eligibility changes, the Child  and Family Services Improvement and Innovation Act, enacted in 2011,  required states to document how any savings were spent. Further,  according to the officials, the calculations are complicated—requiring  states to determine which youth would have been eligible for federal  adoption assistance payments under the old criteria as well as the new.  Officials also suggested that states have likely seen limited savings to  date due to the fact that the requirement has only applied to older children  so far. The revised eligibility criteria will apply to children ages 8 and older  in fiscal year 2014 and to children of all ages by fiscal year 2018. In  addition, HHS officials noted that this provision is not a “maintenance of  effort” requirement that would require states to spend a specified level of  funding for child welfare services. Specifically, it does not address when  these funds must be expended or whether they must be in addition to  other state funds used for these purposes in any specific  period. Therefore, it is possible for a state to document that any  calculated adoption savings were used for child welfare purposes while  also reducing state funding for these purposes—which would not increase  total child welfare spending.
HHS has not provided specific guidance on how states should calculate  the savings, even though in 2008 the Congressional Budget Office  estimated that enacting this provision could result in savings of over $1  billion to states from fiscal years 2009 to 2018. In its 2010 Program  Instruction on implementing the Fostering Connections Act, HHS stated  that title IV-E agencies have the flexibility to determine the methodology  for calculating savings. HHS officials explained they have not issued  further guidance to states on performing the calculations because they  have tried to implement this provision in a way that is not burdensome to  states. In 2013, the Office of Management and Budget did, however,  issue a revision to its single audit compliance supplement that included  some guidance to assist auditors in evaluating states’ compliance with  this requirement. HHS officials informed us that state’s assurances of  these savings calculations are monitored using the single audit process,  which is performed annually by state auditors. In the absence of guidance  to states from HHS on how to perform these calculations, states may  continue to struggle with finding ways to calculate savings resulting from  increased federal reimbursement and thus may be missing an opportunity  to reinvest additional funds into their child welfare programs.
section_title: States Reported Receiving Useful Technical Assistance from HHS, but HHS Has Not Yet Systematically Monitored State Implementation
subsections: section_title: HHS Has Provided Broad Guidance as well as Tailored Assistance, Which Most States Found Useful
paragraphs: To support states in their implementation of the Fostering Connections  Act, HHS provided broad guidance and technical assistance to all states,  including written communications, information posted on various  websites, and webinars. Written communications included Program  Instructions and Information Memoranda to state agencies that clarify and  explain procedures and methods for operationalizing program policies,  activities, or priorities, and in some cases encouraged states to consider  certain practices. In addition, the Training and Technical Assistance  Coordination Center created two-page briefs for states that describe  available training and technical assistance related to the key provisions of  the Fostering Connections Act. As for websites, the Children’s Bureau  and technical assistance network organizations’ websites provide  comprehensive information, including toolkits and resource listings to help  states review their policies and practices related to the Fostering  Connections Act. For example, the Child Welfare Information Gateway  website, one of the websites HHS maintains, has a specific section  dedicated to the Fostering Connections Act that links to text of the  legislation and other relevant resources. Lastly, according to HHS data,  from 2008 to 2013, HHS conducted approximately 53 webinars to assist  states in implementing the Fostering Connections Act through several  national resource centers and the Child Welfare Information Gateway.
In addition to such broad guidance, HHS has also provided tailored  assistance to states that requested it. According to HHS documentation,  from fiscal year 2011 through March 2013, nearly all states requested  tailored assistance to help them implement the Fostering Connections  Act. This assistance may be in the form of consultation, problem solving,  or discussions with individual states. Additionally, on some issues, the  national resource centers provided assistance to multiple states at once.  For example, the National Resource Center for Permanency and Family  Connections worked with HHS and the Department of Education to  convene a national meeting on child welfare, education, and the courts to  encourage cross-system efforts to address educational stability issues  and to showcase collaborative projects and initiatives at state and local  levels that support educational well-being outcomes. In addition, the  National Resource Center for Youth Development organized a number of  efforts to help states implement the extension of foster care beyond age  18, including the development of a virtual meeting place for states that  have implemented the extension to share information and ask questions.
Overall, most states found the assistance they received from HHS and its  technical assistance network useful. Nearly every state reported in our  survey that they found HHS’s Program Instructions and Information  Memoranda (47), as well as regional office assistance (42), useful. One  state official told us that the ongoing assistance via teleconferences and  site visits from their regional HHS officials has been extremely helpful. In  addition, a majority of states (40) reported that they found publications,  such as practice briefs, toolkits, and other articles, useful. See figure 4 for  state views on the usefulness of HHS technical assistance.
section_title: HHS Has Not Yet Systematically Monitored State Implementation of the Fostering Connections Act
paragraphs: To date, HHS’s main oversight of state implementation of the Fostering  Connections Act has consisted of reviewing states’ title IV-E plans to  ensure they comply with federal requirements; however, the agency has  not yet systematically reviewed actual state implementation of the act. To  review title IV-E plans, HHS staff in regional offices assess state laws,  regulations, policies, and procedures for consistency with federal child  welfare requirements, including those established by the Fostering  Connections Act. A state’s title IV-E plan must be amended or updated as  necessary to comply with any new federal requirements, such as changes  to the law. According to HHS, fifty states (including the District of  Columbia) currently have approved title IV-E plans reflecting all  mandatory provisions of the Fostering Connections Act (and other title IV- E requirements). According to officials in HHS regional offices that we  interviewed, HHS’s other oversight activities include reviewing quarterly  expenditure data and ongoing discussions with state child welfare officials  through conference calls, site visits, technical assistance, and joint  planning with state officials around their plans for delivering and  improving child welfare services. Additionally, HHS officials in one  regional office told us that they may follow up on specific issues brought  to their attention by advocates. While these oversight activities allow HHS  to have some knowledge about state implementation of the Fostering  Connections Act, at the time of our interviews, officials at all four HHS  regional offices we spoke to told us that since the Fostering Connections  Act was enacted, they have not comprehensively evaluated compliance  with title IV-E plans within states after they have been approved.
HHS’s last 5-year round of the CFSR process to comprehensively monitor  state child welfare programs began in 2007, before the enactment of the  Fostering Connections Act. HHS regulations provide that states must  undergo a complete review of child welfare programs—including title IV- E—every 5 years, and HHS implements this requirement using the CFSR  process. In March 2014, HHS announced plans to conduct the next round  of CFSRs beginning in fiscal year 2015. This announcement addresses  process changes, such as not requiring stakeholder interviews if HHS  determines that data provided by the state sufficiently demonstrate state  compliance in a particular area. While the assessment instrument used by  HHS for previous CFSRs may be broad enough to capture some of the  new provisions of the Fostering Connections Act, such as placement with  siblings or school stability, HHS has not completed the assessment  instrument for the forthcoming round, so it is not clear what indicators  would be used to assess compliance with these provisions. Additionally,  the previous CFSR instrument does not address other provisions that  involve specific deadlines, such as the requirement that child welfare  agencies identify and notify relatives within 30 days after a child’s removal  from his home or that youth develop a transition plan 90 days prior to  aging out of foster care. HHS officials told us that they are currently  revising this instrument in preparation for the next round of CFSRs and  expected it to be finalized in the summer of 2014.
HHS officials told us that the next round of the CFSRs, which should have  started in 2012, was delayed because the agency was considering how to  best address comments they solicited in 2011 on improving the CFSR  process and what changes, if any, they would need to make to the  regulations to monitor implementation of the Fostering Connections Act.  In the meantime, officials in one regional office told us that with this delay  in the CFSR process, there is no other mechanism in place for HHS to  systematically examine actual state practices. Our previous work found  that regional HHS staff considered the CFSR an important complement to  a state’s planning documents—it enables HHS staff to determine both  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. Officials in all four  regional offices we spoke with told us that a systematic monitoring effort,  like the CFSR, could help states improve their programs. An official in one  regional office added that states can also gain the support needed to  make improvements by showing results from systematic monitoring  reviews.
HHS also lacks adequate data to assess if states are complying with the  policies they outlined in their title IV-E plans or the effectiveness of states’  actions. Internal control standards state that management should obtain  data on a timely basis for effective monitoring. Effective control  structures depend on data analysis to determine whether agencies are  effectively using resources and whether the agency is in compliance with  applicable laws and regulations. However, HHS has not yet updated  information collection requirements for case level data it collects from  states on children in foster care through the Adoption and Foster Care  Analysis and Reporting System (AFCARS). These data do not reflect the  new provisions added by the Fostering Connections Act, such as those  on sibling placement and school stability. HHS officials told us that they  are beginning the process of revising AFCARS completely and plan to  publish a notice of proposed rulemaking in the spring of 2014. AFCARS  data are used to inform oversight activities conducted by HHS, including  the CFSR process. These data will not be revised in time for the  upcoming fiscal year 2015 CFSR process, which relies heavily on  AFCARS for the development of statewide performance indicators.  Meanwhile, officials in two states we visited told us that they were in the  process of updating their state data systems and it would be helpful for  them to know what kind of data HHS would like them to collect before  making a costly and time-intensive investment in overhauling their  system. Additionally, while some states may voluntarily collect information  about the outcomes of their programs, many do not. This lack of data  further hinders HHS’s ability to evaluate implementation of the Fostering  Connections Act.
We found examples of potential uneven implementation of state policies  in the four states we visited. For example, regarding the Fostering  Connections Act school stability provisions, officials in one state we  visited reported that while the state policy requires child welfare agencies  and schools to jointly determine whether changing schools would be in a  child’s best interest, local agencies likely varied in the extent to which  they collaborated and some may not be doing so at all. A local school  official in another state observed that whether or not these best interest  determinations happen may depend on individual caseworkers.  Additionally, practices varied within the states we visited pertaining to the  requirement that caseworkers support youth in developing a transition  plan in the 90 days before they age out of care. All four of the states we  visited had updated their policies to reflect the new requirement, but local  officials in one office indicated that they did not always complete plans for  all youth before they age out of care. Caseworkers in another state told  us that while they aim to engage youth in the 90-day transition plan, the  meeting held to fulfill the requirement may not include the youth in many  cases.
The experiences of the 29 current and former foster youth we met with  also indicate that family connections, school stability, and transitions for   For example, while  older youth may still be a concern for some youth. nine of the youth we met with reported being placed together with their  siblings or were in frequent contact, five youth said they had no contact  with their siblings or had only sporadic contact.that being able to see her sister was treated as a privilege rather than a  right, and that the privilege was taken away, for example, when she did  not perform well in school. In terms of school stability, nearly all of the  youth we met with experienced multiple school changes and one youth  reported missing a month of school upon entering foster care while  waiting for records to be transferred to a new school. The youth we met   One young woman said  with also had mixed experiences with transition planning. Ten of the youth  felt they had benefitted from their transition plans and group decision- making meetings, but eight said they did not recall having a transition  plan or being actively involved in developing it. A systematic monitoring  effort by HHS could help identify and address some of these problems.
section_title: Conclusions
paragraphs: The Fostering Connections Act made changes to address shortcomings  in the foster care system, and states have reported implementing  numerous practices aimed at achieving improved outcomes for children  and their families. More than 5 years after its enactment, however, HHS  has not yet monitored states’ implementation of the act in a systematic  way. States reported facing major challenges with meeting requirements  for sibling placement, educational stability, and several other provisions in  the act. These challenges—some of them longstanding barriers—are  complex, and failure to overcome them could hamper progress toward  meeting the goals of the Fostering Connections Act. HHS has an  important role in helping assess what states have done and what else is  needed to improve outcomes for children in foster care. While HHS has  plans under way to begin monitoring through a new round of CFSRs in  fiscal year 2015, HHS has not specified how it will address changes made  by the Fostering Connections Act. Without monitoring state  implementation of these new provisions, it will be difficult for HHS to have  sufficient information to determine how these approaches are working  and whether changes to state or federal policies or federal guidance and  assistance are needed to improve outcomes for children in foster care. At  the same time, HHS has not yet updated data reporting requirements to  reflect the new provisions of the Fostering Connections Act. These data  are a fundamental element of the CFSR process, yet they will not be  relevant to the changes made by the Fostering Connections Act for the  next round of reviews. Without these data, it will be difficult for HHS to  have adequate information to evaluate implementation and assess states’  progress towards meeting the needs of children in and transitioning out of  foster care. Additionally, for states that have already begun revamping  their own state data systems, incorporating federal requirements at a later  date can lead to additional delay or expense. Lastly, only 21 states  reported calculating their savings from the federal adoption assistance  income eligibility changes for fiscal year 2012, despite the Fostering  Connections Act requirement that states spend these savings on their  child welfare programs. Although states we surveyed reported challenges  performing these calculations, HHS has not issued guidance to states on  how to perform them. The amount states save could grow more  significant as the expanded eligibility criteria are phased in to include all  youth by fiscal year 2018. The state funds freed up as a result of more  children becoming eligible for federal funding could help states address  the persistent challenges they face serving children in foster care. In the  absence of further guidance, states may continue to struggle with  calculating savings and miss an opportunity to take advantage of  increased federal funds to add to limited state resources.
section_title: Recommendations for Executive Action
paragraphs: To ensure implementation of the Fostering Connections Act and improve  outcomes for children in foster care, we recommend the Secretary of  Health and Human Services take the following three actions.
To maximize the amount of funds states are reinvesting into child welfare  services, the Secretary of Health and Human Services should provide  guidance on how states could calculate savings from the changes to the  federal adoption assistance income eligibility criteria.
To help identify areas where states may need additional support or  guidance in their efforts to provide children in foster care with services  and assistance under title IV-E, as amended by the Fostering  Connections Act, the Secretary of Health and Human Services should  proceed with and expeditiously finalize plans to:  systematically monitor state practices for compliance with policies  outlined in their title IV-E plans that cover the new provisions  established by the Fostering Connections Act, and update AFCARS to collect relevant data from states about provisions  established by the Fostering Connections Act.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to HHS and the Department of  Education for review and comment.  HHS provided formal comments that  are reproduced in appendix V. HHS also provided technical comments  that we incorporated, as appropriate. Education did not have comments.
HHS concurred with our recommendations and outlined steps it is taking  to implement them. HHS stated that it is committed to continuing to  support states in providing high quality child welfare services and to  engaging in monitoring activities that hold the states accountable both for  compliance with the law and for improved outcomes for children and  families.
In response to our recommendation to provide guidance on how states  could calculate savings from the changes to the federal adoption  assistance income eligibility criteria, HHS said the department will gather  examples of how savings are being calculated and documented by some  states and develop a document to provide as technical assistance to  other states. HHS further stated that the department’s implementation of  this provision to date has been driven by a desire to avoid imposing an  undue administrative burden on states and the challenge of specifying a  methodology for calculating savings that would work in all state settings.  HHS said that state officials have signed assurances as part of their title  IV-E plan submissions to calculate and reinvest these savings. HHS also  stated that independent auditors are responsible for identifying an  appropriate finding in single audit reports for any states that have not  taken steps to calculate and account for these savings. HHS said it will  work to assure that all needed corrective actions are taken to resolve any  such finding in a state’s single audit.
In response to our recommendation to expeditiously finalize plans to  systematically monitor state practices for compliance with policies  outlined in their title IV-E plans that cover the new provisions established  by the Fostering Connections Act, HHS stated that the CFSR process is  designed to provide federal oversight of states’ compliance with  provisions of titles IV-B and IV-E, and the amendments made by the  Fostering Connections Act to titles IV-B and IV-E will be reflected in the  revised CFSR protocol. HHS said it is in the process of finalizing the  instruments and measures that will be used during the round of reviews  expected to begin in fiscal year 2015 and they will be shared with the  public when finalized. We continue to encourage HHS to ensure that the  new provisions introduced by the Fostering Connections Act are  incorporated into these instruments and measures and that the  department moves quickly to complete the instruments and begin the  third round of CFSR reviews.
In response to our recommendation that HHS expeditiously finalize plans  to update AFCARS to collect relevant data from states about provisions  established by the Fostering Connections Act, HHS stated that ACF has  announced its intent to begin the regulatory process to make changes to  AFCARS by issuing a Notice of Proposed Rulemaking, projected to be  published in the spring of 2014. HHS did not discuss how these changes  would incorporate the provisions in the Fostering Connections Act nor  provide an estimate as to when these changes will be completed. We  encourage HHS to make every effort to expedite these changes within the  rulemaking process. As it is, the next round of CFSRs will proceed  without the benefit of updated data from AFCARS relevant to the  amendments made by the Fostering Connections Act. Without these  data, it will be difficult for HHS to have adequate information to assess  states’ progress in implementing the Fostering Connections Act.
We are sending copies of this report to the Secretaries of Health and  Human Services and Education, and interested congressional  committees. In addition, the report is available at no charge on the GAO  website at http://www.gao.gov.
If you or your staff members have any questions about this report, please  contact me at (202) 512-7215 or brownke@gao.gov. Contact points for  our Offices of Congressional Relations and Public Affairs may be found  on the last page of this report. GAO staff who made key contributions to  this report are listed in appendix VI.