Child Welfare: Improving Social Service Program, Training, and Technical Assistance Information Would Help Address Long-standing Service-Level and Workforce Challenges
Published: 2006-10-06T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Despite substantial federal and state investment, states have not been able to meet all outcome measures for children in their care. Given the complexity of the challenges that state child welfare agencies face, GAO was asked to determine (1) the primary challenges state child welfare agencies face in their efforts to ensure the safety, well-being, and permanent placement of the children under their supervision; (2) the changes states have made to improve the outcomes for children in the child welfare system; and (3) the extent to which states participating in the Department of Health and Human Services (HHS) Child and Family Services Reviews (CFSR) and technical assistance efforts find the assistance to be helpful. GAO surveyed child welfare agencies in 50 states, the District of Columbia, and Puerto Rico and visited 5 states, interviewed program officials, and reviewed laws, policies, and reports.
section_title: What GAO Found
paragraphs: In response to a GAO survey, state child welfare agencies identified three primary challenges as most important to resolve to improve outcomes for children under their supervision: providing an adequate level of services for children and families, recruiting and retaining caseworkers, and finding appropriate homes for certain children. State officials also identified three challenges of increasing concern over the next 5 years: children's growing exposure to illegal drugs, increased demand to provide services for children with special needs, and changing demographic trends or cultural sensitivities in providing services for some groups of children in the states' child welfare systems. Most states reported that they had implemented initiatives to address challenges associated with improving the level of services, recruiting and retaining caseworkers, and finding appropriate homes for children. These initiatives, however, did not always mirror the major challenges. For example, with respect to services, states most frequently identified that they were challenged by the lack of mental health and substance abuse services for children and families, yet only a fourth of the dissatisfied states reported having initiatives to improve the level of these services. In states where evaluations of their initiatives had been completed under a federal demonstration project, the evaluations generally showed that states had achieved mixed results across child welfare outcomes. States we visited reported that HHS reviews of their child welfare systems and training and technical assistance efforts helped them improve their child welfare programs. For example, officials in three of the five states we visited reported that the CFSRs prompted them to develop interagency strategies for providing an array of needed services to children and families. Similarly, nearly all states in our survey reported that HHS-sponsored technical assistance was helpful to some degree. However, HHS officials said that several factors limited their ability to use their technical assistance tracking system as a management tool. For example, not all service providers are included in the tracking system, and some providers inconsistently enter required data into the system. As a result, HHS may be limited in its ability to determine how best to allocate technical assistance resources to help maximize states' ability to address child welfare issues.

section_title: Letter
paragraphs: Despite substantial federal and state investment in various social services,  states continue to receive more than 2 million reports of child  maltreatment each year and report having more than half a million  children in state foster care systems. While children in foster care were  removed from their homes to protect them from harm or neglect, states  have struggled to meet established federal child welfare standards for  ensuring the safety and well-being of these children in their care. Between  March 2001 and March 2004, in its first round of Child and Family Services  Reviews (CFSR) evaluating each state’s child welfare program, the U.S.  Department of Health and Human Services (HHS) found that no state had  achieved all of the federal outcome measures for ensuring the safety, well- being, and permanency of children.
For fiscal year 2006, Congress appropriated about $8 billion to support the  ability of state child welfare systems to provide services that protect  children from abuse and neglect, promote their physical and mental well- being, find them a permanent home, and enable families to successfully  care for their children, including those children with special needs. At the  federal level, HHS’s Children’s Bureau under the Administration for  Children and Families (ACF) establishes federal policy, oversees states’  child welfare programs in part through its CFSRs, and provides technical  assistance to states primarily through its national resource centers (NRCs)  and HHS regional offices. State child welfare agencies administer the  programs and monitor the children and their families. States use federal  funds to support all aspects of the child welfare program, including  helping families stay together; providing financial support for families  fostering children who had been removed from their homes; finding  adoptive or other permanent homes for children; and recruiting, hiring,  and training child welfare employees.
Given the complexity of the challenges facing state child welfare agencies,  you asked us to determine (1) the primary challenges state child welfare  agencies face in their efforts to ensure the safety, well-being, and  permanency of the children under their supervision; (2) the changes states  have made since January 1, 2002, to improve the outcomes for children in  the child welfare system; and (3) the extent to which states participating in  HHS’s Child and Family Services Reviews and technical assistance efforts  find the assistance to be helpful. As part of this work, GAO also examined  the extent to which states had developed written child welfare disaster  plans for dealing with the dispersion of children under state care to other  counties or states, because of disasters. In July 2006, GAO issued the  report Child Welfare: Federal Action Needed to Ensure States Have Plans  to Safeguard Children in the Child Welfare System Displaced by  Disasters (GAO-06-944) in response to the disaster planning part of your  request.
We used multiple data collection methods to obtain this information. First,  we surveyed state child welfare directors in 50 states, the District of  Columbia, and Puerto Rico to obtain information on the most important  challenges that their agencies faced, the changes that their agencies had  made since 2002 to improve the outcomes for children, the extent to which  their states participated in HHS’s oversight and technical assistance  efforts, and the extent to which they viewed the assistance as helpful. We  achieved a 96 percent response rate. Second, we interviewed child welfare  officials in five states: California, New York, North Carolina, Texas, and  Utah. These states were selected for variance in program administration  (state-administered, state-supervised/county-administered, state- and  county-administered), the predominance of urban or rural characteristics,  the achievement of child welfare standards on the CFSRs, changes in the  number of children reported to be in foster care, and geographic location.  We interviewed federal child welfare officials and representatives from  national child welfare organizations concerning state child welfare  programs, the changes that states had made since 2002 to improve the  outcomes for children, and the extent to which states participated in  HHS’s CFSRs and technical assistance efforts. In addition, we reviewed  several national studies and our previous child welfare reports to  determine the challenges that states face in their efforts to ensure the  safety, well-being, and permanency of the children under their supervision.  Finally, we analyzed agency documentation, legislation, and other  documentation related to child welfare programs and requirements. We  conducted our work between October 2005 and August 2006 in  accordance with generally accepted government auditing standards.
subsections: section_title: Background
paragraphs: The well-being of children and families has traditionally been understood  as a primary duty of state governments, and state and local governments  are the primary administrators of child welfare programs designed to  protect children from abuse or neglect. Child welfare caseworkers  investigate allegations of child maltreatment and determine what services  can be offered to stabilize and strengthen a child’s own home. If remaining  in the home is not a safe option for the child—he or she may be placed in  foster care while efforts to improve the home are made. In these  circumstances, foster care may be provided by a family member, also  known as kinship care; caregivers previously unknown to the child; or a  group home or institution. In those instances where reuniting the child  with his or her parents is found not to be in the best interest of the child,  caseworkers must seek a new permanent home for the child, such as an  adoptive home or guardianship. Some children remain in foster care until  they “age out” of the child welfare system. Such children are transitioned  to independent living, generally at the age of 18 years.
subsections: section_title: Federal Funding for State Child Welfare Programs
paragraphs: States use both dedicated and nondedicated federal funds for operating  their child welfare programs and providing services to children and  families. In fiscal year 2006, the federal government provided states with  about $8 billion in dedicated child welfare funds, primarily authorized  under Title IV-B and Title IV-E of the Social Security Act. (See app. II.)  Nearly all of this funding is provided under Title IV-E, which provides  matching funds to states for maintaining eligible children in foster care,  providing subsidies to families adopting children with special needs, and  for related administrative and training costs. About 9 percent of funding is  provided under Title IV-B, which provides grants to states primarily for  improving child welfare services, including a requirement that most funds  be spent on services to preserve and support families.
A significant amount of federal funding for child welfare services also  comes from federal funds not specifically dedicated for child welfare— including the Temporary Assistance for Needy Families (TANF) block  grant, Medicaid, and the Social Services Block Grant. These and hundreds  of other federal assistance programs for children and families, including  many that serve low-income populations, are listed in a centralized  database administered by the General Services Administration that has a  search feature by type of assistance and eligible population. The  Congressional Research Service conservatively estimated that the median  share of total federal child welfare spending derived from nondedicated  federal funding equaled nearly half of all the federal dollars (47 percent)  expended by state child welfare agencies, based on state child welfare  agency data reported to the Urban Institute for state fiscal year 2002.
Despite the large amount of federal funds spent on child welfare from  nondedicated sources, the Congressional Research Service reported that  attention to federal child welfare financing has focused almost exclusively  on dedicated child welfare funding streams and is driven in part by the  belief that the current structure hampers the ability of state child welfare  agencies to achieve positive outcomes for children. Common charges are  that the current structure does not grant states the flexibility needed to  meet the needs of children and their families, and encourages states to rely  too heavily on foster care. Congress authorized HHS to conduct  demonstration projects whereby states were allowed to waive certain  funding restrictions on the use of Title IV-B and Title IV-E funds under the  condition that the flexible use of funds would be cost-neutral to the  federal government. HHS reported that 24 states had participated in  demonstration projects across eight child welfare program areas, such as  caseworker training and services to caretakers with substance abuse  disorders. States were required to conduct an evaluation of project  success in terms of both improving children and family outcomes and cost  neutrality.
section_title: HHS Child and Family Services Reviews and Technical Assistance
paragraphs: As Congress authorized funds for state child welfare programs, it has also  required states to enact policies and meet certain standards related to  those programs. HHS evaluates how well state child welfare systems  achieve federal standards for children through its child and family services  reviews. The CFSR process begins with a state assessment of its efforts,  followed by an on-site review by an HHS team that interviews various  stakeholders in the child welfare system and usually reviews a total of   50 child welfare case files for compliance with federal requirements. After  receiving the team’s assessment and findings, the state develops a program  improvement plan (PIP) to address any areas identified as not in  substantial conformity. Once HHS approves the PIP, states are required to  submit quarterly progress reports. Pursuant to CFSR regulations, federal  child welfare funds can be withheld if states do not show adequate PIP  progress, but these penalties are suspended during the PIP implementation  term.
HHS provides training and technical assistance to help states develop and  implement their PIPs through its training and technical assistance  network. This training and technical assistance focuses on building state  agency capacity and improving the state child welfare system. Technical  assistance providers in this network include HHS’s Children’s Bureau and  regional offices, as well as NRCs and the department’s Child Welfare  Information Gateway.
section_title: States Identified Several Long-standing and Emerging Challenges to Ensuring Child Safety, Well-Being, and Permanency
paragraphs: State child welfare agencies identified three primary challenges as the  most important to resolve to improve outcomes for children under their  supervision: providing an adequate level of services for children and  families, recruiting and retaining caseworkers, and finding appropriate  homes for children. HHS, GAO, and child welfare organizations have  consistently shown these issues to be long-standing challenges for most  states. In addition, state officials identified three challenges of increasing  concern: children’s exposure to illegal drugs; increased demand to provide  services for children with special needs, such as those with developmental  disabilities; and changing demographic trends or needs for cultural  sensitivity for some groups of children in care and their families.
subsections: section_title: Long-standing Challenges Include Providing Adequate Services, Recruitment and Retention of Caseworkers, and Placement Issues
paragraphs: In responding to our survey, states most frequently identified the following  three child welfare challenges as the most important to resolve in order to  improve the safety, permanency, and well-being of children under states’  care: providing adequate services to children and families, recruiting and  retaining caseworkers, and finding appropriate homes for children. (See  fig. 1.)
GAO and child welfare organizations have previously reported on the long- standing nature of these challenges. For example, GAO previously  reported that gaps in the availability and access to services delayed states’  ability to file for a petition to terminate parental rights—a necessary step  in obtaining a permanent home for children who cannot live with their  parents—because parents were unable to obtain timely access to  substance abuse treatment and other services, such as mental health  services and housing. GAO and other organizations have also previously  reported that public and private child welfare agencies face a number of  challenges recruiting and retaining qualified caseworkers and  supervisors. For example, we reported that high caseloads, poor  supervision, and the burden of administrative responsibilities have, in  some cases, prompted caseworkers to voluntarily leave their employment  with child welfare agencies. We also reported difficulties in recruiting  adoptive parents for children with special needs.
The most important challenges identified by state child welfare agencies  are consistent with HHS’s CFSR findings and states’ self-assessments of  their programs. For example, according to the Congressional Research  Service, HHS reviewers found that 43 states needed improvement in  providing accessible services to children and at-risk families in all  jurisdictions of the state and 31 states needed improvement in conducting  diligent recruitment of foster and adoptive parents. The number of states  needing improvement in performance indicators related to child welfare  services, recruitment and retention of caseworkers, and placement of  children in appropriate homes is shown in table 1.
section_title: A Large Array of Specific Services Needed by Children and Families, Especially in the Area of Mental Health and Substance Abuse, Underlie the Challenge
paragraphs: State child welfare agencies identified specific services underlying their  challenge to serve children and families, citing constraints on federal  funding and limited awareness of services among eligible families as  contributing factors. Regarding children, more than half of states reported  that they were dissatisfied with the level of mental health services,  substance abuse services, housing for foster youth transitioning to  independence, and dental care. (See fig. 2.)
States also reported that they were dissatisfied with the level of services  provided to at-risk families in the child welfare system. These services are  needed to help prevent the removal of children from their homes or help  facilitate the reunification of children with their parents after removal.  Specifically, more than half of states responded that they were dissatisfied  with mental health services, substance abuse services, transportation  services, and housing for parents of at-risk families. (See fig. 3.)
For some types of services, states expressed more dissatisfaction with  services available to at-risk families than with services available to  children. For example, more states reported dissatisfaction with the level  of at-risk family services than with children’s services in the areas of  assessment of their service needs, legal services, and advocacy or case  management. (See fig. 4.)
States we visited reported that funding constraints were among the  reasons maintaining an adequate level of services was difficult. For  example, while maintenance payments to foster families for children  under state care is provided as an open-ended entitlement for federal  funding under Title IV-E, federal funding for family support services is  capped at a much lower level under Title IV-B. In addition, because the  proportion of children in foster care who are eligible for federal support  has been declining, states had to provide a greater share of funding at a  time when many states were experiencing budget deficits that adversely  affected overall funding for social services. In prioritizing funding needs,  child welfare officials in 40 states responding to our survey reported that  family support services, such as those that could prevent removal of a  child or help with reunification of a family, were the services most in need  of greater federal, state, or local resources. Officials from 29 states  responded that child protective services such as investigation, assessment  of the need for services, and monitoring were next in need of additional  resources.
Officials in a state we visited indicated that some caseworkers and  families may be unaware of the array of existing services offered by  numerous public and private providers. In North Carolina, for example,  state officials reported that about 70 percent of children and families in the  child welfare system received services from multiple public agencies, and  the CFDA—a repository of information on all federal assistance programs  that is periodically updated—lists over 300 federal programs that provide  youth and family services. However, caseworkers and families are not  always aware of the range of services that are available to support them,  and child welfare officials cited the need for additional information to help  link children and families with needed services. In October 2003, the White  House Task Force for Disadvantaged Youth recommended that the CFDA  be modified to provide a search feature linked to locations where federally  funded programs were operating. A similar model may be found on an  HHS Web link, http://ask.hrsa.gov/pc/, where users can enter a ZIP code to  find the closest community health center locations offering medical,  mental, dental, and other health services on a sliding fee scale.
section_title: Large Caseloads, Administrative Burden, and the Effectiveness of Supervision Underlie the Caseworker Recruitment and Retention Challenge
paragraphs: State child welfare officials most frequently reported dissatisfaction with  the current status of three underlying factors that affect the state’s ability  to recruit and retain caseworkers. Specifically, more than half of the states  reported dissatisfaction with the average number of cases per worker,  administrative responsibilities of caseworkers, and effectiveness of  caseworker supervision. (See fig. 5.)
Child welfare officials in each of the states we visited reported having  trouble recruiting and retaining caseworkers because many caseworkers  are overwhelmed by large caseloads. According to a 2006 Child Welfare  League of America (CWLA) report, some programs lack caseload  standards that reflect time needed to investigate allegations of child  maltreatment, visit children and families, and perform administrative  responsibilities. The report also cites CWLA’s caseload standards of no  more than 12 cases per caseworker investigating allegations of child  maltreatment, and no more than 15 cases for caseworkers responsible for  children in foster care. However, according to the report, most states,  average caseloads in some areas are often more than double the CWLA  standards.
State child welfare officials we interviewed also reported that increasing  amounts of time spent on administrative duties made it difficult to recruit  and retain staff and limiting the amount of time caseworkers could spend  visiting families. For example, child welfare officials in three states we  visited estimated that some caseworkers spent a significant amount of  time on administrative duties such as entering case data in automated  systems, completing forms, and providing informational reports to other  agencies. This administrative burden has limited caseworker ability to  ensure timely investigations of child maltreatment and to make related  decisions concerning the removal of children from their homes, according  to officials, and influenced caseworker decisions to seek other types of  employment.
Some states we visited reported that the lack of effective supervision also  adversely affected staff retention and sometimes resulted in delays  providing appropriate services to children and families. Lack of  supervisory support was cited as a problem in terms of supervisor  inexperience and inaccessibility. For example, a Texas state official said  that because of high turnover, caseworkers are quickly promoted to  supervisory positions, with the result that the caseworkers they supervise  complain of poor management and insufficient support. In Arizona,  caseworkers have expressed dissatisfaction in the support they received  from their supervisors, and this has negatively affected recruitment and  retention. Child welfare officials reported that lack of access to  supervisors was frustrating to caseworkers because it delayed their ability  to specify appropriate permanency goals for children and to develop case  plans to meet the needs of children and families in their care.
section_title: Recruiting and Retaining Foster Parents for All Kinds of Children, but Especially for Children Who Are Older or Have Special Needs, Are Some of the Underlying Placement Challenges for States
paragraphs: Relative to other challenges, state child welfare officials most frequently  identified four factors underlying the challenge to find appropriate homes  for children. (See fig. 6.) Recruiting and retaining foster parents and  serving children with special needs were at the top of the list. Also, more  than half of the states reported that finding homes for children with  special needs, older youth, and youth transitioning into independent living,  and finding and supporting kinship homes, were among their greatest  concerns.
Child welfare officials in two states we visited said that the lack of  therapeutic foster care homes that can properly care for children who  have significant physical, mental, or emotional needs makes it challenging  to find them an appropriate home. In addition, these officials said that  some of the existing facilities are inappropriate for child placement  because they are old and in poor condition or provide outmoded treatment  services. Because of the absence of high-quality therapeutic settings, child  welfare officials said that it has become increasingly difficult to place  children in homes that can appropriately address their individual needs.
Recruiting and retaining foster and adoptive parents has become an  increasingly difficult aspect of placement for a variety of reasons, such as  the lack of a racially and ethnically diverse pool of potential foster and  adoptive parents, and inadequate financial support. For example, child  welfare officials said that some locations have relatively small populations  of certain races and ethnicities, making it difficult to recruit diverse foster  and adoptive parents. Inadequate financial support also hinders  recruiting and retaining foster and adoptive families. Financial support for  foster and adoptive families varies widely among states and local areas,  and may not keep up with inflation. According to a California child  advocacy organization, for example, the state’s payments to foster parents  of $450 per month per child have not been adjusted for inflation since  2001. As a result, according to the organization, the supply of foster care  providers has not increased markedly during this time.
Obtaining permanent homes for older youth and for youth aging out of  foster care is a continuing placement challenge for states. For example,  Texas child welfare officials said that it is difficult to place adolescents  with adoptive parents because older youth can choose not to be adopted.  Finding housing for youth transitioning into independence also can be  difficult in high-cost areas or in areas where special arrangements have  not been made with housing agencies and landlords that typically require a   cosigner on the rental application or a large deposit before moving in.
More than half of the states also reported that limitations in their ability to  identify and support placements with family members or legal guardians  limited opportunities to place children in appropriate homes. For example,  child welfare officials in Ohio reported a lack of resources to conduct  outreach to family members that may be able to provide a stable home for  children in foster care with less disruption to the child. Michigan officials  also reported that the lack of financial resources made it difficult for the  state to meet its placement goals for those children who had been  removed from their home and who had been directed by the court to be  placed with other family members.
section_title: Emerging Challenges Include Children’s Exposure to Illegal Drugs, Caring for Special Needs Children, and Responding to Changing Demographics of the Child Welfare Population
paragraphs: While states have experienced child welfare challenges for many years,  states identified several emerging issues that are of increasing concern  because of their impact on the well-being of children in the child welfare  system. Most states reported a high likelihood that three issues will affect  their systems over the next 5 years: children’s exposure to illegal drugs,  caring for special or high-needs children, and changing demographics and  cultural sensitivities. (See fig. 7.)
Although the overall percentage of drug-related child welfare cases has  not increased, officials in the states we visited reported that the type and  location of drug abuse underlying maltreatment cases is changing,  requiring increased attention by child welfare agencies in certain areas.  For example, child welfare officials reported an increasing number of  children entering state care as a result of methamphetamine use by  parents, primarily in rural areas. Child welfare agencies in these areas may  need to train caseworkers on how this drug is likely to affect parents or  caregivers who use it in order to safely investigate and remove children  from homes, as well as assess the service needs of affected families to  develop an appropriate case plan.
State child welfare officials in all five states we visited said that finding  homes for special needs children is a growing issue because it is hard to  find parents willing to foster or adopt these children and who live near the  types of services required to meet the children’s needs. For example, child  welfare officials in one of the states we visited reported that the state does  not have a sufficient number of adoptive homes for children with special  needs. As a result, these children generally stay in foster care for longer  periods of time.
Child welfare officials we interviewed also said that the growing cultural  diversity of the families who come in contact with the child welfare system  has prompted the need for states to reevaluate how they investigate  allegations of maltreatment and the basis on which they make decisions  that could result in the removal of children from their homes. Child  welfare officials in several states reported that the current protocols for  investigating and removing children from their homes do not necessarily  reflect the cultural norms of some immigrant and other minority families.  These differences include limitations in family functioning that may be  caused by poverty, the environment, or culture as opposed to those that  may be due to unhealthy family conditions or behaviors. In response to  growing cultural diversity, several states we visited stated that they are  revising their protocols to account for religious and language differences  among families who come in contact with the child welfare system.
section_title: State Initiatives Insufficiently Address State Challenges to Improve Child Outcomes, and Evaluations Showed Mixed Results
paragraphs: Most states reported that they had implemented initiatives since January  2002 to address challenges associated with maintaining an adequate level  of services, recruiting and retaining caseworkers, and finding appropriate  homes for children. However, these initiatives did not address all of the  key factors states reported being associated with these challenges. In  states where evaluations of their initiatives had been completed under a  federal demonstration project, the evaluations generally showed that  states had achieved mixed results across child welfare outcomes.
subsections: section_title: State Initiatives Did Not Address All the Key Factors Related to the Three Challenges Cited as Most Important to Improve Child Outcomes
paragraphs: States reported implementing various initiatives to improve child  outcomes, but these initiatives did not always mirror those factors states  reported as most necessary to address in overcoming their primary  challenges. For example, with respect to services, states most frequently  identified that they were challenged by the lack of mental health and  substance abuse services for children and families, yet only a fourth of the  32 states dissatisfied with these services reported having initiatives to  improve the level of these services. (See fig. 8.) This may be because these  services are typically provided outside the child welfare system by other  agencies. About half of the states reporting dissatisfaction also reported  initiatives to improve collaboration with other agencies.
Similarly, most states reported that they had implemented initiatives to  improve recruitment and retention of child welfare caseworkers, but  states reported little or no action to address two of the most frequently  reported factors underlying this challenge. (See fig. 9.) While most states  reported dissatisfaction with the supervision of caseworkers, only two  reported specific initiatives to address this challenge. Similarly, while over  half of the states reported dissatisfaction with the administrative  responsibilities of caseworkers, no state reported an initiative to address  this challenge. One way of streamlining administrative responsibilities— through new technology—may be difficult for many states because nearly  half of the states reported that they did not have an operational statewide  automated child welfare information system.
Almost all states reported implementing initiatives to improve their ability  to find appropriate homes for children, but few states addressed two of  the three most frequently reported factors underlying this challenge (see  fig. 10). For example, three states reported initiatives to find appropriate  homes for older youth transitioning to independence and four states  reported initiatives to find appropriate homes for children with special  needs.
States implementing initiatives under federal demonstration projects were  required to conduct evaluations, and these evaluations showed mixed  results. In general, the demonstration projects offered states the flexibility  to use federal funding under Title IV-B and Title IV-E in eight different  program areas in an effort to improve services and placements— addressing the three primary challenges reported by states (see app. III).  As of 2006, 24 states had implement 38 child welfare waiver  demonstrations. However, evaluation results were mixed across child  welfare outcomes. For example, while Illinois found strong statistical  support for the finding that funding for assisted guardianships increased  attainment of permanent living arrangements, none of the other four  reporting states found similar conclusive evidence of this finding.  Similarly, among four states using Title IV-E funds to fund services and  supports for caregivers with substance abuse disorders, Illinois was the  only state that demonstrated success in connecting caregivers to  treatment services. States can no longer apply for participation in federal  demonstration projects because the program authorization expired in  March 2006.
section_title: States Generally Found HHS Reviews and Technical Assistance Helpful, but HHS’s Monitoring System Has Limitations
paragraphs: States we interviewed reported that HHS’s CFSR and technical assistance  efforts were helpful in implementing federal child welfare requirements.  Similarly, nearly all states in our survey reported that HHS-sponsored  technical assistance was helpful to some degree. However, HHS officials  said that limitations in their technical assistance tracking system made it  difficult to maximize its use as a management tool.
subsections: section_title: HHS Child and Family Services Reviews Helped States Assess Needs and Make Improvements
paragraphs: State child welfare officials generally reported that HHS’s CFSR reviews  have assisted them in assessing their efforts and ability to achieve the  safety, permanence, and well-being for the children under their care and  develop the necessary program improvement plans to meet federal  requirements in this regard. Specifically, state officials responding to our  survey reported that the reviews had helped them to implement system  wide child welfare reform, improve their quality assurance systems, and  increase their collaboration with other child welfare-related agencies.  Additionally, child welfare officials in three of the five states we visited  reported that the reviews prompted them to develop interagency strategies  for providing an array of needed services, such as mental health services  and education for children and families.
Most states reported that there was not much need to improve the  usefulness of the CFSR process to help the state ensure safety,  permanence, and well-being of children in the child welfare system, but  some state officials expressed concern about the outcome measures used.  Of the 48 states responding to our survey question about the CFSR  process, 33 states reported that the usefulness of the CFSR process  needed little to none or some improvement. Some state officials we  interviewed were concerned, however, that the outcomes being measured  in the reviews may not accurately reflect their child welfare program  performance. In addition, officials in three of the five of the states we  visited expressed concern about the small number of sample cases used  by the reviewers to evaluate their state’s performance. Specifically,  officials in one state reported that evaluating only 50 cases left the state  with uncertainty about how pervasive problems are in the state and what  its priority areas should be.
Although the first round of HHS’s reviews showed that no state had  reached substantial conformity on all of the federal outcome goals for  state child welfare systems, HHS officials said that states had made  progress in implementing federal requirements and improving their child  welfare systems. For example, HHS officials said that the quality of data  has improved because states have put a greater focus on having accurate  and reliable data and many states are examining their data in greater detail  than before in an effort to identify problems in their child welfare systems  and to figure out how to meet the CFSR requirements. The next round of  reviews is scheduled to begin at the end of fiscal year 2006, when HHS  officials will once again measure states’ progress in meeting federal child  welfare requirements.
section_title: States Generally Viewed Federal Technical Assistance as Helpful, but HHS’s Monitoring System Has Limitations as a Management Tool
paragraphs: Nearly all states reported in our survey that the federal technical  assistance they received to improve their child welfare programs was  helpful to some degree, although some resources were given higher  ratings than others, as shown in table 2. States generally reported the  highest levels of satisfaction with assistance provided by two of HHS’s  national resource centers that had primary responsibility for helping with  child protective service and organizational improvement. The federal  resources providing technical assistance in the areas of substance abuse,  community-based child abuse prevention, and abandoned infants received  the fewest requests from states.
HHS’s Technical Assistance Tracking Internet System (TATIS) monitors  federal training and technical assistance requested and provided to states,  but several limitations that hinder its use as a management tool. One  limitation is that the system was designed to capture only assistance  provided by eight NRCs. (See app. IV.) Because TATIS does not capture  training and technical assistance provided by the remaining three NRCs,  other federal resource centers, and HHS’s regional offices, HHS officials  do not have a complete picture of the assistance requested by states and  provided to them. For example, the NRC for substance abuse is not  required to enter data into TATIS, but NRC records show that it provided  47 on-site technical assistance visits to 16 states in fiscal year 2005, making  it among one of the most frequent providers of on-site federal assistance.  A second limitation is that the eight NRCs do not always enter information  into TATIS as required, raising concerns about the ability of HHS to  determine how often states use its various resources and for what  purpose. For example, an official from one of the eight NRCs we  interviewed said that his center is not as conscientious as it should be  about entering all of the required data into TATIS. HHS officials said that  without this information, it is difficult to determine how best to allocate  technical assistance resources to help maximize states’ ability to address  child welfare issues.
section_title: Conclusions
paragraphs: States have been facing some of the same child welfare challenges for  many years, and predict that some emerging challenges will have impacts  in the next several years. The federal government has funded hundreds of  programs to meet families’ mental health, substance abuse treatment, and  other social service needs that could help prevent child maltreatment and  keep families together. However, the inability to query the federal  government’s central source of information—the CFDA—to identify which  services across program and agencies are available in various locations  makes it difficult to determine the extent of services available at the local  level to serve children and families in the child welfare system.
HHS has provided state child welfare systems an array of training and  technical assistance that states report as helpful for improving their child  welfare programs. Maximizing the value of its training and technical  assistance is compromised, however, because HHS’s information system  does not capture all training and technical assistance provided to states  from various HHS-sponsored providers, and compliance with the reporting  requirements has not been enforced. In the absence of complete and  timely information, HHS may be limited in its ability to determine how  best to allocate technical assistance resources to help maximize states’  ability to address child welfare issues.
section_title: Recommendations for Executive Action
paragraphs: We are making the following three recommendations to the Secretary of  Health and Human Services for improving awareness of and access to  various social services, and improving the department’s ability to manage  technical assistance provided to state child welfare agencies.
Develop a strategy to centralize information on federal assistance  programs that are available to meet child welfare program and  service needs and that can be accessed by state and local child  welfare staff and providers. This strategy could follow a previous  Administration recommendation to develop an Internet-based  search for services through the Catalog of Federal Domestic  Assistance (CFDA) that is linked to grantees by ZIP code.
Require all HHS technical assistance providers, including HHS  regional offices and all national resource centers, to enter training  and technical assistance data into the department’s Technical  Assistance Tracking Internet System.
Establish policies and procedures to ensure that complete and  accurate data are timely reported to the Technical Assistance  Tracking Internet System.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to HHS for review and comment. HHS’s  written comments are reprinted in appendix V, and the Department’s  technical comment was incorporated into the report. In its written  comments, HHS stated that the report substantially supports many of the  findings of the CFSRs, and agreed with one of our three recommendations.  The department agreed with our recommendation to establish policies and  procedures to ensure complete and accurate reporting of data into TATIS  and said it intended to provide written guidance to the resource centers  requiring this reporting. However, the department stated that the report  misconstrued the intent of the CFSRs and that the remaining  recommendations do not adequately match the articulated needs of state  welfare agencies.
HHS disagreed with GAO’s reference that no state had achieved all of the  federal outcome measures for ensuring the safety, well-being, and  permanency of children. The department stated that it makes separate  determinations regarding substantial conformity for each of the seven  outcome measures and each of the seven systemic factors reviewed. We  revised the text to reflect that no state had reached substantial conformity  on all of the federal outcome goals for state child welfare systems in lieu  of stating that no state had achieved all of the federal performance goals.
HHS disagreed with our recommendation to increase awareness of federal  assistance programs by modifying the CFDA, stating that it was misleading  to assume that state challenges could be significantly met or appreciably  altered by a list of resources, in part because the recommendation  incorrectly implies that local child welfare agencies are not aware of many  valuable services; underestimates the substantive knowledge of resources  currently being utilized by caseworkers; child welfare staff need access to  actual services or service providers rather than general information on  federal assistance programs; resource lists quickly become outdated with  state and county programs and service providers changing annually based  on their budgets; and certain federal programs are designed to meet the  needs of very specific, and sometimes very small, populations.
We acknowledge that increasing awareness of available federal resources  is not the only action needed to address the various challenges facing state  child welfare agencies, but believe that caseworker awareness and referral  of children and families to existing resources is an important first step in  meeting the challenge to provide an adequate level of services to them. As  our report states, our current and past work has found that some  caseworkers were unaware of the full array of federal resources, such as  health and housing services, available in their locales, or had not  coordinated with other agencies and organizations to access them. We  continue to support the view that modifying the CFDA would allow  caseworkers and others to more easily identify services and service  providers funded by federal agencies in closest proximity to the families  they serve. As the department points out, modifying the CFDA would not  address issues related to outdated listings of state or local resources;  however, the CFDA is updated biweekly or more often in response to new  or changing information regarding federal assistance. Further, while it is  true that some federal programs target specific populations, these  populations are often low-income or minority groups that are also served  by the child welfare system.
The department also disagreed with our recommendation to require all  HHS technical assistance providers to enter data into TATIS, stating that  the system was not designed to monitor all technical assistance provided  to states, nor would it be an effective stand-alone mechanism to determine  how best to allocate technical assistance resources to states; the  recommendation does not give sufficient weight to the CFSR process;  including training and technical assistance by regional offices in TATIS  would be superfluous as these activities are in regional office job  descriptions; and the recommendation does not recognize that training  and technical assistance is provided to a variety of audiences beyond the  state child welfare agencies, and including more information would  confuse the tracking of technical assistance.
Our report recognizes that TATIS was designed to monitor on-site training  and technical assistance provided by 8 of the 11 resource centers.  However, we continue to believe that expanding TATIS to capture the  substantial on-site assistance provided by the remaining resource centers  and other HHS providers would enhance its contribution to the  department in determining how best to allocate training and technical  assistance resources to states. We acknowledge the benefit of the CFSRs  in identifying states’ technical assistance needs. However, state  implementation of program improvement plans in response to the CFSR  findings is only a part of training and technical assistance requested and  provided to states. In addition, while regional office job descriptions may  include training and technical assistance responsibilities, we do not  believe that capturing the amount and type of this assistance actually  provided to states would be superfluous, but rather provide a more  complete picture of the on-site assistance received by states. Further, our  recommendation was not intended to include training and technical  assistance provided to audiences beyond the state child welfare agencies,  and we modified the report text to clarify this point.
Copies of this report are being sent to the Secretary of Health and Human  Services, relevant congressional committees, and other interested parties.  We will also make copies available to others upon request. In addition, the  report will be made available at no charge on GAO’s Web site at  http://www.gao.gov. Please contact me on (202) 512-7215 if you or your  staff have any questions about this report. Other contacts and major  contributors are listed in appendix VI.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: We were asked to examine (1) the primary challenges state child welfare  agencies face in their efforts to ensure the safety, well-being, and  permanency of the children under their supervision; (2) the changes states  have made since January 1, 2002, to improve the outcomes for children in  the child welfare system; and (3) the extent to which states participating in  the Department of Health and Human Services (HHS) Child and Family  Services Reviews (CFSR) and technical assistance efforts find the  assistance to be helpful. As part of this work, GAO also examined the  extent to which states had developed written child welfare disaster plans  for dealing with the dispersion of children under state care to other  counties or states, because of disasters. In July 2006, GAO issued the  report Child Welfare: Federal Action Needed to Ensure States Have Plans  to Safeguard Children in the Child Welfare System Displaced by  Disasters (GAO-06-944) in response to the disaster planning part of your  request.
To learn more about these objectives, we conducted a Web-based survey  of state child welfare directors and conducted site visits in five states  where we interviewed state officials. We also interviewed federal child  welfare officials and representatives from national child welfare  organizations concerning state child welfare programs, the changes that  states had made since 2002 to improve the outcomes for children, and the  extent to which states participated in HHS’s CFSR and technical  assistance efforts. In addition, we reviewed several national studies and  our previous child welfare reports to determine the challenges that states  face in their efforts to ensure the safety, well-being, and permanency of the  children under their supervision. Finally, we analyzed agency  documentation, legislation, and other documentation related to child  welfare programs and requirements. We conducted our work between  October 2005 and August 2006 in accordance with generally accepted  government auditing standards.
subsections: section_title: Web-Based Survey
paragraphs: To obtain state perspectives on our objectives and the relative priority  state child welfare agencies place on the challenges they face, we  conducted a Web-based survey of child welfare directors in the 50 states,  the District of Columbia, and Puerto Rico. The survey was conducted  using a self-administered electronic questionnaire posted on the Web. We  contacted directors via e-mail announcing the survey and sent follow-up e- mails to encourage responses. The survey data were collected between  February and May 2006. We received completed surveys from 48 states,  the District of Columbia, and Puerto Rico (a 96 percent response rate).
The states of Massachusetts and Nebraska did not return completed  surveys.
To develop the survey questions, we reviewed several national studies and  our previous child welfare reports to determine the challenges that states  face in their efforts to ensure the safety, well-being, and permanency of the  children under their supervision. We analyzed agency documentation to  identify HHS’s oversight and technical assistance efforts. In November  2005, we also held two discussion groups with representatives from child  welfare stakeholder groups to identify any additional issues that may not  be covered in the published documents we reviewed. The stakeholders  included representatives from the Association of Administrators of the  Interstate Compact on the Placement of Children, the Child Welfare  League of America, the National Association of Public Child Welfare  Administrators, the AARP Grandparent Information Center, the Pew  Commission on Children in Foster Care, the Urban Institute, American Bar  Association Center on Children and the Law, the Center for the Study of  Social Policy, the American Public Human Services Association, and Casey  Family Services.
We worked to develop the questionnaire with social science survey  specialists. Because these were not sample surveys, there are no sampling  errors. However, the practical difficulties of conducting any survey may  introduce errors, commonly referred to as nonsampling errors. For  example, differences in how a particular question is interpreted, in the  sources of information that are available to respondents, or how the data  are entered into a database can introduce unwanted variability into the  survey results. We took steps in the development of the questionnaires, the  data collection, and data analysis to minimize these nonsampling errors.  For example, prior to administering the survey, we pretested the content  and format of the questionnaire with several states to determine whether  (1) the survey questions were clear, (2) the terms used were precise,   (3) respondents were able to provide the information we were seeking,  and (4) the questions were unbiased. We made changes to the content and  format of the final questionnaire based on pretest results. In that these  were Web-based surveys in which respondents entered their responses  directly into our database, there was a reduced possibility of data entry  error. We also performed computer analyses to identify inconsistencies in  responses and other indications of error. In addition, an independent  analyst verified that the computer programs used to analyze the data were  written correctly.
section_title: Site Visits
paragraphs: We visited five states—California, New York, North Carolina, Texas, and  Utah. We selected these states because they represent different types of  program administration (state-administered, state-supervised and county- administered, state- and county-administered), the predominance of urban  or rural characteristics, the achievement of child welfare standards on the  CFSR, changes in the number of children reported to be in foster care, and  are geographically diverse. During these visits, we interviewed state child  welfare officials and collected relevant state agency policies and  procedures and reports.
Information that we gathered on our site visits represents only the  conditions present in the states and local areas at the time of our site  visits. We cannot comment on any changes that may have occurred after  our fieldwork was completed. Furthermore, our fieldwork focused on in- depth analysis of only a few selected states. On the basis of our site visit  information, we cannot generalize our findings beyond the states we  visited.
section_title: Appendix II: Federal Funding for State Child Welfare Programs
paragraphs: Final funding (in millions of dollars)
Foster care—Open-ended reimbursement of eligible state  claims for maintaining children in foster care and for related  administrative and training costs   Adoption assistance—Open-ended reimbursement of eligible  state claims for providing subsidies to special needs adoptees  and for related administrative and training costs   Foster care independence—Formula grants to states for  provision of independent living services to youth expected to age  out of foster care and to youth who have aged out of care   Education and training vouchers—Formula grants to states to  provide education and training vouchers to youth who have aged  out of foster care   Adoption incentives—Bonus funds to states that increase the  number of foster children adopted   Promoting safe and stable families—Formula grants to states  for four kinds of services: family preservation, family support,  time-limited reunification, and adoption promotion and support   Child welfare services—Formula grants to states to improve  public child welfare services   Court improvement—Formula grants to states’ highest courts  to strengthen handling of court child welfare proceedings   Child welfare training—Competitive grants to private nonprofit  institutions of higher education to develop and improve  education and training programs for child welfare workers   Child Abuse Prevention and Treatment Act (CAPTA)
Final funding (in millions of dollars)
section_title: Appendix III: Type, Description, and Status of Title IV-E Waiver Demonstration Programs, as of August 2006
paragraphs: Appendix III: Type, Description, and Status of  Title IV-E Waiver Demonstration Programs, as  of August 2006 Status of demonstration by state  Illinois (2008)
Delaware  (2002)
North Carolina,  Oregon (2009)
Maryland  (2004)
Indiana (2005)  North Carolina,  Ohio, Oregon  (2009)
New  Hampshire  (2005)
Delaware  (2002)
Maryland  (2002)
Michigan  (2003)
Colorado,  Washington  (2003)
Connecticut,  Maryland  (2002)
California  (2005)
Mississippi  (2004)
Maine (2004)
section_title: Appendix IV: Department of Health and Human Services Child Welfare National Resource Centers and whether They Are Included in the Technical Assistance Tracking Internet System Database
subsections: section_title: National Resource Centers Included In the Technical Assistance Tracking Internet System Database (TATIS)
paragraphs: Assists with strategic planning, CFSRs, outcome  evaluation and workforce training and  development; facilitates the involvement of  stakeholders; and monitors the technical  assistance progress.
Works to build state and local CPS capacity,  assists in determining eligibility for the Child Abuse  Prevention and Treatment Act (CAPTA) grant, and  provides support to state liaison officers.
Provides states legal and judicial issue analysis for  the CFSRs, assists in action planning and  implementation of program improvement plans.
Provides assistance through all stages of the  CFSRs, emphasizes family-centered principles  and practices, and builds knowledge of foster care  issues.
Provides support for technical issues, conducts  data use and management training, and helps in  preparation and use of state data profiles.
Analyzes adoption and permanency options,  provides support for increasing cultural  competency, and examines systematic problems  and solutions.
Supports youth participation in child welfare policy,  program development and planning, offers  assistance for foster care independence and  education voucher program implementation.
Provides training and technical assistance on  quality recruitment and retention services for foster  and adoptive families.
National resource centers not included In TATIS  National Center on Substance Abuse and  Child Welfare (cosponsored with the  Substance Abuse and Mental Health Services  Administration)
Works to develop knowledge and provides  assistance to child welfare agencies on substance  abuse related disorders in the child welfare and  family court systems.
Works to enhance the quality of social and health  services for children abandoned because of the  presence of drugs or HIV in the family.
Focuses on primary child abuse and neglect  prevention, assists in implementation for family  support strategies.
section_title: Appendix V: Comments from the Department of Health and Human Services
section_title: Appendix VI: GAO Contacts and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: Cindy Ayers (Assistant Director) and Arthur T. Merriam Jr. (Analyst-in- Charge) managed all aspects of the assignment. Mark E. Ward made  significant contributions to this report, in all aspects of the work.  Christopher T. Langford and Kathleen L. Boggs analyzed the results of the  GAO survey of child welfare challenges and assisted in the report  development. In addition, Carolyn M. Taylor contributed to the initial  design of the engagement, Carolyn Boyce provided technical support in  design and methodology, survey research, and statistical analysis; James  Rebbe provided legal support; and Charles Willson assisted in the message  and report development.
section_title: Related GAO Products
paragraphs: Child Welfare: Federal Action Needed to Ensure States Have Plans to  Safeguard Children in the Child Welfare System Displaced by Disasters.  GAO-06-944. Washington, D.C.: July 28, 2006.
Foster Care and Adoption Assistance: Federal Oversight Needed to  Safeguard Funds and Ensure Consistent Support for States’  Administrative Costs. GAO-06-649. Washington, D.C.: June 15, 2006.
Child Welfare: Federal Oversight of State IV-B Activities Could Inform  Action Needed to Improve Services to Families and Statutory  Compliance. GAO-06-787T. Washington, D.C.: May 23, 2006.
Indian Child Welfare Act: Existing Information on Implementation  Issues Could Be Used to Target Guidance and Assistance to States.   GAO-05-290. Washington, D.C.: April 4, 2005.
Foster Youth: HHS Actions Could Improve Coordination of Services and  Monitoring of States’ Independent Living Programs. GAO-05-25.  Washington, D.C.: November 18, 2004.
D.C. Child and Family Services Agency: More Focus Needed on Human  Capital Management Issues for Caseworkers and Foster Parent  Recruitment and Retention. GAO-04-1017. Washington, D.C.:   September 24, 2004.
Child and Family Services Reviews: States and HHS Face Challenges in  Assessing and Improving State Performance. GAO-04-781T. Washington,  D.C.: May 13, 2004.
D.C. Family Court: Operations and Case Management Have Improved,  but Critical Issues Remain. GAO-04-685T. Washington, D.C.: April 23,  2004.
Child and Family Services Reviews: Better Use of Data and Improved  Guidance Could Enhance HHS’s Oversight of State Performance.   GAO-04-333. Washington, D.C.: April 20, 2004.
Child Welfare: Improved Federal Oversight Could Assist States in  Overcoming Key Challenges. GAO-04-418T. Washington, D.C.:   January 28, 2004.
D.C. Family Court: Progress Has Been Made in Implementing Its  Transition. GAO-04-234. Washington, D.C.: January 6, 2004.
Child Welfare: States Face Challenges in Developing Information  Systems and Reporting Reliable Child Welfare Data. GAO-04-267T.  Washington, D.C.: November 19, 2003.
Child Welfare: Enhanced Federal Oversight of Title IV-B Could Provide  States Additional Information to Improve Services. GAO-03-956.  Washington, D.C.: September 12, 2003.
Child Welfare: Most 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: Better Policy Implementation and  Documentation of Related Activities Would Help Improve Performance.  GAO-03-646. Washington, D.C.: May 27, 2003.
Child Welfare and Juvenile Justice: Federal Agencies Could Play a  Stronger Role in Helping States Reduce the Number of Children Placed  Solely to Obtain Mental Health Services. GAO-03-397. Washington, D.C.:  April 21, 2003.
Foster Care: States Focusing on Finding Permanent Homes for Children,  but Long-Standing Barriers Remain. GAO-03-626T. Washington, D.C.:  April 8, 2003.
Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare  Agencies Recruit and Retain Staff. GAO-03-357. Washington, D.C.:   March 31, 2003.
Foster Care: Recent Legislation Helps States Focus on Finding  Permanent Homes for Children, but Long-Standing Barriers Remain.  GAO-02-585. Washington, D.C.: June 28, 2002.
District of Columbia Child Welfare: Long-Term Challenges to Ensuring  Children’s Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000.
Child Welfare: New Financing and Service Strategies Hold Promise, but  Effects Unknown. GAO/T-HEHS-00-158. Washington, D.C.: July 20, 2000.
Foster Care: States’ Early Experiences Implementing the Adoption and  Safe Families Act. GAO/HEHS-00-1. Washington, D.C.: December 22, 1999.
Foster Care: HHS Could Better Facilitate the Interjurisdictional  Adoption Process. GAO/HEHS-00-12. Washington, D.C.: November 19,  1999.
Foster Care: Kinship Care Quality and Permanency Issues.   GAO/HEHS-99-32. Washington, D.C.: May 6, 1999.
Foster Care: Agencies Face Challenges Securing Stable Homes for  Children of Substance Abusers. GAO/HEHS-98-182. Washington, D.C.:  September 30, 1998.