Title IV-B of the Social Security Act, established in 1935, authorizes funds to states to provide a wide array of services to prevent the occurrence of abuse, neglect, and foster care placements. In 1993, the Congress created a new program as subpart 2 of Title IV-B (now known as Promoting Safe and Stable Families), which funds similar types of services but is more prescriptive in how states can spend the funds. No federal eligibility criteria apply to the children and families receiving services funded by Title IV-B. The amount of subpart 1 funds a state receives is based on its population under the age of 21 and the state per capita income, while subpart 2 funding is determined by the percentage of children in a state who receive food stamps. In fiscal year 2003, the Congress appropriated $292 million for subpart 1 and $405 million for subpart 2. These federal funds cover 75 percent of states’ total Title IV-B expenditures because states must provide an additional 25 percent using nonfederal dollars. Title IV-B funding is relatively small compared with the other federal and state funds used for child welfare services. According to the most recent data available, states spent an estimated $10.1 billion in state and local funds for child welfare services in state fiscal year 2000, while federal Title IV-E expenditures in federal fiscal year 2000 were $5.3 billion. In comparison, Title IV-B appropriations in federal fiscal year 2000 were $587 million. Title IV-E provides an open-ended individual entitlement for foster care maintenance payments to cover a portion of the food, housing, and incidental expenses for all foster children whose parents meet certain federal eligibility criteria. Title IV-E also provides payments to adoptive parents of eligible foster children with special needs. States may choose to use Title IV-B funds to provide foster care maintenance or adoption assistance payments for children without regard to their eligibility for these payments under Title IV-E. The Administration for Children and Families within HHS is responsible for the administration and oversight of federal funding to states for child welfare services under Titles IV-B and IV-E. HHS headquarters staff are responsible for developing appropriate policies and procedures for states to follow in terms of obtaining and using federal child welfare funds, while staff in HHS’s 10 regional offices are responsible for providing direct oversight of state child welfare systems. In 2000, HHS established a new federal review system to monitor state compliance with federal child welfare laws. One component of this system is the CFSR, which assesses state performance in achieving safety and permanency for children, along with well-being for children and families. The CFSR process includes a self-assessment by the state, an analysis of state performance in meeting national standards established by HHS, and an on-site review by a joint team of federal and state officials. Based on a review of statewide data, interviews with community stakeholders and some families engaged in services, and a review of a sample of cases, HHS determines whether a state achieved substantial conformity with (1) outcomes related to safety, permanency, and well-being, such as keeping children protected from abuse and neglect and achieving permanent and stable living situations for children and (2) key systemic factors, such as having an adequate case review system and an adequate array of services. States are required to develop program improvement plans to address all areas of nonconformity. Subpart 1 provides grants to states for child welfare services, which are broadly defined. Subpart 1 funds are intended for services that are directed toward the accomplishment of the following purposes: protect and promote the welfare of all children; prevent or remedy problems that may result in the abuse or neglect of children; prevent the unnecessary separation of children from their families by helping families address problems that can lead to out-of-home placements; reunite children with their families; place children in appropriate adoptive homes when reunification is not ensure adequate care to children away from their homes in cases in which the child cannot be returned home or cannot be placed for adoption. When the Congress enacted the Adoption Assistance and Child Welfare Act of 1980, it established a dollar cap on the amount of subpart 1 funds that states could use for certain services and created Title IV-E of the Social Security Act. This legislation limited the total subpart 1 funds states could use for three categories of services: foster care maintenance payments, adoption assistance payments, and child care related to a parent’s employment or training. While appropriations for subpart 1 increased from $56.5 million in 1979 to $163.6 million in 1981, the law requires that the total of subpart 1 funds used for foster care maintenance, adoption assistance, and child care payments cannot exceed a state’s total 1979 subpart 1 expenditures for all types of services. The intent of this restriction, according to a congressional document, was to encourage states to devote increases in subpart 1 funding as much as possible to supportive services that could prevent the need for out-of-home placements. However, this restriction applies only to the federal portion of subpart 1 expenditures, as the law notes that states may use any or all of their state matching funds for foster care maintenance payments. In 1993, the Congress established the family preservation and family support program under Title IV-B subpart 2, authorizing grants to states to provide two categories of services: family preservation and community- based family support services. The Adoption and Safe Families Act of 1997 reauthorized the program, renaming it Promoting Safe and Stable Families and adding two new service categories: adoption promotion and support services and time-limited family reunification services. Through fiscal year 2006, the Congress has authorized $305 million in mandatory funding for subpart 2 and up to $200 million annually in additional discretionary funding. In fiscal year 2002, the Congress appropriated $70 million in discretionary funding for the program. The definitions of the four subpart 2 service categories are: Family preservation services: Services designed to help families at risk or in crisis, including services to (1) help reunify children with their families when safe and appropriate; (2) place children in permanent homes through adoption, guardianship, or some other permanent living arrangement; (3) help children at risk of foster care placement remain safely with their families; (4) provide follow-up assistance to families when a child has been returned after a foster care placement; (5) provide temporary respite care; and (6) improve parenting skills. Family support services: Community-based services to promote the safety and well-being of children and families designed to increase the strength and stability of families, to increase parental competence, to provide children a safe and supportive family environment, to strengthen parental relationships, and to enhance child development. Examples of such services include parenting skills training and home visiting programs for first time parents of newborns. Time-limited family reunification services: Services provided to a child placed in foster care and to the parents of the child in order to facilitate the safe reunification of the child within 15 months of placement. These services include: counseling, substance abuse treatment services, mental health services, and assistance to address domestic violence. Adoption promotion and support services: Services designed to encourage more adoptions of children in foster care when adoption is in the best interest of the child, including services to expedite the adoption process and support adoptive families. These services are similar to those allowed under subpart 1, although the range of services allowed under subpart 2 is more limited in some cases. For example, time-limited family reunification services can only be provided during a child’s first 15 months in foster care, while no such restriction is placed on the use of subpart 1 funds. In addition, states must spend a “significant portion” of their subpart 2 funds on each of the four service categories. HHS program instructions require states to spend at least 20 percent of their subpart 2 funds on each of the four service categories, unless a state has a strong rationale for some other spending pattern. By statute, states can spend no more than 10 percent of subpart 2 funds on administrative costs. A congressional document notes that states already had the flexibility to use subpart 1 funds for family support and family preservation services, but that few states used a significant share of these funds for these services. In creating subpart 2, the Congress did not revise any components of subpart 1. To receive Title IV-B funds, states are required to submit a 5-year child and family services plan to HHS. These plans have a number of specific reporting and procedural requirements. While several of the requirements are similar for subparts 1 and 2, states are required to provide information about more aspects of their child welfare systems under subpart 1. Some of the major requirements are outlined in table 1. Federal child welfare funding has long been criticized for entitling states to reimbursement for foster care placements, while providing little funding for services to prevent such placements. HHS is currently developing a legislative proposal to give states more flexibility in using Title IV-E foster care funds for such preventive services. Under this new proposal, states could voluntarily choose to receive a fixed IV-E foster care allocation (based on historic expenditure rates) over a 5-year period, rather than receiving a per child allocation. The fixed allocation would be an estimate of how much a state would have received in Title IV-E foster care maintenance funds. States could use this allocation for any services provided under Titles IV-B and IV-E, but would also have to fund any foster care maintenance payments and associated administrative costs from this fixed grant or use state funds. Since 1994, HHS has also been authorized to establish child welfare demonstrations that waive certain restrictions in Titles IV-B and IV-E and allow states a broader use of federal funds. States with an approved waiver must conduct a formal evaluation of the project’s effectiveness and must demonstrate the waiver’s cost neutrality—that is, a state cannot spend more in Title IV-B and IV-E funds than it would have without the waiver. Projects generally are to last no more than 5 years. HHS’s authority to approve these waivers is scheduled to expire at the end of fiscal year 2003. On a national level, our survey showed that the primary emphases of subparts 1 and 2 vary somewhat, but the range of services offered and the types of families served overlap significantly. According to our survey data for fiscal year 2002, states spent subpart 1 funds most frequently on the salaries of child welfare agency staff—primarily social work staff who can provide a variety of services, such as CPS investigations, recruiting foster parents, and referring families for needed services. The next three largest categories—administration and management expenses, CPS services, and foster care maintenance payments—accounted for about 43 percent of subpart 1 funding. Subpart 2 funds, in comparison, were used primarily to fund programs within its required service categories—family support, family preservation, family reunification, and adoption promotion and support services. Some social work staff whose salaries were funded with subpart 1 may provide similar services to families as the staff in these programs funded by subpart 2. On a national basis, however, no service category was solely funded by either subparts 1 or 2. The programs funded by subpart 1 and 2 dollars served similar types of children and families. States used the majority of funds from each subpart to provide services to children at risk of abuse and neglect and their parents, as well as foster children and their parents. Officials in most HHS regional offices said that they believe that the current structure of Title IV-B offers a good balance in allowing states some flexibility to address state needs and targeting some federal funds toward services to keep families together and prevent children from entering foster care. Although no category of service is funded solely by either subparts 1 or 2 dollars, somewhat different spending patterns emerged with regard to the distribution of these funds among the categories. The states responding to our survey reported spending about 28 percent of subpart 1 funds in fiscal year 2002 on the salaries of child welfare agency staff, with an additional 43 percent used for administration and management expenses, foster care maintenance payments, and direct CPS services (see table 2). In comparison, states used over 80 percent of subpart 2 dollars to fund services in its mandated service categories—family support, family preservation, family reunification, and adoption promotion and support services. However, neither subparts 1 nor 2 funded a unique category of service at the national level. For example, states typically reported using subpart 1 to fund CPS programs; however, 5 states used subpart 2 dollars to fund programs in this category. Subpart 1 dollars were most frequently used to fund staff salaries, with almost half of these funds designated for the salaries of CPS social workers. Another 20 percent of these funds were used for the salaries of other social workers (see fig. 1). During our site visit, Washington child welfare officials told us that they used over 50 percent of the state’s subpart 1 funds for salaries of staff providing direct services, including CPS social workers, social workers who provide ongoing case management and support services to families involved with the child welfare agency due to concerns about abuse or neglect, social work supervisors, and clerical support staff. While states also reported using subpart 2 funds for staff salaries, only 2 percent of subpart 2 dollars were used for this purpose. This comparison may underestimate the overlap in services funded by subparts 1 and 2, however, because much of the costs of programs funded by subpart 2 is likely attributable to staff salaries. Similarly, some social work staff whose salaries are funded by subpart 1 likely provide a variety of services, such as family preservation services, recruiting foster families, and referring families for needed services, some of which may be similar to services funded by subpart 2. Percentages do not total to 100 due to rounding. Administration and management comprised the second largest category of service, accounting for almost 17 percent of subpart 1 dollars. These services included rent and utilities for office space, travel expenses for agency staff, and staff training. Ohio, for example, used most of its subpart 1 dollars to fund state and county child welfare agency administrative expenses. In contrast, states spent less than 5 percent of their subpart 2 funds on administration and management. CPS represents the third largest category of services that states funded with subpart 1. States used about 16 percent of their subpart 1 funds to provide a variety of CPS services, such as telephone hotlines for the public to report instances of child abuse and neglect, emergency shelters for children who needed to be removed from their homes, and investigative services. During our site visit to California, for example, officials reported using about 40 percent of their subpart 1 dollars to fund staff salaries and operating expenses associated with a variety of shelter care services provided by counties, such as emergency shelters and foster homes. A child is placed in one of these shelters when no other placement option is immediately available—for example, when an investigation in the middle of the night determines that the child is at immediate risk of harm or when a child runs away from a foster home. In comparison to states’ use of subpart 1 funds, states reported using less than 1 percent of their subpart 2 dollars to fund programs within this service category. States used nearly 11 percent of their subpart 1 funds to make recurring payments for the room and board of foster children who are not eligible for reimbursement through Title IV-E. For instance, New Jersey officials reported spending over 50 percent of the state’s subpart 1 funds on foster care maintenance payments. Seventeen states spend subpart 1 funds on foster care maintenance payments, while only 2 states reported using subpart 2 funds for this purpose, accounting for less than 1 percent of total subpart 2 expenditures. States reported using half of their subpart 2 dollars to fund family support services. These services included mentoring programs to help pregnant adolescents learn to be self-sufficient, financial assistance to low-income families to help with rent and utility payments, and parenting classes, child care, and support groups provided by a community-based resource center. One California county we visited used subpart 2 to fund a network of family support services with the goal of strengthening communities and keeping families from becoming involved with the child welfare system. Funds were granted to community groups to provide support and improve the healthy development of families for different populations, such as grandparent caregivers and adolescent mothers. Washington funded a network of public health nurses and social service agencies to provide support services to families that are the subject of a report of abuse or neglect—these services are provided in lieu of, or following, a formal investigation when the level of risk to the child is not considered high. Over one-third of the states responding to our survey also reported using subpart 1 funds to provide family support services similar to those funded by subpart 2, although family support services only accounted for 8 percent of subpart 1 expenditures. For example, New Jersey transferred about 27 percent of its subpart 1 funds to local child welfare agencies to provide family support services, which included parent education classes, transportation, and mentoring for children. Family preservation services—designed to keep families together and prevent the need to place a child in foster care—represented the second largest service category funded by subpart 2. Washington used subpart 2 funds for its statewide family preservation program, which offers counseling and parent training services for up to 6 months to families with children who are at risk of being placed in foster care. In some cases, services provided in this category were similar to those in the family support category, but were intended to help keep families together. For example, Florida funded several neighborhood resource centers, which provide child care, parenting classes, adult education and training opportunities, mental health services, transportation services, and a food pantry. Although states primarily used subpart 2 dollars to provide these services, states also reported using approximately 2 percent of subpart 1 funds on family preservation services. In addition, states reported using about 11 percent of their subpart 2 funds for adoption support and preservation services. With these funds, states provided services such as counseling for children who are going to be adopted, family preservation services to adoptive families, and respite care for adoptive parents. Officials in Ohio reported using almost half of its subpart 2 dollars for adoption services, including post adoption services and services to recruit families for children in need of adoptive homes. Similarly, Florida funded adoption support services for children with special needs who are awaiting adoption, including counseling, behavior modification, tutoring, and other services to expedite the adoption process. In contrast, less than 1 percent of subpart 1 dollars were used to provide adoption support and preservation services. Finally, states spent about 9 percent of their subpart 2 dollars on family reunification services. States funded a diverse array of family reunification programs, such as supervised visitation centers for parents to visit with their children and coordinators for alcohol and drug treatment services for families whose primary barrier to reunification is substance abuse. New Jersey funded a supervised visitation program that offers parenting education, counseling, transportation, and support groups and is located in a private home, allowing families to visit together in a homelike setting and engage in more natural interactions. One county we visited in California used subpart 2 funds for a shared family care program, in which the parent and child are placed together in a mentor home. The mentor provides a role model for good parenting behavior and provides hands-on parenting guidance to keep the family together, while a case manager ensures that family members receive services to address problems that could lead to the removal of the child, such as substance abuse or homelessness. Subpart 1 funds were used much less frequently for family reunification services; states reported using 1 percent of subpart 1 funds for these services. Significant overlap exists among the types of children and families served by these subparts, although certain populations are more closely associated with a particular subpart. Services funded by each subpart predominantly targeted children at risk of abuse or neglect and their parents, as well as children in foster care and their parents. States responding to our survey reported that services funded by subpart 1 in fiscal year 2002 most frequently served children living in foster care and/or their parents, while 9 percent of subpart 2 funds are used for services that target the same population (see table 3). Similarly, while subpart 2 services most commonly targeted children at risk of abuse and neglect and/or their parents, about 17 percent of subpart 1 funds were also used for services aimed at this population. In addition, 9 percent of subpart 1 funds and 11 percent of subpart 2 funds were used to fund services intended for both of these types of families. The overlap in populations observed at the national level can also be seen when looking at the children and families targeted by individual states. We found that individual states frequently funded programs with each subpart that served the same types of children and families. For example, all 20 states that used subpart 1 dollars to fund services for children at risk of abuse or neglect and/or their parents also used subpart 2 dollars to fund a program serving this same population type (see table 4). Alaska, for instance, used subpart 1 dollars to fund a broad family support program, which provided services to children at risk of abuse and neglect and their parents. The state also used subpart 2 funds to provide another family support program, which provides similar services to the same types of children and families. In addition, 17 states funded one or more individual services with funds from both subparts, so that subparts 1 and 2 were serving the same children and families. In our second survey, we requested more detailed information about the populations served by programs funded by subparts 1 and 2, such as demographic and socioeconomic characteristics. However, few of the 17 states responding to the second survey were able to provide this kind of data. When asked about selected subpart 1 services, 10 of the 17 states were able to estimate the extent to which the same children and families receiving the identified service funded by subpart 1 also received services funded by subpart 2. Of children and families receiving the identified subpart 1 service, four states reported that generally none or almost none of the recipients also received a service funded by subpart 2, three states reported that generally less than half of the recipients received subpart 2 services, one state reported that all or almost all recipients received subpart 2 two states provided varying estimates for different subpart 1 services. While none of the states we visited were able to provide data about the extent to which the same children and families were receiving services funded by both subparts 1 and 2, state officials in each of these states recognized some overlap among the types of populations participating in these services. Officials in California and New Jersey told us that they use subpart 1 for services to families that are involved with the child welfare agency due to a report of abuse or neglect, while services funded by subpart 2 target a broader population, including families who are at risk of abusing their children. However, while some of the subpart 2 programs these officials described focused on this at risk population, many of them were targeted to families who were already involved with the agency. Officials at a California child welfare agency told us that all of the services provided by subparts 1 and 2 are targeted toward the same high-risk communities in which many people are involved with the agency, and they considered it likely that families receiving subpart 1 services have also received subpart 2 services in the past or will at some time in the future. Washington officials noted that children and families involved with the child welfare agency may receive multiple services, some of which may be funded by subpart 1 and some of which may be funded by subpart 2. Finally, although Ohio does not track clients served, one state official estimated that the types of children and families served by the programs funded by subparts 1 and 2 overlap by 100 percent. One New Jersey state official described the services funded by subparts 1 and 2 as part of a continuum of child welfare services, such that some population overlap is to be expected. In New Jersey, services funded by subpart 1 target families who are experiencing difficulties that may jeopardize the safety and well-being of their children. Programs funded by subpart 2 may also serve these families. However, they also target families who are not currently having difficulties, but who could become involved with the child welfare agency in the future. In addition, some subpart 2 programs serve adopted children, many of whom were previously involved with the child welfare agency and received services funded by subpart 1. None of the states we visited could provide data on the numbers of children and families who participated in services funded by subparts 1 and 2 dollars. Given the overlap observed between the two subparts, we discussed the potential advantages and disadvantages of consolidation with HHS regional officials and asked states for their perspective on our survey. Officials in almost all of HHS’s regional offices said that Title IV-B should maintain its current balance between allowing states some flexibility and targeting some resources toward prevention. Officials in all regional offices told us that they believe states need some flexibility to use Title IV- B funds to address state specific child welfare needs as is currently the case under subpart 1. One regional office noted that subpart 1 gives states the flexibility to address unexpected circumstances affecting the child welfare system—for example, by developing substance abuse treatment programs to address the needs of parents affected by the cocaine epidemic of the 1980s. Similarly, officials in three states we visited felt strongly that the flexibility to direct the use of subpart 1 funds for state priorities was important and they would not want to lose this flexibility in any consolidated program. Our survey results also indicate that the flexibility to use subpart 1 to meet the needs of their child welfare systems is important to states. For example, when asked about their preference between subparts 1 and 2 with regard to different program components, 24 and 26 states, respectively, reported that they preferred subpart 1 when considering (1) spending restrictions on the percentage of funds that can be used for specific services and (2) allowable spending categories (see fig. 2). When asked about the advantages and disadvantages of Title IV-B’s current structure, several states cited the spending restrictions of subpart 2 as a disadvantage, while a couple of states mentioned the flexibility associated with subpart 1 as an advantage. At the same time, officials in 8 of HHS’s 10 regional offices also stressed the importance of subpart 2 to ensure that states use some funds on family support services and prevention activities to help preserve families and keep children from entering foster care. Several regional offices expressed concern that, in the absence of the minimum spending requirements outlined in subpart 2, states would neglect preventive services, while using Title IV-B funds for more urgent services, such as CPS or foster care. One state we visited expressed opposition to consolidation for this reason, arguing that keeping a separate subpart 2 was important to ensure that states fund some prevention services. State and county officials in this state noted that subpart 2 represents an important federal investment in prevention services and expressed concern that states would use all available funds to provide services to families already involved with the child welfare agency unless funds were specifically targeted for services to support families at risk of abusing or neglecting their children. In addition, on our survey, several states cited the prevention focus of subpart 2 as an advantage of Title IV-B’s current structure. Officials in 8 of HHS’s regional offices said that they believe that the current structure of Title IV-B offers a good balance between flexibility and targeting resources toward prevention. Officials in the other 2 regional offices told us that Title IV-B provides a good mix of flexibility and a focus on services considered to be federal priorities. One regional office noted that a consolidated Title IV-B program could be structured to offer this balance. For example, a consolidated program could require some minimum spending levels for the current subpart 2 categories, but also set aside some funds that states could use for a broader array of child welfare services. In addition, most of the regional offices did not believe that consolidation would lead to any significant administrative savings. For example, several regional offices explained that consolidating the subparts would not reduce HHS’s oversight responsibilities, while another noted that consolidation would have little impact on HHS regional or state offices, which are staffed and organized to manage multiple sources of funding. Another regional office noted that the planning and reporting requirements for the two subparts are already consolidated in the planning documents states submit to HHS. State and local child welfare officials in one state, along with officials at 2 HHS regional offices, commented that increasing the funds available for service provision was more critical than consolidating the two subparts. They believe that states need more federal funds to provide services to prevent foster care placements, such as an increase in funds available under Title IV-B or more flexibility to use Title IV-E funds to provide services, rather than paying primarily for foster care maintenance payments as it currently does. Since 1994, states have been able to apply for demonstration waivers to use federal child welfare funds to test innovative foster care and adoption practices without regard to certain restrictions in Titles IV-B and IV-E. For example, four states are using demonstration waivers to create fixed Title IV-E budgets for counties within the state in which funds can be used more flexibly for prevention and community-based services not traditionally reimbursed by Title IV-E. However, HHS’s authority to approve such waivers is scheduled to expire at the end of fiscal year 2003. States may soon have another mechanism to use Title IV-E funds to provide preventive services through the child welfare option HHS is currently proposing. HHS’s oversight focuses primarily on states’ overall child welfare systems and outcomes, but the agency provides relatively little oversight specific to subpart 1. For example, HHS regional offices work with states to establish overall goals to improve the safety, permanency, and well-being of children and measure progress toward those goals. However, HHS has limited knowledge about how states use their subpart 1 funds. HHS does not collect data on subpart 1 expenditures and instead requires states to submit annual estimates about how they plan to use their subpart 1 funds in the upcoming year. HHS regional offices reported that they review these estimates for relatively limited purposes, with several HHS officials noting that they do not review the spending plans for subpart 1 as closely as subpart 2 because subpart 1 has few restrictions as to how these funds can be used. We also found that HHS regional offices pay little attention to statutory limits on the use of subpart 1 funds for foster care maintenance and adoption assistance payments. As a result, HHS approved projected 2002 spending plans for 15 states that reported planned spending amounts that exceeded these spending limits. In response to our survey, 10 states reported actual 2002 subpart 1 expenditures that exceeded the spending limits by over $15 million in total. HHS focuses much of its programmatic oversight on the overall child welfare system in each state, rather than focusing specifically on subpart 1 or any other federal funding source. In discussing their oversight of subpart 1, several HHS officials at headquarters and in the regional offices emphasized the importance of reviewing the overall child welfare system and the outcomes achieved, rather than scrutinizing individual programs outside of that context. A major component of HHS’s subpart 1 oversight is having the regional offices actively work with states to develop appropriate goals for their child welfare systems and ensure that available funds, including subpart 1, are used to support those goals. To receive Title IV-B funding, HHS requires states to submit a Child and Family Services Plan, which covers a 5-year period and describes the state’s goals and objectives toward improving outcomes related to the safety, permanency, and well-being of children and families. This 5-year plan includes a description of services and programs the state will pursue to achieve these goals. In addition to the 5-year plan, HHS requires states to submit an Annual Progress and Services Report (APSR) each year to discuss their progress in meeting the goals outlined in their plans and revise the goals as necessary. Regional HHS staff review this planning document to ensure that they meet all the technical requirements outlined in the annual program instructions issued by HHS. For example, states must certify that, in administering and conducting services under the 5-year plan, the safety of the children to be served shall be of paramount concern. In addition, some regional offices reported that they review the state’s objectives and goals to determine if they are reasonable, assess the progress the state has made in achieving these goals and objectives, and determine whether child welfare services are coordinated with the efforts of other agencies serving children. Some regional officials noted that states are still struggling to use these documents appropriately for planning purposes. These officials told us that instead of focusing on outcomes and collecting data to measure progress toward those outcomes, frequently states simply describe their current programs. In addition to reviewing planning documents, all of the regional offices consult regularly with states to discuss child welfare issues and provide technical assistance. For example, the regional office may provide guidance on how to comply with specific program regulations or how to develop a 5-year plan that will function as a strategic plan for the state’s child welfare agency. Two regional offices told us that they also conduct site visits to states as part of their oversight. One regional office reported visiting states in its region to gain a better understanding of each state’s child welfare services. This allows the regional office to share good ideas with other states and to ensure that states are working on areas the regional office has identified as in need of improvement. Other regional offices reported that they would like to conduct site visits to states under their purview, but a lack of travel funds prevented them from doing so. The CFSR process is an additional tool HHS uses to ensure that states conform with federal child welfare requirements and to help states improve their child welfare services. Staff at one regional office described the CFSR as a thorough review of the services funded by different federal programs, such as Title IV-B. They consider the CFSR an important complement to a state’s planning documents—it gives them an opportunity to determine whether states are providing the services they report in their planning documents and whether those services are adequate and appropriate to meet the needs of the state’s children and families. CFSR results for the past 2 years indicate that states have not performed strongly in terms of assessing families to determine what services they need and providing those services. While 21 of the 32 states that underwent a CFSR in 2001 or 2002 were considered to have an appropriate array of services for families, HHS found that the accessibility of services was a particular weakness in that many services were either not available statewide or had long waiting lists or other barriers to accessibility. When HHS reviewed case files, however, it determined that 31 of these states needed improvement in terms of assessing family needs and providing services to meet those needs. When asked about HHS’s role in guiding states’ use of subpart 1 funds to address weaknesses identified by the CFSRs, an HHS official told us that the agency provides technical assistance to states to help them determine the most effective use of their resources. However, the official also pointed out that HHS gives states a lot of latitude to determine the most appropriate use of their subpart 1 funds and that the agency cannot become too involved in state budget decisions given the complexities of the budget processes for states. HHS has little information about states’ use of subpart 1 funds. Each year, HHS requires states to submit a form CFS-101, which includes state estimates of the amount of subpart 1, subpart 2, and other federal funds the state plans to spend in the upcoming year on different categories of services (such as family support or CPS). The descriptions provided by regional office staff of their review of these estimates indicate that they review them for relatively limited purposes. Officials in 4 of the regional offices told us that they generally use the CFS-101 data to ensure that states request the total amount of subpart 1 funds to which they are entitled and that they comply with the requirement to match 25 percent of subpart 1 funds with state funds. Most regional offices indicated that their reviews of the CFS-101s focus more on subpart 2 than subpart 1. For example, they reported that they review states’ planned subpart 2 spending more closely to ensure that states are meeting the requirement that they spend at least 20 percent of funds on each of the service categories and spend no more than 10 percent of funds for administrative purposes. Several HHS officials reported that they do not monitor the use of subpart 1 funds as closely as other federal child welfare funds due to the relatively small funding amount and the lack of detailed requirements about how the funds can be used. Moreover, the CFS-101 estimates may not provide reliable data as to how states are using subpart 1 funds. HHS officials explained that the CFS-101 data are estimates and that states’ actual expenditures may vary from these estimates, as they address unforeseen circumstances. The timing for submitting the CFS-101 also affects how well states can estimate their planned subpart 1 spending. HHS requires states to submit their initial CFS-101 for the upcoming fiscal year by June 30, which forces states to estimate their planned spending before the final spending amounts for Title IV-B and other federal funds have been appropriated. Some regional officials indicated that they did not know how well states’ CFS-101 estimates reflect their actual subpart 1 spending. We did not conduct a review of the reasonableness of the data states submit on their CFS-101s, but we did identify a few instances that suggested that the data are not always accurate. Two states with county-administered child welfare systems told us that they do not have reliable data to allow them to accurately estimate planned spending. A child welfare official in one of these states told us that its CFS-101 data represented its “best guess” as to how subpart 1 funds will be used, because the state distributes these funds to county child welfare agencies and does not collect any data on how the counties use these funds. The other state told us that its current CFS-101 data are most likely based on county data from several years ago and that counties may now be spending subpart 1 funds on different services. HHS does not require states to provide any additional data about their use of subpart 1 funds, such as their subpart 1 expenditures for specific services. As a result, several regional offices noted that they have no way of knowing how states actually spend their subpart 1 funds. An official from one regional office explained that the only way to determine how a state actually uses its Title IV-B funds is to review its financial accounts, which HHS does not do. Some regional officials suggested that it would be helpful to have actual expenditure data for both Title IV-B subparts, especially to determine if states were actually using 20 percent of their subpart 2 funds for each of the four required service categories. Three regional offices indicated that they have begun asking states to provide Title IV-B expenditure data. Given that HHS’s subpart 1 oversight focuses primarily on a state’s overall child welfare goals and outcomes, the regional offices pay little attention to the statutory limits on the use of federal subpart 1 funds for foster care maintenance and adoption assistance payments. Most HHS regional offices do not review the CFS-101s for compliance with the statutory limits. In addition, HHS’s annual program instruction, which details what information states must include in their CFS-101 submittals and serves as the basis for the regional offices’ review of subpart 1 spending, does not mention the subpart 1 limits. Only 1 of HHS’s 10 regional offices told us that it compares states’ planned subpart 1 spending reported on the CFS-101 with the actual dollar limit for each state to ensure that states observe the statutory limits. This office used an HHS program instruction for 1979 listing each state’s subpart 1 allocation to determine the ceiling on foster care maintenance and adoption assistance payments. In contrast, 5 regional offices were unaware that any limits on the use of subpart 1 funds existed, although 1 of these offices indicated that it generally did not consider it appropriate for states to use subpart 1 funds for foster care maintenance payments because subpart 1 should be used to fund services for families. Nonetheless, this office approved a CFS-101 for 1 state that exceeded the statutory limits. Four other regional offices were aware that some limitations with regard to foster care maintenance and adoption assistance payments existed, but did not ensure that states complied with the limits. These 4 regional offices provided several reasons for why they did not monitor states’ planned spending for compliance with the subpart 1 limits. Two regional offices indicated that HHS had provided no guidance as to how such limits should be enforced or that no data were available to calculate subpart 1 limits for each state. The third regional office reported that it did not have the specific ceiling amounts for each state. However, officials in this office said they reviewed planned subpart 1 spending for foster care maintenance and adoption assistance payments on the CFS-101 to determine if they had increased from the previous year. If the amounts had not increased, the regional office assumed that someone had checked the amounts previously and that they were within the limits. This regional office approved CFS-101s for 2 states in the region that reported planned subpart 1 spending for foster care maintenance and adoption assistance payments in excess of the limits. The fourth regional office told us that, in the past, it had a list of the maximum spending limits for each state in its region and that it had previously checked states’ CFS-101s to ensure that planned spending did not exceed the limits. However, the regional office no longer conducts such reviews; regional officials said that they consider the limits to be meaningless because state funds spent on child welfare services greatly exceed subpart 1 funds. In other words, any attempt to enforce the limits would only lead to changes in how states accounted for their funds—if a state was spending $1 million in state funds on CPS investigations and $1 million in subpart 1 funds for foster care maintenance and adoption assistance payments, the state could simply switch state and subpart 1 funding so that state funds paid for the foster care maintenance and adoption assistance payments, while subpart 1 funding paid for CPS investigations. This lack of review led HHS to approve CFS-101s for 15 states that reported fiscal year 2002 planned subpart 1 expenditures for foster care maintenance and adoption assistance payments that exceeded the statutory limits (see fig. 3). The dollar amounts by which the subpart 1 spending estimates surpassed the limits were small in some cases, but large in others. For example, Georgia reported that it planned to spend $1,497,000 of subpart 1 funds for these purposes in 2002, which would exceed its statutory limit by $1,558. At the other extreme, Florida’s CFS- 101 indicated that it planned to spend over $9 million, which was more than $7 million over the maximum allowable spending of $1.9 million. In total, these 15 states submitted planned subpart 1 spending estimates for foster care maintenance and adoption assistance payments that would exceed the statutory limits by over $30 million. Moreover, 13 of these 15 states submitted fiscal year 2003 CFS-101s with planned subpart 1 spending above the statutory ceiling, which were approved by HHS. Several regional offices noted that they judge the appropriateness of subpart 1 spending on foster care maintenance and adoption assistance payments in the context of a state’s overall child welfare system. For example, these regional offices said that they are not concerned about a state planning to spend significant proportions of its subpart 1 funds on foster care maintenance and adoption assistance payments if they believed the state had a strong child welfare system with an appropriate array of services. Regional office staff said they would, however, ask a state to reconsider its funding strategy if the state were performing poorly. However, many of the states with approved CFS-101 subpart 1 estimates above the statutory ceilings did not achieve strong outcomes on their CFSR evaluations with regard to providing needed services and having an appropriate array of services. HHS has conducted CFSRs on 12 of the 15 states with approved CFS-101s over the subpart 1 spending limits and determined that appropriately assessing family needs and providing services to address those needs was an area needing improvement in 11 of the 12 states. In addition, 6 of the 12 states were also determined to need improvement in terms of having an appropriate array of services to meet the needs of families in the state. We also compared our survey data on states’ fiscal year 2002 subpart 1 expenditures for foster care maintenance and adoption assistance payments with the statutory limits and found that 10 states reported spending subpart 1 funds on these payments that exceeded the legal limits (see fig. 4). As with their planned spending estimates, states’ subpart 1 actual spending for foster care maintenance and adoption assistance payments exceeded the statutory limits by varying amounts. Michigan, for example, reported on our survey that it spent over $6 million on foster care maintenance payments in fiscal year 2002—well over its $2.2 million limit for such payments—while New Hampshire’s use of subpart 1 for foster care maintenance and adoption assistance payments was only about $27,000 above its limit. In total, these 10 states reported subpart 1 expenditures for foster care maintenance and adoption assistance payments that exceeded the statutory limits by over $15 million. Our survey results may underestimate the number of states with subpart 1 spending over the statutory limits, because several states reported on our survey that they used subpart 1 for foster care maintenance or adoption assistance payments, but were not able to identify the specific dollar amount of subpart 1 funds used for these purposes. Four of these 10 states with subpart 1 expenditures over the statutory limits were also part of the 15 states with CFS-101s that indicated planned spending above the limits. The remaining 6 states did not report estimated subpart 1 spending over these limits. For example, Colorado did not report any planned subpart 1 spending for foster care maintenance or adoption assistance payments. On our survey, however, the state reported using over $3 million in subpart 1 funds for these purposes, well over its $700,000 limit. Little research is available on the effectiveness of unique services funded by subpart 1 because few states have evaluated these services. While our survey data revealed no unique categories of services funded by subpart 1 on a national level, 37 states reported categories of services that were uniquely funded by subpart 1—that is, the individual state used subpart 1, but not subpart 2, to fund services in a particular category. For example, Delaware funded two CPS programs with subpart 1—assessments of a caregiver’s parenting ability and legal services to represent the child welfare agency in court cases—but did not use any subpart 2 funds for this service category. We contacted the states with unique service categories in their states (other than administration, staff salaries, adoption assistance payments, or foster care maintenance payments) and none of these states had conducted rigorous evaluations of these services, although several states provided some data on the effectiveness of services included in these categories. Our literature review on the effectiveness of child welfare practices identified research for some of these unique service categories, such as certain types of family preservation programs. With two exceptions, however, it did not identify any evaluations of the specific services included in these categories. The most common service categories for which individual states used only subpart 1 funds were CPS, foster care maintenance payments, and staff salaries. The 37 states generally reported 1 or 2 unique categories, with 14 states reporting 1 unique category and 1 state reporting a high of 6 categories. Examples of unique subpart 1 services in the CPS category include specialized investigations of reports of child abuse or neglect, telephone hotlines to report incidents of child abuse or neglect, and temporary shelter services for children removed from their homes at times when no other placement option is available, such as evenings and weekends. States also provided other types of services that were funded uniquely by subpart 1. For example, Minnesota provided intensive in-home services to prevent children from being placed in foster care, North Carolina contracted for legal services with the state’s Attorney General’s office, and Maine helped adopted youth pay for post-secondary education costs. Our review of child welfare literature and Internet sites that identified promising child welfare practices found few studies that evaluated the effectiveness of the specific services that states funded uniquely with subpart 1 funds. Based on the information provided on our survey, we identified evaluation research on two of these services. Texas used subpart 1 to fund its Home Instruction For Parents of Preschool Youngsters (HIPPY) Program. The goal of HIPPY is to prevent academic underachievement of children when they enter school. HIPPY works with parents in their homes or in parent group meetings to increase the degree and variety of literacy experiences in the home. The program also seeks to prevent child abuse by enhancing parent-child interactions and focuses on economically disadvantaged parents who may not be involved in parenting programs. While Texas has not formally evaluated this program, the model has been evaluated in other states. Strengthening America’s Families, a Web site about effective family programs to prevent juvenile delinquency funded by the Office of Juvenile Justice and Delinquency Prevention, cites HIPPY as a model program for which evaluations have shown positive effects on children’s measured competence and classroom behavior at the end of second grade for children who participated in HIPPY compared with children with no formal preschool experience. In addition, a 1999 article summarizing research on the HIPPY program found mixed results. For example, an evaluation in New York found that children whose parents participated in HIPPY in 1990 outperformed control group children on measures of classroom adaptation and reading scores 1 year later, but children whose parents participated in HIPPY in 1991 had similar outcomes as children in the control group. The article suggested that variability in how the program is implemented and in parental commitment to the program may explain the mixed results. Missouri funded an alternative response system with subpart 1 funds, which offers assessment services (rather than an investigation) for families that are the subject of a report of abuse or neglect when the risk to the child is not considered high to determine if the family needs services to reduce the risk of harm to the child. By responding to low risk reports of abuse or neglect in a nonaccusatory manner, the goal is to encourage families to collaborate in identifying their needs and cooperate with supportive services. A 1998 evaluation of Missouri counties testing the state’s alternative response system found that the safety of children was not compromised by the lack of an investigation and that, compared to counties that were not using the alternative response system, needed services were delivered more quickly, subsequent reports of abuse or neglect decreased, and the cooperation of families improved. An evaluation of Minnesota’s alternative response systems has also shown promising results. For example, initial results from the randomized experimental evaluation showed an increase in the use of community services with no increase in subsequent reports of abuse or neglect. Of the 37 states that reported unique subpart 1 service categories, we asked the 22 states with unique subpart 1 service categories other than foster care maintenance payments, adoption assistance payments, staff salaries, or administration, whether they had evaluated the effectiveness of the programs included in their unique categories. None of these states had conducted rigorous evaluations of the effectiveness of these services using randomly selected control groups. One official explained that few states can afford to divert resources from providing direct services to conducting formal evaluations of programs, given the tremendous service needs of families involved with the child welfare system. However, 5 states provided some information on the outcomes of the services they funded uniquely with subpart 1. North Dakota used subpart 1 dollars to uniquely fund a component of its family preservation program— family focused services—which the state characterized as a family reunification service. The state provided us with a draft evaluation report of its family preservation program, which includes this specific service. The family preservation program is intended for families with children at risk of being placed in foster care and offers a range of services, including parent aides who provide hands-on parenting education and therapists who are available 24 hours a day to work with the family in the home to address the issues that may result in the children being removed from the home. The evaluation of its total family preservation program found that families receiving services and the social worker involved with the families both reported improved family functioning upon completion of the services compared to their functioning prior to the services. The study also found that fewer children were at risk of being placed in foster care upon completion of services. However, the evaluation did not include any control group to determine if these results would have been achieved if families had not received these services. Massachusetts used some of its subpart 1 funds to pay for a contractor to operate a telephone service for reports of child abuse or neglect that are received in the evenings and on weekends. Officials from Massachusetts provided an internal study conducted in February 2000 that discussed problems with this telephone service, most notably limited staff and resources to handle an increasing volume of calls. The report recommended several actions to improve the operation of the telephone service, including an increase in staff to field telephone calls, upgrading the telephone system so that fewer people receive a busy signal, and increasing the number of beds available for emergency placements in the evenings and on weekends. Arizona also funded its child abuse telephone hotline uniquely with subpart 1 funds and provided the following statistics. In fiscal year 2003, 69 percent of calls to the hotline were answered without any wait. Of the calls that were not answered directly, the average wait time was 3.5 minutes and about 13 percent of calls were abandoned. In addition, quality assurance staff reviewed over 17,000 calls for which it was determined that the report did not meet the state’s criteria for a CPS report requiring investigation and changed only 15 of these to a CPS report. Missouri funded several CPS services with subpart 1 funds, including intensive in-home services for children at imminent risk of removal from the home- and family-centered services for families for whom an investigation determined services are needed to eliminate the risk of harm to the child. Missouri provided two annual reports for fiscal year 2002 that provide some data on the outcomes of these services. Consumer surveys indicated that many families found the intensive in-home services useful, and the annual report on the intensive in-home services indicated that 88 percent of at-risk children were still with their families when services ended after approximately 6 weeks. In addition, 79 percent of children who exited the program in 2001 were still at home 1 year after services ended. With regard to family centered services, the annual report indicated that over 70 percent of families had achieved their goals at the time their case was closed. Wisconsin used subpart 1 to fund a Youth Aids Program, in which the state provides grants to counties to provide services to prevent the placement of children in correctional facilities and other out- of-home care. The state has not evaluated services provided by the counties, but a 1995 report notes that in the first several years of operation, this program produced major reductions in institutional placements and helped encourage the development of community-based resources. Over time, however, an increase in youth crime has led to large increases in institutional and out-of-home care, so that much of Youth Aids funding at the time was reported to be used for out-of-home placements. Despite its relatively small funding level compared to other funding sources for child welfare services, Title IV-B represents an important federal commitment to providing supportive services to help preserve and reunify families. The primary emphases of the two subparts vary somewhat, but the range of services offered and the types of families served overlap significantly. In part because of the relatively small funding involved and the flexible nature of the funding, HHS does not provide in- depth oversight specific to Title IV-B subpart 1. Instead, HHS focuses much of its oversight efforts on states’ progress toward the overall goals of their child welfare systems and the outcomes achieved by these systems. While this type of oversight is appropriate, HHS could provide valuable assistance to states by obtaining more concrete data about states’ use of these funds and synthesizing these data with CFSR data on states’ outcomes with respect to properly identifying the service needs of children and families and providing needed services. Such analyses could allow HHS to develop information on how investments in certain types of services correlate to improved outcomes for children, which could be shared with states to help them more effectively target their spending. HHS could also use this enhanced knowledge of Title IV-B to help develop an appropriate accountability strategy for its newly proposed child welfare option. If enacted, the additional spending flexibility proposed—given the size of the Title IV-E allocations that would become available for spending on a variety of child welfare services—could have a significant impact on a state’s child welfare system. Given the limited information available about the services funded with subpart 1 and the effectiveness of these services, as well as HHS’s findings about the ability of states’ to meet families’ needs, ensuring that states use this flexibility to provide effective services will be critical to the success of this option. Opportunities also exist for HHS to continue to encourage states to conduct evaluations of the programs the states implement. We recommend that the Secretary of HHS provide the necessary guidance to ensure that HHS regional offices monitor states’ use of Title IV-B subpart 1 funds for compliance with statutory restrictions on the use of these funds. In addition, we recommend that the Secretary consider the feasibility of collecting basic data on states’ use of these funds to facilitate its oversight of the program and to provide guidance to help states determine appropriate services to fund. For example, an analysis of how states’ spending patterns correlate to outcomes—both positive and negative—from the CFSRs could yield useful information for this purpose. Given that HHS is currently developing the new child welfare option that would allow states to use Title IV-E dollars for services similar to those provided under Title IV-B subpart 1, we further recommend that the Secretary use the information gained through enhanced oversight of subpart 1—as well as information it may have on states’ use of subpart 2 funds—to inform its design of this option. For example, HHS could use this information to help states determine the most appropriate services to provide under this option. We provided a draft of this report to HHS for comment. The Department’s Administration for Children and Families provided comments. These comments are reproduced in appendix II. ACF also provided technical clarifications, which we incorporated when appropriate. ACF agreed with our recommendation that the Secretary of HHS provide the necessary guidance to ensure that HHS regional offices monitor states’ use of Title IV-B subpart 1 funds for compliance with statutory restrictions on the use of these funds. ACF agreed to provide guidance to the regional offices to enable them to enforce the statutory limits on subpart 1 funds. However, ACF also noted that this limitation no longer serves a useful purpose and is incompatible with the current proposal to offer states much more flexibility in using other federal child welfare dollars. ACF said that it plans to explore ways to provide states flexibility with respect to the subpart 1 limits. ACF disagreed with our recommendation to consider the feasibility of collecting basic data on states’ use of subpart 1 funds. ACF said that it believes that its level of oversight is commensurate with the scope and intent of the program and minimizes states’ reporting requirements. Rather than using information on Title IV-B expenditures to help states most effectively use their resources, ACF believes that its oversight is more appropriately focused on the CFSR process, which requires states to develop actions in response to weaknesses identified by the CFSR and which measures the impact of these actions on actual outcomes. In ACF’s opinion, analyzing how states’ spending patterns correlate to CFSR results is not useful, given the lack of a direct relationship between the relatively small Title IV-B funding levels and the broad outcome areas of safety, permanency, and well-being. In addition, ACF noted that any data collected on subpart 1 expenditures would be outdated because states have 2 years to spend Title IV-B expenditures and are not required to report final expenditures until 90 days after the 2-year period has ended. We believe, however, that assessing the feasibility of collecting some basic data on states’ subpart 1 expenditures could enhance ACF’s overall oversight of states’ child welfare operations and outcomes. While the impact of states’ program improvement efforts under the CFSR process is unknown because states are just getting these efforts underway, the service deficiencies identified by the CFSRs suggest that states could benefit from some guidance on the services that are associated with positive CFSR outcomes. An analysis of how states’ spending patterns correlate to CFSR outcomes need not be limited to subpart 1 spending; such an analysis could help to identify effective services (regardless of funding source) that are associated with positive CFSR outcomes and help states target their subpart 1 and other funding sources more effectively. Furthermore, we do not believe that 2-year old data on subpart 1 expenditures are necessarily outdated; rather, we believe such data would provide better information on states’ use of subpart 1 funds than states’ current estimates of planned spending. In addition, ACF could request expenditure data for a shorter period, such as a year or a quarter or whatever time period best fits states’ other reporting requirements. ACF did not comment on our recommendation that it use the information gained through enhanced oversight to inform its design of its child welfare option. However, we believe that guidance on services associated with positive CFSR outcomes could also help states that choose to participate in the proposed child welfare option to manage their fixed Title IV-E funding. ACF also commented on our finding that the services provided and families served under subparts 1 and 2 overlap to some extent. Specifically, ACF noted that by not permitting the funds, services, and families to overlap, ACF would significantly impede the functionality of the continuum of child welfare services funded by Title IV-B and other federal funding streams and possibly lead to families not receiving needed services. While we described the overlap in services provided and families served, we did not state or imply that such overlap was inappropriate or unnecessary. We also provided a draft of this report to child welfare officials in the 4 states we visited (California, New Jersey, Ohio, and Washington). Officials from California and Washington provided a few technical clarifications that we incorporated, while New Jersey and Ohio did not have any comments. In addition, Washington expressed concern that our recommendations for HHS to (1) ensure that the regional offices monitor states’ use of subpart 1 funds for compliance with the statutory limits and (2) consider collecting data on states’ use of these funds will add to the reporting burden of states without providing additional funds to offset that burden. We recommended that HHS consider the feasibility of collecting such data and would expect HHS to take into account the burden placed on states in making this decision. We are sending copies of this report to the Secretary of HHS, appropriate congressional committees, state child welfare directors, selected county child welfare directors, and other interested parties. We will also make copies available to others upon request. In addition, the report will be available at no charge on GAO’s Web site at http://www.gao.gov. If you have any questions, or wish to discuss this report further, please call me at (202) 512-8403 or Diana Pietrowiak at (202) 512-6239. Key contributors to this report are listed in appendix III. To determine how the services provided and populations served under subpart 1 compare with those under subpart 2, we surveyed child welfare directors in all 50 states and the District of Columbia. We sent a survey to all states to obtain information on how they use Title IV-B funds. We also sent a second survey to certain states that responded to the first survey. We pretested both survey instruments in New Hampshire, Rhode Island, and Wisconsin and obtained input from several other states and from a Department of Health and Human Services (HHS) official. In January 2003, we mailed a copy of the first survey to the states, asking for specific data on state spending and populations served for subparts 1 and 2, as well as their opinions about the current structure of Title IV-B. To address differences in the administrative structure and reporting systems of state child welfare agencies, a different version of this survey was sent to states with county-administered child welfare systems. We received responses from 47 states, although some states were unable to provide complete information. To encourage as many states as possible to complete the survey, we conducted follow-up telephone calls to states that did not respond to our survey by the initial deadline. After a state responded to the first survey, we mailed the second survey, requesting more detailed information on the three services receiving the largest portions of subpart 1 funding and the three services receiving the largest portions of subpart 2 funding. The second survey also asked for copies of any existing evaluations of the effectiveness of these services. We sent the second survey to the 30 states that provided sufficient data on their first survey by mid-April 2003 and received responses from 17 states. We did not independently verify the information obtained through either survey. The responses of the 47 states to the first survey can be used to explain how the 50 states and the District of Columbia in general used Title IV-B funds. Since we received responses from only 17 states for our second survey, they may not be representative of all states. Consequently, we have used these data only as examples or for illustrative purposes. As a result, we based our analyses of the populations of children and families served on data from our first survey. However, states that completed the county-administered version of the survey did not provide data on the types of children and families who received services funded by Title IV-B and were not included in these analyses. As a result, the data on populations served by subparts 1 and 2 cannot be generalized to states with county-administered child welfare systems. Data from both surveys were double-keyed to ensure data entry accuracy, and the information was analyzed using statistical software. On the first survey, we asked states to describe the nature of each service and select one service category that best characterized each program funded by Title IV-B, using the following choices: child protective services (CPS), family support/prevention programs, parent training programs, health programs, educational programs, substance abuse programs, counseling and mental health services, domestic violence programs, formal family preservation programs, family reunification programs, recruitment and training for foster/adoptive parents, adoption preservation services, administration and management, foster care maintenance payments, adoption subsidy payments, and other. The data were analyzed using states’ self-identified categories except in the following situations: (1) if a state clearly described a program as funding salaries for staff at the child welfare agency, we included these data under the staff category; (2) if a state used the “other” category for a service that clearly fell into one of the existing categories (writing in “foster care maintenance payments,” for example), we revised the survey response to reflect the actual category; (3) if it appeared that a state mistakenly checked the wrong box; for example, we changed the category from CPS to family reunification if the program was described as a family reunification service; (4) if a state checked multiple categories, we reported these programs separately under “multiple responses;” (5) if a state did not check any categories, we selected a service category that best fit the description of the program and used “other” if the description did not clearly fall into one of our categories; and finally (6) if a state clearly described the use of Title IV-B funds as administrative, but categorized it in another category, we revised the survey to indicate that the funds were used for administration and management. Some states explained that Title IV-B funds were used to cover administrative expenses for a particular program and characterized the use of these funds based on the nature of the program. For example, a state might have selected family preservation program when Title IV-B funds were used for administrative expenses for that program. As noted earlier in the report, we recognize that some states may not have separately identified administration or management expenses associated with a program and may have included these expenses in the program costs. For reporting purposes, we combined several service categories for which states reported spending small percentages of Title IV-B funds, such as parent training and substance abuse services, and reported these dollars in the “other” category. We recognize that the service categories used are not necessarily mutually exclusive. For example, several HHS officials told us that the delineation between family support and family preservation services is not clear, so that 2 states providing the same services to the same types of children and families may report them in different categories. In addition, because the survey for states with state-administered child welfare systems asked them to choose one service category for each program, the reported service categories may not fully capture all relevant programs that fall into more than one service category. Inconsistencies in how states categorized services could have an effect on any measured differences between service categories. To obtain more in-depth information on the services provided and the types of children and families served under Title IV-B, we conducted site visits in California, New Jersey, Ohio, and Washington. We selected these states to represent a range of geographic locations and subpart 1 spending patterns. In addition, because preliminary data indicated that significant subpart 1 funds were devoted to CPS, we selected states that used innovative CPS tools or processes. However, the experiences of these states are not necessarily representative of the experiences of any other state. During these site visits, we interviewed state and local child welfare officials and service providers and reviewed relevant documentation. To learn about the federal government’s role in overseeing subpart 1, we reviewed applicable laws and regulations and interviewed HHS central office officials. We also conducted interviews with HHS officials in all 10 HHS regional offices to discuss their oversight activities and reviewed results from HHS’s CFSR reports. In addition, we reviewed states’ CFS- 101s for fiscal year 2002 and compared states’ planned subpart 1 spending for foster care maintenance, adoption assistance, and child care payments with states’ final subpart 1 allocations for fiscal year 1979 as reported on an HHS program instruction from that year. States are required to submit the CFS-101 by June 30 of the preceding year—June 30, 2001, for fiscal year 2002. At that time, federal appropriations for Title IV-B and other federal child welfare funds often are not yet finalized, so states base their estimates on the previous year’s allocation. States must submit a revised CFS-101 by June 30, 2002, to request any additional fiscal year 2002 Title IV-B funds that might be available to them once appropriations are finalized. In addition, states can request additional Title IV-B funds if other states do not use the total funds to which they are entitled. In most cases, we reviewed the final revised CFS-101s approved by HHS. For one state, we used the initial CFS-101 approved by HHS because it included planned subpart 1 expenditures that exceeded the limits for foster care maintenance and adoption assistance payments, but the revised CFS-101 did not. Although the revised CFS-101 did not show the state planned to exceed the limit, we used the initial CFS-101 to show that HHS had previously approved a spending plan that did not comply with the statutory limits. We used our survey results to identify services unique to subpart 1—that is, categories of services funded by subpart 1 that are not funded by subpart 2. While no category of service was unique to subpart 1 at the national level, some states funded unique categories of services within their state with subpart 1. In our second survey, we asked states to provide a copy of any evaluations they had conducted of the three largest services funded by subpart 1. If we did not have survey data for one of the identified services, either because we did not send a second survey to the state or because the second survey did not ask for data on the particular service, we contacted the state directly to ask if any evaluation had been conducted. In addition, to identify other evaluations on the effectiveness of the services in these unique categories, we conducted a literature review and interviewed child welfare research experts. The reports and Internet sites we reviewed included the following: Strengthening America’s Families: Effective Family Programs for the Prevention of Delinquency (http://www.strengtheningfamilies.org/html/programs_1999/programs_list_ 1999.html). Child Welfare League of America’s Research to Practice Initiative (http://www.cwla.org/programs/r2p/). Casey Family Programs: Promising Approaches to Working with Youth and Families (http://www.casey.org/whatworks/). Promising Practices Network on Children, Families, and Communities (http://www.promisingpractices.net/). U. S. Department of Health and Human Services, “Emerging Practices In the Prevention of Child Abuse and Neglect” (Washington, D.C.: n.d.). We conducted our work between August 2002 and July 2003 in accordance with generally accepted government auditing standards. In addition to those named above, Melissa Mink and J. Bryan Rasmussen made key contributions to the report. Anne Rhodes-Kline, Alison Martin, Luann Moy, and George Quinn, Jr., provided key technical assistance. Child Welfare: Most States Are Developing Statewide Information Systems, but the Reliability of Child Welfare Data Could be Improved. GAO-03-809. Washington, D.C.: July 31, 2003. D.C. Child and Family Services: Key Issues Affecting the Management of Its Foster Care Cases. GAO-03-758T. Washington, D.C.: May 16, 2003. Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services. GAO-03-397. Washington, D.C.: April 21, 2003. Foster Care: States Focusing on Finding Permanent Homes for Children, but Long-Standing Barriers Remain. GAO-03-626T. Washington, D.C.: April 8, 2003. Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare Agencies Recruit and Retain Staff. GAO-03-357. Washington, D.C.: March 31, 2003. Foster Care: Recent Legislation Helps States Focus on Finding Permanent Homes for Children, but Long-Standing Barriers Remain. GAO-02-585. Washington, D.C.: June 28, 2002. District of Columbia Child Welfare: Long-Term Challenges to Ensuring Children’s Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000. Foster Care: HHS Should Ensure That Juvenile Justice Placements Are Reviewed. GAO/HEHS-00-42. Washington, D.C.: June 9, 2000. Juvenile Courts: Reforms Aim to Better Serve Maltreated Children. GAO/HEHS-99-13. Washington, D.C.: January 11, 2000. Foster Care: States’ Early Experiences Implementing the Adoption and Safe Families Act. GAO/HEHS-00-1. Washington, D.C.: December 22, 1999. Foster Care: HHS Could Better Facilitate the Interjurisdictional Adoption Process. GAO/HEHS-00-12. Washington, D.C.: November 19, 1999. Foster Care: Effectiveness of Independent Living Services Unknown. GAO/HEHS-00-13. Washington, D.C.: November 5, 1999. Child Welfare: States’ Progress in Implementing Family Preservation and Support Services. GAO/HEHS-97-34. Washington, D.C.: February 18, 1997. Child Welfare: Opportunities to Further Enhance Family Preservation and Support Activities. GAO/HEHS-95-112. Washington, D.C.: June 15, 1995.

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