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

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