Foster care laws and regulations have historically emphasized the importance of both reunifying families and achieving permanency for children in a timely manner. Permanency outcomes from foster care include family reunification, adoption, and legal guardianship. The Congress recently enacted legislation that places a greater emphasis on adoption when foster children cannot be safely returned to their parents in a timely manner. Failing to secure a safe, permanent home for foster children before they reach age 18—sometimes referred to as aging out of the foster care system—can have damaging consequences for their emotional stability and future self-sufficiency. Although federal law requires states to make “reasonable efforts” to reunify foster children with their parents, neither federal laws nor regulations clearly define “reasonable efforts.” At a minimum, the law does require states to develop a case plan with a permanency goal. When family reunification is the goal, the case plan must describe the services—such as drug or alcohol treatment, counseling, or parenting classes—that will be provided to help parents rectify the problems or conditions that led to their children entering foster care. In order to evaluate the progress that parents have made in complying with their case plan requirements, states are required to hold court or administrative reviews every 6 months. They also must hold permanency planning hearings at which the judge must determine whether to continue family reunification efforts or begin to pursue some other permanency goal, such as adoption or guardianship. In determining if and when to end efforts to reunify the family, foster care agencies and the courts must balance the goals of reunifying children with their parents and meeting children’s need for timely permanency. The Adoption and Safe Families Act of 1997 (P.L. 105-89) emphasizes that a child’s health and safety are of paramount concern by specifying situations in which states do not have to make reasonable efforts to reunify the family before parental rights can be terminated. This law also stresses the importance of securing safe, permanent homes for children in a timely manner by (1) requiring states to file a petition to terminate parental rights (TPR) if the child has been in foster care for at least 15 of the most recent 22 months, (2) shortening from 18 to 12 months the time period within which a permanency planning hearing must be held, and (3) providing incentive payments to states for increasing the number of foster children who are adopted. This law also authorizes funds for time-limited family reunification efforts. Currently, data on foster care outcomes—including family reunification rates—and length of stay in foster care are limited. A longitudinal study of foster care outcomes in California found that, while 44 percent of children who entered foster care in 1990 as infants were reunified with their families within 4 years, 37 percent were still in care after 4 years.This study also showed that foster care outcomes vary by placement type, age at entry, and ethnicity. Data on how parental substance abuse may affect the length of time children spend in foster care and their outcomes are particularly limited. However, Illinois reported that the percentage of foster children who were reunified with their families dropped between 1990 and 1995, which foster care agency officials attribute to the “epidemic level of parental drug abuse.” Parental substance abuse may also result in children re-entering foster care. The California study cited above found that among those who were reunified with their families, 28 percent re-entered foster care within 3 years. This study found that parental substance abuse was particularly common among cases in which children had re-entered foster care. Research suggests that children who spend long periods of time in foster care, or age out of the system before a permanency outcome has been achieved, may have emotional, behavioral, or educational problems that can adversely affect their future well-being and self-sufficiency. A study of the title IV-E foster care independent living program, which assists children in their transition from foster care to self-sufficiency, found that about 2-1/2 to 4 years after aging out of the system, 46 percent of foster children had not completed high school; 38 percent had not held a job for longer than 1 year; 25 percent had been homeless for at least 1 night; and 60 percent of those who were female had given birth to a child. Furthermore, 40 percent had been on public assistance, incarcerated, or a cost to the community in some other way. The Department of Health and Human Services (HHS) is responsible for the management and oversight of federal programs providing services to foster children. HHS issues federal foster care regulations, monitors states’ compliance with them, and administers federal funding. Federal foster care funds are authorized under title IV-E of the Social Security Act of 1935. Title IV-E is an uncapped entitlement program that reimburses states for a portion of the maintenance cost for foster children whose parents meet federal eligibility criteria related to their income level. Federal expenditures for the administration and maintenance of children eligible for title IV-E funding increased from about $546 million in 1985 to an estimated $3.3 billion in 1997. States and counties must bear the full cost for maintaining foster children who are not eligible for title IV-E funding. Children are exiting foster care at a slower rate than they are entering. As a result, the foster care population nationwide has nearly doubled since the mid-1980s, increasing from about 276,000 in 1985 to about 500,000 in 1997. Following the advent of crack-cocaine in the mid-1980s, cocaine use increased dramatically and reached alarming proportions by the end of the 1980s. Research indicates that the “crack epidemic” may have contributed to the increase in foster care caseloads. We reported that, in 1991, nearly two-thirds of foster children 36 months of age or younger in Los Angeles County, New York City, and Philadelphia County combined were known to have been prenatally exposed to drugs or alcohol. Most of them were exposed to cocaine. Although research indicates that the number of new crack-cocaine users is declining, chronic use among parents of foster children is still common. While crack-cocaine use is declining, the use of other hard drugs is on the rise. Methamphetamine use has been growing, particularly in the West and Southwest, and there is a resurgence of heroin use throughout much of the country. Heroin’s growing popularity may stem from its sharply increased availability; decreased cost; and higher purity level, in a form that does not need to be injected. Both crystallized methamphetamines and crack-cocaine are inexpensive, smokable drugs that produce immediate and intense highs and increased alertness. In March 1998, we reported that major studies have shown that drug treatment is beneficial, although concerns about the validity of self-reported data suggest that the degree of success may be overstated.Nonetheless, substantial numbers of clients do report reductions in drug use and criminal activity following treatment. Research also indicates that those who remain in treatment for longer periods generally have better treatment outcomes. Methadone maintenance has been shown to be the most effective approach for treating heroin abuse. Research on the best treatment approach or setting for other groups of drug abusers, however, is less definitive. To date, there is no effective pharmacological treatment for cocaine abuse, but studies have shown that several cognitive-behavioral treatment approaches show promise for treating cocaine addiction. Little is known about the effectiveness of treating methamphetamine addiction. According to our survey, most children in foster care in California and Illinois had at least one parent with a serious and long-standing substance abuse problem that makes recovery extremely difficult. Most of these parents had been abusing drugs or alcohol for 5 years or more. About two-thirds of these parents had used one or more hard drugs such as cocaine, heroin, or methamphetamines. These hard drugs are highly addictive and debilitating and can greatly diminish the ability to parent. These substance-abusing parents often neglect their children because their primary focus is obtaining and using drugs. In addition, substance abusers often engage in criminal activity that can threaten the safety and well-being of their children. Recovery from drug and alcohol addiction depends on many factors, such as the substance abuser’s readiness for recovery, and relapse is common. On the basis of the results of our survey, we estimate that about 65 percent of the foster children in California and 74 percent in Illinois, or about 84,600 children combined, had at least one parent who was required to undergo drug or alcohol treatment as part of the case plan for family reunification. (See fig. 1.) In about 40 percent of these cases in each state the father was required to undergo drug or alcohol treatment, while the mother was required to undergo treatment in over 90 percent of these cases in each state. In about one-third of the cases involving parental substance abuse in each state, either the father was deceased or his whereabouts were unknown. As a result, the mother was usually the focus of the foster care agency’s family reunification efforts. Caseworkers in our case study locations explained that fathers whose whereabouts are unknown may not even be aware they have children in the foster care system; and even if they are aware, they may never have been involved in the care of their children. In both California and Illinois, at least two-thirds of the substance-abusing parents of foster children in our survey used cocaine, methamphetamines, or heroin—hard drugs that are highly addictive and debilitating. In each state, about 50 percent of the mothers who abused drugs or alcohol used more than one substance. Alcohol was often used in combination with one or more of the hard drugs mentioned above, although alcohol abuse alone was much less common in both states. Less than 10 percent of the substance-abusing mothers in each state used only alcohol. In some instances, substance-abusing parents in each state were using marijuana.