[WPRT 109-9]
[From the U.S. Government Publishing Office]




109th Congress                                                    WMCP:
                            COMMITTEE PRINT                       
 2nd Session                                                      109-9
_______________________________________________________________________

                                     


                      COMMITTEE ON WAYS AND MEANS

                     U.S. HOUSE OF REPRESENTATIVES

                               __________

                                 REPORT

                                   on
 
                     P.L. 109-288, THE ``CHILD AND
                      FAMILY SERVICES IMPROVEMENT
                             ACT OF 2006''


                                     
[GRAPHIC] [TIFF OMITTED] TONGRESS.#13

                                     
                            OCTOBER 11, 2006

 Prepared for the use of Members of the Committee on Ways and Means by 
members of its staff. This document has not been officially approved by 
       the Committee and may not reflect the views of its embers.


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                      COMMITTEE ON WAYS AND MEANS

                   BILL THOMAS, California, Chairman

E. CLAY SHAW, JR., Florida           CHARLES B. RANGEL, New York
NANCY L. JOHNSON, Connecticut        FORTNEY PETE STARK, California
WALLY HERGER, California             SANDER M. LEVIN, Michigan
JIM MCCRERY, Louisiana               BENJAMIN L. CARDIN, Maryland
DAVE CAMP, Michigan                  JIM MCDERMOTT, Washington
JIM RAMSTAD, Minnesota               JOHN LEWIS, Georgia
JIM NUSSLE, Iowa                     RICHARD E. NEAL, Massachusetts
SAM JOHNSON, Texas                   MICHAEL R. MCNULTY, New York
PHIL ENGLISH, Pennsylvania           WILLIAM J. JEFFERSON, Louisiana
J.D. HAYWORTH, Arizona               JOHN S. TANNER, Tennessee
JERRY WELLER, Illinois               XAVIER BECERRA, California
KENNY C. HULSHOF, Missouri           LLOYD DOGGETT, Texas
RON LEWIS, Kentucky                  EARL POMEROY, North Dakota
MARK FOLEY, Florida                  STEPHANIE TUBBS JONES, Ohio
KEVIN BRADY, Texas                   MIKE THOMPSON, California
THOMAS M. REYNOLDS, New York         JOHN B. LARSON, Connecticut
PAUL RYAN, Wisconsin                 RAHM EMANUEL, Illinois
ERIC CANTOR, Virginia
JOHN LINDER, Georgia
BOB BEAUPREZ, Colorado
MELISSA A. HART, Pennsylvania
CHRIS CHOCOLA, Indiana
DEVIN NUNES, California

                    Allison H. Giles, Chief of Staff

                  Janice Mays, Minority Chief Counsel



                            C O N T E N T S

                               __________

                                                                   Page

Overview.........................................................     1
Explanation of Provisions........................................     2
Congressional Budget Office Report...............................     8
Letters of Support...............................................    12
      
                                OVERVIEW
    The Child and Family Services Improvement Act of 2006 (P.L. 109-
288), signed into law on September 28, 2006, makes a number 
ofimprovements to the nation's child protection system. The legislation 
includes provisions to (1) reauthorize the Promoting Safe and Stable 
Families (PSSF) program, (2) target resources towards ensuring children 
in foster care are visited on a monthly basis by caseworkers and 
towards assisting regional partnerships with their efforts to combat 
the effects of parental substance abuse, particularly methamphetamine 
abuse, on the child protection system, (3) improve the Child Welfare 
Services (CWS) program, (4) reauthorize the Court Improvement Program, 
(5) reauthorize and improve the Mentoring Children of Prisoners 
Program, and (6) appropriate for fiscal year (FY) 2006 the additional 
$40 million in mandatory funding provided under the Deficit Reduction 
Act of 2005 (P.L. 109-171) for the PSSF program.
    The Committee on Ways and Means marked up an earlier version of 
this legislation (H.R. 5640), on June 29, 2006 and ordered the bill, as 
amended, favorably reported. The Committee on Ways and Means 
Subcommittee on Human Resources held a hearing on May 23, 2006 on 
proposals to improve child protective services such as those supported 
by the PSSF and CWS programs. Witnesses at this hearing provided 
comments on draft legislation reflecting provisions subsequently 
introduced by Subcommittee on Human Resources Chairman Wally Herger (R-
CA) and Ranking Member Jim McDermott (D-WA) as H.R. 5640. In recent 
years, the Subcommittee on Human Resources also has conducted a series 
of oversight hearings on various aspects of the child protection 
system, which generally indicated a need for improved oversight and 
accountability throughout these programs.
    On July 25, 2006, the U.S. House of Representatives amended S. 
3525, as previously passed by the Senate by inserting the text of H.R. 
5640 and sending the measure back to the Senate for its consideration. 
The final version of S. 3525, as amended, that is described in this 
report reflects agreement between Members of the House and the Senate 
on final provisions to be included in this legislation. The Senate 
unanimously passed S. 3525, as amended, on September 20, 2006, followed 
by the U.S. House of Representatives which unanimously passed the 
legislation on September 26, 2006.

                       Explanation of Provisions

S. 3525, The Child and Family Services Improvement Act of 2006 (P.L. 
        109-288)
Section 1 -- Short Title
    ``The Child and Family Services Improvement Act of 2006''
Section 2 -- Findings
    The legislation makes a number of findings regarding the provision 
of services under two child welfare programs authorized under Title IV-
B of the Social Security Act, the Child Welfare Services (CWS) program 
and the Promoting Safe and Stable Families (PSSF) program. The findings 
note the importance of monthly caseworker visits in improving outcomes 
for children. They also outline the relationship between the entry of 
children into the child welfare system and their parent's abuse of 
methamphetamine and other substances.
Section 3 - Reauthorization of the Promoting Safe and Stable Families 
        Program
Current Law
    For fiscal year (FY) 2006, authorizes mandatory funding of $345 
million for the Promoting Safe and Stable Families (PSSF) program 
(Title IV-B, Subpart 2 of the Social Security Act) and discretionary 
funding of $200 million for each of FYs 2002 through 2006.
S.3525
    The legislation extends the mandatory PSSF funding authorization of 
$345 million for five years (FYs 2007 through 2011) and extends the 
discretionary funding authorization of $200 million for each of those 
same five years. The legislation expands the reporting requirement to 
include both proposed spending and actual spending under the CWS and 
PSSF programs, and at State option, other programs that support child 
abuse prevention activities and child welfare services. The legislation 
also prohibits HHS from making any payment of PSSF funds to a State for 
administrative costs that exceed 10 percent of total program 
expenditures (Federal and non-Federal) of a State.
Reason for Change
    The PSSF program supports four categories of services provided to 
children and families: family preservation services, community-based 
family support services, time-limited reunification services, and 
adoption promotion and support services. The legislation recognizes the 
importance of encouraging States to invest in these activities. Thus 
the legislation provides for the $200 million increase in mandatory 
PSSF funds over the next five years included in the Deficit Reduction 
Act of 2005 (P.L. 109-171). In total $345 million in mandatory funds 
(the recent $305 million allotment of annual mandatory funds, plus a 
$40 million annual increase provided under the Deficit Reduction Act of 
2005) will be provided in each of FYs 2007 through 2011.
    The legislation also will ensure better oversight and 
accountability of spending under the CWS and PSSF programs by requiring 
States to report on projected and actual spending under these two 
programs. Specifically, data on actual spending will help track State 
investments for the four priorities of the PSSF program.
Section 4 -- Targeting of Promoting Safe and Stable Families Program 
        Resources
Current Law
    Current law requires States to include assurances in their PSSF 
plan that they will spend significant portions of their PSSF funds in 
each of four priority areas: (1) family preservation services; (2) 
community-based family support services; (3) time-limited family 
reunification services; and (4) adoption promotion and support 
services.
S. 3525
    The legislation retains the four priorities of PSSF while targeting 
the additional $40 million per year provided under the Deficit 
Reduction Act of 2005 (P.L. 109-171) to two new priorities: (1) support 
for monthly caseworker visits; and (2) competitive grants to promote 
the well-being of children in or at risk of placement in the child 
welfare system as a result of their parent's abuse of methamphetamine 
or other substances.
    The legislation provides a total of $95 million to States to 
support monthly caseworker visits of children in foster care under the 
responsibility of the State, with a primary emphasis on activities 
designed to improve caseworker retention, recruitment, training, and 
ability to access the benefits of technology. States will receive $40 
million from FY 2006 PSSF funds (with these funds available through FY 
2009), $5 million in FY 2008, $10 million in FY 2009, and $20 million 
in each of FYs 2010 and 2011 to support monthly caseworker visits. 
States cannot use these funds to supplant any Federal funds already 
paid to the State under the Title IV-E program that could be used for 
the purposes outlined above.
    To promote the well-being of children affected by their parent's 
abuse of methamphetamine or other substances, the legislation provides 
a total of $145 million to the Secretary of the Department of Health 
and Human Services (HHS) to award competitive grants to regional 
partnerships to pursue innovative approaches to help children and 
families. Funding will be $40 million in FY 2007, $35 million in FY 
2008, $30 million, in FY 2009 and $20 million in each of FYs 2010 and 
2011. Partnerships must include the State child welfare agency or an 
Indian tribe and at least one other eligible partner, including: child 
welfare service providers (non-profit and for-profit), community 
providers of health or mental health services, local law enforcement 
agencies, judges and court personnel, juvenile justice officials, 
school personnel, the State agency responsible for administering the 
substance abuse prevention and treatment block grant (authorized under 
Title XIX-B, Subpart II of the Public Health Services Act), and any 
other providers, agencies, personnel, officials or entities related to 
the provision of child and family services. Grants of between $500,000 
and $1 million per year will be awarded for 2 to 5 year periods.
    A priority will be given to grant applications that propose to 
combat methamphetamine abuse, given its substantial affect on child 
welfare in some areas. Funding for the grants must be used to support 
the purposes of this program, which may include family-based 
comprehensive long-term substance abuse treatment services, early 
intervention and prevention services, mental health services, parent 
skills training, and replication of successful models for providing 
family-based comprehensive long-term substance abuse treatment 
services. Grantees must provide a 15 percent match in the first and 
second year, a 20 percent match in the third and fourth year, and a 25 
percent match in the fifth year. In-kind contributions can qualify 
towards the match requirement. The Secretary of HHS must consult with 
State leaders to develop performance indicators and reporting is 
required of all grant recipients.
    The legislation also redirects current PSSF research funding to 
support evaluation, research, and technical assistance related to the 
above two PSSF funding priorities. In each of FYs 2007 through 2011, at 
least $1 million must be spent for research and technical assistance 
activities that support monthly caseworker visits and at least $1 
million must be spent for research and technical assistance activities 
with respect to the competitive grant program to promote the well-being 
of children in or at risk of placement in the child welfare system due 
to a parent's abuse of methamphetamine or other substances.
Reason for Change
    The targeting of funds to support monthly visits of foster children 
is in response to research highlighting how monthly visits lead to 
better outcomes for children. The Child and Family Service Reviews 
(CFSRs) completed in each State found a strong correlation between 
frequent caseworker visits with children and positive outcomes for 
children, such as timely achievement of permanency and other indicators 
of child well-being. However, despite the fact that nearly all States 
had written standards suggesting monthly visits were State policy, a 
December 2005 report completed by the HHS Office of the Inspector 
General found that only 20 States were able to produce reports showing 
whether caseworkers actually visited children in foster care on at 
least a monthly basis. States are encouraged to invest these resources 
in those activities with proven effectiveness in supporting monthly 
caseworker visits of foster children and should be cognizant that these 
funds may not supplant what States already spend from their Title IV-E 
programs for these activities. These resources are intended to increase 
State investment in these important areas.
    Parental substance abuse is a well-known problem affecting the 
child welfare system, and the Office of Applied Studies of the 
Substance Abuse and Mental Health Services Administration reported that 
the number of new uses of methamphetamines (meth) has increased 72 
percent in the past decade. A study by the National Association of 
Counties which surveyed 300 counties in 13 States reported that meth 
abuse is a major cause of child abuse and neglect. Forty percent of all 
the child welfare officials in the survey reported an increase in out-
of-home placements due to meth abuse in 2005.
Section 5 -- Allotments and Grants to Indian Tribes
Current Law
    Requires that 1 percent of all mandatory PSSF funds, and 2 percent 
of any discretionary appropriations for the PSSF program, be set aside 
for tribal programs. (The minimum tribal funding provided is $3.45 
million and the maximum annual tribal funding possible is $7.45 
million.)
    ut of the tribal funds reserved, Indian tribes or tribal 
organizations with an approved plan must be allotted PSSF funds (based 
on the relative share of tribal persons under age 21 but only among 
tribes or tribal organizations with approved plans). The Secretary of 
HHS may exempt a tribe from any plan requirement that it determines 
would be inappropriate for that tribe (taking into account the 
resources, needs, and other circumstances of that tribe). However, no 
tribe or tribal organization may have an approved plan (or receive 
funds) unless its allotment is equal to at least $10,000. Funds 
allotted are paid directly to the tribal organization of the Indian 
tribe to which the money is allotted.
S.3525
    The legislation increases the set-aside for tribal programs to 3 
percent of any discretionary funds appropriated. It also increases the 
set-aside for tribal programs to 3 percent of the mandatory funds 
authorized and which remain after the separate reservation of funds is 
made for (1) monthly caseworker visits, and (2) competitive grants to 
combat methamphetamine and other substance abuse. Therefore, the 
minimum funding available per year for tribal programs would be $9.15 
million and the maximum funding would be $15.15 million. The 
legislation eliminates the ability of the Secretary of HHS to exempt 
tribes from the PSSF plan requirements related to nonsupplantation, 
data reporting, and monitoring. However, the Secretary retains the 
ability to waive for Indian tribes the PSSF requirement to invest 
significant amounts of program funds in each of the four PSSF 
activities and to spend no more than 10 percent of PSSF funds on 
administrative costs.
    The legislation also permits tribal consortia to have access to an 
allotment of PSSF funds (and related technical assistance) on the same 
basis as such funds are currently available to Indian tribes. A tribal 
consortium's allotment is to be determined based on the number of 
tribal persons under age 21 in each tribe that is a part of the tribal 
consortium. If tribes choose to apply collectively as a consortium, the 
population of tribal persons under age 21 for each tribe would be 
combined in order to determine the size of the grant to the consortium, 
including whether the consortium meets the $10,000 eligibility 
threshold in the Act. A tribal consortium could select which Indian 
tribal organization (among the tribes in the consortium) would receive 
the direct payment of its allotment.
Reason for Change
    The legislation recognizes the importance of assisting tribes in 
their efforts to assist abused and neglected children. The legislation 
significantly increases the amount of funds provided to tribes and 
allows tribal consortia to apply for PSSF funds. This step is being 
taken to encourage the further development of tribal child welfare 
programs, which largely serve severely disadvantaged communities and 
families and can do so in a culturally appropriate manner. Permanency 
outcomes for Indian children can be improved if tribal consortia are 
able to have access to an allotment of PSSF funding on the same basis 
as is currently available to Indian tribes. This will facilitate 
smaller tribes' building their own programs and will allow for 
administrative efficiencies in tribal program administration.
    To collect additional data and ensure proper oversight of these 
funds, tribes and tribal consortia interested in applying for this 
substantial increase in PSSF funds will be required to adhere to the 
same data and monitoring plan requirements as States. This additional 
data will inform how these funds have helped the tribes better ensure 
the safety, permanency, and well-being of tribal children.
Section 6 -- Improvements to the Child Welfare Services (CWS) Program
Current Law
    Up to $325 million annually is authorized on an indefinite basis 
for the Child Welfare Services (CWS) program, which provides funds to 
States to support a wide range of child welfare activities. Federal 
funding represents 75 percent of total funding for this program, and 
States are required to contribute 25 percent of total CWS funding from 
State funds.
S.3525
    The legislation maintains the annual discretionary authorization 
level of $325 million per year but limits the funding authorization to 
FYs 2007 through 2011. The legislation also specifies that the purpose 
of the CWS program for which funds may be expended is to promote State 
flexibility in the development and expansion of a coordinated child and 
family services program that utilizes community-based agencies and that 
ensures all children are raised in safe, loving families, by: (1) 
protecting and promoting the welfare of all children; (2) preventing 
the neglect, abuse, or exploitation of children; (3) supporting at-risk 
families through services which allow children, where appropriate, to 
remain safely with their families or return to their families in a 
timely manner; (4) promoting the safety, permanence and well-being of 
children in foster care and adoptive families; and (5) providing 
training, professional development and support to ensure a well-
qualified child welfare workforce.
    The legislation eliminates the plan requirements related to child 
day care standards and those related to the use of paraprofessionals or 
volunteers and restates and renumbers the remaining provisions with 
generally the same intent. It rewrites the provision concerning 
policies and procedures for children abandoned shortly after birth to 
assert that a State must have in effect administrative and judicial 
procedures for children who are abandoned at or shortly after birth 
(including policies and procedures providing for legal representation 
of the children) to ensure expeditious decisions can be made for their 
permanent placement. Further, it clarifies that the State may include 
residential educational programs as a living arrangement for children 
for whom reunification, adoption, or guardianship have been ruled out 
as permanency goals. This provision does not undermine current State 
policies regarding placement of children in adoptive homes and does not 
eliminate the 25 bed policy.
    Beginning October 1, 2007 (i.e. the beginning of FY 2008), the 
legislation limits administrative funding to 10 percent, but defines 
administrative funds to exclude caseworker services and supervision of 
such services. Also beginning in FY 2008, the legislation limits how 
much each State can expend from Federal CWS funding for foster care 
maintenance payments, adoption assistance payments, or child day care 
to what the State can show that it spent for such purposes in FY 2005. 
Further, beginning with FY 2008, States are not allowed to use State 
spending on foster care maintenance payments to meet the State matching 
requirement to receive Federal CWS fund in amounts that exceed what the 
State spent from such funds in FY 2005.
    The legislation also adds new requirements to the CWS plan the 
State submits to (1) describe how the State consults with and involves 
physicians and other appropriate medical professionals in the 
assessment of children in foster care and in determining appropriate 
medical treatment, and (2) develop a plan on how to respond, track and 
continue care for children receiving child welfare services in the 
event of a disaster.
Reason for Change
    The legislation will reorganize and update the CWS program and 
encourage more effective oversight. It also aligns the program to be 
coterminous with the reauthorization of the PSSF program to allow for 
better coordination between the two programs. It will encourage States 
to invest funding in prevention services, but allows each State to 
maintain in the coming years its FY 2005 level of spending from Federal 
CWS funds for foster care, adoption assistance and child care purposes. 
It adds a new State planning requirement to ensure consultation with 
medical professionals as well as State planning to continue the 
availability of child welfare services during a disaster.
Section 7 -- Monthly Caseworker Standard
Current Law
    There is no minimum Federal standard for monthly visits of foster 
children in State custody.
S.3525
    The legislation requires the State to update its CWS State plan by 
October 1, 2007 to describe its standards for the content and frequency 
of caseworker visits of foster children in State custody, which at a 
minimum must ensure that children are visited on a monthly basis and 
that the caseworker visits are well-planned and focused on issues 
pertinent to case planning and service delivery to ensure the safety, 
permanency, and well-being of children.
    The legislation also sets a minimum Federal standard requiring each 
State and territory to achieve by October 1, 2011 monthly caseworker 
visits for at least 90 percent of foster children in State custody, 
with the majority of those visits occurring in the child's residence. 
Each State and territory would be held accountable for its efforts and 
the legislation prescribes a planning process to achieve this goal. To 
receive FY 2008 CWS funds, States must submit to HHS data for FY 2007 
on the percentage of foster children visited on a monthly basis by 
their caseworker and the percentage of those visits that occurred in 
the child's residence. Based on this data, HHS will work with each 
State to set target levels for the State to meet to achieve a 90 
percent monthly visitation standard by FY 2012 and will establish these 
target levels by June 30, 2008. Then, beginning in FY 2009, States must 
achieve their annual goal for the percentage of caseworker visits and 
the percentage of visits that occur in the child's residence, or face 
an enhanced matching requirement in order to draw down their full 
allotment of Federal CWS funds. The share of non-Federal spending that 
is required in a State that does not meet its visitation target level 
in a year increases by a minimum of 1 percentage point, up to a maximum 
of 5 percentage points, depending on the degree to which the State has 
missed its target level; absent the commitment of additional State 
funds, Federal funds would be reduced to yield the modified State share 
of overall CWS funding, consistent with the degree of the State's 
failure to achieve its visitation target for that year.
    No later than March 31, 2010, HHS must submit to the House 
Committee on Ways and Means and the Senate Committee on Finance a 
report that outlines the progress States have made in meeting their 
caseworker visitation standards and that offers recommendations, 
developed in consultation with State administrators of child welfare 
programs and members of State legislatures, to assist States in meeting 
this standard.
Reason for Change
    Holding States accountable for achieving monthly caseworker visits 
for at least 90 percent of foster children responds to research 
highlighting how monthly visits lead to better outcomes for children. 
HHS shall work with the States to establish a plan to achieve this goal 
by FY 2012 and States are encouraged to invest the new PSSF resources 
provided in FY 2006 and later fiscal years in activities that have been 
shown to be effective in achieving increased caseworker visitation of 
foster children. The above accountability measure will ensure that, 
even in the case of a State that fails to fulfill its specified level 
of caseworker visits, the full Federal CWS allotment to a State will 
remain available so long as that State increases its State CWS spending 
modestly, according to the provisions of the legislation.
Section 8 -- Reauthorization of Program for Mentoring Children of 
        Prisoners
Current Law
    The Mentoring Children of Prisoners program is administered by HHS 
and makes competitive grants to support the establishment or expansion 
and operation of programs that provide mentoring services to children 
of prisoners.
S.3525
    The legislation reauthorizes the existing Mentoring Children of 
Prisoners program through FY 2011 at such sums as may be necessary and 
increases the HHS set-aside for research, technical assistance, and 
evaluation from 2.5 percent to 4 percent. It authorizes a new 3-year 
pilot program to provide vouchers to qualified mentoring groups to 
offer services to individual children of prisoners, but specifies both 
annual caps on funding for this purpose and that at least $25 million 
must be available each year for site-based grants provided under the 
program. The voucher pilot program will be administered by a national 
group that will work closely with HHS to manage the program with the 
goal to distribute least 3,000 vouchers in the first year, 8,000 
vouchers in the second year and 13,000 vouchers in the third year. The 
legislation specifies that the national group must identify in its 
voucher distribution plan how the group will prioritize providing 
vouchers to children in areas which have not been served under the 
current site-based mentoring program. During the third year of this 
pilot HHS shall provide a report based on an independent evaluation to 
the House Committee on Ways and Means and the Senate Committee on 
Finance on the number of children who received vouchers for mentoring 
services and any conclusions regarding the voucher pilot program's 
effectiveness.
Reason for Change
    The continuation of the Mentoring Children of Prisoners program 
will enable public and private organizations to establish or expand 
projects that provide one-on-one mentoring for children of incarcerated 
parents and those recently released from prison. At the same time, 
children have not been able to access mentoring services in some States 
and rural areas because of the absence of a site-based grant to provide 
this service. The voucher pilot program will evaluate the effectiveness 
of using vouchers to expand the delivery of mentoring services to 
children of prisoners, including to children in rural and underserved 
areas.
Section 9 -- Reauthorization of the Court Improvement Program
Current Law
    For each of FYs 2002 through 2006, an eligible highest State court 
(with an approved application) is entitled to a share of funds to 
assess and make improvements to its handling of child welfare 
procedures. A set-aside of $10 million from the mandatory funds 
authorized and 3.3 percent of any discretionary appropriation is 
provided from the PSSF program to support the Court Improvement 
Program. To receive its full allotment of these funds the court, in 
each of FYs 2002 through 2006, is required to provide at least 25 
percent of the expenditures for this purpose.
S.3525
    The legislation reauthorizes the funding for the Court Improvement 
Program for 5 years, through FY 2011.
Reason for Change
    The Court Improvement Program has played an important role in 
assisting State courts in their efforts to expedite judicial 
proceedings for at-risk children. The legislation will ensure these 
funds continue to remain available, and is in addition to the $100 
million provided over FYs 2006 through 2010 under the Deficit Reduction 
Act of 2005 (P.L. 109-171) to support training and data collection 
efforts of State courts.
Section 10 -- Requirement for Foster Care Proceedings to Include, in an 
        Age-Appropriate Manner, Consultation with the Child that Is the 
        Subject of the Proceeding
Current Law
    Current law does not include a standard for consulting with 
children in court proceedings.
S.3525
    The legislation requires States to assure that in any permanency 
hearing held with respect to the child, including any hearing regarding 
the transition of the child from foster care to independent living, the 
court or administrative body conducting the hearing consults in an age-
appropriate manner with the child regarding the plan being proposed for 
the child.
Reason for Change
    Each child deserves the opportunity to participate and be consulted 
in any court proceeding affecting his or her future, in an age-
appropriate manner.
Section 11 -- Technical Amendments
Section 12 -- Effective Dates
    The legislation will become effective on October 1, 2006, except 
for provisions with other specified effective date or if HHS determines 
that a State legislature must act before the State can comply with the 
changes.