Child Welfare: Enhanced Federal Oversight of Title IV-B Could	 
Provide States Additional Information to Improve Services	 
(12-SEP-03, GAO-03-956).					 
                                                                 
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.			 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-03-956 					        
    ACCNO:   A08114						        
  TITLE:     Child Welfare: Enhanced Federal Oversight of Title IV-B  
Could Provide States Additional Information to Improve Services  
     DATE:   09/12/2003 
  SUBJECT:   Child abuse					 
	     Children						 
	     Federal funds					 
	     Federal/state relations				 
	     Funds management					 
	     Surveys						 

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GAO-03-956

Report to the Chairman, Subcommittee on Human Resources, Committee on Ways
and Means, House of Representatives

United States General Accounting Office

GAO

September 2003 CHILD WELFARE Enhanced Federal Oversight of Title IV- B
Could Provide States Additional Information to Improve Services

GAO- 03- 956

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.

Examples of Services Funded by Title IV- B

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. GAO recommends that the

Secretary of the Department of Health and Human Services (HHS) (1) provide
guidance to ensure that HHS regional offices provide appropriate oversight
of subpart 1; (2) consider the feasibility of

collecting data on states* use of these funds to facilitate program
oversight; and (3) use the information gained through enhanced oversight
of subpart 1 in designing its proposed child

welfare option, which would allow states to use other federal child
welfare funds for services allowed under Title IV- B. HHS generally agreed
with GAO*s findings, but did not fully concur with these

recommendations.

www. gao. gov/ cgi- bin/ getrpt? GAO- 03- 956. To view the full product,
including the scope and methodology, click on the link above. For more
information, contact Cornelia Ashby at (202) 512- 8403 or ashbyc@ gao.
gov. Highlights of GAO- 03- 956, a report to the

Chairman, Subcommittee on Human Resources, Committee on Ways and Means,
House of Representatives

September 2003

CHILD WELFARE

Enhanced Federal Oversight of Title IV- B Could Provide States Additional
Information to Improve Services

Page i GAO- 03- 956 Title IV- B Child Welfare Services Letter 1 Results in
Brief 3 Background 5 The Primary Emphases of These Subparts Vary Somewhat,
but the

Range of Services and Types of Families Served Overlap Significantly 12
HHS Focuses Oversight on Overall Child Welfare System, but Has

Limited Knowledge about States* Use of Subpart 1 Funds 26 Some Unique
Subpart 1 Service Categories Exist at the State Level, but Little Research
Exists on the Effectiveness of These Services 36 Conclusions 41
Recommendations 41 Agency Comments 42 Appendix I Scope and Methodology 45

Appendix II Comments from the Department of Health and Human Services 50

Appendix III GAO Contacts and Acknowledgments 54 GAO Contacts 54
Acknowledgments 54 Related GAO Products 55

Tables

Table 1: Selected Requirements to Obtain Grants under Subparts 1 and 2 of
Title IV- B 11 Table 2: Fiscal Year 2002 Expenditures for Subparts 1 and 2
Service

Categories 14 Table 3: Populations Targeted by Services Funded by Subparts
1 and 2 of Title IV- B in Fiscal Year 2002 20 Table 4: Number of States
Using Funds from Each Subpart of Title IV- B to Target Specific
Populations 21 Contents

Page ii GAO- 03- 956 Title IV- B Child Welfare Services Figures

Figure 1: Percentage of Subpart 1 Funds Used for Staff Salaries Dedicated
to Each Type of Staff Position in Fiscal Year 2002 16 Figure 2: Survey
Data on States* Preferences between Subparts 1

and 2 of Title IV- B for Different Program Components 24 Figure 3: Fifteen
States with Approved CFS- 101s with Fiscal Year 2002 Subpart 1 Spending
Estimates that Exceeded Limits for Foster Care Maintenance and Adoption
Assistance Payments 33 Figure 4: Ten States That Reported Fiscal Year 2002
Subpart 1

Expenditures Exceeding Limits for Foster Care Maintenance and Adoption
Assistance Payments 35 Abbreviations

ACF Administration for Children and Families APSR Annual Progress and
Services Report CFSR Child and Family Services Review

CPS child protective services HHS Health and Human Services HIPPY Home
Instruction for Parents of Preschool

Youngsters

This is a work of the U. S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
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separately.

Page 1 GAO- 03- 956 Title IV- B Child Welfare Services

September 12, 2003 The Honorable Wally Herger Chairman Subcommittee on
Human Resources Committee on Ways and Means House of Representatives

Dear Mr. Chairman: In 2001, child protective services (CPS) staff in state
child welfare agencies determined that over 900,000 children had been the
victims of abuse or neglect by their parents or other caretakers. 1 Title
IV- B of the Social Security Act is the primary source of federal funding
for services to help families address problems that lead to child abuse
and neglect and to prevent the unnecessary separation of children from
their families. Title

IV- B is divided into two parts. States can use subpart 1 funds on almost
any child welfare activity. Subpart 2 provides grants to states for
similar types of child welfare services, such as family support services
to enhance family stability and services to help parents reunify with a
child in foster care, but is more restrictive in how the funds can be
spent. In fiscal year 2003, appropriations were $292 million for subpart 1
and $405 million for subpart 2. 2 Title IV- B represents a small
percentage of total federal spending on child

welfare activities. Most federal funding for these activities comes from
Title IV- E of the Social Security Act and is devoted primarily to paying
for the room and board of children in foster care* known as foster care
maintenance payments. Title IV- B dollars can also be used for foster care
maintenance payments, but are more frequently used for other types of
services. As the Congress has enacted various pieces of legislation to
help move children from foster care into permanent homes more quickly, it
has

emphasized the need for states to use Title IV- B funding to provide 1
Child protective services activities typically include reviewing reports
of alleged child abuse and neglect, investigating those that meet the
state*s criteria as a potential incident of abuse or neglect to determine
if the alleged incident occurred, and, in some cases, referring families
to needed services and removing the child from the home, if necessary. 2
States are required to provide matching funds in order to receive federal
Title IV- B dollars.

United States General Accounting Office Washington, DC 20548

Page 2 GAO- 03- 956 Title IV- B Child Welfare Services

supportive services needed to preserve and reunify families. In 1980, for
example, the Congress increased appropriations for subpart 1, but enacted
limits on the use of these funds for foster care maintenance payments and
adoption assistance payments to encourage states to use the additional

funding for services to families. 3 In addition, while states could
already use subpart 1 funds for services targeted in the new subpart 2
program, the creation of subpart 2 was motivated in part by the fact that
few states used a significant share of their subpart 1 funds for these
types of services. The Department of Health and Human Services* (HHS)
Administration for Children and Families is currently developing a child
welfare option that would allow states to use Title IV- E funds for the
same range of services allowed under Title IV- B. Because of your interest
in the services states are providing to meet the

needs of families, 4 you asked us to examine the following: (1) How do the
services provided and populations served under subpart 1 compare with
those under subpart 2? (2) What has the federal government*s role been in
overseeing the use of Title IV- B subpart 1 funds? (3) What does the

research say about the effectiveness of services unique to subpart 1? To
answer these questions, we sent two surveys to child welfare directors to
obtain information on how they use Title IV- B funds. To obtain a
breakdown of state spending for subparts 1 and 2, we sent the first survey
to all 50 states and the District of Columbia and received responses from
47 states. 5 We sent the second survey to the 30 states that provided
sufficient data on their first survey within the timeframe that allowed us
to conduct the second survey. We received responses from 17 states,
providing detailed information on the 3 services they reported as
receiving the most subpart 1 funding and the 3 services they reported as
receiving the most subpart 2 funding. Because the data from these states
may not be representative of all states, we have used data from the second
survey to provide examples of the types of children and families served by

3 Adoption assistance payments are provided to parents adopting a child
with special needs, such as a physical or mental disability, to assist
with the costs of services required to meet the child*s needs. The subpart
1 limits also apply to child care services to support a parent*s
employment or training. 4 This report focuses primarily on subpart 1
because little, if any, research has been conducted on how subpart 1 funds
have been spent on child welfare services. In contrast, a number of
studies have been conducted on the services provided under subpart 2. 5 We
did not receive responses from the District of Columbia, Indiana,
Kentucky, or Montana.

Page 3 GAO- 03- 956 Title IV- B Child Welfare Services

Title IV- B. We also conducted site visits in California, New Jersey,
Ohio, and Washington, where we interviewed state and local officials and
service providers to obtain more in- depth information on the services
provided and the types of children and families served. These states
represent both geographic diversity and diversity in how states used
subpart 1 funds. In addition, these states were identified as using
innovative CPS tools or processes. Further, we reviewed applicable laws
and regulations; interviewed HHS central and regional office officials
about their oversight activities with regard to Title IV- B; reviewed
results from HHS*s assessments of state child welfare agencies, known as
Child and Family Services Reviews (CFSR); reviewed the literature
assessing the effectiveness of child welfare services; and interviewed
child welfare experts.

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. Our survey found that no
single category of service was funded solely by subpart 1 or subpart 2 in
fiscal year 2002. In response to our survey, states reported spending
about 28 percent of subpart 1 funds on the salaries of child welfare
agency staff* primarily social work staff who can provide a variety of
services, including CPS investigations, recruiting foster parents, and
referring families for needed services. The next three largest spending
categories* administration and management expenses, such as rent and
utilities; CPS services; and foster care maintenance payments* accounted
for about 43 percent of subpart 1 spending. In comparison, states spent
over 80 percent of subpart 2 dollars on the four mandated service
categories* family support, family preservation, family reunification, and
adoption promotion and support services. States reported funding services
with subparts 1 and 2 that serve similar populations* primarily children
at risk of abuse and neglect and their parents, as well as children living
in foster care and their parents. While none of the four states we visited
could provide data on the extent to which the same families participated
in services funded by subparts 1 and 2, officials in three of these states
believed that the two subparts generally served the same types of children
and families. Officials in almost all HHS regional offices said that they
believe that the two subparts offer a good balance in allowing states some
flexibility to address state needs and targeting some federal funds toward
services to keep families together.

HHS*s oversight focuses primarily on states* overall child welfare systems
and outcomes, but the agency provides relatively little oversight specific
to Results in Brief

Page 4 GAO- 03- 956 Title IV- B Child Welfare Services

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. Using its CFSR process,
HHS also evaluates how well states are achieving positive outcomes for
children and has found that many states do not have strong outcomes with
regard to providing the services families need. However, HHS has limited
knowledge about how states spend their subpart 1 funds. HHS does not
collect data on subpart 1 expenditures, requiring instead that states
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, such as

ensuring that states provide required matching funds. Several HHS
officials noted that they do not review the spending plans for subpart 1
as closely as subpart 2 because subpart 1 has few restrictions on how
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. 6 For example, 9 of HHS*s 10 regional
offices do not monitor states* compliance with these limits. As a result,
HHS approved projected 2002 spending plans for 15 states with planned
spending amounts that exceeded these limits. In response to our survey, 10
states reported a total of over $15 million in actual 2002 subpart 1
expenditures that exceeded the spending limits and were thus out of
compliance with the law.

Little research is available on the effectiveness of unique services
funded by subpart 1 at the state level because few states have evaluated
these services. While our survey data reveal no unique categories of
services funded by subpart 1 on a national level, 37 states generally
reported 1 or 2 categories of services that were uniquely funded by
subpart 1 within

their state* that is, they used subpart 1, but not subpart 2, to fund
services in particular categories. The most common unique categories were
CPS, foster care maintenance payments, and staff salaries. Within the CPS
category, for example, unique services include professional assessments of
a caregiver*s parenting skills, telephone hotlines to report child abuse
and

neglect, and short- term shelter placement services. We contacted the 6
The statutory limit also includes payments for child care services
required due to a parent*s employment or training needs. However, only 2
states reported any planned subpart 1 spending on this type of child care
service for fiscal year 2002. For this report, we mention only foster care
maintenance and adoption assistance payments when referring to subpart 1
limits, although we did include planned spending on child care in our
analyses of states* planned subpart 1 spending.

Page 5 GAO- 03- 956 Title IV- B Child Welfare Services

states with unique service categories other than administration, salaries,
and foster care maintenance and adoption assistance payments and none of
these states had conducted rigorous evaluations of these services,
although several states provided some outcomes data for the 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 family preservation programs, but only
two specific services included in a unique subpart 1 category were
identified in the research. For example, research on a service that works
with parents to prepare their children for school and to enhance
parentchild interactions has shown mixed results.

We are recommending that the Secretary of HHS (1) provide the necessary
guidance to ensure that HHS regional offices are providing appropriate
oversight of subpart 1, (2) 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, and (3) use the information gained through enhanced
oversight of subpart 1 to inform its design of the child welfare option
that would allow states to use Title IV- E funds for the same range of
services allowed under Title IV- B. HHS*s Administration for Children and
Families (ACF) generally agreed with our findings, but did not fully
concur with our recommendations. While ACF agreed with our recommendation
to provide the necessary guidance to ensure that its regional offices
monitor states* use of Title IV- B subpart 1 funds, it said that these
limits no longer serve a useful purpose. ACF disagreed with our
recommendation to consider collecting data on subpart 1 expenditures. ACF
believes its current level of oversight is commensurate with the scope and
intent of subpart 1, noting that its oversight efforts are more
appropriately focused on the CFSR process. 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. ACF did not comment on our recommendation
to use such data to inform the design of its child welfare option.

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 Background

Page 6 GAO- 03- 956 Title IV- B Child Welfare Services

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 7 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 8 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. 9 Title IV- E also provides payments to adoptive parents of
eligible foster children with special needs. 10 States may choose to use
Title IV- B funds to provide foster care maintenance or adoption
assistance payments

7 Urban Institute, The Cost of Protecting Vulnerable Children III: What
Factors Affect States* Fiscal Decisions? (Washington, D. C.: n. d.). 8 In
fiscal year 2002, total Title IV- E spending was approximately $6.1
billion. The state matching rate for these payments is based on a state*s
per capita income and ranges from 50 percent to 83 percent. 9 States are
entitled to Title IV- E reimbursement on behalf of children who would have
been eligible for Aid to Families with Dependent Children (AFDC) (as AFCD
existed on July 16, 1996), but for the fact that they were removed from
the home of certain specified relatives.

While the AFDC program was replaced by the Temporary Assistance for Needy
Families program in 1996, eligibility for Title IV- E payments remains
tied to the income eligibility requirements of the now defunct AFDC
program. In addition, certain judicial findings must be present for the
child, and all other requirements included in section 472 (a) and (b) of
the Social Security Act must be met, in order for the child to be eligible
for Title IV- E foster care maintenance payments.

10 Special needs are characteristics that can make it difficult for a
child to be adopted and may include emotional, physical, or mental
disabilities, emotional disturbance, age, or being a member of a minority
race. To qualify for an adoption subsidy under Title IV- E, a state must
determine that the child cannot or should not return home; a state must
make a reasonable, but unsuccessful effort to place the child without the
subsidy; and a specific

factor or condition must exist that makes it difficult to place the child
without a subsidy.

Page 7 GAO- 03- 956 Title IV- B Child Welfare Services

for children without regard to their eligibility for these payments under
Title IV- E. 11 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; 11 Foster care maintenance payments funded by Title IV- B would
require 25 percent in matching state funds. Subpart 1

Page 8 GAO- 03- 956 Title IV- B Child Welfare Services

 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
possible; and

 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. 12 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
communitybased 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
12 Staff of the House Committee on Ways and Means, 106th Congress,
Background Material and Data on Programs Within the Jurisdiction of the
Committee on Ways and Means (Comm. Print 2000). Subpart 2

Page 9 GAO- 03- 956 Title IV- B Child Welfare Services

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. 13 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.

13 Some subpart 2 funds are reserved for specific activities. For example,
$10 million in mandatory funds and 3.3 percent of discretionary funds in
each fiscal year are reserved for grants to state courts to improve child
welfare proceedings. In addition, 1 percent of mandatory funds and 2
percent of discretionary funds are reserved for grants to Indian tribes.

Page 10 GAO- 03- 956 Title IV- B Child Welfare Services

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. 14 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.
14 Staff of the House Committee on Ways and Means, 106th Congress,
Background Material

and Data on Programs Within the Jurisdiction of the Committee on Ways and
Means (Comm. Print 2000). State Plan Requirements

for Subparts 1 and 2

Page 11 GAO- 03- 956 Title IV- B Child Welfare Services

Table 1: Selected Requirements to Obtain Grants under Subparts 1 and 2 of
Title IV- B Subpart 1 Subpart 2

To receive subpart 1 funding, states must submit to HHS a 5- year plan
outlining the goals of the child welfare agency and annual reports
describing the progress made toward those goals. In this plan, states
must:

 To receive subpart 2 funding, states must submit to HHS a 5- year plan
outlining the goals of the child welfare agency and annual reports
describing the progress made toward those goals. In this plan, states
must:

 Specify the goals that will be accomplished by the end of the 5- year
plan, specific and measurable objectives that will be undertaken to
achieve each goal, and describe the

methods to be used in measuring annual progress in meeting these goals.

 Specify the goals that will be accomplished by the end of the 5- year
plan, specific and measurable objectives that will be undertaken to
achieve each goal, and describe the methods to be used in measuring annual
progress in meeting these goals.

 Describe the child welfare services provided and the geographic areas
where they are available.

 Describe the child welfare services provided and the geographic areas
where they are available and the populations to be served.

 Describe the steps taken to provide child welfare services and to make
progress in developing new services and expanding access to services.

 Describe how subpart 2 funds will be used to develop or expand services
covered by subpart 2.

 Consult with appropriate public and community- based organizations in
designing programs.

 Consult with appropriate public and community- based organizations in
designing programs.

 Ensure that the state will administer the plan in accordance with
methods determined by HHS to be proper and efficient.

 Ensure that the state will administer the plan in accordance with
methods determined by HHS to be proper and efficient.

 Provide reports and participate in evaluations as required by HHS.

 Provide reports and participate in evaluations as required by HHS.

 Describe activities undertaken for children adopted from other countries
and report certain data on those children who enter state custody due to
the disruption or dissolution of such an adoption.

 Ensure that the safety of children will be the paramount concern in
administering and conducting services.

 Ensure that the state will develop plans for the effective use of cross-
jurisdictional resources to facilitate timely adoptions for children
waiting to be adopted.  Ensure that, at the end of the 5- year period
covered by the

state*s child welfare plan, states review with appropriate public and
community- based organizations the progress made toward goals, publish a
report on the progress, and develop

new goals for the program.

 Provide for the diligent recruitment of foster and adoptive families
that reflect the racial and ethnic diversity of children in the state who
need foster or adoptive homes.

 Ensure that federal funds provided under subpart 2 will not supplant
federal or nonfederal funds for existing services that promote the
purposes of subpart 2.

 Describe specific measures taken to comply with the Indian Child Welfare
Act.

 Ensure that no more than 10 percent of expenditures will be used for
administrative costs.

 Ensure that the state has implemented policies and procedures that allow
expeditious decisions about permanent placement for children who are
abandoned at birth.

 Explain how organizations were selected to provide family support
services and how these organizations meet the requirement that family
support services be community based.

 Ensure that the state operates a case review system for each child in
state- supervised foster care.  Ensure that the state operates a
statewide information

system to provide information about children in foster care. Source: Title
IV- B of the Social Security Act and 45 CFR 1357. Note: Bolded text
indicates where subpart 2 requirements differ from those pertaining to
subpart 1.

Page 12 GAO- 03- 956 Title IV- B Child Welfare Services

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 Alternative Financing Mechanisms for Child

Welfare Services The Primary Emphases of These Subparts Vary Somewhat, but
the Range of Services and Types of Families Served Overlap Significantly

Page 13 GAO- 03- 956 Title IV- B Child Welfare Services

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. 15 However, neither subparts 1 nor 2 funded a unique category of
service at the national level. 16 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.

15 The adoption promotion and support services category includes the
recruitment and training of foster and adoptive parents, adoption support
services, and adoption preservation services.

16 Although no unique service categories are funded exclusively by either
subpart at the national level, states did report individual service
categories that were funded by subpart 1, but not subpart 2. However, no
national trend emerged among the types of services that

were funded uniquely by subpart 1. While the Distribution of Funds Differs
Somewhat,

Some Overlap in Service Categories Exists

Page 14 GAO- 03- 956 Title IV- B Child Welfare Services

Table 2: Fiscal Year 2002 Expenditures for Subparts 1 and 2 Service
Categories Subpart 1 Subpart 2

Service category Number of states Amount of subpart 1 funding a

Percentage of subpart 1 funding Number of

states Amount of subpart 2 funding a Percentage of subpart 2

funding b Staff positions 25 $70,965,578 27.6 17 $6,229,058 2. 4
Administration and management 16 43,143,097 16.8 18 11,614,667 4. 5

Child protective services 17 40,543,000 15.8 5 2,248,690 0. 9 Foster care
maintenance payments 17 27,890,783 10.8 2 647,154 0. 3

Multiple responses c 8 25,806,347 10.0 4 3,503,585 1. 4 Family support/
prevention 17 19,840,891 7. 7 28 127,430,496 49.8

Counseling and mental health services 2 8,350,562 3. 2 5 1,354,763 0. 5

Family preservation 7 5,986,045 2. 3 23 30,308,896 11.8 Adoption subsidy
payments 7 4,657,546 1. 8 2 737,412 0. 3

Family reunification 4 2,446,570 1. 0 26 23,625,973 9. 2 Recruitment and
training for foster/ adoptive parents 9 2,260,061 0. 9 16 6,828,885 2. 7

Adoption support and preservation services 2 446,877 0. 2 27 28,481,585
11.1

Other 11 4,817,180 1. 9 15 12,795,915 5. 0

Total d $257,154,537 100.0% $255,807,079 100.0% Source: GAO survey. Notes:
Percentages do not always total to 100 due to rounding. Data on subpart 1
expenditures are based on survey responses from 46 states and data on
subpart 2 expenditures are based on survey responses from 44 states. While
Pennsylvania responded to our survey, it did not provide expenditure data
for subparts 1 or 2. a When providing data for our survey, states were
asked to indicate the single service category that

best described the type of program funded by subparts 1 and 2. Thus,
programs that fall into multiple service categories may not be fully
captured. For example, one state indicated it funded a family support
program, which includes some family preservation and reunification
services. In addition, states may not have been consistent in categorizing
services. For example, several HHS officials told us that the delineation
between family support and family preservation services is not clear, so
that

two states providing the same services to the same types of families may
report them in different categories. Inconsistencies such as these could
have an effect on any measured differences among service categories.

Page 15 GAO- 03- 956 Title IV- B Child Welfare Services

b States may spend less than 20 percent of their subpart 2 funds on any of
the required service categories if they have a strong rationale. Some HHS
regional officials said that they approve exceptions to the 20 percent
requirement if a state is spending a significant amount of nonfederal
funds on a subpart 2 service category. c Although states were asked to
indicate the single service category that best described the type of

program funded by subparts 1 and 2, several states selected multiple
program categories when responding to our survey. For example, Rhode
Island reported that it funded a home visitation program and indicated
that this program includes family support, health, and family
reunification services. Thus, the responses from states that reported
multiple categories for a program are represented by this category. d The
aggregate dollars reported in the service categories do not match the
total allocations for

subparts 1 and 2 in fiscal year 2002. States have 2 years to spend their
Title IV- B allocations; as a result, expenditures in fiscal year 2002 may
include dollars from a state*s fiscal year 2001 Title IV- B allocation, as
well as its fiscal year 2002 Title IV- B allocation. Similarly, some
fiscal year 2002 allocations may not have been spent until fiscal year
2003.

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). 17 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.

17 The survey data reported in this category reflect the salaries of staff
affiliated with the child welfare agency. These figures do not include the
salaries of child welfare agency staff dedicated to a specific program,
which may be embedded within some of the other direct service categories,
such as family support and family preservation. In addition, a state may
use Title IV- B funds to contract with an organization to provide a
particular program, which may include salary expenses as well as direct
service expenditures.

Page 16 GAO- 03- 956 Title IV- B Child Welfare Services

Figure 1: Percentage of Subpart 1 Funds Used for Staff Salaries Dedicated
to Each Type of Staff Position in Fiscal Year 2002 Notes: Some states
spent subpart 1 funds on salaries, but could not provide information on
the types

of staff positions included. 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. 18 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 18 This amount may be underestimated, since some states may not
have separately reported

administrative expenses associated with a specific program. For example,
officials in one state reported that the total spending for a family
support program included salaries for agency staff, overhead expenses, and
related staff travel.

47%

CPS social workers/ staff

20% All other social workers

20% 

Other staff

     

3%

Supervisory social workers

3%

Legal services staff

4%

Administrative staff

4%

Management staff Source: GAO survey data.

Page 17 GAO- 03- 956 Title IV- B Child Welfare Services

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

Page 18 GAO- 03- 956 Title IV- B Child Welfare Services

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

Page 19 GAO- 03- 956 Title IV- B Child Welfare Services

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. Significant Overlap Exists

among the Types of Children and Families Served by Subparts 1 and 2

Page 20 GAO- 03- 956 Title IV- B Child Welfare Services

Table 3: Populations Targeted by Services Funded by Subparts 1 and 2 of
Title IV- B in Fiscal Year 2002 Subpart 1 Subpart 2

Population served No. of services Amount of subpart 1

funding Percent of funding No. of services Amount of subpart 2

funding Percent of funding

Children in foster care and/ or their parents 33 $34,732,673 42 46
$15,218,065 9

Children at risk of child abuse and neglect and/ or their parents 28
13,751,328 17 133 73,996,404 44

Programs serving multiple populations 21 11,949,444 14 43 18,119,756 11

Children at risk of child abuse or neglect and/ or their parents and
children living in foster care and/ or their parents 12 7,077,448 9 39
17,606,172 11

Programs serving all populations 5 7,513,368 9 7 11,028,464 7

Children waiting for adoption, adopted children, and adoptive parents 9
4,153,271 5 54 27,340,372 16

Other populations, such as delinquent teens and foster parents 10
3,492,142 4 16 3,336,070 2

Total a 118 $82,669,674 100% 338 $166,645,301 100%

Source: GAO survey. Note: This analysis is based on survey responses from
35 states with state- administered child welfare systems that provided
population data for their subpart 1 services and 39 states with
stateadministered child welfare systems that provided population data for
their subpart 2 services. Therefore, these data can only be generalized to
states with state- administered child welfare systems. a The dollar totals
in this table do not match those in table 2 because we do not have
population data

from states that completed the county- administered survey. Due to the
differences in information available from states with county- administered
child welfare systems, we did not request data in the first county-
administered survey on the types of children and families who received
services funded by Title IV- B* these data were to have been obtained on
the second survey. In addition, we did not collect data on the populations
served for the category of staff salaries, and we excluded population data
for the category of administration and management expenses since these
expenses are not targeted to a particular population of children and
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

Page 21 GAO- 03- 956 Title IV- B Child Welfare Services

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.

Table 4: Number of States Using Funds from Each Subpart of Title IV- B to
Target Specific Populations Population type Number of states providing
services for this population type with subpart 1 funds a Number of states

providing services for this population type with subpart 2

funds a Number of states providing services for

this population type with both subpart 1 and subpart 2 funds Children in
foster care or parents with children living in foster care 20 29 15

Children at risk of child abuse or neglect and parents with children at
risk of child abuse and neglect 20 34 20

Children waiting for adoption, adopted children, and adoptive parents 8 26
5

Foster parents 5 7 3 Source: GAO survey.

Note: This analysis is based on survey responses from 35 states with
state- administered child welfare systems that provided population data
for their subpart 1 services and 39 states with stateadministered child
welfare systems that provided population data for their subpart 2
services. Therefore, these data can only be generalized to states with
state- administered child welfare systems. Due to the differences in
information available from states with county- administered child welfare
systems, we did not request data in the first county- administered survey
on the types of children and families who received services funded by
Title IV- B* these data were to have been obtained on the second survey. a
We did not collect data on the populations served for the category of
staff salaries. In addition, we

excluded population data for the category of administration and management
expenses since these expenses are not targeted to a particular population
of 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

Page 22 GAO- 03- 956 Title IV- B Child Welfare Services

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

services, and  two states provided varying estimates for different
subpart 1 services. 19 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.

19 The second survey requested information about the three services
receiving the largest portions of subpart 1 funding, so states generally
only estimated the extent to which recipients of these services also
received services funded by subpart 2. These data are not

necessarily representative of other subpart 1 services or other states.

Page 23 GAO- 03- 956 Title IV- B Child Welfare Services

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 IVB 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. HHS Officials Believe Title

IV- B Offers Flexibility While Targeting Prevention Activities, and States
Emphasize the Need for Flexibility

Page 24 GAO- 03- 956 Title IV- B Child Welfare Services

Figure 2: Survey Data on States* Preferences between Subparts 1 and 2 of
Title IV- B for Different Program Components

Note: Data on state preferences are based on responses from 46 states,
although they did not all respond to each item.

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,

0 5

10 15

20 25

30 Formula for state grant

Allowable spending categories

Spending restrictions

Federal set asides

Reporting requirements

Formula for Indian tribe grants

Subpart 1 preferred Subpart 2 preferred Equally preferred Not applicable
Source: GAO survey data.

Number of states expressing a preference

Page 25 GAO- 03- 956 Title IV- B Child Welfare Services

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. 20 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.

20 Several officials noted that allowing a little more flexibility with
the 20 percent spending requirement for subpart 2 could provide some
additional flexibility to states without having to seek approval from HHS.
For example, staff in one regional office suggested that requiring states
to spend no less than 10 percent and no more than 40 percent of subpart 2
funds in any service category would offer this additional flexibility.

Page 26 GAO- 03- 956 Title IV- B Child Welfare Services

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. 21 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

21 The statutory limit also includes payments for child care services
required due to a parent*s employment or training needs. However, only two
states reported any planned subpart 1 spending on this type of child care
service for fiscal year 2002. For the purposes of this report, we mention
only foster care maintenance and adoption assistance payments when
referring to subpart 1 limits, although we did include planned spending on
child care in our analyses of states* planned subpart 1 spending. HHS
Focuses

Oversight on Overall Child Welfare System, but Has Limited Knowledge about
States* Use of Subpart 1 Funds HHS Focuses Much of Its

Oversight on States* Overall Child Welfare Systems and Outcomes

Page 27 GAO- 03- 956 Title IV- B Child Welfare Services

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. 22 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

22 In addition, HHS funds eight national resource centers to disseminate
information on best practices and provide technical assistance to help
states implement federal legislation intended to ensure the safety,
permanent placement, and well- being of children who enter the child
welfare system.

Page 28 GAO- 03- 956 Title IV- B Child Welfare Services

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 HHS
Has Little Information

about States* Use of Subpart 1 Funds

Page 29 GAO- 03- 956 Title IV- B Child Welfare Services

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. 23 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. 24 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

23 For example, the CFS- 101 for fiscal year 2002 was due by June 30,
2001. Because they are submitted before final appropriations have been
enacted, a state might not request the full amount of funds to which it is
entitled, if the final appropriation is greater than the state*s initial
estimate. 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.

24 While most states administer their child welfare systems at the state
level, a handful of states delegate administrative responsibility and
substantial control to counties or other local entities. Several large
states, such as California, New York, Ohio, and Pennsylvania, are county-
administered.

Page 30 GAO- 03- 956 Title IV- B Child Welfare Services

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. 25 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

25 States are required to submit general reports on their total subpart 1
expenditures, but these provide no data on how the funds are actually
used. Per instructions from the Office of Management and Budget, agencies
must require states receiving federal grants to complete a financial
status report (SF 269), providing general information on state
expenditures. For example, the form might indicate that a state spent $10
million in subpart 1 funds in a specific fiscal quarter, but it provides
no details on how the $10 million was used. HHS Regional Offices Are
Unaware of Subpart 1

Spending Limits or Do Not Enforce Them

Page 31 GAO- 03- 956 Title IV- B Child Welfare Services

adoption assistance payments. 26 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.

26 Each state*s ceiling on the use of subpart 1 funds for foster care
maintenance and adoption assistance payments is based on its total 1979
subpart 1 expenditures for all types of services.

Page 32 GAO- 03- 956 Title IV- B Child Welfare Services

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). 27 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 CFS101
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.

27 In most cases, we reviewed the final revised CFS- 101 approved by HHS.
For 1 state, however, we used the initial CFS- 101 approved by HHS because
it included planned subpart 1 expenditures that exceeded the limits for
foster care and adoption assistance payments. Although the revised CFS-
101 did not show that 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. In addition, we were
unable to determine whether the planned fiscal year 2002 subpart 1
spending for 5 other states exceeded the limits because HHS approved their
CFS- 101s with flawed data. These 5 states* Iowa,

Nevada, New Hampshire, New Jersey, and New Mexico* all reported planned
subpart 1 spending for foster care maintenance and adoption assistance
payments in excess of the statutory limits. However, although states are
supposed to separately estimate planned spending for the federal portion
of their subpart 1 funds on the CFS- 101, these 5 states included the
state match and/ or other funds in their estimates. In these cases, we
could not determine whether the spending plans exceeded the statutory
limits for federal subpart 1 funds. States are allowed to use all of their
state matching funds for foster care

maintenance or adoption assistance payments.

Page 33 GAO- 03- 956 Title IV- B Child Welfare Services

Figure 3: Fifteen States with Approved CFS- 101s with Fiscal Year 2002
Subpart 1 Spending Estimates that Exceeded Limits for Foster Care
Maintenance and Adoption Assistance Payments 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

Ala. Conn. Fla. Ga. Hawaii Kans. Md. Mich. Miss. Nebr. N. Y. Pa. S. Dak.
Tenn. Wyo.

Statutory limit on total subpart 1 spending for foster care maintenance
and adoption assistance payments Combined subpart 1 planned spending for
foster care maintenance and adoption assistance payments (as reported on
CFS- 101)

Source: GAO analysis of HHS data.

Dollars in millions $0 $2,000,000

$4,000,000 $6,000,000

$8,000,000 $10,000,000

Page 34 GAO- 03- 956 Title IV- B Child Welfare Services

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. 28 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.

28 Nine of the 12 states were also cited as needing improvement in
ensuring that needed services are accessible to families in all areas of
the state and 8 of the 12 states were categorized as needing improvement
in terms of individualizing services to meet the unique needs of
individual families.

Page 35 GAO- 03- 956 Title IV- B Child Welfare Services

Figure 4: Ten States That Reported Fiscal Year 2002 Subpart 1 Expenditures
Exceeding Limits for Foster Care Maintenance and Adoption Assistance
Payments 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

Statutory limit on total subpart 1 spending for foster care maintenance
and adoption assistance payments Combined subpart 1 expenditures for
foster care maintenance and adoption assistance payments (as reported on
GAO*s survey)

Source: Analysis of GAO survey and HHS data.

Dollars in millions $0

Colo. Fla. Kans. Mich. Nev. N. H. N. J. N. Mex. Okla. S. Dak. $1,000,000

$2,000,000 $3,000,000

$4,000,000 $5,000,000

$6,000,000 $7,000,000

Page 36 GAO- 03- 956 Title IV- B Child Welfare Services

spending above the limits. 29 The remaining 6 states did not report
estimated subpart 1 spending over these limits. 30 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

29 Of the 15 states with planned spending above the limits, 8 reported
subpart 1 expenditures within the statutory limits, 4 reported subpart 1
expenditures above the limits, and 3 did not separately identify foster
care maintenance and adoption assistance payments on their surveys.

30 Four of the 6 states included state matching funds in their CFS- 101
estimates, so we could not determine whether the spending plans for those
states exceeded the statutory limits. Some Unique Subpart

1 Service Categories Exist at the State Level, but Little Research Exists
on the Effectiveness of These Services

Page 37 GAO- 03- 956 Title IV- B Child Welfare Services

6 categories. 31 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. 32 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

31 Virginia did not provide any data on its subpart 2 spending, so we were
not able to determine whether the state uniquely funded any service
categories with subpart 1. New York does not receive any subpart 2 funds,
so we considered all services funded by subpart 1 to be unique.

32 See http:// www. strengtheningfamilies. org/ html/ programs_ 1999/ 22_
HIPPY. html.

Page 38 GAO- 03- 956 Title IV- B Child Welfare Services

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. 33 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. 34 One official explained that few
states can afford to divert resources from providing direct services to

33 The Future of Children, *The Home Instruction Program for Preschool
Youngsters (HIPPY)* (Los Altos, CA: Spring/ Summer 1999). 34 While few
states had evaluated their unique subpart 1 services, 4 of the 17 states
responding to our second survey indicated that they had evaluated other
subpart 1 services that were not unique.

Page 39 GAO- 03- 956 Title IV- B Child Welfare Services

conducting formal evaluations of programs, given the tremendous service
needs of families involved with the child welfare system. 35 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. 36 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

35 Some national research exists for some of the unique service categories
at the state level; however, the extent to which the research is
applicable to the specific services in the unique subpart 1 categories is
difficult to determine. For example, in some cases, the

service in a unique subpart 1 category was not based on the same model
that was evaluated or states did not provide sufficient information on our
survey to determine whether the program was based on this particular
model. Therefore, we do not discuss this research in our report.

36 A number of evaluations of similar types of family preservation
programs have found that children in control groups also had low rates of
out- of- home placement, raising questions about the effectiveness of
these services.

Page 40 GAO- 03- 956 Title IV- B Child Welfare Services

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 outof- 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. 37 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. 37 Ira M. Cutler, Alexandra Tan, and Laura Downs, State
Investments in Education and

Other Children*s Services: Case Studies of State Innovations (n. p.:
September 1995), http:// www. financeprojectinfo. org/ Publications/
studies. html (downloaded Jul. 8, 2003).

Page 41 GAO- 03- 956 Title IV- B Child Welfare Services

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 indepth
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.
Conclusions

Recommendations

Page 42 GAO- 03- 956 Title IV- B Child Welfare Services

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.
Agency Comments

Page 43 GAO- 03- 956 Title IV- B Child Welfare Services

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

Page 44 GAO- 03- 956 Title IV- B Child Welfare Services

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.

Sincerely yours, Cornelia M. Ashby Director, Education, Workforce,

and Income Security Issues

Appendix I: Scope and Methodology Page 45 GAO- 03- 956 Title IV- B Child
Welfare Services

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. 1 We
received responses from 47 states, although some states were unable to
provide complete information. 2 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. 3
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
1 The following 7 states completed the county- administered survey
version: Colorado, Georgia, Maryland, Minnesota, New York, Pennsylvania,
and Wisconsin. 2 We did not receive responses from the District of
Columbia, Indiana, Kentucky, or Montana. 3 The 17 states that responded to
the second survey were Arkansas, Delaware, Florida,

Hawaii, Illinois, Kansas, Louisiana, Massachusetts, New Mexico, North
Dakota, Oklahoma, South Dakota, Texas, Utah, Vermont, Washington, and
Wyoming. Appendix I: Scope and Methodology

Appendix I: Scope and Methodology Page 46 GAO- 03- 956 Title IV- B Child
Welfare Services

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.

Appendix I: Scope and Methodology Page 47 GAO- 03- 956 Title IV- B Child
Welfare Services

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* CFS101s
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

Appendix I: Scope and Methodology Page 48 GAO- 03- 956 Title IV- B Child
Welfare Services

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/).

Appendix I: Scope and Methodology Page 49 GAO- 03- 956 Title IV- B Child
Welfare Services

 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.

Appendix II: Comments from the Department of Health and Human Services
Page 50 GAO- 03- 956 Title IV- B Child Welfare Services

Appendix II: Comments from the Department of Health and Human Services

Appendix II: Comments from the Department of Health and Human Services
Page 51 GAO- 03- 956 Title IV- B Child Welfare Services

Appendix II: Comments from the Department of Health and Human Services
Page 52 GAO- 03- 956 Title IV- B Child Welfare Services

Appendix II: Comments from the Department of Health and Human Services
Page 53 GAO- 03- 956 Title IV- B Child Welfare Services

Appendix III: GAO Contacts and Acknowledgments

Page 54 GAO- 03- 956 Title IV- B Child Welfare Services

Diana Pietrowiak (202) 512- 6239 Michelle St. Pierre (617) 788- 0558

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. Appendix
III: GAO Contacts and

Acknowledgments GAO Contacts Acknowledgments

Related GAO Products Page 55 GAO- 03- 956 Title IV- B Child Welfare
Services

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. Related GAO
Products

Related GAO Products Page 56 GAO- 03- 956 Title IV- B Child Welfare
Services

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.

(130177)

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