Child Welfare: Improving Social Service Program, Training, and	 
Technical Assistance Information Would Help Address Long-standing
Service-Level and Workforce Challenges (06-OCT-06, GAO-07-75).	 
                                                                 
Despite substantial federal and state investment, states have not
been able to meet all outcome measures for children in their	 
care. Given the complexity of the challenges that state child	 
welfare agencies face, GAO was asked to determine (1) the primary
challenges state child welfare agencies face in their efforts to 
ensure the safety, well-being, and permanent placement of the	 
children under their supervision; (2) the changes states have	 
made to improve the outcomes for children in the child welfare	 
system; and (3) the extent to which states participating in the  
Department of Health and Human Services (HHS) Child and Family	 
Services Reviews (CFSR) and technical assistance efforts find the
assistance to be helpful. GAO surveyed child welfare agencies in 
50 states, the District of Columbia, and Puerto Rico and visited 
5 states, interviewed program officials, and reviewed laws,	 
policies, and reports.						 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-07-75						        
    ACCNO:   A61928						        
  TITLE:     Child Welfare: Improving Social Service Program,	      
Training, and Technical Assistance Information Would Help Address
Long-standing Service-Level and Workforce Challenges		 
     DATE:   10/06/2006 
  SUBJECT:   Child care programs				 
	     Child welfare					 
	     Employee training					 
	     Federal aid to states				 
	     Federal funds					 
	     Federal/state relations				 
	     Foster children					 
	     Monitoring 					 
	     Program evaluation 				 
	     State-administered programs			 
	     Surveys						 
	     Technical assistance				 
	     Social services					 
	     HHS Child and Family Services Reviews		 
	     System						 
                                                                 

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GAO-07-75

     

     * Results in Brief
     * Background
          * Federal Funding for State Child Welfare Programs
          * HHS Child and Family Services Reviews and Technical Assistan
     * States Identified Several Long-standing and Emerging Challen
          * Long-standing Challenges Include Providing Adequate Services
          * A Large Array of Specific Services Needed by Children and Fa
          * Large Caseloads, Administrative Burden, and the Effectivenes
          * Recruiting and Retaining Foster Parents for All Kinds of Chi
     * Emerging Challenges Include Children's Exposure to Illegal D
     * State Initiatives Insufficiently Address State Challenges to
          * State Initiatives Did Not Address All the Key Factors Relate
     * States Generally Found HHS Reviews and Technical Assistance
          * HHS Child and Family Services Reviews Helped States Assess N
          * States Generally Viewed Federal Technical Assistance as Help
     * Conclusions
     * Recommendations for Executive Action
     * Agency Comments and Our Evaluation
          * Web-Based Survey
          * Site Visits
     * GAO Contact
     * Staff Acknowledgments
     * GAO's Mission
     * Obtaining Copies of GAO Reports and Testimony
          * Order by Mail or Phone
     * To Report Fraud, Waste, and Abuse in Federal Programs
     * Congressional Relations
     * Public Affairs

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

United States Government Accountability Office

GAO

October 2006

CHILD WELFARE

Improving Social Service Program, Training, and Technical Assistance
Information Would Help Address Long-standing Service-Level and Workforce
Challenges

GAO-07-75

Contents

Letter 1

Results in Brief 3
Background 5
States Identified Several Long-standing and Emerging Challenges to
Ensuring Child Safety, Well-Being, and Permanency 7
Emerging Challenges Include Children's Exposure to Illegal Drugs, Caring
for Special Needs Children, and Responding to Changing Demographics of the
Child Welfare Population 19
State Initiatives Insufficiently Address State Challenges to Improve Child
Outcomes, and Evaluations Showed Mixed Results 20
States Generally Found HHS Reviews and Technical Assistance Helpful, but
HHS's Monitoring System Has Limitations 26
Conclusions 29
Recommendations for Executive Action 30
Agency Comments and Our Evaluation 30
Appendix I Objectives, Scope, and Methodology 33
Appendix II Federal Funding for State Child Welfare Programs 36
Appendix III Type, Description, and Status of Title IV-E Waiver
Demonstration Programs, as of August 2006 38
Appendix IV Department of Health and Human Services Child Welfare National
Resource Centers and whether They Are Included in the Technical Assistance
Tracking Internet System Database 41
Appendix V Comments from the Department of Health and Human Services 42
Appendix VI GAO Contacts and Staff Acknowledgments 47
Related GAO Products 48

Tables

Table 1: Child and Family Services Review Results Related to the Three
Most Important Child Welfare Challenges Reported by States 10
Table 2: State-Reported Use and Assessment of HHS Training and Technical
Assistance 28

Figures

Figure 1: Child Welfare Challenges Reported by States as the Three Most
Important Challenges to Resolve 8
Figure 2: States Reporting Dissatisfaction with the Level of Services
Provided to Children in the Child Welfare System 11
Figure 3: States Reporting Dissatisfaction with the Level of Services
Provided to Parents of At-Risk Families in the Child Welfare System 12
Figure 4: States Reporting Dissatisfaction with the Level of Services
Provided to Children and to Parents of At-Risk Families in the Child
Welfare System 13
Figure 5: States Reporting Dissatisfaction with Factors That Could Affect
the State's Ability to Recruit and Retain Caseworkers 15
Figure 6: States Reporting Factors of Greatest Concern in Making
Appropriate Placements for Children 17
Figure 7: State-Reported Emerging Issues That Are Likely to Affect
Children in Child Welfare System over the Next 5 Years 19
Figure 8: State-Reported Initiatives to Improve Services to Children and
Families 22
Figure 9: State-Reported Initiatives to Recruit and Retain Caseworkers 23
Figure 10: State-Reported Initiatives to Find Appropriate Homes for
Children 25

Abbreviations

ACF Administration for Children and Families CAPTA Child Abuse Prevention
and Treatment Act CFDA Catalog of Federal Domestic Assistance CFSR Child
and Family Services Reviews CHA Children's Health Act CPS Child Protective
Services CWLA Child Welfare League of America HHS Health and Human
Services NRC national resource center PIP program improvement plan TANF
Temporary Assistance for Needy Families TATIS Technical Assistance
Tracking Internet System VCAA Victims of Child Abuse Act

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separately.

United States Government Accountability Office

Washington, DC 20548

October 6, 2006

The Honorable Jim McDermott Ranking Minority Member Subcommittee on Human
Resources Committee on Ways and Means House of Representatives

Despite substantial federal and state investment in various social
services, states continue to receive more than 2 million reports of child
maltreatment each year and report having more than half a million children
in state foster care systems. While children in foster care were removed
from their homes to protect them from harm or neglect, states have
struggled to meet established federal child welfare standards for ensuring
the safety and well-being of these children in their care. Between March
2001 and March 2004, in its first round of Child and Family Services
Reviews (CFSR) evaluating each state's1 child welfare program, the U.S.
Department of Health and Human Services (HHS) found that no state had
achieved all of the federal outcome measures for ensuring the safety,
well-being, and permanency2 of children.

For fiscal year 2006, Congress appropriated about $8 billion to support
the ability of state child welfare systems to provide services that
protect children from abuse and neglect, promote their physical and mental
well-being, find them a permanent home, and enable families to
successfully care for their children, including those children with
special needs.3 At the federal level, HHS's Children's Bureau under the
Administration for Children and Families (ACF) establishes federal policy,
oversees states' child welfare programs in part through its CFSRs, and
provides technical assistance to states primarily through its national
resource centers (NRCs) and HHS regional offices. State child welfare
agencies administer the programs and monitor the children and their
families. States use federal funds to support all aspects of the child
welfare program, including helping families stay together; providing
financial support for families fostering children who had been removed
from their homes; finding adoptive or other permanent homes for children;
and recruiting, hiring, and training child welfare employees.

1In this report, we use the term states to refer collectively to the 50
states plus the District of Columbia and Puerto Rico.

2Permanency is defined as providing a lifetime commitment to a child in a
setting where he or she is safe, can have a sense of belonging and
well-being, and can live to adulthood.

3Special needs are factors that can include medical, emotional, mental, or
behavioral needs that will require ongoing assistance and support, age, or
membership in a minority group.

Given the complexity of the challenges facing state child welfare
agencies, you asked us to determine (1) the primary challenges state child
welfare agencies face in their efforts to ensure the safety, well-being,
and permanency of the children under their supervision; (2) the changes
states have made since January 1, 20024, to improve the outcomes for
children in the child welfare system; and (3) the extent to which states
participating in HHS's Child and Family Services Reviews and technical
assistance efforts find the assistance to be helpful. As part of this
work, GAO also examined the extent to which states had developed written
child welfare disaster plans for dealing with the dispersion of children
under state care to other counties or states, because of disasters. In
July 2006, GAO issued the report Child Welfare: Federal Action Needed to
Ensure States Have Plans to Safeguard Children in the Child Welfare System
Displaced by Disasters ( GAO-06-944 ) in response to the disaster planning
part of your request.

We used multiple data collection methods to obtain this information.
First, we surveyed state child welfare directors in 50 states, the
District of Columbia, and Puerto Rico to obtain information on the most
important challenges that their agencies faced, the changes that their
agencies had made since 2002 to improve the outcomes for children, the
extent to which their states participated in HHS's oversight and technical
assistance efforts, and the extent to which they viewed the assistance as
helpful. We achieved a 96 percent response rate. Second, we interviewed
child welfare officials in five states: California, New York, North
Carolina, Texas, and Utah. These states were selected for variance in
program administration (state-administered,
state-supervised/county-administered, state- and county-administered), the
predominance of urban or rural characteristics, the achievement of child
welfare standards on the CFSRs, changes in the number of children reported
to be in foster care, and geographic location. We interviewed federal
child welfare officials and representatives from national child welfare
organizations concerning state child welfare programs, the changes that
states had made since 2002 to improve the outcomes for children, and the
extent to which states participated in HHS's CFSRs and technical
assistance efforts. In addition, we reviewed several national studies and
our previous child welfare reports to determine the challenges that states
face in their efforts to ensure the safety, well-being, and permanency of
the children under their supervision. Finally, we analyzed agency
documentation, legislation, and other documentation related to child
welfare programs and requirements. We conducted our work between October
2005 and August 2006 in accordance with generally accepted government
auditing standards.

4The first round of HHS's Child and Family Services Reviews began in March
2001. By January 2002, states had begun to develop programs improvement
plans and implement changes to address the child welfare areas that were
identified as needing improvement during the reviews.

                                Results in Brief

State child welfare agencies identified three primary challenges as most
important to resolve to improve outcomes for children under their
supervision: providing an adequate level of services for children and
families, recruiting and retaining caseworkers, and finding appropriate
homes for certain children. Specifically, most states expressed
dissatisfaction with the level of mental health and substance abuse
services for both parents and children, the high average number of child
welfare cases per worker, and their ability to find homes for children
with special needs, such as those with developmental disabilities. GAO,
child welfare organizations, and the Administration have consistently
shown these issues to be long-standing challenges for most states and have
pointed to the need for a multi-agency approach to addressing them. For
example, to address the lack of information on available services, the
White House Task Force for Disadvantaged Youth recommended in 2003 that
the Catalog of Federal Domestic Assistance (CFDA)-a repository of
information on all federal assistance programs-be modified to provide a
search function of the locations where more than 300 federal programs are
operating to assist youth and families. State officials also identified
three challenges of increasing concern: children's growing exposure to
illegal drugs; increased demand to provide services for children with
special needs; and changing demographic trends or cultural sensitivities
in providing services for some groups of children in the states' child
welfare systems.

Most states reported that they had implemented initiatives to address
challenges associated with improving the level of services, recruiting and
retaining caseworkers, and finding appropriate homes for children. The
frequency of these initiatives, however, did not always mirror the levels
of dissatisfaction with the major challenges. For example, with respect to
services, state child welfare agencies responding to our survey most
frequently identified that they were challenged by the lack of mental
health and substance abuse services for children and families, yet only a
fourth of the states reporting dissatisfaction in these areas also
reported having initiatives to improve the level of these services. One
reason may be that these services are typically provided outside of the
child welfare system, and about half of the states reporting this
challenge also reported initiatives to improve collaboration with other
agencies. Most states reported that they had implemented initiatives to
improve recruitment and retention of child welfare caseworkers, but states
reported little or no action to address two of the most frequently
reported factors underlying this challenge. For example, while most states
reported dissatisfaction with caseworker supervision, only two states
reported specific initiatives to address this challenge, and no states
reported initiatives to address caseworker administrative burden.
Similarly, most states reported initiatives to find appropriate homes for
children, including finding and supporting kinship homes, but only three
states had initiatives to find appropriate homes for older youth and four
to find homes for children with special needs. In states where evaluations
of their initiatives had been completed under a federal demonstration
project, the evaluations generally showed that states had achieved mixed
results across child welfare outcomes.

States we visited reported that HHS's Child and Family Services Reviews
and training and technical assistance efforts helped them assess their
efforts and ability to achieve safety, permanence, and well-being for the
children and families under their care and develop the necessary program
improvement plans to meet federal requirements for improving their child
welfare programs. For example, officials in three of the five states we
visited reported that the CFSRs prompted them to develop interagency
strategies for providing an array of needed services to children and
families. Nearly all states in our survey reported that HHS-sponsored
technical assistance was helpful to some degree. However, HHS officials
said that its technical assistance tracking system has several limitations
that hinder its use as a management tool. For example, only 8 of the 11
NRCs are required to report to the tracking system, and those that do
inconsistently enter information into the system. As a result, HHS
officials told us that it is difficult to determine how best to allocate
technical assistance resources to help maximize states' ability to address
child welfare issues.

We are making three recommendations to the Secretary of Health and Human
Services for improving awareness of, and access to, various social
services, and improving the department's ability to manage technical
assistance. HHS agreed that technical assistance data should be complete,
accurate, and timely, but disagreed that centralized program information
and recording all technical assistance would adequately address states'
child welfare challenges or improve their ability to effectively allocate
technical assistance to states. GAO continues to believe that implementing
these recommendations would help states address their long-standing child
welfare challenges.

                                   Background

The well-being of children and families has traditionally been understood
as a primary duty of state governments, and state and local governments
are the primary administrators of child welfare programs designed to
protect children from abuse or neglect. Child welfare caseworkers
investigate allegations of child maltreatment and determine what services
can be offered to stabilize and strengthen a child's own home. If
remaining in the home is not a safe option for the child-he or she may be
placed in foster care while efforts to improve the home are made. In these
circumstances, foster care may be provided by a family member, also known
as kinship care; caregivers previously unknown to the child; or a group
home or institution. In those instances where reuniting the child with his
or her parents is found not to be in the best interest of the child,
caseworkers must seek a new permanent home for the child, such as an
adoptive home or guardianship. Some children remain in foster care until
they "age out" of the child welfare system. Such children are transitioned
to independent living, generally at the age of 18 years.

Federal Funding for State Child Welfare Programs

States use both dedicated and nondedicated federal funds for operating
their child welfare programs and providing services to children and
families. In fiscal year 2006, the federal government provided states with
about $8 billion in dedicated child welfare funds, primarily authorized
under Title IV-B and Title IV-E of the Social Security Act. (See app. II.)
Nearly all of this funding is provided under Title IV-E, which provides
matching funds to states for maintaining eligible children in foster care,
providing subsidies to families adopting children with special needs, and
for related administrative and training costs.5 About 9 percent of funding
is provided under Title IV-B, which provides grants to states primarily
for improving child welfare services, including a requirement that most
funds be spent on services to preserve and support families.

5Title IV-E also provides grants to states for providing independent
living services to youth who are expected to age out of foster care or who
have already aged out of care. Grants are also provided to states for
providing education and training vouchers for youth aging out of care.

A significant amount of federal funding for child welfare services also
comes from federal funds not specifically dedicated for child
welfare-including the Temporary Assistance for Needy Families (TANF) block
grant, Medicaid, and the Social Services Block Grant. These and hundreds
of other federal assistance programs for children and families, including
many that serve low-income populations, are listed in a centralized
database administered by the General Services Administration that has a
search feature by type of assistance and eligible population. The
Congressional Research Service conservatively estimated that the median
share of total federal child welfare spending derived from nondedicated
federal funding equaled nearly half of all the federal dollars (47
percent) expended by state child welfare agencies,6 based on state child
welfare agency data reported to the Urban Institute for state fiscal year
2002. 7

Despite the large amount of federal funds spent on child welfare from
nondedicated sources, the Congressional Research Service reported that
attention to federal child welfare financing has focused almost
exclusively on dedicated child welfare funding streams and is driven in
part by the belief that the current structure hampers the ability of state
child welfare agencies to achieve positive outcomes for children. Common
charges are that the current structure does not grant states the
flexibility needed to meet the needs of children and their families, and
encourages states to rely too heavily on foster care. Congress authorized
HHS to conduct demonstration projects whereby states were allowed to waive
certain funding restrictions on the use of Title IV-B and Title IV-E funds
under the condition that the flexible use of funds would be cost-neutral
to the federal government. HHS reported that 24 states had participated in
demonstration projects across eight child welfare program areas, such as
caseworker training and services to caretakers with substance abuse
disorders. States were required to conduct an evaluation of project
success in terms of both improving children and family outcomes and cost
neutrality.

6States' use of nondedicated federal funding varied considerably from a
high of 75 percent of total federal child welfare funds expended in
Alabama to less than 2 percent of total federal child welfare funds
expended in North Carolina.

7The Congressional Research Service reported that this is likely an
understatement of nondedicated federal funding states used for their child
welfare programs.

HHS Child and Family Services Reviews and Technical Assistance

As Congress authorized funds for state child welfare programs, it has also
required states to enact policies and meet certain standards related to
those programs. HHS evaluates how well state child welfare systems achieve
federal standards for children through its child and family services
reviews. The CFSR process begins with a state assessment of its efforts,
followed by an on-site review by an HHS team that interviews various
stakeholders in the child welfare system and usually reviews a total of 50
child welfare case files for compliance with federal requirements. After
receiving the team's assessment and findings, the state develops a program
improvement plan (PIP) to address any areas identified as not in
substantial conformity. Once HHS approves the PIP, states are required to
submit quarterly progress reports. Pursuant to CFSR regulations, federal
child welfare funds can be withheld if states do not show adequate PIP
progress, but these penalties are suspended during the PIP implementation
term.

HHS provides training and technical assistance to help states develop and
implement their PIPs through its training and technical assistance
network. This training and technical assistance focuses on building state
agency capacity and improving the state child welfare system. Technical
assistance providers in this network include HHS's Children's Bureau and
regional offices, as well as NRCs and the department's Child Welfare
Information Gateway.8

  States Identified Several Long-standing and Emerging Challenges to Ensuring
                    Child Safety, Well-Being, and Permanency

State child welfare agencies identified three primary challenges as the
most important to resolve to improve outcomes for children under their
supervision: providing an adequate level of services for children and
families, recruiting and retaining caseworkers, and finding appropriate
homes for children. HHS, GAO, and child welfare organizations have
consistently shown these issues to be long-standing challenges for most
states. In addition, state officials identified three challenges of
increasing concern: children's exposure to illegal drugs; increased demand
to provide services for children with special needs, such as those with
developmental disabilities; and changing demographic trends or needs for
cultural sensitivity for some groups of children in care and their
families.

8The Information Gateway provides consolidated access to information on a
Web site about a range of child welfare topics, including international
adoption, foster care, family preservation, and child abuse.

Long-standing Challenges Include Providing Adequate Services, Recruitment and
Retention of Caseworkers, and Placement Issues

In responding to our survey, states most frequently identified the
following three child welfare challenges as the most important to resolve
in order to improve the safety, permanency, and well-being of children
under states' care: providing adequate services to children and families,
recruiting and retaining caseworkers, and finding appropriate homes for
children. (See fig. 1.)

Figure 1: Child Welfare Challenges Reported by States as the Three Most
Important Challenges to Resolve

GAO and child welfare organizations have previously reported on the
long-standing nature of these challenges. For example, GAO previously
reported that gaps in the availability and access to services delayed
states' ability to file for a petition to terminate parental rights-a
necessary step in obtaining a permanent home for children who cannot live
with their parents-because parents were unable to obtain timely access to
substance abuse treatment and other services, such as mental health
services and housing.9 GAO and other organizations have also previously
reported that public and private child welfare agencies face a number of
challenges recruiting and retaining qualified caseworkers and
supervisors.10 For example, we reported that high caseloads, poor
supervision, and the burden of administrative responsibilities have, in
some cases, prompted caseworkers to voluntarily leave their employment
with child welfare agencies. We also reported difficulties in recruiting
adoptive parents for children with special needs. 11

The most important challenges identified by state child welfare agencies
are consistent with HHS's CFSR findings and states' self-assessments of
their programs. For example, according to the Congressional Research
Service, HHS reviewers found that 43 states needed improvement in
providing accessible services to children and at-risk families in all
jurisdictions of the state and 31 states needed improvement in conducting
diligent recruitment of foster and adoptive parents.12 The number of
states needing improvement in performance indicators related to child
welfare services, recruitment and retention of caseworkers, and placement
of children in appropriate homes is shown in table 1.

9One provision of the Adoption and Safe Families Act of 1997 requires
states to file a termination of parental rights with the courts if the
child has been in foster care for 15 of the most recent 22 months unless,
among other reasons, the state has not provided services needed to make
the home safe for the child's return. For additional information, see GAO,
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).

10See GAO, D.C. Child and Family Services Agency: More Focus Needed on
Human Capital Management Issues for Caseworkers and Foster Parent
Recruitment and Retention, GAO-04-1017 (Washington, D.C.: Sept. 24, 2004),
and 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).

11See GAO-02-585 , and GAO, Child Welfare: Better Data and Evaluations
Could Improve Processes and Programs for Adopting Children with Special
Needs, GAO-05-292 (Washington, D.C.: June 13, 2005)

12See Congressional Research Service, Child Welfare: State Performance on
Child and Family Services Reviews, (Washington, D.C.: June 29, 2005).

Table 1: Child and Family Services Review Results Related to the Three
Most Important Child Welfare Challenges Reported by States

Child welfare                                             Number of states 
challenge             Performance Indicator            needing improvement 
Services              Providing accessible services to                  43 
                         children and at-risk families in 
                         all jurisdictions within a state 
Services              Responsiveness of services to                     27 
                         the needs of children and        
                         at-risk families                 
Services              Tailoring services to the unique                  22 
                         needs of children and at-risk    
                         families                         
Recruitment and       Providing ongoing training for                    25 
retention of          staff that addresses the skills  
caseworkers           and knowledge needed to carry    
                         out their duties                 
Recruitment and       Providing initial training for                    18 
retention of          all staff who provide child      
caseworkers           welfare services                 
Placement of children Ensuring the diligent                             31 
in appropriate homes  recruitment of foster and        
                         adoptive parents                 

Source: GAO analysis of Congressional Research Service data.

A Large Array of Specific Services Needed by Children and Families, Especially
in the Area of Mental Health and Substance Abuse, Underlie the Challenge

State child welfare agencies identified specific services underlying their
challenge to serve children and families, citing constraints on federal
funding and limited awareness of services among eligible families as
contributing factors. Regarding children, more than half of states
reported that they were dissatisfied with the level of mental health
services, substance abuse services, housing for foster youth transitioning
to independence, and dental care. (See fig. 2.)

Figure 2: States Reporting Dissatisfaction with the Level of Services
Provided to Children in the Child Welfare System

States also reported that they were dissatisfied with the level of
services provided to at-risk families in the child welfare system. These
services are needed to help prevent the removal of children from their
homes or help facilitate the reunification of children with their parents
after removal. Specifically, more than half of states responded that they
were dissatisfied with mental health services, substance abuse services,
transportation services, and housing for parents of at-risk families. (See
fig. 3.)

Figure 3: States Reporting Dissatisfaction with the Level of Services
Provided to Parents of At-Risk Families in the Child Welfare System

For some types of services, states expressed more dissatisfaction with
services available to at-risk families than with services available to
children. For example, more states reported dissatisfaction with the level
of at-risk family services than with children's services in the areas of
assessment of their service needs, legal services, and advocacy or case
management. (See fig. 4.)

Figure 4: States Reporting Dissatisfaction with the Level of Services
Provided to Children and to Parents of At-Risk Families in the Child
Welfare System

States we visited reported that funding constraints were among the reasons
maintaining an adequate level of services was difficult. For example,
while maintenance payments to foster families for children under state
care is provided as an open-ended entitlement for federal funding under
Title IV-E, federal funding for family support services is capped at a
much lower level under Title IV-B. In addition, because the proportion of
children in foster care who are eligible for federal support has been
declining, states had to provide a greater share of funding at a time when
many states were experiencing budget deficits that adversely affected
overall funding for social services. In prioritizing funding needs, child
welfare officials in 40 states responding to our survey reported that
family support services, such as those that could prevent removal of a
child or help with reunification of a family, were the services most in
need of greater federal, state, or local resources. Officials from 29
states responded that child protective services such as investigation,
assessment of the need for services, and monitoring were next in need of
additional resources.

Officials in a state we visited indicated that some caseworkers and
families may be unaware of the array of existing services offered by
numerous public and private providers. In North Carolina, for example,
state officials reported that about 70 percent of children and families in
the child welfare system received services from multiple public agencies,
and the CFDA-a repository of information on all federal assistance
programs that is periodically updated-lists over 300 federal programs that
provide youth and family services. However, caseworkers and families are
not always aware of the range of services that are available to support
them, and child welfare officials cited the need for additional
information to help link children and families with needed services. In
October 2003, the White House Task Force for Disadvantaged Youth
recommended that the CFDA be modified to provide a search feature linked
to locations where federally funded programs were operating. A similar
model may be found on an HHS Web link, http://ask.hrsa.gov/pc/, where
users can enter a ZIP code to find the closest community health center
locations offering medical, mental, dental, and other health services on a
sliding fee scale.

Large Caseloads, Administrative Burden, and the Effectiveness of Supervision
Underlie the Caseworker Recruitment and Retention Challenge

State child welfare officials most frequently reported dissatisfaction
with the current status of three underlying factors that affect the
state's ability to recruit and retain caseworkers. Specifically, more than
half of the states reported dissatisfaction with the average number of
cases per worker, administrative responsibilities of caseworkers, and
effectiveness of caseworker supervision. (See fig. 5.)

Figure 5: States Reporting Dissatisfaction with Factors That Could Affect
the State's Ability to Recruit and Retain Caseworkers

Child welfare officials in each of the states we visited reported having
trouble recruiting and retaining caseworkers because many caseworkers are
overwhelmed by large caseloads. According to a 2006 Child Welfare League
of America (CWLA) report, some programs lack caseload standards that
reflect time needed to investigate allegations of child maltreatment,
visit children and families, and perform administrative responsibilities.
The report also cites CWLA's caseload standards of no more than 12 cases
per caseworker investigating allegations of child maltreatment, and no
more than 15 cases for caseworkers responsible for children in foster
care. However, according to the report, most states, average caseloads in
some areas are often more than double the CWLA standards.

State child welfare officials we interviewed also reported that increasing
amounts of time spent on administrative duties made it difficult to
recruit and retain staff and limiting the amount of time caseworkers could
spend visiting families. For example, child welfare officials in three
states we visited estimated that some caseworkers spent a significant
amount of time on administrative duties such as entering case data in
automated systems, completing forms, and providing informational reports
to other agencies. This administrative burden has limited caseworker
ability to ensure timely investigations of child maltreatment and to make
related decisions concerning the removal of children from their homes,
according to officials, and influenced caseworker decisions to seek other
types of employment.

Some states we visited reported that the lack of effective supervision
also adversely affected staff retention and sometimes resulted in delays
providing appropriate services to children and families. Lack of
supervisory support was cited as a problem in terms of supervisor
inexperience and inaccessibility. For example, a Texas state official said
that because of high turnover, caseworkers are quickly promoted to
supervisory positions, with the result that the caseworkers they supervise
complain of poor management and insufficient support. In Arizona,
caseworkers have expressed dissatisfaction in the support they received
from their supervisors, and this has negatively affected recruitment and
retention. Child welfare officials reported that lack of access to
supervisors was frustrating to caseworkers because it delayed their
ability to specify appropriate permanency goals for children and to
develop case plans to meet the needs of children and families in their
care.

Recruiting and Retaining Foster Parents for All Kinds of Children, but
Especially for Children Who Are Older or Have Special Needs, Are Some of the
Underlying Placement Challenges for States

Relative to other challenges, state child welfare officials most
frequently identified four factors underlying the challenge to find
appropriate homes for children. (See fig. 6.) Recruiting and retaining
foster parents and serving children with special needs were at the top of
the list. Also, more than half of the states reported that finding homes
for children with special needs, older youth, and youth transitioning into
independent living, and finding and supporting kinship homes, were among
their greatest concerns.

Figure 6: States Reporting Factors of Greatest Concern in Making
Appropriate Placements for Children

Child welfare officials in two states we visited said that the lack of
therapeutic foster care homes that can properly care for children who have
significant physical, mental, or emotional needs makes it challenging to
find them an appropriate home. In addition, these officials said that some
of the existing facilities are inappropriate for child placement because
they are old and in poor condition or provide outmoded treatment services.
Because of the absence of high-quality therapeutic settings, child welfare
officials said that it has become increasingly difficult to place children
in homes that can appropriately address their individual needs.

Recruiting and retaining foster and adoptive parents has become an
increasingly difficult aspect of placement for a variety of reasons, such
as the lack of a racially and ethnically diverse pool of potential foster
and adoptive parents, and inadequate financial support. For example, child
welfare officials said that some locations have relatively small
populations of certain races and ethnicities, making it difficult to
recruit diverse foster and adoptive parents.13 Inadequate financial
support also hinders recruiting and retaining foster and adoptive
families. Financial support for foster and adoptive families varies widely
among states and local areas, and may not keep up with inflation.
According to a California child advocacy organization, for example, the
state's payments to foster parents of $450 per month per child have not
been adjusted for inflation since 2001. As a result, according to the
organization, the supply of foster care providers has not increased
markedly during this time.

13Generally, states and other entities involved in adoption or foster care
are prohibited by law from delaying or denying the placement of a child
for adoption or into foster care, on the basis of the race, color, or
national origin of the adoptive or foster parent, or the child, involved.
42 U.S.C. S: 1996b.

Obtaining permanent homes for older youth and for youth aging out of
foster care is a continuing placement challenge for states. For example,
Texas child welfare officials said that it is difficult to place
adolescents with adoptive parents because older youth can choose not to be
adopted. Finding housing for youth transitioning into independence also
can be difficult in high-cost areas or in areas where special arrangements
have not been made with housing agencies and landlords that typically
require a cosigner on the rental application or a large deposit before
moving in.14

More than half of the states also reported that limitations in their
ability to identify and support placements with family members or legal
guardians limited opportunities to place children in appropriate homes.
For example, child welfare officials in Ohio reported a lack of resources
to conduct outreach to family members that may be able to provide a stable
home for children in foster care with less disruption to the child.
Michigan officials also reported that the lack of financial resources made
it difficult for the state to meet its placement goals for those children
who had been removed from their home and who had been directed by the
court to be placed with other family members.

14See GAO, Foster Youth: HHS Actions Could Improve Coordination of
Services and Monitoring of States' Independent Living Programs, GAO-05-25
(Washington, D.C.: Nov. 18, 2004).

  Emerging Challenges Include Children's Exposure to Illegal Drugs, Caring for
  Special Needs Children, and Responding to Changing Demographics of the Child
                               Welfare Population

While states have experienced child welfare challenges for many years,
states identified several emerging issues that are of increasing concern
because of their impact on the well-being of children in the child welfare
system. Most states reported a high likelihood that three issues will
affect their systems over the next 5 years: children's exposure to illegal
drugs, caring for special or high-needs children, and changing
demographics and cultural sensitivities. (See fig. 7.)

Figure 7: State-Reported Emerging Issues That Are Likely to Affect
Children in Child Welfare System over the Next 5 Years

Although the overall percentage of drug-related child welfare cases has
not increased, officials in the states we visited reported that the type
and location of drug abuse underlying maltreatment cases is changing,
requiring increased attention by child welfare agencies in certain areas.
For example, child welfare officials reported an increasing number of
children entering state care as a result of methamphetamine use by
parents, primarily in rural areas. Child welfare agencies in these areas
may need to train caseworkers on how this drug is likely to affect parents
or caregivers who use it in order to safely investigate and remove
children from homes, as well as assess the service needs of affected
families to develop an appropriate case plan.15

15Methamphetamine users often exhibit poor judgment, confusion,
irritability, paranoia, and increased violence.

State child welfare officials in all five states we visited said that
finding homes for special needs children is a growing issue because it is
hard to find parents willing to foster or adopt these children and who
live near the types of services required to meet the children's needs. For
example, child welfare officials in one of the states we visited reported
that the state does not have a sufficient number of adoptive homes for
children with special needs. As a result, these children generally stay in
foster care for longer periods of time.

Child welfare officials we interviewed also said that the growing cultural
diversity of the families who come in contact with the child welfare
system has prompted the need for states to reevaluate how they investigate
allegations of maltreatment and the basis on which they make decisions
that could result in the removal of children from their homes. Child
welfare officials in several states reported that the current protocols
for investigating and removing children from their homes do not
necessarily reflect the cultural norms of some immigrant and other
minority families. These differences include limitations in family
functioning that may be caused by poverty, the environment, or culture as
opposed to those that may be due to unhealthy family conditions or
behaviors. In response to growing cultural diversity, several states we
visited stated that they are revising their protocols to account for
religious and language differences among families who come in contact with
the child welfare system.

State Initiatives Insufficiently Address State Challenges to Improve Child
                 Outcomes, and Evaluations Showed Mixed Results

Most states reported that they had implemented initiatives since January
2002 to address challenges associated with maintaining an adequate level
of services, recruiting and retaining caseworkers, and finding appropriate
homes for children. However, these initiatives did not address all of the
key factors states reported being associated with these challenges. In
states where evaluations of their initiatives had been completed under a
federal demonstration project, the evaluations generally showed that
states had achieved mixed results across child welfare outcomes.

State Initiatives Did Not Address All the Key Factors Related to the Three
Challenges Cited as Most Important to Improve Child Outcomes

States reported implementing various initiatives to improve child
outcomes, but these initiatives did not always mirror those factors states
reported as most necessary to address in overcoming their primary
challenges. For example, with respect to services, states most frequently
identified that they were challenged by the lack of mental health and
substance abuse services for children and families, yet only a fourth of
the 32 states dissatisfied with these services reported having initiatives
to improve the level of these services. (See fig. 8.) This may be because
these services are typically provided outside the child welfare system by
other agencies. About half of the states reporting dissatisfaction also
reported initiatives to improve collaboration with other agencies.16

16We previously reported on how problems requiring interagency solutions
often go unaddressed in such areas as transportation and housing. See
GAO-05-25 and GAO, Child Welfare: Improved Federal Oversight Could Assist
States in Overcoming Key Challenges. GAO-04-418T (Washington, D.C.: Jan.
28, 2004).

Figure 8: State-Reported Initiatives to Improve Services to Children and
Families

aOther initiatives include court-required changes of services, focusing on
children 0-3 years of age, and creating a family division in the court
system.

Similarly, most states reported that they had implemented initiatives to
improve recruitment and retention of child welfare caseworkers, but states
reported little or no action to address two of the most frequently
reported factors underlying this challenge. (See fig. 9.) While most
states reported dissatisfaction with the supervision of caseworkers, only
two reported specific initiatives to address this challenge. Similarly,
while over half of the states reported dissatisfaction with the
administrative responsibilities of caseworkers, no state reported an
initiative to address this challenge. One way of streamlining
administrative responsibilities-through new technology-may be difficult
for many states because nearly half of the states reported that they did
not have an operational statewide automated child welfare information
system.

Figure 9: State-Reported Initiatives to Recruit and Retain Caseworkers

aOther initiatives include developing a child welfare leadership program,
centralizing hiring processes, and expanding community-based services.

Almost all states reported implementing initiatives to improve their
ability to find appropriate homes for children, but few states addressed
two of the three most frequently reported factors underlying this
challenge (see fig. 10). For example, three states reported initiatives to
find appropriate homes for older youth transitioning to independence and
four states reported initiatives to find appropriate homes for children
with special needs.17

17GAO previously reported that child welfare agencies focused on preparing
youth for independent living while they were in foster care, but were less
apt to work with other agencies-such as the local housing authority-to
transition youth out of care because of conflicting policies and a lack
awareness about needed services. See GAO-05-25 .

Figure 10: State-Reported Initiatives to Find Appropriate Homes for
Children

aOther initiatives include working with Native American groups on child
placement, implementing team decision making, and ensuring that children
in out-of-region placements are seen regularly.

States implementing initiatives under federal demonstration projects were
required to conduct evaluations, and these evaluations showed mixed
results. In general, the demonstration projects offered states the
flexibility to use federal funding under Title IV-B and Title IV-E in
eight different program areas in an effort to improve services and
placements-addressing the three primary challenges reported by states (see
app. III). As of 2006, 24 states had implement 38 child welfare waiver
demonstrations. However, evaluation results were mixed across child
welfare outcomes. For example, while Illinois found strong statistical
support for the finding that funding for assisted guardianships increased
attainment of permanent living arrangements, none of the other four
reporting states found similar conclusive evidence of this finding.
Similarly, among four states using Title IV-E funds to fund services and
supports for caregivers with substance abuse disorders, Illinois was the
only state that demonstrated success in connecting caregivers to treatment
services. States can no longer apply for participation in federal
demonstration projects because the program authorization expired in March
2006.

 States Generally Found HHS Reviews and Technical Assistance Helpful, but HHS's
                       Monitoring System Has Limitations

States we interviewed reported that HHS's CFSR and technical assistance
efforts were helpful in implementing federal child welfare requirements.
Similarly, nearly all states in our survey reported that HHS-sponsored
technical assistance was helpful to some degree. However, HHS officials
said that limitations in their technical assistance tracking system made
it difficult to maximize its use as a management tool.

HHS Child and Family Services Reviews Helped States Assess Needs and Make
Improvements

State child welfare officials generally reported that HHS's CFSR reviews
have assisted them in assessing their efforts and ability to achieve the
safety, permanence, and well-being for the children under their care and
develop the necessary program improvement plans to meet federal
requirements in this regard. Specifically, state officials responding to
our survey reported that the reviews had helped them to implement system
wide child welfare reform, improve their quality assurance systems, and
increase their collaboration with other child welfare-related agencies.
Additionally, child welfare officials in three of the five states we
visited reported that the reviews prompted them to develop interagency
strategies for providing an array of needed services, such as mental
health services and education for children and families.

Most states reported that there was not much need to improve the
usefulness of the CFSR process to help the state ensure safety,
permanence, and well-being of children in the child welfare system, but
some state officials expressed concern about the outcome measures used. Of
the 48 states responding to our survey question about the CFSR process, 33
states reported that the usefulness of the CFSR process needed little to
none or some improvement. Some state officials we interviewed were
concerned, however, that the outcomes being measured in the reviews may
not accurately reflect their child welfare program performance. In
addition, officials in three of the five of the states we visited
expressed concern about the small number of sample cases used by the
reviewers to evaluate their state's performance. Specifically, officials
in one state reported that evaluating only 50 cases left the state with
uncertainty about how pervasive problems are in the state and what its
priority areas should be.18

Although the first round of HHS's reviews showed that no state had reached
substantial conformity on all of the federal outcome goals for state child
welfare systems, HHS officials said that states had made progress in
implementing federal requirements and improving their child welfare
systems. For example, HHS officials said that the quality of data has
improved because states have put a greater focus on having accurate and
reliable data and many states are examining their data in greater detail
than before in an effort to identify problems in their child welfare
systems and to figure out how to meet the CFSR requirements. The next
round of reviews is scheduled to begin at the end of fiscal year 2006,
when HHS officials will once again measure states' progress in meeting
federal child welfare requirements.

States Generally Viewed Federal Technical Assistance as Helpful, but HHS's
Monitoring System Has Limitations as a Management Tool

Nearly all states reported in our survey that the federal technical
assistance they received to improve their child welfare programs was
helpful to some degree,19 although some resources were given higher
ratings than others, as shown in table 2. States generally reported the
highest levels of satisfaction with assistance provided by two of HHS's
national resource centers that had primary responsibility for helping with
child protective service and organizational improvement. The federal
resources providing technical assistance in the areas of substance abuse,
community-based child abuse prevention, and abandoned infants received the
fewest requests from states.

18See GAO, Child and Family Services Reviews: Better Use of Data and
Improved Guidance Could Enhance HHS's Oversight of State Performance.
GAO-04-333 (Washington, D.C.: Apr. 20, 2004).

19States responded to a survey question and said that HHS technical
assistance was most often either helpful, very helpful, or extremely
helpful.

Table 2: State-Reported Use and Assessment of HHS Training and Technical
Assistance

                                                             Number of states 
                                           Number of states           finding 
                                                    finding        assistance 
                          Number of states  assistance very       somewhat or 
                           using technical     or extremely        moderately 
                                assistance          helpful           helpful 
National child welfare resource centers
Center for Child                     33               31                 2 
Protective Services                                      
Center for                           36               32                 3 
Organizational                                           
Improvement                                              
Center for Youth                     27               22                 5 
Development                                              
Collaboration to                     37               30                 6 
AdoptUsKids                                              
Center for                           34               26                 8 
Family-Centered                                          
Practice and                                             
Permanency Planning                                      
Center for Adoption                  24               18                 5 
Center on Legal &                    26               19                 5 
Judicial Issues                                          
Center for Child                     31               20                11 
Welfare Data &                                           
Technology                                               
Other federal resources
National Adoption                    29               23                 6 
Information                                              
Clearinghouse                                            
National Clearinghouse               33               22                11 
on Child Abuse and                                       
Neglect Information                                      
HHS regional offices                 47               31                16 
Center on Substance                  17               11                 4 
Abuse and Child                                          
Welfare                                                  
Center for                           11                7                 4 
Community-Based Child                                    
Abuse Prevention                                         
Programs                                                 
National Abandoned                    6                1                 4 
Infants Assistance                                       
Resource Center                                          

Source: GAO analysis of state child welfare survey responses.

HHS's Technical Assistance Tracking Internet System (TATIS) monitors
federal training and technical assistance requested and provided to
states, but several limitations that hinder its use as a management tool.
One limitation is that the system was designed to capture only assistance
provided by eight NRCs. (See app. IV.) Because TATIS does not capture
training and technical assistance provided by the remaining three NRCs,
other federal resource centers, and HHS's regional offices, HHS officials
do not have a complete picture of the assistance requested by states and
provided to them. For example, the NRC for substance abuse is not required
to enter data into TATIS, but NRC records show that it provided 47 on-site
technical assistance visits to 16 states in fiscal year 2005, making it
among one of the most frequent providers of on-site federal assistance. A
second limitation is that the eight NRCs do not always enter information
into TATIS as required, raising concerns about the ability of HHS to
determine how often states use its various resources and for what purpose.
For example, an official from one of the eight NRCs we interviewed said
that his center is not as conscientious as it should be about entering all
of the required data into TATIS. HHS officials said that without this
information, it is difficult to determine how best to allocate technical
assistance resources to help maximize states' ability to address child
welfare issues.

                                  Conclusions

States have been facing some of the same child welfare challenges for many
years, and predict that some emerging challenges will have impacts in the
next several years. The federal government has funded hundreds of programs
to meet families' mental health, substance abuse treatment, and other
social service needs that could help prevent child maltreatment and keep
families together. However, the inability to query the federal
government's central source of information-the CFDA-to identify which
services across program and agencies are available in various locations
makes it difficult to determine the extent of services available at the
local level to serve children and families in the child welfare system.

HHS has provided state child welfare systems an array of training and
technical assistance that states report as helpful for improving their
child welfare programs. Maximizing the value of its training and technical
assistance is compromised, however, because HHS's information system does
not capture all training and technical assistance provided to states from
various HHS-sponsored providers, and compliance with the reporting
requirements has not been enforced. In the absence of complete and timely
information, HHS may be limited in its ability to determine how best to
allocate technical assistance resources to help maximize states' ability
to address child welfare issues.

                      Recommendations for Executive Action

We are making the following three recommendations to the Secretary of
Health and Human Services for improving awareness of and access to various
social services, and improving the department's ability to manage
technical assistance provided to state child welfare agencies.

           o  Develop a strategy to centralize information on federal
           assistance programs that are available to meet child welfare
           program and service needs and that can be accessed by state and
           local child welfare staff and providers. This strategy could
           follow a previous Administration recommendation to develop an
           Internet-based search for services through the Catalog of Federal
           Domestic Assistance (CFDA) that is linked to grantees by ZIP code.

           o  Require all HHS technical assistance providers, including HHS
           regional offices and all national resource centers, to enter
           training and technical assistance data into the department's
           Technical Assistance Tracking Internet System.

           o  Establish policies and procedures to ensure that complete and
           accurate data are timely reported to the Technical Assistance
           Tracking Internet System.

                       Agency Comments and Our Evaluation

We provided a draft of this report to HHS for review and comment. HHS's
written comments are reprinted in appendix V, and the Department's
technical comment was incorporated into the report. In its written
comments, HHS stated that the report substantially supports many of the
findings of the CFSRs, and agreed with one of our three recommendations.
The department agreed with our recommendation to establish policies and
procedures to ensure complete and accurate reporting of data into TATIS
and said it intended to provide written guidance to the resource centers
requiring this reporting. However, the department stated that the report
misconstrued the intent of the CFSRs and that the remaining
recommendations do not adequately match the articulated needs of state
welfare agencies.

HHS disagreed with GAO's reference that no state had achieved all of the
federal outcome measures for ensuring the safety, well-being, and
permanency of children. The department stated that it makes separate
determinations regarding substantial conformity for each of the seven
outcome measures and each of the seven systemic factors reviewed. We
revised the text to reflect that no state had reached substantial
conformity on all of the federal outcome goals for state child welfare
systems in lieu of stating that no state had achieved all of the federal
performance goals.

HHS disagreed with our recommendation to increase awareness of federal
assistance programs by modifying the CFDA, stating that it was misleading
to assume that state challenges could be significantly met or appreciably
altered by a list of resources, in part because the recommendation
incorrectly implies that local child welfare agencies are not aware of
many valuable services; underestimates the substantive knowledge of
resources currently being utilized by caseworkers; child welfare staff
need access to actual services or service providers rather than general
information on federal assistance programs; resource lists quickly become
outdated with state and county programs and service providers changing
annually based on their budgets; and certain federal programs are designed
to meet the needs of very specific, and sometimes very small, populations.

We acknowledge that increasing awareness of available federal resources is
not the only action needed to address the various challenges facing state
child welfare agencies, but believe that caseworker awareness and referral
of children and families to existing resources is an important first step
in meeting the challenge to provide an adequate level of services to them.
As our report states, our current and past work has found that some
caseworkers were unaware of the full array of federal resources, such as
health and housing services, available in their locales, or had not
coordinated with other agencies and organizations to access them. We
continue to support the view that modifying the CFDA would allow
caseworkers and others to more easily identify services and service
providers funded by federal agencies in closest proximity to the families
they serve. As the department points out, modifying the CFDA would not
address issues related to outdated listings of state or local resources;
however, the CFDA is updated biweekly or more often in response to new or
changing information regarding federal assistance. Further, while it is
true that some federal programs target specific populations, these
populations are often low-income or minority groups that are also served
by the child welfare system.

The department also disagreed with our recommendation to require all HHS
technical assistance providers to enter data into TATIS, stating that the
system was not designed to monitor all technical assistance provided to
states, nor would it be an effective stand-alone mechanism to determine
how best to allocate technical assistance resources to states; the
recommendation does not give sufficient weight to the CFSR process;
including training and technical assistance by regional offices in TATIS
would be superfluous as these activities are in regional office job
descriptions; and the recommendation does not recognize that training and
technical assistance is provided to a variety of audiences beyond the
state child welfare agencies, and including more information would confuse
the tracking of technical assistance.

Our report recognizes that TATIS was designed to monitor on-site training
and technical assistance provided by 8 of the 11 resource centers.
However, we continue to believe that expanding TATIS to capture the
substantial on-site assistance provided by the remaining resource centers
and other HHS providers would enhance its contribution to the department
in determining how best to allocate training and technical assistance
resources to states. We acknowledge the benefit of the CFSRs in
identifying states' technical assistance needs. However, state
implementation of program improvement plans in response to the CFSR
findings is only a part of training and technical assistance requested and
provided to states. In addition, while regional office job descriptions
may include training and technical assistance responsibilities, we do not
believe that capturing the amount and type of this assistance actually
provided to states would be superfluous, but rather provide a more
complete picture of the on-site assistance received by states. Further,
our recommendation was not intended to include training and technical
assistance provided to audiences beyond the state child welfare agencies,
and we modified the report text to clarify this point.

Copies of this report are being sent to the Secretary of Health and Human
Services, relevant congressional committees, and other interested parties.
We will also make copies available to others upon request. In addition,
the report will be made available at no charge on GAO's Web site at
http://www.gao.gov. Please contact me on (202) 512-7215 if you or your
staff have any questions about this report. Other contacts and major
contributors are listed in appendix VI.

Sincerely yours,

Cornelia M. Ashby Director, Education, Workforce, and Income Security
Issues

Appendix I: Objectives, Scope, and Methodology

We were asked to examine (1) the primary challenges state child welfare
agencies face in their efforts to ensure the safety, well-being, and
permanency of the children under their supervision; (2) the changes states
have made since January 1, 2002, to improve the outcomes for children in
the child welfare system; and (3) the extent to which states participating
in the Department of Health and Human Services (HHS) Child and Family
Services Reviews (CFSR) and technical assistance efforts find the
assistance to be helpful. As part of this work, GAO also examined the
extent to which states had developed written child welfare disaster plans
for dealing with the dispersion of children under state care to other
counties or states, because of disasters. In July 2006, GAO issued the
report Child Welfare: Federal Action Needed to Ensure States Have Plans to
Safeguard Children in the Child Welfare System Displaced by Disasters (
GAO-06-944 ) in response to the disaster planning part of your request.

To learn more about these objectives, we conducted a Web-based survey of
state child welfare directors and conducted site visits in five states
where we interviewed state officials. We also interviewed federal child
welfare officials and representatives from national child welfare
organizations concerning state child welfare programs, the changes that
states had made since 2002 to improve the outcomes for children, and the
extent to which states participated in HHS's CFSR and technical assistance
efforts. In addition, we reviewed several national studies and our
previous child welfare reports to determine the challenges that states
face in their efforts to ensure the safety, well-being, and permanency of
the children under their supervision. Finally, we analyzed agency
documentation, legislation, and other documentation related to child
welfare programs and requirements. We conducted our work between October
2005 and August 2006 in accordance with generally accepted government
auditing standards.

Web-Based Survey

To obtain state perspectives on our objectives and the relative priority
state child welfare agencies place on the challenges they face, we
conducted a Web-based survey of child welfare directors in the 50 states,
the District of Columbia, and Puerto Rico. The survey was conducted using
a self-administered electronic questionnaire posted on the Web. We
contacted directors via e-mail announcing the survey and sent follow-up
e-mails to encourage responses. The survey data were collected between
February and May 2006. We received completed surveys from 48 states, the
District of Columbia, and Puerto Rico (a 96 percent response rate). The
states of Massachusetts and Nebraska did not return completed surveys.

To develop the survey questions, we reviewed several national studies and
our previous child welfare reports to determine the challenges that states
face in their efforts to ensure the safety, well-being, and permanency of
the children under their supervision. We analyzed agency documentation to
identify HHS's oversight and technical assistance efforts. In November
2005, we also held two discussion groups with representatives from child
welfare stakeholder groups to identify any additional issues that may not
be covered in the published documents we reviewed. The stakeholders
included representatives from the Association of Administrators of the
Interstate Compact on the Placement of Children, the Child Welfare League
of America, the National Association of Public Child Welfare
Administrators, the AARP Grandparent Information Center, the Pew
Commission on Children in Foster Care, the Urban Institute, American Bar
Association Center on Children and the Law, the Center for the Study of
Social Policy, the American Public Human Services Association, and Casey
Family Services.

We worked to develop the questionnaire with social science survey
specialists. Because these were not sample surveys, there are no sampling
errors. However, the practical difficulties of conducting any survey may
introduce errors, commonly referred to as nonsampling errors. For example,
differences in how a particular question is interpreted, in the sources of
information that are available to respondents, or how the data are entered
into a database can introduce unwanted variability into the survey
results. We took steps in the development of the questionnaires, the data
collection, and data analysis to minimize these nonsampling errors. For
example, prior to administering the survey, we pretested the content and
format of the questionnaire with several states to determine whether (1)
the survey questions were clear, (2) the terms used were precise, (3)
respondents were able to provide the information we were seeking, and (4)
the questions were unbiased. We made changes to the content and format of
the final questionnaire based on pretest results. In that these were
Web-based surveys in which respondents entered their responses directly
into our database, there was a reduced possibility of data entry error. We
also performed computer analyses to identify inconsistencies in responses
and other indications of error. In addition, an independent analyst
verified that the computer programs used to analyze the data were written
correctly.

Site Visits

We visited five states-California, New York, North Carolina, Texas, and
Utah. We selected these states because they represent different types of
program administration (state-administered, state-supervised and
county-administered, state- and county-administered), the predominance of
urban or rural characteristics, the achievement of child welfare standards
on the CFSR, changes in the number of children reported to be in foster
care, and are geographically diverse. During these visits, we interviewed
state child welfare officials and collected relevant state agency policies
and procedures and reports.

Information that we gathered on our site visits represents only the
conditions present in the states and local areas at the time of our site
visits. We cannot comment on any changes that may have occurred after our
fieldwork was completed. Furthermore, our fieldwork focused on in-depth
analysis of only a few selected states. On the basis of our site visit
information, we cannot generalize our findings beyond the states we
visited.

Appendix II: Federal Funding for State Child Welfare Programs

                                                                  President's 
                                       Final funding (in millions   budget    
Program                                    of dollars)           request   
Fiscal year                           2004      2005     2006     2007     
Child welfare total                 7,756     7,764     7,676  7,989       
Title IV-E of the Social Security Act
Title IV-E subtotal                 6,866.2   6,861.9   6,772  7,048.9     
Foster care-Open-ended              4,974     4,896     4,685  4,786       
reimbursement of eligible state                                
claims for maintaining children in                             
foster care and for related                                    
administrative and training costs                              
Adoption assistance-Open-ended      1,700     1,770     1,883  2,047       
reimbursement of eligible state                                
claims for providing subsidies to                              
special needs adoptees and for                                 
related administrative and training                            
costs                                                          
Foster care independence-Formula    140       140       140    140         
grants to states for provision of                              
independent living services to                                 
youth expected to age out of foster                            
care and to youth who have aged out                            
of care                                                        
Education and training              44.7      46.6      46.2   46.2        
vouchers-Formula grants to states                              
to provide education and training                              
vouchers to youth who have aged out                            
of foster care                                                 
Adoption incentives-Bonus funds to  7.5       9.3       17.8   29.7        
states that increase the number of                             
foster children adopted                                        
Title IV-B of the Social Security Act
IV-B subtotal                       700.4     701.4     708.3  748.3       
Promoting safe and stable           404       404       394    434         
families-Formula grants to states                              
for four kinds of services: family                             
preservation, family support,                                  
time-limited reunification, and                                
adoption promotion and support                                 
Child welfare services-Formula      289       290       287    287         
grants to states to improve public                             
child welfare services                                         
Court improvement-Formula grants to    NA        NA     20     20.0        
states' highest courts to                                      
strengthen handling of court child                             
welfare proceedings                                            
Child welfare training-Competitive  7.4       7.4       7.3    7.3         
grants to private nonprofit                                    
institutions of higher education to                            
develop and improve education and                              
training programs for child welfare                            
workers                                                        
Child Abuse Prevention and Treatment Act (CAPTA)
CAPTA subtotal                      89.5      101.8     95.2   95.2        
Community-based grants for child    33.2      42.9      42.4   42.4        
abuse prevention-Formula grants to                             
lead entity in each state to                                   
support community-based services                               
designed to prevent child abuse and                            
neglect                                                        
Basic state grants-Formula grants   21.9      27.3      27.0   27.0        
to states to improve their child                               
protection services                                            
Discretionary                       34.4      31.6      25.8   25.8        
activities-Competitive grants for                              
research and demonstration programs                            
related to preventing or treating                              
child maltreatment                                             
Victims of Child Abuse Act (VCAA)   
VCAA subtotal                       26.9      28.6      28.8   25.8        
Court-appointed special             11.6      11.7      11.7   11.8        
advocates-Competitive grants to                                
support advocacy in court for child                            
victims of abuse and neglect                                   
Children's advocacy                 13.0      15.0      14.8   11.7        
centers-Competitive grants for                                 
services to child victims of abuse                             
(and nonoffending family members),                             
to coordinate child abuse                                      
investigations in ways that reduce                             
their trauma, and for related                                  
training and technical assistance                              
Training for judicial practitioners 2.3       1.9       2.3    2.3         
and personnel-Competitive grant to                             
improve court handling of child                                
abuse and neglect cases                                        
Children's Health Act (CHA)         
CHA subtotal                        12.8      12.8      12.7   12.7        
Infant adoption                     9.8       9.8       9.7    9.7         
awareness-Competitive grants to                                
train staff in non-profit health                               
centers about adoption                                         
Special needs adoption              3.0       3.0       3.0    3.0         
awareness-Competitive grants for a                             
public campaign about adoption of                              
children with special needs                                    
Other programs                      
Subtotal (other)                    59.3      59.1      58.6   58.6        
Adoption opportunities-Competitive  27.2      27.1      26.8   26.8        
grants to eliminate barriers to                                
adoptions-especially to special                                
needs adoptions                                                
Children's Justice Act              20.0      20.0      20.0   20.0        
grants-Formula grant to states to                              
improve the handling,                                          
investigation, and prosecution of                              
child abuse and neglect cases                                  
Abandoned infants                   12.1      12.0      11.8   11.8        
assistance-Competitive grants to                               
prevent abandonment of infants                                 
exposed to HIV/AIDS or drugs and                               
for services and programs to                                   
address needs of abandoned children                            

Source: Congressional Research Service documents.

Appendix III: Type, Description, and Status of Title IV-E Waiver
Demonstration Programs, as of August 2006 

                                        Status of demonstration by state                                     
                                                           Completed                                         
                         Active demonstrations          demonstrations                                       
                Under    Under                                          Approved,                            
Project type    original short-term      Under 5-year   On   Terminated not                       Evaluation 
and description waiver   extension       extensiona     time early      implemented               progress   
Assisted        Montana (2006)                  Illinois    Delaware (2002)                      Minnesota    Completed:   
guardianship/                                   (2008)                                                        Delaware,    
kinship         New Mexico                                  Maryland (2004)                      Wisconsin    Illinois,    
permanence:     (2005)                          North                                                         Maryland,    
Relatives/other                                 Carolina,                                                     North        
caregivers who                                  Oregon                                                        Carolina,    
assume legal                                    (2009)                                                        Oregon, New  
custody of                                                                                                    Mexico       
children are                                                                                                               
eligible for a                                                                                                Expected:    
monthly subsidy                                                                                               Montana      
equal or                                                                                                      March 2007   
comparable to                                                                                                 
foster care                                                                                                   
payments.                                                                                                     
Capped IV-E                    Indiana (2005)   North                                                         Completed:   
allocations and                                 Carolina,                                                     Indiana,     
flexibility to                                  Ohio,                                                         North        
local agencies:                                 Oregon                                                        Carolina,    
States give                                     (2009)                                                        Ohio, Oregon 
counties or                                                                                                   
other local                                                                                                   
entities                                                                                                      
flexibility in                                                                                                
spending child                                                                                                
welfare dollars                                                                                               
for new                                                                                                       
services and                                                                                                  
supports in                                                                                                   
exchange for a                                                                                                
capped per                                                                                                    
child/per                                                                                                     
family                                                                                                        
allocation of                                                                                                 
Title IV-E                                                                                                    
funds.                                                                                                        
Services to     Illinois       New Hampshire                Delaware (2002)         Maryland                  Completed:   
caretakers with (2005)         (2005)                                               (2002)                    Delaware,    
substance use                                                                                                 Illinois     
disorders:                                                                                                                 
States use                                                                                                    Expected:    
Title IV-E                                                                                                    New          
dollars to fund                                                                                               Hampshire    
services and                                                                                                  Pending      
supports for                                                                                                  Exemption:   
caregivers with                                                                                               Maryland     
substance abuse                                                                                               
disorders.                                                                                                    
Managed care                                                Michigan (2003)         Colorado,                 Completed:   
payment                                                                             Washington                Colorado,    
systems: States                                                                     (2003)                    Connecticut, 
use alternative                                                                                               Michigan,    
managed care                                                                        Connecticut,              Washington   
financing                                                                           Maryland                               
mechanisms to                                                                       (2002)                    Exemption:   
reduce child                                                                                                  Maryland     
welfare costs                                                                                                 
while improving                                                                                               
permanency,                                                                                                   
safety, and                                                                                                   
well-being                                                                                                    
outcomes for                                                                                                  
targeted                                                                                                      
families.                                                                                                     
Intensive                      California                                           Mississippi               Completed:   
service                        (2005)                                               (2004)                    California,  
options: States                                                                                               Mississippi  
increase the                                                                                                  
variety and                                                                                                   
intensity of                                                                                                  
services and                                                                                                  
supports to                                                                                                   
reduce                                                                                                        
out-of-home                                                                                                   
placement rates                                                                                               
and improve                                                                                                   
other                                                                                                         
permanency and                                                                                                
safety                                                                                                        
outcomes.                                                                                                     
Adoptions and                                               Maine (2004)                         Minnesota    Completed:   
post-permanency                                                                                               Maine        
services:                                                                                                     
States                                                                                                        
strengthen                                                                                                    
existing or                                                                                                   
provide new                                                                                                   
post-adoption                                                                                                 
and                                                                                                           
postpermanency                                                                                                
services and                                                                                                  
supports.                                                                                                     
Tribal          New Mexico                                                                                    Completed:   
administration  (2005)                                                                                        New Mexico   
of IV-E funds:                                                                                                
Tribes develop                                                                                                
administrative                                                                                                
and financial                                                                                                 
systems to                                                                                                    
administer                                                                                                    
Title IV-E                                                                                                    
foster care                                                                                                   
programs                                                                                                      
independently                                                                                                 
and directly                                                                                                  
claim federal                                                                                                 
reimbursement.                                                                                                
Enhanced        Illinois                                                                                      Expected:    
training for    (2007)                                                                                        Illinois     
child welfare                                                                                                 June 2008    
staff: Training                                                                                               
for public and                                                                                                
private sector                                                                                                
child welfare                                                                                                 
professionals                                                                                                 
serving                                                                                                       
children and                                                                                                  
their families                                                                                                
to improve                                                                                                    
permanency and                                                                                                
safety                                                                                                        
outcomes.                                                                                                     

Source: GAO analysis of HHS information on child welfare waiver
demonstrations.

aEvaluations will be submitted by the four states with 5-year extensions.

Appendix IV: Department of Health and Human Services Child Welfare
National Resource Centers and whether They Are Included in the Technical
Assistance Tracking Internet System Database

National                                                          
resource center Description     Web site                          
National Resource Centers Included In the Technical Assistance    
Tracking Internet System Database (TATIS)                         
National Child  Assists with    http://www.nrcoi.org              
Welfare         strategic                                         National    Works to build  http://www.nrccps.org         
Resource Center planning,                                         Resource    state and local 
for             CFSRs, outcome                                    Center for  CPS capacity,   
Organizational  evaluation and                                    Child       assists in      
Improvement     workforce                                         Protective  determining     
                training and                                      Services    eligibility for 
                development;                                      (CPS)       the Child Abuse 
                facilitates the                                               Prevention and  
                involvement of                                                Treatment Act   
                stakeholders;                                                 (CAPTA) grant,  
                and monitors                                                  and provides    
                the technical                                                 support to      
                assistance                                                    state liaison   
                progress.                                                     officers.       
National Child  Provides states http://www.abanet.org/child/rclji 
Welfare         legal and                                         
Resource Center judicial issue                                    
on Legal and    analysis for                                      
Judicial Issues the CFSRs,                                        
                assists in                                        
                action planning                                   
                and                                               
                implementation                                    
                of program                                        
                improvement                                       
                plans.                                            
National        Provides        http://www.nrcfcppp.org           
Resource Center assistance                                        
for             through all                                       
Family-Centered stages of the                                     
Practice and    CFSRs,                                            
Permanency      emphasizes                                        
Planning        family-centered                                   
                principles and                                    
                practices, and                                    
                builds                                            
                knowledge of                                      
                foster care                                       
                issues.                                           
National        Provides        http://www.nrccwdt.org            National    Analyzes        http://www.nrcadoption.org    
Resource Center support for                                       Child       adoption and    
for Child       technical                                         Welfare     permanency      
Welfare Data    issues,                                           Resource    options,        
and Technology  conducts data                                     Center for  provides        
                use and                                           Adoption    support for     
                management                                                    increasing      
                training, and                                                 cultural        
                helps in                                                      competency, and 
                preparation and                                               examines        
                use of state                                                  systematic      
                data profiles.                                                problems and    
                                                                              solutions.      
                                                                  National    Supports youth  http://www.nrcys.ou.edu/nrcyd 
                                                                  Child       participation   
                                                                  Welfare     in child        
                                                                  Resource    welfare policy, 
                                                                  Center for  program         
                                                                  Youth       development and 
                                                                  Development planning,       
                                                                              offers          
                                                                              assistance for  
                                                                              foster care     
                                                                              independence    
                                                                              and education   
                                                                              voucher program 
                                                                              implementation. 
The             Provides        http://www.adoptuskids.org        
Collaboration   training and                                      
to AdoptUsKids  technical                                         
                assistance on                                     
                quality                                           
                recruitment and                                   
                retention                                         
                services for                                      
                foster and                                        
                adoptive                                          
                families.                                         
National resource centers not included In TATIS                   
National Center Works to        http://www.ncsacw.samhsa.gov      
on Substance    develop                                           
Abuse and Child knowledge and                                     
Welfare         provides                                          
(cosponsored    assistance to                                     
with the        child welfare                                     
Substance Abuse agencies on                                       
and Mental      substance abuse                                   
Health Services related                                           
Administration) disorders in                                      
                the child                                         
                welfare and                                       
                family court                                      
                systems.                                          
National        Works to        http://aia.berkeley.edu/          
Abandoned       enhance the                                       
Infants         quality of                                        
Assistance      social and                                        
Resource Center health services                                   
                for children                                      
                abandoned                                         
                because of the                                    
                presence of                                       
                drugs or HIV in                                   
                the family.                                       
National        Focuses on      http://www.friendsnrc.org         
Resource Center primary child                                     
for             abuse and                                         
Community-Based neglect                                           
Child Abuse     prevention,                                       
Prevention      assists in                                        
Programs        implementation                                    
                for family                                        
                support                                           
                strategies.                                       

Source: HHS training and technical assistance documents.

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

Appendix VI: GAO Contacts and Staff Acknowledgments

GAO Contact

Cornelia M. Ashby, (202)512-7215, [email protected]

Staff Acknowledgments

Cindy Ayers (Assistant Director) and Arthur T. Merriam Jr.
(Analyst-in-Charge) managed all aspects of the assignment. Mark E. Ward
made significant contributions to this report, in all aspects of the work.
Christopher T. Langford and Kathleen L. Boggs analyzed the results of the
GAO survey of child welfare challenges and assisted in the report
development. In addition, Carolyn M. Taylor contributed to the initial
design of the engagement, Carolyn Boyce provided technical support in
design and methodology, survey research, and statistical analysis; James
Rebbe provided legal support; and Charles Willson assisted in the message
and report development.

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(130526)

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www.gao.gov/cgi-bin/getrpt? GAO-07-75 .

To view the full product, including the scope
and methodology, click on the link above.

For more information, contact Cornelia M. Ashby at (202) 512-7215 or
[email protected].

Highlights of GAO-07-75 , a report to Minority Member, Subcommittee on
Human Resources, Committee on Ways and Means, House of Representatives

October 2006

CHILD WELFARE

Improving Social Service Program, Training, and Technical Assistance
Information Would Help Address Long-standing Service-Level and Workforce
Challenges

Despite substantial federal and state investment, states have not been
able to meet all outcome measures for children in their care. Given the
complexity of the challenges that state child welfare agencies face, GAO
was asked to determine (1) the primary challenges state child welfare
agencies face in their efforts to ensure the safety, well-being, and
permanent placement of the children under their supervision; (2) the
changes states have made to improve the outcomes for children in the child
welfare system; and (3) the extent to which states participating in the
Department of Health and Human Services (HHS) Child and Family Services
Reviews (CFSR) and technical assistance efforts find the assistance to be
helpful. GAO surveyed child welfare agencies in 50 states, the District of
Columbia, and Puerto Rico and visited 5 states, interviewed program
officials, and reviewed laws, policies, and reports.

What GAO Recommends

GAO recommends that HHS develop a strategy to centralize federal program
information, record all technical assistance to states in its Technical
Assistance Tracking Internet System, and ensure that these data are
complete, accurate, and timely. HHS agreed that data should be complete,
accurate, and timely, but disagreed that centralized program information
and recording all technical assistance would adequately address states'
child welfare challenges or improve their ability to more effectively
allocate technical assistance to states. GAO continues to support these
recommendations.

In response to a GAO survey, state child welfare agencies identified three
primary challenges as most important to resolve to improve outcomes for
children under their supervision: providing an adequate level of services
for children and families, recruiting and retaining caseworkers, and
finding appropriate homes for certain children. State officials also
identified three challenges of increasing concern over the next 5 years:
children's growing exposure to illegal drugs, increased demand to provide
services for children with special needs, and changing demographic trends
or cultural sensitivities in providing services for some groups of
children in the states' child welfare systems.

Child Welfare Challenges Reported by States, in Fiscal Year 2006, as the
Top Three Most Important Challenges to Resolve

Most states reported that they had implemented initiatives to address
challenges associated with improving the level of services, recruiting and
retaining caseworkers, and finding appropriate homes for children. These
initiatives, however, did not always mirror the major challenges. For
example, with respect to services, states most frequently identified that
they were challenged by the lack of mental health and substance abuse
services for children and families, yet only a fourth of the dissatisfied
states reported having initiatives to improve the level of these services.
In states where evaluations of their initiatives had been completed under
a federal demonstration project, the evaluations generally showed that
states had achieved mixed results across child welfare outcomes.

States we visited reported that HHS reviews of their child welfare systems
and training and technical assistance efforts helped them improve their
child welfare programs. For example, officials in three of the five states
we visited reported that the CFSRs prompted them to develop interagency
strategies for providing an array of needed services to children and
families. Similarly, nearly all states in our survey reported that
HHS-sponsored technical assistance was helpful to some degree. However,
HHS officials said that several factors limited their ability to use their
technical assistance tracking system as a management tool. For example,
not all service providers are included in the tracking system, and some
providers inconsistently enter required data into the system. As a result,
HHS may be limited in its ability to determine how best to allocate
technical assistance resources to help maximize states' ability to address
child welfare issues.
*** End of document. ***