Child Welfare: Additional Federal Action Could Help States	 
Address Challenges in Providing Services to Children and Families
(15-MAY-07, GAO-07-850T).					 
                                                                 
Despite substantial federal and state investment, states have had
difficulty ensuring the safety, well-being, and permanency of	 
children in foster care. Ensuring these outcomes becomes even	 
more difficult in the event of disasters such as Hurricanes	 
Katrina and Rita, when children and families may become displaced
across state lines. This testimony discusses (1) the issues that 
states reported as most important to resolve now and in the	 
future to improve outcomes for children under their supervision  
(2) initiatives states reported taking to address these issues	 
and how recent law provides support for additional state efforts 
and (3) federal action taken to assist states' efforts in	 
developing child welfare disaster plans. This testimony is	 
primarily based on our October 2006 report on state child welfare
challenges (GAO-07-75) and our July 2006 report on state child	 
welfare disaster planning (GAO-06-944). The Department of Health 
and Human Services (HHS) and the Congress took action that	 
addressed our July report recommendations. However, HHS disagreed
with our October report recommendation to improve awareness of	 
and access to federal social services by modifying the Catalog of
Federal Domestic Assistance or other means. We continue to	 
believe that taking such action would help improve services to	 
children and families.						 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-07-850T					        
    ACCNO:   A69645						        
  TITLE:     Child Welfare: Additional Federal Action Could Help      
States Address Challenges in Providing Services to Children and  
Families							 
     DATE:   05/15/2007 
  SUBJECT:   Child care programs				 
	     Child welfare					 
	     Children with disabilities 			 
	     Disadvantaged persons				 
	     Disaster planning					 
	     Employment assistance programs			 
	     Federal aid to states				 
	     Federal/state relations				 
	     Foster children					 
	     Monitoring 					 
	     Policy evaluation					 
	     Program evaluation 				 
	     State-administered programs			 
	     Strategic planning 				 
	     Social services					 
	     HHS Promoting Safe and Stable Families		 
	     Program						 
                                                                 
	     HHS Temporary Assistance for Needy 		 
	     Families Block Grant				 
                                                                 
	     Social Services Block Grant			 

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GAO-07-850T

   

     * [1]Background
     * [2]Current and Future Issues That Challenge States' Ability to

          * [3]Inadequate Levels of Mental Health, Substance Abuse, and Oth
          * [4]High Caseloads and Other Factors Challenge the Ability of Ch
          * [5]Serving Children with Special Needs Is among Factors Challen
          * [6]Increasing Complexity and Diversity of Child Welfare Populat

     * [7]State Initiatives to Resolve Challenges
     * [8]Federal Action Taken To Ensure States Develop Plans to Serve
     * [9]Concluding Observations
     * [10]GAO Contacts
     * [11]GAO's Mission
     * [12]Obtaining Copies of GAO Reports and Testimony

          * [13]Order by Mail or Phone

     * [14]To Report Fraud, Waste, and Abuse in Federal Programs
     * [15]Congressional Relations
     * [16]Public Affairs

Testimony

Before the Subcommittee on Income Security and Family Support, Committee
on Ways and Means, U.S. House of Representatives

United States Government Accountability Office

GAO

For Release on Delivery
Expected at 10:00 a.m. EDT
Tuesday, May 15, 2007

CHILD WELFARE

Additional Federal Action Could Help States Address Challenges in
Providing Services to Children and Families

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

GAO-07-850T

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to present information from our recent
reports on the challenges that state foster care systems face in serving
the more than half a million children under their care.^1 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
permanent homes, and enable families to successfully care for their
children. State and local governments contributed more than $12 billion
for these purposes, according to information available from 2004.^2
Despite this substantial investment, federal evaluations of state child
welfare programs showed that states continue to struggle to meet federal
outcome goals established by the Department of Health and Human Services
(HHS) to ensure the safety, well-being, and permanency of children in
foster care. Ensuring these outcomes becomes even more difficult in the
event of disasters such as Hurricanes Katrina and Rita for states that do
not have plans in place to continue child welfare services for children
and families who may become displaced within or across state lines.

State child welfare agencies are responsible for administering their
programs within federal policies established by the Children's Bureau
under the Administration for Children and Families within the Department
of Health and Human Services. This federal agency oversees states' child
welfare programs in part through its child and family services reviews
(CFSR), which measure states' performance in meeting federal outcome
goals. During its first round of CFSRs, completed in the 3 year period
ending March 2004, HHS reported that no state had substantially conformed
with all federal performance goals, and half or more states did not meet
performance indicators such as providing adequate services for children
and families, providing child welfare staff with the ongoing training
needed to fulfill their duties, and ensuring the diligent recruitment of
foster and adoptive homes. Further, while HHS requested states to submit
plans that address the challenges of serving child welfare families in
times of disaster, we reported that as of July 2006, few states had
comprehensive plans in place. Since our reports, HHS and the Congress have
taken action to help states address some of these long-standing challenges
and HHS has begun its next round of CFSRs. My testimony today will focus
on (1) the issues that states reported as most important to resolve now
and in the future to improve outcomes for children under their
supervision, (2) initiatives states reported taking to address these
issues and how recent law provides support for additional state efforts,
and (3) federal action taken to assist states' efforts in developing child
welfare disaster plans. My testimony is based primarily on findings from
our July and October 2006 reports. Those findings were based on multiple
methodologies including a survey of child welfare directors on challenges
they face in improving outcomes for children and the extent that they had
developed child welfare disaster plans. We supplemented these surveys by
conducting multiple site visits to states and counties and by interviewing
child welfare experts and HHS child welfare officials. We conducted our
work in accordance with generally accepted government auditing standards.

^1 GAO, Child Welfare: Improving Social Service Program, Training, and
Technical Assistance Would Help Address Longstanding Service-Level and
Workforce Challenges, [17]GAO-07-75 (Washington, D.C.: Oct. 6, 2006), and
GAO, Child Welfare: Federal Action Needed to Ensure States Have Plans to
Safeguard Children in the Child Welfare System Displaced by Disasters,
[18]GAO-06-944 (Washington, D.C.: July 28, 2006).

^2The Urban Institute, The Cost of Protecting Vulnerable Children V:
Understanding State Variation in Child Welfare Financing (Washington D.C.:
May 2006).

In summary, states reported that inadequate levels of mental health and
substance abuse services, the high average number of child welfare cases
per worker, and the difficulty of finding homes for children with special
needs were the most important challenges to resolve in order to improve
outcomes for children under states' care. Child welfare officials cited
various reasons these challenges existed in their states. One reason
maintaining an adequate level of services is difficult, for example, is
that the funding for family support services has not kept up with the
need, which in turn may result in children entering foster care and
staying there longer. Some states did not have caseload standards to
ensure that caseworkers had enough time to adequately serve each child and
family, and caseworkers in some areas of most states often carried more
than double the caseload standard established by the Child Welfare League
of America (CWLA).^3 State child welfare officials predict that these
caseloads will continue to become increasingly complex and culturally
diverse. Growing challenges for state child welfare systems in the next 5
years were cited as serving the population of children with special needs
or who have been exposed to illegal drugs, and changing demographic trends
that will require greater multicultural sensitivity in providing services
to some groups of children and their families. States have some
initiatives in place to address challenges, but the frequency of
initiatives states reported did not always mirror the levels of
dissatisfaction with the major challenges. For example, 4 of 39 states
dissatisfied with the level of service in finding homes for children with
developmental disabilities or other needs reported initiatives in this
area. Recently enacted legislation, the Child and Family Services
Improvement Act of 2006^4, assists states in addressing some important
challenges by targeting funds to children affected by substance abuse and
to activities designed to recruit and retain caseworkers. Our October
report had recommended that HHS also take action to improve awareness of
and access to federal social services by such means as modifying the
Catalog of Federal Domestic Assistance. In its comments, however, HHS
disagreed with this recommendation, stating that it was insufficient to
address the problem and incorrectly implied that caseworkers were not
already aware of existing resources. We continue to support the
recommendation based on the results of our work. HHS has taken action
along with the Congress to better ensure that states are planning for the
challenges they will face in safeguarding children and families displaced
by disaster, per our July report recommendations. HHS has updated its
guidance and provided technical assistance. In addition, the law now
requires all states to submit child welfare disaster plans to HHS. The
deadline set by HHS for submission of these plans is June 30, 2007.

^3CWLA is an association of nearly 800 public and private nonprofit
agencies with a mission to ensure the safety and well-being of children
and families. CWLA sets and promotes standards for best practice and
advocates for the advancement of public policy.

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 (this is
known as kinship care), caregivers previously unknown to the child, or a
group home or institution. In those instances in which 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.

^4 Pub. L. No. 109-288.

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. Nearly all of
this funding is provided under Title IV-E, which provides matching funds
to states for maintaining eligible children in foster care,^5 providing
subsidies to families adopting children with special needs, and for
related administrative and training costs.^6 About 9 percent of funding is
provided under Title IV-B, which provides grants to states primarily for
improving child welfare services and requires that most funds be spent on
services to preserve and support families.

A significant amount of federal funding for child welfare services also
comes from federal funds not specifically dedicated to 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,^7 based on
state child welfare agency data reported to the Urban Institute for state
fiscal year 2002.^8

5States are entitled to Title IV-E reimbursement on behalf of children who
would have been eligible for Aid to Families with Dependent Children
(AFDC) (as AFDC existed on July 16, 1996), but for the fact that they were
removed from the home of certain specified relatives. While the AFDC
program was replaced by the Temporary Assistance for Needy Families
Program in 1996, eligibility for Title IV-E payments remains tied to the
income eligibility requirements of the now defunct AFDC program. In
addition, certain judicial findings must be present, and all other
requirements included in section 472 (a) and (b) of the Social Security
Act must be met, in order for the child to be eligible for Title IV-E
foster care maintenance payments.

^6Title 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.

The Congress has authorized funds for state child welfare programs and
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 with federal requirements. 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 2-year PIP implementation term. HHS conducted its first round of CFSRs
for all states from March 2001 through March 2004 and began the second
round of CFSRs in March 2007.

States must also meet a set of program requirements that are described in
their 5-year Child and Family Services Plans to receive federal child
welfare funds.^9 Until recently, however, there were no federal
requirements for states to develop plans that address the needs of
children during disasters. In 2005, 29 states and Puerto Rico experienced
federally declared disasters--most commonly severe storms and flooding.
However, a disaster can affect states that do not directly experience the
disaster when they receive children evacuated from affected states. For
example, two 2005 disasters--Hurricanes Katrina and Rita--resulted in a
prolonged interruption of child welfare services and the dispersion of
thousands of Louisiana's child welfare recipients to 19 states.

^7States' 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.

^8The Congressional Research Service reported that this is likely an
understatement of nondedicated federal funding states used for their child
welfare programs.

^9States were required to develop and submit a 5 year Child and Family
Services Plan for fiscal years 2005-2009, by June 30, 2004.

Current and Future Issues That Challenge States' Ability to Improve Child
Outcomes

States reported that their ability to improve child outcomes was
challenged most by inadequate levels of mental health and substance abuse
services available to children and families, too few caseworkers for too
many child welfare cases, and a lack of homes that can meet the needs of
certain children, such as those with developmental disabilities.
Challenges are expected to grow in future years related to serving
children with special needs or who have been exposed to illegal drugs, and
changing demographic trends that will require greater multicultural
sensitivity in providing services to an increasingly diverse child welfare
population.

Inadequate Levels of Mental Health, Substance Abuse, and Other Services
Challenge States' Ability to Meet the Needs of Children and Families

State child welfare agencies identified specific services underlying their
challenge to serve children and families, citing constraints on federal
funding, service gaps, and limited awareness of services outside the child
welfare system as contributing factors. Regarding services provided to
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. 1.)

Fig. 1: 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 to 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 in at-risk
families. (See fig. 2.)

Figure 2: States Reporting Dissatisfaction with the Level of Services
Provided to Parents in 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 are 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, many states experienced
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.

Another reason providing services may be challenging in some states or
areas is 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 Catalog of Federal
Domestic Assistance (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 children and families, 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 that can be used to identify locations where federally
funded programs were operating.^10

High Caseloads and Other Factors Challenge the Ability of Child Welfare Staff to
Adequately Serve Children and Families

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 to serve children and
families in the child welfare system. 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. 3.)

^10A 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.

Figure 3: 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 the Child Welfare League of
America, some child welfare programs lack caseload standards that reflect
time needed to investigate allegations of child maltreatment, visit
children and families, and perform administrative responsibilities. CWLA
set 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 CWLA, in 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 limited 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 also expressed dissatisfaction with 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.

Serving Children with Special Needs Is among Factors Challenging States' Ability
to Place Children in Appropriate Homes

State child welfare officials most frequently identified four factors
underlying the challenge to find appropriate homes for children. (See fig.
4.) More than half of the states reported that finding homes for children
with special needs, recruiting and retaining foster and adoptive parents,
serving older youth and youth transitioning into independent living, and
finding and supporting kinship or guardianship homes were among their
greatest concerns.

Figure 4: 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.^11 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.

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.^12

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.

^11Generally, states and other entities that receive federal financial
assistance and are involved in adoption or foster care are prohibited 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 671(a)(18). However,
HHS guidance recognizes that some children may have specific needs based
on the child's race or ethnicity, and HHS has required that states put in
place a process for ensuring the diligent recruitment of potential foster
and adoptive families that reflects the ethnic and racial diversity of
children needing homes.

^12See GAO, Foster Youth: HHS Actions Could Improve Coordination of
Services and Monitoring of States' Independent Living Programs,
[20]GAO-05-25 (Washington, D.C.: Nov. 18, 2004).

Increasing Complexity and Diversity of Child Welfare Population Expected to
Challenge States in the Future

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. 5.)

Figure 5: State-Reported Emerging Issues That Are Likely to Affect
Children in the 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.^13

13Methamphetamine 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 who are 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 Texas 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 to Resolve Challenges

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
reported that they were challenged by the lack of mental health and
substance abuse services for children and families, yet only four states
reported having initiatives to improve the level of these services. (See
fig. 6.) This may be because these services are typically provided outside
the child welfare system by other agencies.^14 Recent legislation supports
states' efforts to improve substance abuse services. For each fiscal year
from 2007 through 2011, the Child and Family Services Improvement Act of
2006 reserves funds under the Promoting Safe and Stable Families program
for competitive grants to improve outcomes of children affected by
parent/caretaker abuse of methamphetamine or another substance.^15

14We previously reported on how problems requiring interagency solutions
often go unaddressed in such areas as transportation and housing. See
[21]GAO-05-25 and GAO, Child Welfare: Improved Federal Oversight Could
Assist States in Overcoming Key Challenges, [22]GAO-04-418T (Washington,
D.C.: Jan. 28, 2004).

^15The law reserves $40 million for fiscal year 2007, $35 million for
fiscal year 2008, $30 million for fiscal year 2009, and $20 million for
each of fiscal years 2010 and 2011.

Figure 6: State-Reported Initiatives to Improve Services to Children and
Families

Most states also reported that they had implemented initiatives to improve
recruitment and retention of child welfare caseworkers, but few states
reported initiatives to address two of the most frequently reported
factors underlying this challenge--the administrative burden on
caseworkers and effective supervision. (See fig. 7.) Recent law supports
states' efforts in this area as well. For fiscal years 2008 through 2011,
the Child and Family Services Improvement Act reserves funds to support
monthly caseworker visits to children who are in foster care with an
emphasis on activities designed to improve caseworker retention,
recruitment, training, and ability to access the benefits of
technology.^16 In addition, the law reorganized the Child Welfare Services
program funded under Title IV-B, adding a purpose section to the law that
included: "providing training, professional development, and support to
ensure a well-qualified child welfare workforce."^17

^16The law directs the Secretary of HHS to reserve the following amounts:
$5 million for fiscal year 2008, $10 million for fiscal year 2009, and $20
million for each of fiscal years 2010 and 2011.

^17 Pub. L. No. 109-288, sec. 6(b)(3) (codified at 42 U.S.C. 621).

Figure 7: State-Reported Initiatives to Recruit and Retain Caseworkers

Almost all states reported implementing initiatives to improve their
ability to find appropriate homes for children, but few states reported
initiatives that addressed two of the three most frequently reported
factors underlying this challenge (see fig. 8). 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.^18

18GAO 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 of
awareness about needed services. See [23]GAO-05-25 .

Figure 8: State-Reported Initiatives to Find Appropriate Homes for
Children

Some states implemented initiatives under federal demonstration projects,
and evaluations of outcomes states were required to conduct under these
projects 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^19 in an effort to improve
services and placements--addressing the three primary challenges reported
by states. As of 2006, 24 states had implement 38 child welfare
demonstration projects.^20 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.

Federal Action Taken To Ensure States Develop Plans to Serve Children and
Families Displaced by Disaster

Several actions have been taken by HHS and the Congress to better ensure
that states are prepared to continue child welfare services for children
and families displaced by disaster across county or state lines. We
reported in July 2006 that although 29 states, plus Puerto Rico,
experienced a federally declared disaster in 2005, only 8 of these states
reported having a written child welfare disaster plan. (See fig. 9.)

^19Projects in the eight program areas included (1) providing monthly
subsidies equal or comparable to foster care maintenance payments to
relatives or other caregivers who assume legal custody of children; (2)
providing capped Title IV-E allocations in exchange for flexibility in
spending child welfare dollars for new services and supports; (3) using
Title IV-E dollars to fund services and supports for caregivers with
substance abuse disorders; (4) using alternative managed care financing
mechanisms to reduce costs; (5) increasing the variety and intensity of
services and supports to reduce out-of-home placement rates and improve
other outcomes; (6) strengthening existing or provide new post-adoption
and post-permanency services and supports; (7) tribal development of
administrative and financial systems to independently administer Title
IV-E foster care programs and directly claim federal reimbursement; and
(8) training for public and private sector child welfare professionals
serving children and their families.

^20States can no longer apply for participation in federal demonstration
projects because the program authorization expired in March 2006.

Fig. 9: Disaster Plan Status for States with Federally Declared Disasters
in 2005

In addition, while 21 states in all reported having a disaster plan in
place, there was great variance in the extent to which they addressed
selected child welfare program elements. For example, most states included
strategies to preserve information, but few states had included strategies
for placing children from other states. (See fig.10) The need for such
plans was highlighted when close to 2,000 of the 5,000 children in
Louisiana's child welfare system were displaced in the aftermath of
Hurricane Katrina.

Fig. 10: Program Components Addressed by State Disaster Plans

At the time of our review, HHS had issued guidance to states in 1995 to
help states develop child welfare disaster plans and also provided nearly
$3 million for technical assistance to states. This guidance, however, did
not address strategies states needed to continue services to child welfare
families displaced across county or states lines. State child welfare
officials reported that additional federal assistance would be helpful,
including information on disaster planning requirements or criteria,
training on how to develop a disaster plan, examples of good plans, and
forums for exchanging information with other states.

HHS took action that addressed states' concerns and our report
recommendations including updating its 1995 disaster plan guidance,
providing technical assistance, and asking states to voluntarily submit
copies of their disaster plans for review by December 2006.^21 Further,
the Child and Family Services Improvement Act of 2006 also established a
legislative requirement for states to submit child welfare disaster plans
to HHS that prepare for displacement of children. The deadline set by HHS
for submission of these plans is June 30, 2007.

Concluding Observations

State challenges in serving the children and families in the child welfare
system are long-standing and continuing. Resolving these problems has been
difficult, however, in part due to the child welfare system's heavy
reliance on various nondedicated funding streams at the federal and state
levels that require an interagency approach to establish appropriate
priority and funding for child welfare families across different programs
and populations. As funding fluctuates or declines, full awareness of
resources outside the child welfare system becomes especially important,
and we recommended in our October 2006 report that the Secretary of HHS
improve awareness of and access to various social services funded by the
federal government.

HHS disagreed with our recommendation, stating that it was insufficient to
address the need for additional services and that the recommendation
incorrectly implied that local child welfare agencies were not already
aware of and using such resources. We acknowledged that increasing
awareness of existing federal resources is not the only action needed, but
in the course of our work we found that caseworkers sometimes were unaware
of the full array of federal resources, such as health and housing,
available in their locale or had not coordinated with other agencies to
use them. We continue to support the view that federal action, such as
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.

History has shown that in the absence of specific federal requirements or
dedicated child welfare funding, many states have been slow to address
existing and future challenges, such as recruiting and retaining child
welfare workers or preparing child welfare disaster plans. Recent federal
action has been taken to establish requirements and dedicate funding to
states to help address these specific problems now and in the future. The
next round of HHS state oversight reviews will determine the extent that
these actions and others taken by states have been able to improve child
outcomes.

^21GAO's July 2006 report recommended that HHS guidance to states address
the dispersion of children and families within and across state lines, and
also recommended that HHS develop and provide training to states on child
welfare disaster planning. This report also asked the Congress to consider
requiring states to develop and submit child welfare disaster plans for
HHS review.

GAO Contacts

For further information regarding this testimony, please contact me at
(202) 512-7215. Individuals making key contributions to this testimony
include Lacinda Ayers and Cathy Roark.

Related GAO Products

Child Welfare: Improving Social Service Program, Training, and Technical
Assistance Information Would Help Address Longstanding Service-Level and
Workforce Challenges. [24]GAO-07-75 . Washington, D.C.: October 6, 2006.

Child Welfare: Federal Action Needed to Ensure States Have Plans to
Safeguard Children in the Child Welfare System Displaced by Disasters.
[25]GAO-06-944 . Washington, D.C.: July 28, 2006.

Foster Care and Adoption Assistance: Federal Oversight Needed to Safeguard
Funds and Ensure Consistent Support for States' Administrative Costs.
[26]GAO-06-649 . Washington, D.C.: June 15, 2006.

Child Welfare: Federal Oversight of State IV-B Activities Could Inform
Action Needed to Improve Services to Families and Statutory Compliance.
[27]GAO-06-787T . Washington, D.C.: May 23, 2006.

Lessons Learned for Protecting and Educating Children after the Gulf Coast
Hurricanes, [28]GAO-06-680R . Washington, D.C.: May 11, 2006.

Hurricane Katrina: GAO's Preliminary Observations Regarding Preparedness,
Response, and Recovery, [29]GAO-06-442T . Washington, D.C.: March 8, 2006.

Hurricanes Katrina and Rita: Provision of Charitable Assistance,
[30]GAO-06-297T . Washington, D.C.: December 13, 2005.

Child Welfare: Better Data and Evaluations Could Improve Processes and
Programs for Adopting Children with Special Needs. [31]GAO-05-292 .
Washington, D.C.: June 13, 2005.

Indian Child Welfare Act: Existing Information on Implementation Issues
Could Be Used to Target Guidance and Assistance to States. [32]GAO-05-290
. Washington, D.C.: April 4, 2005.

Foster Youth: HHS Actions Could Improve Coordination of Services and
Monitoring of States' Independent Living Programs. [33]GAO-05-25 .
Washington, D.C.: November 18, 2004.

D.C. Child and Family Services Agency: More Focus Needed on Human Capital
Management Issues for Caseworkers and Foster Parent Recruitment and
Retention. [34]GAO-04-1017 . Washington, D.C.: September 24, 2004.

Child and Family Services Reviews: States and HHS Face Challenges in
Assessing and Improving State Performance. [35]GAO-04-781T . Washington,
D.C.: May 13, 2004.

D.C. Family Court: Operations and Case Management Have Improved, but
Critical Issues Remain. [36]GAO-04-685T . Washington, D.C.: April 23,
2004.

Child and Family Services Reviews: Better Use of Data and Improved
Guidance Could Enhance HHS's Oversight of State Performance.
[37]GAO-04-333 . Washington, D.C.: April 20, 2004.

Child Welfare: Improved Federal Oversight Could Assist States in
Overcoming Key Challenges. [38]GAO-04-418T . Washington, D.C.: January 28,
2004.

D.C. Family Court: Progress Has Been Made in Implementing Its Transition.
[39]GAO-04-234 . Washington, D.C.: January 6, 2004.

Child Welfare: States Face Challenges in Developing Information Systems
and Reporting Reliable Child Welfare Data. [40]GAO-04-267T . Washington,
D.C.: November 19, 2003.

Child Welfare: Enhanced Federal Oversight of Title IV-B Could Provide
States Additional Information to Improve Services. [41]GAO-03-956 .
Washington, D.C.: September 12, 2003.

Child Welfare: Most States Are Developing Statewide Information Systems,
but the Reliability of Child Welfare Data Could Be Improved.
[42]GAO-03-809 . Washington, D.C.: July 31, 2003.

D.C. Child and Family Services: Better Policy Implementation and
Documentation of Related Activities Would Help Improve Performance.
[43]GAO-03-646 . Washington, D.C.: May 27, 2003.

Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger
Role in Helping States Reduce the Number of Children Placed Solely to
Obtain Mental Health Services. [44]GAO-03-397 . Washington, D.C.: April
21, 2003.

Foster Care: States Focusing on Finding Permanent Homes for Children, but
Long-Standing Barriers Remain. [45]GAO-03-626T . Washington, D.C.: April
8, 2003.

Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare
Agencies Recruit and Retain Staff. [46]GAO-03-357 . Washington, D.C.:
March 31, 2003.

(130672)

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www.gao.gov/cgi-bin/getrpt?GAO-07-850T .

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[email protected]..

Highlights of [54]GAO-07-850T , a testimony before the Subcommittee on
Income Security and Family Support, Committee on Ways and Means, House of
Representatives

May 15, 2007

CHILD WELFARE

Additional Federal Action Could Help States Address Challenges in
Providing Services to Children and Families

Despite substantial federal and state investment, states have had
difficulty ensuring the safety, well-being, and permanency of children in
foster care. Ensuring these outcomes becomes even more difficult in the
event of disasters such as Hurricanes Katrina and Rita, when children and
families may become displaced across state lines. This testimony discusses
(1) the issues that states reported as most important to resolve now and
in the future to improve outcomes for children under their supervision (2)
initiatives states reported taking to address these issues and how recent
law provides support for additional state efforts and (3) federal action
taken to assist states' efforts in developing child welfare disaster
plans.

This testimony is primarily based on our October 2006 report on state
child welfare challenges (GAO-07-75) and our July 2006 report on state
child welfare disaster planning (GAO-06-944). The Department of Health and
Human Services (HHS) and the Congress took action that addressed our July
report recommendations. However, HHS disagreed with our October report
recommendation to improve awareness of and access to federal social
services by modifying the Catalog of Federal Domestic Assistance or other
means. We continue to believe that taking such action would help improve
services to children and families.

States reported in our survey that inadequate levels of mental health and
substance abuse services, the high average number of child welfare cases
per worker, and the difficulty finding homes for children with special
needs were the most important challenges to resolve in order to improve
outcomes for children under states' care. Child welfare officials cited
various reasons these challenges existed in their states, such as a lack
of funding for family support services and a lack of caseload standards.
Over the next 5 years, major challenges for state child welfare systems
were cited as serving a growing population of children with special needs
or who have been exposed to illegal drugs, and changing demographic trends
that will require greater multicultural sensitivity in providing services
to some groups of children and their families.

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

States have some initiatives in place to address these challenges, but
these initiatives do not always address areas of states' greatest concern.
For example, only 4 of 31 states dissatisfied with substance abuse
services reported initiatives to improve the level of these services.
Similarly, states reported little or no action to address two of the most
frequently reported factors underlying the challenge to recruit and retain
caseworkers - the administrative burden on caseworkers and effective
supervision. Recent law provides additional requirements and funding to
help states address these challenges. Some states implemented initiatives
under federal demonstration projects, including those to improve substance
abuse services and permanent homes for children. However, outcome
evaluations of these initiatives have shown mixed results.

Several actions have been taken by HHS and the Congress to better ensure
that states are prepared to continue child welfare services for children
displaced by disaster. Our earlier work showed that although 29 states,
plus Puerto Rico, experienced a federally declared disaster in 2005, only
8 of these states reported having a written child welfare disaster plan.
Since that time, HHS has updated its guidance to states and provided
technical assistance. In addition, the Congress passed the Child and
Family Services Improvement Act of 2006, requiring that states have
procedures in place concerning how state child welfare agencies would
respond in the event of a disaster. The deadline set by HHS for submission
of these plans is June 30, 2007.

References

Visible links
  17. http://www.gao.gov/cgi-bin/getrpt?GAO-07-75
  18. http://www.gao.gov/cgi-bin/getrpt?GAO-06-944
  20. http://www.gao.gov/cgi-bin/getrpt?GAO-05-25
  21. http://www.gao.gov/cgi-bin/getrpt?GAO-05-25
  22. http://www.gao.gov/cgi-bin/getrpt?GAO-04-418T
  23. http://www.gao.gov/cgi-bin/getrpt?GAO-05-25
  24. http://www.gao.gov/cgi-bin/getrpt?GAO-07-75
  25. http://www.gao.gov/cgi-bin/getrpt?GAO-06-944
  26. http://www.gao.gov/cgi-bin/getrpt?GAO-06-649
  27. http://www.gao.gov/cgi-bin/getrpt?GAO-06-787T
  28. http://www.gao.gov/cgi-bin/getrpt?GAO-06-680R
  29. http://www.gao.gov/cgi-bin/getrpt?GAO-06-442T
  30. http://www.gao.gov/cgi-bin/getrpt?GAO-06-297T
  31. http://www.gao.gov/cgi-bin/getrpt?GAO-05-292
  32. http://www.gao.gov/cgi-bin/getrpt?GAO-05-290
  33. http://www.gao.gov/cgi-bin/getrpt?GAO-05-25
  34. http://www.gao.gov/cgi-bin/getrpt?GAO-04-1017
  35. http://www.gao.gov/cgi-bin/getrpt?GAO-04-781T
  36. http://www.gao.gov/cgi-bin/getrpt?GAO-04-685T
  37. http://www.gao.gov/cgi-bin/getrpt?GAO-04-333
  38. http://www.gao.gov/cgi-bin/getrpt?GAO-04-418T
  39. http://www.gao.gov/cgi-bin/getrpt?GAO-04-234
  40. http://www.gao.gov/cgi-bin/getrpt?GAO-04-267T
  41. http://www.gao.gov/cgi-bin/getrpt?GAO-03-956
  42. http://www.gao.gov/cgi-bin/getrpt?GAO-03-809
  43. http://www.gao.gov/cgi-bin/getrpt?GAO-03-646
  44. http://www.gao.gov/cgi-bin/getrpt?GAO-03-397
  45. http://www.gao.gov/cgi-bin/getrpt?GAO-03-626T
  46. http://www.gao.gov/cgi-bin/getrpt?GAO-03-357
  47. http://www.gao.gov/
  54. http://www.gao.gov/cgi-bin/getrpt?GAO-07-850T
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