Foster Care: Effectiveness of Independent Living Services Unknown (Letter
Report, 11/10/1999, GAO/HEHS-00-13).

Pursuant to a congressional request, GAO provided information on the
independent living program (ILP), focusing on: (1) the extent of
services provided under ILPs; and (2) what is known about the effect of
these services on youths' ability to live on their own.

GAO noted that: (1) states provide a wide range of services to better
ensure that foster care youths are prepared to live on their own after
they leave the foster care system; (2) those services--funded by
federal, state, local, and private dollars totalling at least $131.5
million in 1998--include assisting youths in attaining their educational
goals, such as completing high school or passing the General Educational
Development test and attending postsecondary schools; as well as
assisting youths in finding and maintaining employment; (3) in addition,
youths attend classes in daily living skills; (4) other transitional
services, such as supervised practice living arrangements and after-care
services, allow youths to try living on their own prior to leaving the
foster care system and provide temporary assistance to ease the
transition to independence; (5) however, state and local administrators
told GAO that their ILPs cannot always provide all of the assistance
administrators and youths say is needed to help youths learn to live on
their own; (6) even though the federal ILP was established in 1985, few
national or local studies have been completed to assess the
effectiveness of independent living services in helping youths through
the transition to living on their own after foster care; (7) GAO
identified only one national study that has been completed to date,
which found that services provided by ILPs have the potential to improve
outcomes for youths; (8) in addition, although several states indicated
they have completed studies that measure general youth outcomes, such as
education and employment status, only a few attempted to measure the
helpfulness of ILP services in youths' ability to attain
self-sufficiency; (9) while the Department of Health and Human Services
(HHS) is tasked with overseeing implementation of ILP, it has done
little to determine program effectiveness and has no established method
to review the states' progress in helping youths in the transition from
foster care; (10) HHS officials told GAO they recognize these
deficiencies and the need to improve monitoring efforts; and (11) to
begin the improvement process, HHS issued a contract in September of
1998 to analyze 10 years of annual state ILP reports to determine, among
other things, which states are producing good ILP reports that could be
models for other states and what measures HHS can take to improve state
reporting and evaluation.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-00-13
     TITLE:  Foster Care: Effectiveness of Independent Living Services
	     Unknown
      DATE:  11/10/1999
   SUBJECT:  Disadvantaged persons
	     Foster children
	     Youth
	     Public assistance programs
	     Federal/state relations
	     Reporting requirements
	     Program evaluation
	     Youth employment programs
	     Performance measures
IDENTIFIER:  HHS Transitional Living for Runaway and Homeless Youth
	     Program
	     New York (NY)
	     Contra Costa County (CA)
	     San Antonio (TX)
	     Baltimore (MD)
	     HHS Independent Living Program

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FOSTER CARE: Effectiveness of Independent Living Services Unknown GAO/HEHS-00-13
United States General Accounting Office
GAO Report to The Honorable Nancy L. Johnson, U. S. House of Representatives
November 1999 FOSTER CARE Effectiveness of Independent Living Services Unknown

GAO/HEHS-00-13

GAO United States General Accounting Office
Washington, D. C. 20548 Health, Education, and Human Services Division
B- 283530 November 5, 1999 The Honorable Nancy L. Johnson Chairman, Subcommittee on Human Resources Committee on Ways and Means House of Representatives
Dear Madam Chairman: Each year approximately 20,000 youths exit the foster care system with the expectation that they will be able to live self- sufficiently. 1 After exiting the system, many of these youths face serious problems, including homelessness, lack of employment stability, incarceration, and early pregnancy. Recently, a congressional subcommittee raised concerns in hearings that the federal Independent Living Program (ILP), designed to help foster care youths make the transition to living independently, does not give youths leaving foster care the necessary life skills to complete basic education, find and maintain employment, or otherwise live self- sufficiently after leaving care. The Congress is currently considering legislation that would double program funds and expand services for youths in foster care and those who will leave foster care.
All states provide independent living services to youths about to leave the foster care system. Because of your concerns that little is known about the level of services offered to these youths and whether the services match their needs, you asked us to (1) describe the extent of services provided under ILPs, and (2) discuss what is known about the effect of these services on youths' ability to live on their own. 2 In conducting this work, we reviewed relevant literature and 1998 annual ILP reports submitted by the states to the Department of Health and Human Services (HHS). We also interviewed state and federal officials and independent living experts and visited independent living programs in four locations Contra Costa County, California; Baltimore City and County, Maryland; New York, New York; and the San Antonio region, Texas. In addition, to obtain national information on additional services offered by state ILPs, we surveyed all 50 states and the District of Columbia. We conducted our work between January and September 1999 in accordance with generally accepted
1 When youths who have not been reunited with their families or adopted attain age 18, federal reimbursement is no longer made to states for the youths' maintenance in foster care. However, some states allow youths to remain in care, at state expense, until age 21.
2 We testified on these issues in May 1999 and this report expands on that information. See Foster Care: Challenges in Helping Youths Live Independently (GAO/ T- HEHS- 99- 121, May 13, 1999).
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government auditing standards. (A more detailed discussion of our scope and methodology appears in appendix I.)
Results in Brief States provide a wide range of services to better ensure that foster care youths are prepared to live on their own after they leave the foster care
system. Those services funded by federal, state, local, and private dollars totalling at least $131.5 million in 1998 include assisting youths in attaining their educational goals, such as completing high school or passing the General Educational Development (GED) test and attending postsecondary schools; as well as assisting youths in finding and maintaining employment. 3 In addition, youths attend classes in daily living skills, covering such topics as money management, hygiene, housekeeping, and nutrition, and receive instruction in areas that help youths interact successfully with adults, such as conflict management. Other transitional services, such as supervised practice living arrangements and after- care services, allow youths to try living on their own prior to leaving the foster care system and provide temporary assistance to ease the transition to independence. However, state and local administrators told us that their ILPs cannot always provide all of the assistance administrators and youths say is needed to help youths learn to live on their own. For example, some programs do not have fully developed links with employers to provide job leads, lack opportunities for youths to practice skills in real- life settings, and fall short on the number of supervised practice living arrangements needed for youths to become more proficient at living self- sufficiently.
Even though the federal ILP was established in 1985, few national or local studies have been completed to assess the effectiveness of independent living services in helping youths through the transition to living on their own after foster care. 4 We identified only one national study that has been completed to date, which found that services provided by ILPs have the potential to improve outcomes for youths. In addition, although several states indicated they have completed studies that measure general youth outcomes, such as education and employment status, only a few attempted to measure the helpfulness of ILP services in youths' ability to attain self- sufficiency. While HHS is tasked with overseeing implementation of ILP, it has done little to determine program effectiveness and has no
3 Some states were unable to identify the amount of additional state, local, or private funds spent on their ILPs. 4 Although ILP was established in 1985, funds for payments to the states were not appropriated until 1987.
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established method to review the states' progress in helping youths in the transition from foster care. For example, HHS primarily relies on state annual program reports for effectiveness information and has no other monitoring efforts in place. However, the content and quality of the reports vary and they contain little information on program outcomes. HHS officials told us they recognize these deficiencies and the need to improve monitoring efforts. To begin the improvement process, HHS issued a contract in September of 1998 to analyze 10 years of annual state ILP reports to determine, among other things, which states are producing good ILP reports that could be models for other states and what measures HHS can take to improve state reporting and evaluation. We are making recommendations to HHS concerning the need to enhance HHS' and states' accountability for preparing youths to live on their own.
Background Adolescents in foster care, especially those who have been in care for a number of years, face numerous challenges in preparing to become
self- sufficient adults once they leave the foster care system. Several programs help foster care youths in their transition to independent living, but only one ILP is specifically designed to serve this population.
The transition from the foster care system to self- sufficiency can be difficult. Research has shown that many former foster care youths have serious educational deficiencies and rely on public assistance. For example, a 1991 study of foster care youths interviewed 2.5 to 4 years after they left care found that 46 percent had not finished high school. 5 Additionally, almost 40 percent were found to be a cost to the community through their dependence on such programs as public assistance and Medicaid. Similarly, the University of Wisconsin recently studied youths who had been out of care between 12 and 18 months, and found that 37 percent had not finished high school and 32 percent were receiving public assistance. 6 In addition, former foster care youths often find themselves lacking adequate housing. The Westat study reported that 25 percent of the youths were homeless at least 1 night, and the University of Wisconsin study found that, after leaving care, 14 percent of the males and 10 percent of the females had been homeless at least once. Additional difficulties may further impede youths' ability to become self- sufficient. The Westat study found that 51 percent of the youths were unemployed
5 Westat, Inc., A National Evaluation of Title IV- E Foster Care Independent Living Programs for Youth (Washington, D. C.: HHS, 1991). 6 Mark E. Courtney and Irving Piliavin, Foster Youth Transitions to Adulthood: Outcomes 12 to 18 Months After Leaving Out- of- Home Care (Madison, Wisc.: University of Wisconsin, 1998).
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and 42 percent had given birth or fathered a child. Likewise, the University of Wisconsin found that 39 percent of the youths were unemployed, and that 27 percent of the males and 10 percent of the females had been incarcerated at least once.
ILP the primary program designed to help foster care youths become self- sufficient authorizes federal funding for states to establish and implement services to assist youths aged 16 and over in making the transition from foster care to independent living. Originally authorized in 1985 by P. L. 99- 272 for a limited period, the program was reauthorized indefinitely as part of the Omnibus Budget Reconciliation Act of 1993 (P. L. 103- 66), which also increased federal funding to the current level of $70 million per year. A portion of the federal funds$ 45 million is distributed to states as an entitlement based on each state's proportion of all youths receiving federal foster care maintenance payments in fiscal year 1984. 7 States are also eligible to receive a proportional share of the remaining $25 million in federal funds to match the funds they provide.
HHS estimates that almost 77,000 youths aged 16 to 20 were in foster care as of September 1998. While approximately 40 percent of the youths in this age range will return to their biological families, almost 20,000 adolescents per year leave the foster care system and are expected to live self- sufficiently. Eligible ILP participants include youths aged 16 and over for whom federal foster care payments are being made. 8 At their option, states may use ILP funds for foster care youths not receiving federal assistance and former foster care youths who were in foster care after the age of 16. Likewise, states may provide services to any of these youths until the age of 21. Youth participation in ILP services is voluntary.
Other federal programs may also provide some assistance to this population, but are not designed to specifically provide services to foster care youths. For example, HHS' Transitional Living Program for Homeless Youth provides funds to communities for housing and independent living services to homeless youths. A variety of other programs may also assist
7 Under Title IV- E of the Social Security Act, federal matching funds are provided to states for foster care maintenance costs. These funds cover a portion of the food, housing, and incidental expenses for foster care children from families who would have been eligible for benefits under the former Aid to Families With Dependent Children program using 1995 eligibility criteria. States are responsible for any foster care costs they incur for children not eligible for federal support.
8 States can receive federal foster care maintenance payments for eligible children while they are in foster care family homes, private for- profit or nonprofit child care facilities, or public child care institutions. Youths become ineligible for federal foster care maintenance payments at age 18 or, at a state's option, age 19 if a child in foster care is a full- time student in a secondary school and is expected to complete the educational program prior to turning 19.
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youths. For example, Job Corps, under the auspices of the U. S. Department of Labor, enrolls youths aged 16 to 24 who are economically disadvantaged, in need of additional education or training, and living under disorienting conditions such as a disruptive homelife. In addition, other agencies, such as the Departments of Justice, Education, and Housing and Urban Development, have education and employment assistance programs targeted to disadvantaged and at- risk youths. Service agencies in the states may also provide assistance to youths, including educational, juvenile justice, mental health, public assistance, and substance- abuse service agencies.
The federal government provides most of the funding for ILP. In addition, HHS is responsible for assisting state child welfare systems by promoting continuous improvement in the delivery of child welfare services. In this regard, HHS central office staff are responsible for developing ILP- related policies, procedures, and regulations, and for ensuring their implementation by the states. HHS' regional office staff serve as the local ILP contacts for the states, review and approve state applications for ILP funds, and review the annual state ILP reports. Regional staff also provide technical assistance to the states and clarification on program requirements. In addition, the University of Oklahoma's National Child Welfare Resource Center for Youth Development, under cooperative agreement with HHS, is responsible for providing ILP training and technical assistance to the states in coordination with the regional offices.
HHS issued instructions to states in December 1993 outlining allowable ILP services including education and employment assistance, instruction in daily living skills, and other support services to ease youths' transition to independent living. In addition, states must provide written transitional independent living plans based on an assessment of each youth's needs and may establish outreach programs to attract individuals eligible to participate in the program.
Multiple Services Assist Youths in Achieving Independence, but ILPs Fall Short in Key Areas
To better ensure that foster care youths are prepared to live on their own, state ILPs provide an array of services using a combination of federal, state, local, and private funds. These services include assistance with completing education and finding employment; instruction in the basic skills needed to live independently, such as money management, hygiene, housekeeping, and nutrition; and transitional services, such as supervised practice living arrangements (see appendix II). However, state and local administrators told us that their current ILPs fall short in key areas. For example, some
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programs do not sufficiently seek out employment opportunities in the community and offer few opportunities for youths to participate in real- life practice opportunities or esteem- building experiences. Moreover, some programs could not provide enough housing or other transitional assistance to both youths still in care and those who have left care. To address these shortcomings, a few locations have added specialized stuff and programs, such as developing partnerships with local businesses for part- time youth employment.
ILP Services Supported by Federal, State, and Other Funds
To provide ILP services, states use federal annual ILP funds of $70 million, $25 million in state matching funds, and additional dollars provided by a variety of sources. For example, our survey showed that 35 states reported spending additional state, local, and private funding on their ILPs totaling at least $36.5 million (see table 1). 9 Also, 20 states reported receiving in- kind ILP donations such as mentoring services, use of facilities for training, attorney services, drivers' education training, college scholarships, books, school supplies, clothing, computers, gift certificates, and household supplies for youths.
Table 1: Categories of Non- Federal ILP Funding
Type of funding Range of funding among reporting states Total funding reported
State (20 states) $75,000 to $11 million $22.8 million Local (7 states) $1,000 to $6.5 million $13 million Private (7 states) $1,500 to $295,000 $0.7 million
Because federal funds can only be used to serve youths aged 16 to 21, more than one- third of the states reported using some additional funds to provide services to some youths younger than 16. During federal fiscal year 1998, the states served a total of 2,169 youths under age 16. Our review of state annual ILP reports showed that approximately 42,680 youths aged 16 or older only about 60 percent of all eligible youths volunteered to receive ILP services in 1998, and officials in the states we visited noted that attracting youths to participate in the program is a challenge. 10
9 Thirty- five states reported spending additional dollars beyond the federal funds and state match, but not all of these states reported the amounts spent in each category. 10 Although not all states included participation figures in their annual reports, we determined that at least 42,680 youths in 40 states received some type of independent living service during 1998.
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Education and Employment Assistance Offered, but Few Pathways From Foster Care Developed
According to our review of annual state ILP reports, 41 states reported assisting youths with preparing for, or completing, education or vocational training. 11 Of these 41 states, 26 offered assistance, such as tutoring or remedial training, to help youths graduate from high school or receive a GED; 28 states helped youths prepare for vocational school, for instance through vocational testing or referral; and 33 states helped youths pursue postsecondary education, such as through educational planning or assessments, assistance in applying for financial aid or college admission, or campus tours. 12 Further, 21 states awarded some tuition aid or scholarships for college or vocational schools, and 20 helped pay for other educational expenses such as books, training materials, uniforms, college entrance exam fees, or college application fees.
In total, 40 states reported providing employment services to youths. Of these, 28 states assisted youths with job readiness, including instructing them in how to write resumes, how to interview for and maintain a job, and how to complete job applications; and 24 states helped youths with job search. Moreover, 18 states helped with job placement. For example, for several youths with negligible work skills, the District of Columbia contracted for job placement services that included a job coach, on- the- job assistance with work problems, transportation assistance, mentoring, and periodic group sessions.
Although all four areas we visited provided assistance with education and employment, we found that the ILPs did not provide services that fully matched foster care youths to appropriate employment pathways. For example, officials in three of the sites told us that vocational opportunities for youths were limited for several reasons. State and local coordinators in Texas indicated that few apprenticeship positions are available, while ILP coordinators in Baltimore City and New York reported a lack of vocational education programs that youths can afford and a lack of ILP funds to pay for such programs. These officials also reported that culinary arts and technology- related programs two programs popular with foster care youths are relatively expensive. Of the four sites we visited, only Texas
11 We reviewed 1998 annual state ILP reports from 45 states plus the District of Columbia. However, because no standard report format exists, states do not consistently report services offered during the previous year. We counted only those states that specifically mentioned providing a particular service either throughout, or in some portion of, the state in their 1998 report, although others may have provided the service but not included this information as part of their program description. According to an HHS ILP official, annual reports from Alaska, California, New York, South Carolina, and Wyoming were not available at the time of our review.
12 Many of these states reported providing all the educational services mentioned.
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offers statewide tuition waivers for all state- supported vocational, technical, and postsecondary schools.
Our field visits also revealed that connections between the ILP and potential employers were not thoroughly developed. For example, ILP coordinators in one location told us they did not have time to establish relationships with very many employers and that employment development efforts in their location are largely informal. State officials in California and Maryland indicated that they believe more public- private partnerships are needed to provide youths with employment opportunities. In addition, New York City officials told us that they are just beginning to devise ways to link with employers to enhance youths' job prospects. Several officials also pointed out that more staff need to be assigned to this task if it is to be accomplished.
Some locations are attempting to address these training and employment shortcomings. For instance, Maryland established a partnership between the ILP, the United Parcel Service (UPS), the Living Classroom Foundation, and the Annie E. Casey Foundation. This program provides employment opportunities, according to UPS officials, to expose youths to a significant and demanding first job that teaches them invaluable, transferable workplace skills. UPS supervisors work closely with youths to identify barriers and access other resources if needed (such as mentoring, counseling, or job readiness programs), and strive to instill leadership skills and develop the youths' potential. For example, the youths attend career and academic goal- setting sessions with a UPS School- to- Work Specialist. Moreover, UPS supervisors maintain close contact with youths after they have been hired to ensure their success on the job. Transportation to the work site is provided and on- site college- level classes are available, as well as opportunities to combine working for UPS with working for other area employers such as banks, grocery stores, and drug stores. UPS planned to hire 75 foster care youths during the first year of the partnership.
States Provide Assistance in Learning Daily Living Skills, but Opportunities to Practice Skills Are Lacking
In our review of annual state ILP reports, we found that 46 states report training youths in daily living skills such as money management, health and safety, nutrition, housekeeping, parenting and sexual responsibility, and interpersonal and other social skills. The four areas we visited also offer training in daily living skills. For example, in Contra Costa County, California, youths attend a series of living skills workshops that cover, among other topics, how to prepare a budget and how to open and use a
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checking account. Likewise, life skills classes in the San Antonio, Texas, area meet for 8 weeks and cover core areas, including personal and interpersonal skills, health and safety, money management, and planning for the future. In New York City, life skills classes provide instruction on housekeeping, health care, interpersonal skills, food management, transportation, and family planning, among others.
Although some daily living skills are taught in a classroom setting, officials in the four states we visited stressed the importance of experiential learning, and independent living experts concurred that youths benefit from activities in which they can practice the skills learned. State and local program officials acknowledged the importance of activities that allow youths to perform and perhaps initially fail at daily tasks until they become proficient. According to local officials and service providers, many foster youths have learned to depend on the child welfare system for their care and thus may not have been exposed to everyday experiences other teens take for granted, such as cooking, grocery shopping, driving, or taking excursions outside their communities. To address this, Texas and California conduct a program called Independent City a simulated community in which young persons are assigned an income and must apply for jobs, sign leases for apartments, arrange for utilities, open checking accounts, and buy cars.
In addition to the need to gain practical living experience, officials in three of the locations we visited reported that youths need to learn interpersonal skills, such as conflict management, communication, and decision- making. Officials report that youths who do not master these other skills may have difficulty finding and maintaining employment. To learn these skills, youths may participate in classroom- based training or in recreational events. In New York City, for example, one service provider takes youths to Broadway plays or restaurants to allow them to learn how to interact in social situations, including how to behave and how to order from a menu. After the activity, youths meet with the coordinator to discuss lessons learned. Other opportunities for youths to develop social skills, such as team- building and leadership, are provided by teen conferences, retreats, and youth advisory boards. For instance, Maryland holds an annual statewide teen conference where youths attend workshops on self- empowerment, conflict resolution, and goal achievement. Texas offers wilderness challenge and ropes courses to strengthen problem- solving and team- building abilities. Moreover, according to our review of annual reports, 22 states have youth advisory boards that work to improve policies and services affecting foster youths. The Youth Advisory Board in
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Massachusetts, for example, meets with the commissioner of the social services department quarterly to express concerns and recommendations regarding agency foster care services and policies.
Further, officials in the four states we visited emphasized that youths need to be able to form and maintain relationships with others. Establishing a connection to an adult is so important, according to Texas state officials, that one goal of the state's ILP is for every young adult to have a significant adult in his or her life when he or she leaves foster care. To help youths receive this type of social support, many states use mentoring programs. According to a study of 29 child welfare programs' mentoring services, these services can take many forms: some link adult mentors to youths to assist them in making the transition from foster care to adult living, while other programs involve workplace mentoring where the employer provides jobs, monitors the work experience, and offers career development opportunities to young persons. 13 Officials in all the locations we visited viewed mentoring programs as one method to provide youths with a vocational role model and opportunities to practice independent living skills, as well as opportunities to form connections to adults who serve as positive role models.
We found that opportunities to practice daily life tasks and to develop self- esteem were limited in some of the locations we visited. Program officials in two locations and foster care youths in three locations told us that issues such as safety regulations for group homes inhibit or prevent certain activities, such as practicing cooking. In addition, esteem- building experiences are often limited to a small number of youths. For example, local officials in Texas reported that opportunities for foster care youths to participate in postsecondary school conferences or extended outdoor activities were limited. In addition, programs offering adult mentors serve a small number of youths. For example, a foster care service provider in Texas contracted by the state specifically to develop mentor programs reported difficulty finding mentors.
13 Edmund V. Mech and others, Mentors for Adolescents in Foster Care, Child and Adolescent Social Work Journal, Vol. 12, No. 4 (Aug. 1995).
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Housing and Other Transitional Support Services Provide Bridges to Adulthood, but Obstacles Impede Self- Sufficiency
Transitional living arrangements allow youths to live on their own and practice becoming proficient at managing their lives while still receiving supervision and financial support. Our survey showed that more than 80 percent of the states provided transitional practice living arrangements to some youths while they are still in foster care to allow them an opportunity to experience independent living for a period of time. About 37 percent of the states offered housing to some youths after they left the foster care system. In Baltimore County, Maryland, for example, the Challengers Independent Living program seeks to provide youths with the means to cope with independence once they leave foster care. In this program, foster care youths can reside for 18 to 24 months in apartments furnished and supervised by the service provider and receive a weekly stipend to purchase clothing, food, and household supplies. They are also responsible for cleaning the apartments and doing their own laundry. Each youth's foster care payment covers the cost of rent, utilities, and administration of the program. Program staff also offer educational, vocational, clinical, and home- life support, including additional independent living skills training. Similar programs, such as the Real Solutions Transitional Living Program in San Antonio, Texas, are available to young adults who have left foster care. This privately funded program provides youths with a group living arrangement for up to 3 years, normally from ages 18 to 21, while they adjust to self- sufficiency.
Additional transitional support services provided by the states include counseling, programs for youths with special needs and disabilities, and after- care programs for youths who are no longer in the foster care system. 14 Officials in the states we visited said that many youths have mental health issues that need to be addressed. Some states noted in their annual ILP reports that individual or group counseling may help address issues that act as barriers to independent living for the teen population, such as drug abuse, or may increase the youths' ability to utilize independent living skills they were taught. Thirty- one states indicated in their annual reports that they offer some type of counseling service, such as individual, group, or peer counseling. In Illinois, for example, support groups provide a forum for youths to express their feelings about being in foster care, as well as to identify issues and fears about leaving it. Seven states offered specialized programs for developmentally disabled youths and four states offered services for those with emotional or behavioral problems.
14 HHS data for 1998 identified 20 percent of foster youths between the ages of 16 and 20 as having a disability.
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To assist youths who have exited foster care, our survey showed that, in federal fiscal year 1998, 30 states provided formal services for a period of time after foster care, serving a total of 7,830 youths between the ages of 11 and 24. The majority of these states reported providing a full range of services, including education and employment assistance, training in daily living skills, and individual and/ or group counseling. In addition, 21 states reported providing other services and assistance such as mentoring, transportation assistance, medical coverage, and clothing. Our field visits confirm that some states offer after- care services. For example, Florida reports serving former foster care youths through tuition assistance, counseling, opportunities to attend conferences and receive skills training or to serve as mentors or co- trainers, referrals to other agencies for assistance in finding a job or housing, transportation assistance, and opportunities to use the resource library.
However, we noted some concerns about these services. For example, the number of transitional living arrangements is limited. Our survey showed that 38 states served 6,320 current foster youths and 12 states served 1,787 former foster youths. 15 Officials in the four areas we visited confirmed that the number of supervised transitional housing sites is very limited and that they could not provide adequate housing for both youths in care and those who have left the system. One transitional housing provider in Texas indicated that the program has space for only 6 youths, while an additional 80 to 100 youths with no place to live upon exiting foster care could benefit from this type of housing program. A transitional housing provider in a second location explained that program staff carefully screen youths for readiness to handle the responsibilities of managing their own place to live and, because of limited capacity, accept only the most promising teens into the program. In addition, some officials noted that their after- care services are limited and that they believe youths could benefit from more services than they can offer. For example, in Texas, after- care services are available for only 6 months after the youth exits care. The services consist mainly of referrals to other service agencies, visits to colleges, and a small stipend for 4 months. After- care services in Baltimore County and New York City are limited to referring the youths to other agencies that can assist them.
15 According to our survey, 43 states reported providing transitional housing to current foster care youths and 19 states reported providing this service to former foster care youths in fiscal year 1998. Only 38 and 12 states, respectively, provided the number of youths served.
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Information on Program Effectiveness Is Limited
Given the significant challenges that youths face in moving from foster care to adulthood, it is important to understand how effective the ILP is in better ensuring outcomes for foster care youths. However, little information is available to help in understanding the outcomes these programs achieve. HHS has not taken an active role in identifying whether state ILPs are providing services that increase youths' chances of becoming self- sufficient once they leave the foster care system or in sharing information among the states.
Few National and Local Studies on ILP Effectiveness
Few studies that address ILP effectiveness have been conducted on a national or local level. Only one national study has been completed since ILP was established in 1985. This study conducted by Westat, Inc., with funding from HHS found that services provided by ILPs have the potential to improve outcomes for youths. The study found that skills training in particular areas led to better outcomes (e. g., health training aided youths in gaining access to health care), although no one skill area had a consistent effect across all outcomes assessed. More comprehensive effects were achieved when youths were taught a combination of skills. Youths who received training in managing money, obtaining a credit card, and buying a car, as well as help in how to find a job and gain access to appropriate education opportunities, were more likely to keep a job for at least a year.
Two other studies are currently under way; study results are due in fall 1999. The Child Welfare League of America recently developed a state survey on independent living services to gather comprehensive information on ILP topics such as the population served, the type of foster care placement and permanency plan for these youths, fiscal information on ILP funds, ILP policies, transitional living arrangements, and model programs. In 1997, the Annie E. Casey Foundation awarded a grant to the National Child Welfare Resource Center for Organizational Improvement at the University of Southern Maine and the National Resource Center for Youth Services at the University of Oklahoma to define the current knowledge base regarding the transition of youths out of foster care and to examine effective practices and policies which may improve opportunities for youths to become fulfilled, productive adults.
In addition, 12 states told us they had conducted follow- up studies of youths who had left foster care and 14 additional states reported they had a follow- up study under way or were planning such a study. Eight states provided a copy of completed studies; only three of these studies asked
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 13
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former foster care youths about the effectiveness of independent living services they received while in care. For example, an evaluation of the Wayne County, Michigan, ILP attempted to contact former ILP participants to obtain information on their current situations. 16 However, none of the former clients could be located and the study was changed to a survey of youths currently participating in an ILP or those receiving after- care services. Of the 61 youths surveyed, over 80 percent indicated that their quality of life improved after they received independent living services. Youths judged housing and health care services more effective than other services, and judged employment services among the least effective. A study of 26 youths in Nevada about 3 months after leaving foster care showed that most of the respondents believed the ILP helped prepare them to some extent for making the transition to living on their own, including preparing them to find a place to live, prepare meals, budget money, and locate community resources. 17 However, 53 percent of the youths were not satisfied with their independent living services. Finally, in a 1995 North Carolina study comparing 44 ILP participants and 32 nonparticipants who left foster care between 1992 and 1995, 65 to 73 percent of the participants felt that ILP services were helpful to some extent in preparing them for independent living, although no specific area of ILP assistance stood out. Fifty- five percent of the ILP participants started living independently immediately after leaving foster care, compared to only 12 percent of nonparticipants. Similarly, 30 percent of the ILP participants were paying all their housing expenses within 1 to 3 years after leaving foster care, as compared to 19 percent of nonparticipants. According to the study, these and other housing- related findings indicate a definite, though gradual, movement toward independent living that is more pronounced for ILP participants than for nonparticipants.
We identified three additional local studies that show positive effects of ILP services and link participation in ILP with improved education, housing, and other outcomes from Baltimore County, Harris County (Houston, Texas), and New York City. In the Baltimore County study, youths who received ILP services were more likely to complete high school, have an employment history, and be employed when they left foster care. 18 In the Harris County study, the author found that graduates of the Texas ILP
16 Moore & Associates, Inc., Final Report: An Evaluation of the Wayne County Independent Living Coalition, submitted to the Michigan Family Independence Agency (Sept. 1998). 17 Hailu Abatena, Independent Living Initiative Program: A Follow Up Survey Report of the Youth Released from Foster Care in Nevada in 1996 (Henderson, Nev.: Nevada Research, Evaluation, and Planning Consultants, undated).
18 Maria Scannapieco and others, Independent Living Programs: Do They Make A Difference? Child and Adolescent Social Work Journal, Vol. 12, No. 5 (Oct. 1995).
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achieved full- time employment earlier and were more likely to complete high school or a GED at a younger age than youths who did not receive independent living services. 19 The New York City study of independent living services provided by Green Chimneys Children's Services showed that 75 percent of the youths had completed high school or a GED, 72 percent had full- time employment when they left care, and 65 percent had savings accounts. 20
HHS Slow in Leading Efforts to Determine ILP Effectiveness
A 1994 HHS Office of the Inspector General (OIG) report and a 1995 Harvard University study both recommended HHS take a stronger role in managing ILPs. However, HHS has been slow in leading efforts to determine if state ILPs improve the ability of youths leaving the foster care system to live on their own. 21 The OIG report made two broad recommendations: (1) that HHS' Administration for Children and Families (ACF) should restructure its ILP application and program reporting procedures to more adequately support state plans and to gain an accurate national picture of independent living efforts, and (2) that ACF should focus its management and program reporting efforts on sharing information among the states. The OIG report noted that the lack of accurate national information on independent living efforts weakens basic accountability and hinders efforts to improve programs and to determine effective practices. In addition, the Harvard study recommended that greater emphasis be placed on sharing information, with HHS' regional offices taking the lead in exchanging information among these offices and the states for which they are responsible. According to the study, only 3 of the 10 regional offices provided technical assistance to states beyond policy interpretation.
Currently, HHS has few strategies in place to review the states' progress in helping youths in the transition from foster care. HHS primarily relies on annual state ILP reports and summary statistics from these reports for information about ILP effectiveness. According to HHS staff, no additional monitoring strategies are in effect. There are two problems with relying on the annual reports to determine ILP effectiveness. First, as the OIG report noted and we confirmed during our review of annual state reports, states' approaches to program reporting and the quality of their program reports
19 Jane T. Simmons, PAL Evaluation Final Report, unpublished report submitted to Harris County (Texas) Children's Protective Services (Mar. 6, 1990). 20 Gerald P. Mallon, After Care, Then Where? Outcomes of an Independent Living Program, Child Welfare, Vol. 77 (Jan./ Feb. 1998). 21 Office of Inspector General, Independent Living Programs for Foster Care Youths: Strategies for Improved ACF Management and Reporting, HHS (# OEI- 01- 93- 00090, Nov. 1994); and Kari Burrell and Valeria Perez Ferreiro, Policy Analysis Exercise (Cambridge, Mass.: Harvard University, Apr. 12, 1995).
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vary greatly. According to the OIG report, many state reports do not adequately address the intensity of services or the range of efforts made for youths in various placement settings. Likewise, states use various definitions of terms, which the OIG reported can result in duplicate counts and inconsistent statistics. To illustrate, the term to be served can mean in one state that a youth has received an assessment, while in another state it means that the youth was enrolled in a formal life skills course. Second, states are required to report certain information to HHS on the status of ILP participants 90 days after program completion such as whether the youths are employed, have completed high school or a GED, or are living independent of public assistance. However, states inconsistently report this information and question the value of the data because they believe that 90 days may be too soon to judge youths' independence. For example, the OIG found that some states provide information on youths 90 days after discharge from foster care, while other states look at youths' status 90 days after completing the discrete ILP. Our review of 1998 annual state reports reveals that few reports address the effectiveness of services and outcomes for youths, making these reports an ineffective means of consolidating information on program effectiveness across the nation. To illustrate the difficulty in obtaining this outcome information, our nationwide survey showed that while 29 states attempt to contact ILP youths in response to the 90- day requirement, only four states reported success in contacting more than half of the former foster care youths. The majority of the states could locate only some or a few.
HHS officials told us that they recognize deficiencies in the annual state ILP reports, and that the agency needs to improve its monitoring of the program. However, because no other data currently exist with which to determine program effectiveness, HHS issued a contract in September 1998 to conduct an analysis of 10 years of annual state ILP reports so it can begin to fill the data gaps. According to project staff, this analysis represents HHS' first attempt since ILP began to summarize what states are doing with their ILP funds. Project objectives include identifying which states are producing ILP reports that could be used as models by other states, as well as what measures HHS can take to improve state reporting and evaluation.
Conclusions The Congress has identified adolescent foster youths as an important part of the foster care population and raised questions about whether states are
doing enough to prepare youths to live self- sufficiently. Unfortunately, serving the population of youths about to leave the foster care system is
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difficult. Research has shown that many pitfalls are encountered by these youths once they are on their own. Information on the services foster care youths need to help them become independent is critical to the success of ILPs. However, states do not routinely receive information on what has worked best in other states and have inconsistently applied HHS regulations on following up with youths. HHS has not analyzed information from state ILPs to develop a national perspective on what services are most needed and which services are less important in preparing youths to live on their own once foster care ends. We believe HHS should take steps to build a system of reporting and monitoring tools that would provide policymakers and program officials with the necessary information to assess the effectiveness of ILPs.
Recommendations To enhance HHS' and the states' accountability in preparing youths to live on their own after leaving the foster care system, the Secretary of HHS
should develop a uniform set of data elements and a report format for state reporting on ILP so that analysis of ILP information can be conducted using consistent data and the results shared with the states; and concrete measures of effectiveness for assessing state ILPs, such as the number of youths with stable employment and housing at the time they leave foster care and at specific intervals thereafter.
Agency and Other Comments
We requested comments on this report from HHS and state ILP officials in the four states we visited. HHS, New York, and Texas provided technical comments, which we incorporated where appropriate. In addition, New York's comments mentioned the need for additional incentives to encourage youths' participation in the program. California and Maryland did not comment.
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We are sending copies of this report to the Honorable Donna E. Shalala, Secretary of Health and Human Services; state ILP coordinators; state child welfare agencies; and other interested parties. Copies will also be made available to others on request. If you or your staff have any questions about this report, please call me at (202) 512- 7215. Other major contributors to this report are listed in appendix III.
Sincerely yours, Cynthia M. Fagnoni, Director Education, Workforce, and Income Security Issues
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 18
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 19
Contents Letter 1 Appendix I Scope and Methodology
22 Appendix II Figures From Our Review of Annual State Reports
24 Appendix III GAO Contacts and Staff Acknowledgments
32 Related GAO Products 33 Table Table 1: Categories of Non- Federal ILP Funding 6 Figures Figure II. 1: Specific Education Services Reported by States
During 1998 24
Figure II. 2: Specific Employment Services Reported by States During 1998
26 Figure II. 3: Specific Daily Living Skills Training Reported by
States During 1998 28
Figure II. 4: Specific Financial Assistance Provided by States During 1998
30
Abbreviations
ACF Administration for Children and Families GED General Educational Development HHS U. S. Department Health and Human Service ILP Independent Living Program OIG Office of the Inspector General UPS United Parcel Service
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 20
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 21
Appendix I Scope and Methodology
To identify what is currently known about the services provided by Independent Living Programs (ILP) and the effect of these services on youths' ability to live on their own, we reviewed the relevant literature on problems former foster care youths face in living independently, 1998 annual ILP reports submitted by the states to the Department of Health and Human Services (HHS) (see appendix II) 22 , and studies showing the effectiveness of ILP services. We also interviewed experts on independent living services. We obtained the perspectives of representatives of the National Child Welfare Resource Center for Youth Development, the National Independent Living Association, the Child Welfare League of America, and the Casey Family Program. In addition, we interviewed officials of HHS' Children's Bureau and Family and Youth Services Bureau.
We developed a state survey to obtain national information on additional services offered by state ILPs and on additional funds spent beyond the federal dollars and required state matching funds. In April 1999, we surveyed ILP coordinators in each of the 50 states and the District of Columbia. We received responses from all states and the District of Columbia, and from these responses we obtained general information on (1) additional state, local, and private funds spent on ILPs, (2) the number of youths younger than age 16 served who were served and the services provided to them, (3) the extent of after- care programs, (4) the states' ability to follow up with youths after leaving care, and (5) the extent of transitional housing services. We also obtained information on outcome studies conducted by the states. We did not verify the information obtained through the survey. However, we conducted telephone interviews with state respondents to clarify answers, as needed.
To obtain information on the services offered by states to youths leaving care and the problems states face in meeting their needs, we visited independent living programs in four locations Contra Costa County, California; Baltimore City and County, Maryland; New York City, New York; and the San Antonio region, Texas. We chose these four locations because our analysis of the literature and discussions with key independent living experts identified these localities as having ILPs that provide critical services to help youths become self- sufficient, such as postsecondary tuition waivers and well- developed employment links in the community. California and New York also have large populations of foster
22 We reviewed 45 annual state reports, plus the report from the District of Columbia. At the time of our review, reports were not available from Alaska, California, New York, South Carolina, and Wyoming. HHS subsequently received reports from Alaska, California, New York, and South Carolina, but these were received too late to be included in our analysis. Wyoming did not submit an annual report because the state did not use federal ILP funds in 1998.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 22
Appendix I Scope and Methodology
care youths. In each state, we met with state ILP officials to obtain an overview of how the program is implemented throughout the state. At the local sites, we met with a variety of staff and clients, including ILP coordinators, case workers, private service providers, and current and former foster care youths. Where available, we met with youth advocacy organizations.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 23
Appendix II Figures From Our Review of Annual State Reports
Figure II. 1: Specific Education Services Reported by States During 1998
Note: Delaware and Missouri provided education services but did not specify the type of services in their 1998 annual reports.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 24
Appendix II Figures From Our Review of Annual State Reports
a High school or General Educational Development (GED) services enable participants to seek a high- school diploma or its equivalent. Tutoring is an example of such services. b Vocational services enable youths to participate in appropriate vocational training and may include vocational testing or referral. c Postsecondary education services enable youths to prepare for or attend college or university. These services may include educational planning, assistance obtaining financial aid or college admission, or college testing preparation.
Source: State annual ILP reports for 1998.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 25
Appendix II Figures From Our Review of Annual State Reports
Figure II. 2: Specific Employment Services Reported by States During 1998
Note: Louisiana, Nebraska, and Vermont provided employment services, but did not specify which services.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 26
Appendix II Figures From Our Review of Annual State Reports
a Job readiness services can include information on how to prepare for a job, such as how to prepare a resume or complete job applications, or how to maintain employment.
Source: State annual ILP reports for 1998.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 27
Appendix II Figures From Our Review of Annual State Reports
Figure II. 3: Specific Daily Living Skills Training Reported by States During 1998
a Money management can include instruction in budgeting or opening a bank or credit card account.
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Appendix II Figures From Our Review of Annual State Reports
b Health and safety can include information about substance abuse, hygiene, parenting, first aid, and leisure. c Food and nutrition can include information about how to shop for groceries or prepare and cook food. d Community resources can include information about access to resources such as medical care, legal services, transportation, and recreation. e Social skills can include activities to improve self- esteem, interpersonal relationships, problem- solving, leadership, and sexual responsibility. f Montana reported providing daily living skills but did not identify specific training offered.
Source: State annual ILP reports for 1998.
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Appendix II Figures From Our Review of Annual State Reports
Figure II. 4: Specific Financial Assistance Provided by States During 1998
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 30
Appendix II Figures From Our Review of Annual State Reports
a Financial incentives or stipends can include incentives for completing training or units of training in daily living skills. b These services include tuition waivers or scholarships. c These services include books, training materials, uniforms, college exam fees, and college application fees. d These expenses can include fares for buses, trains, or airplanes; or gas for youths' automobiles. e Start- up assistance includes items such as utility deposits or household items (e. g., furniture, dishes, and linens).
Source: State annual ILP reports for 1998.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 31
Appendix III GAO Contacts and Staff Acknowledgments
GAO Contacts David D. Bellis, Assistant Director, (202) 512- 7278 Diana M. Pietrowiak, Evaluator- in- Charge, (202) 512- 6239
Staff Acknowledgments
Ellen Soltow, Suzanne Sterling, Jay Smale, and Joel Grossman also made important contributions to this report.
GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 32
Related GAO Products Youth Mentoring Programs: Fiscal Year 1998 (GAO/ HEHS- 99- 129R, May 28, 1999).
Foster Care: Challenges in Helping Youths Live Independently (GAO/ T- HEHS- 99- 121, May 13, 1999).
Foster Care: Increases in Adoption Rates (GAO/ HEHS- 99- 114R, Apr. 20, 1999). Juvenile Courts: Reforms Aim to Better Serve Maltreated Children (GAO/ HEHS- 99- 13, Jan. 11, 1999).
Child Welfare: Early Experiences Implementing a Managed Care Approach (GAO/ HEHS- 99- 8, Oct. 21, 1998).
Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Abusers (GAO/ HEHS- 98- 182, Sept. 30, 1998).
Foster Care: Implementation of the Multiethnic Placement Act Poses Difficult Challenges (GAO/ HEHS- 98- 204, Sept. 14, 1998).
Child Protective Services: Complex Challenges Require New Strategies (GAO/ HEHS- 97- 115, July 21, 1997).
Foster Care: State Efforts to Improve the Permanency Planning Process Show Some Promise (GAO/ HEHS- 97- 73, May 7, 1997).
Child Welfare: Complex Needs Strain Capacity to Provide Services (GAO/ HEHS- 95- 208, Sept. 26, 1995).
(116033) GAO/ HEHS- 00- 13 Foster Care: Independent Living Page 33
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FOSTER CARE: Effectiveness of Independent Living Services Unknown
GAO/HEHS-00-13 United States General Accounting Office GAO Report
to The Honorable Nancy L. Johnson, U. S. House of Representatives
November 1999 FOSTER CARE Effectiveness of Independent Living
Services Unknown   GAO/HEHS-00-13  GAO United States General
Accounting Office Washington, D. C. 20548 Health, Education, and
Human Services Division B-283530 November 5, 1999 The Honorable
Nancy L. Johnson Chairman, Subcommittee on Human Resources
Committee on Ways and Means House of Representatives Dear Madam
Chairman: Each year approximately 20,000 youths exit the foster
care system with the expectation that they will be able to live
self- sufficiently. 1 After exiting the system, many of these
youths face serious problems, including homelessness, lack of
employment stability, incarceration, and early pregnancy.
Recently, a congressional subcommittee raised concerns in hearings
that the federal Independent Living Program (ILP), designed to
help foster care youths make the transition to living
independently, does not give youths leaving foster care the
necessary life skills to complete basic education, find and
maintain employment, or otherwise live self- sufficiently after
leaving care. The Congress is currently considering legislation
that would double program funds and expand services for youths in
foster care and those who will leave foster care. All states
provide independent living services to youths about to leave the
foster care system. Because of your concerns that little is known
about the level of services offered to these youths and whether
the services match their needs, you asked us to (1) describe the
extent of services provided under ILPs, and (2) discuss what is
known about the effect of these services on youths' ability to
live on their own. 2 In conducting this work, we reviewed relevant
literature and 1998 annual ILP reports submitted by the states to
the Department of Health and Human Services (HHS). We also
interviewed state and federal officials and independent living
experts and visited independent living programs in four locations
Contra Costa County, California; Baltimore City and County,
Maryland; New York, New York; and the San Antonio region, Texas.
In addition, to obtain national information on additional services
offered by state ILPs, we surveyed all 50 states and the District
of Columbia. We conducted our work between January and September
1999 in accordance with generally accepted 1 When youths who have
not been reunited with their families or adopted attain age 18,
federal reimbursement is no longer made to states for the youths'
maintenance in foster care. However, some states allow youths to
remain in care, at state expense, until age 21. 2 We testified on
these issues in May 1999 and this report expands on that
information. See Foster Care: Challenges in Helping Youths Live
Independently (GAO/T-HEHS-99-121, May 13, 1999). GAO/HEHS-00-13
Foster Care: Independent Living Page 1 B-283530 government
auditing standards. (A more detailed discussion of our scope and
methodology appears in appendix I.) Results in Brief States
provide a wide range of services to better ensure that foster care
youths are prepared to live on their own after they leave the
foster care system. Those services funded by federal, state,
local, and private dollars totalling at least $131.5 million in
1998 include assisting youths in attaining their educational
goals, such as completing high school or passing the General
Educational Development (GED) test and attending postsecondary
schools; as well as assisting youths in finding and maintaining
employment. 3 In addition, youths attend classes in daily living
skills, covering such topics as money management, hygiene,
housekeeping, and nutrition, and receive instruction in areas that
help youths interact successfully with adults, such as conflict
management. Other transitional services, such as supervised
practice living arrangements and after- care services, allow
youths to try living on their own prior to leaving the foster care
system and provide temporary assistance to ease the transition to
independence. However, state and local administrators told us that
their ILPs cannot always provide all of the assistance
administrators and youths say is needed to help youths learn to
live on their own. For example, some programs do not have fully
developed links with employers to provide job leads, lack
opportunities for youths to practice skills in real- life
settings, and fall short on the number of supervised practice
living arrangements needed for youths to become more proficient at
living self- sufficiently. Even though the federal ILP was
established in 1985, few national or local studies have been
completed to assess the effectiveness of independent living
services in helping youths through the transition to living on
their own after foster care. 4 We identified only one national
study that has been completed to date, which found that services
provided by ILPs have the potential to improve outcomes for
youths. In addition, although several states indicated they have
completed studies that measure general youth outcomes, such as
education and employment status, only a few attempted to measure
the helpfulness of ILP services in youths' ability to attain self-
sufficiency. While HHS is tasked with overseeing implementation of
ILP, it has done little to determine program effectiveness and has
no 3 Some states were unable to identify the amount of additional
state, local, or private funds spent on their ILPs. 4 Although ILP
was established in 1985, funds for payments to the states were not
appropriated until 1987. GAO/HEHS-00-13 Foster Care: Independent
Living Page 2 B-283530 established method to review the states'
progress in helping youths in the transition from foster care. For
example, HHS primarily relies on state annual program reports for
effectiveness information and has no other monitoring efforts in
place. However, the content and quality of the reports vary and
they contain little information on program outcomes. HHS officials
told us they recognize these deficiencies and the need to improve
monitoring efforts. To begin the improvement process, HHS issued a
contract in September of 1998 to analyze 10 years of annual state
ILP reports to determine, among other things, which states are
producing good ILP reports that could be models for other states
and what measures HHS can take to improve state reporting and
evaluation. We are making recommendations to HHS concerning the
need to enhance HHS' and states' accountability for preparing
youths to live on their own. Background Adolescents in foster
care, especially those who have been in care for a number of
years, face numerous challenges in preparing to become self-
sufficient adults once they leave the foster care system. Several
programs help foster care youths in their transition to
independent living, but only one ILP is specifically designed to
serve this population. The transition from the foster care system
to self- sufficiency can be difficult. Research has shown that
many former foster care youths have serious educational
deficiencies and rely on public assistance. For example, a 1991
study of foster care youths interviewed 2.5 to 4 years after they
left care found that 46 percent had not finished high school. 5
Additionally, almost 40 percent were found to be a cost to the
community through their dependence on such programs as public
assistance and Medicaid. Similarly, the University of Wisconsin
recently studied youths who had been out of care between 12 and 18
months, and found that 37 percent had not finished high school and
32 percent were receiving public assistance. 6 In addition, former
foster care youths often find themselves lacking adequate housing.
The Westat study reported that 25 percent of the youths were
homeless at least 1 night, and the University of Wisconsin study
found that, after leaving care, 14 percent of the males and 10
percent of the females had been homeless at least once. Additional
difficulties may further impede youths' ability to become self-
sufficient. The Westat study found that 51 percent of the youths
were unemployed 5 Westat, Inc., A National Evaluation of Title IV-
E Foster Care Independent Living Programs for Youth (Washington,
D. C.: HHS, 1991). 6 Mark E. Courtney and Irving Piliavin, Foster
Youth Transitions to Adulthood: Outcomes 12 to 18 Months After
Leaving Out- of- Home Care (Madison, Wisc.: University of
Wisconsin, 1998). GAO/HEHS-00-13 Foster Care: Independent Living
Page 3 B-283530 and 42 percent had given birth or fathered a
child. Likewise, the University of Wisconsin found that 39 percent
of the youths were unemployed, and that 27 percent of the males
and 10 percent of the females had been incarcerated at least once.
ILP the primary program designed to help foster care youths become
self- sufficient authorizes federal funding for states to
establish and implement services to assist youths aged 16 and over
in making the transition from foster care to independent living.
Originally authorized in 1985 by P. L. 99- 272 for a limited
period, the program was reauthorized indefinitely as part of the
Omnibus Budget Reconciliation Act of 1993 (P. L. 103- 66), which
also increased federal funding to the current level of $70 million
per year. A portion of the federal funds$ 45 million is
distributed to states as an entitlement based on each state's
proportion of all youths receiving federal foster care maintenance
payments in fiscal year 1984. 7 States are also eligible to
receive a proportional share of the remaining $25 million in
federal funds to match the funds they provide. HHS estimates that
almost 77,000 youths aged 16 to 20 were in foster care as of
September 1998. While approximately 40 percent of the youths in
this age range will return to their biological families, almost
20,000 adolescents per year leave the foster care system and are
expected to live self- sufficiently. Eligible ILP participants
include youths aged 16 and over for whom federal foster care
payments are being made. 8 At their option, states may use ILP
funds for foster care youths not receiving federal assistance and
former foster care youths who were in foster care after the age of
16. Likewise, states may provide services to any of these youths
until the age of 21. Youth participation in ILP services is
voluntary. Other federal programs may also provide some assistance
to this population, but are not designed to specifically provide
services to foster care youths. For example, HHS' Transitional
Living Program for Homeless Youth provides funds to communities
for housing and independent living services to homeless youths. A
variety of other programs may also assist 7 Under Title IV- E of
the Social Security Act, federal matching funds are provided to
states for foster care maintenance costs. These funds cover a
portion of the food, housing, and incidental expenses for foster
care children from families who would have been eligible for
benefits under the former Aid to Families With Dependent Children
program using 1995 eligibility criteria. States are responsible
for any foster care costs they incur for children not eligible for
federal support. 8 States can receive federal foster care
maintenance payments for eligible children while they are in
foster care family homes, private for- profit or nonprofit child
care facilities, or public child care institutions. Youths become
ineligible for federal foster care maintenance payments at age 18
or, at a state's option, age 19 if a child in foster care is a
full- time student in a secondary school and is expected to
complete the educational program prior to turning 19. GAO/HEHS-00-
13 Foster Care: Independent Living Page 4 B-283530 youths. For
example, Job Corps, under the auspices of the U. S. Department of
Labor, enrolls youths aged 16 to 24 who are economically
disadvantaged, in need of additional education or training, and
living under disorienting conditions such as a disruptive
homelife. In addition, other agencies, such as the Departments of
Justice, Education, and Housing and Urban Development, have
education and employment assistance programs targeted to
disadvantaged and at- risk youths. Service agencies in the states
may also provide assistance to youths, including educational,
juvenile justice, mental health, public assistance, and substance-
abuse service agencies. The federal government provides most of
the funding for ILP. In addition, HHS is responsible for assisting
state child welfare systems by promoting continuous improvement in
the delivery of child welfare services. In this regard, HHS
central office staff are responsible for developing ILP- related
policies, procedures, and regulations, and for ensuring their
implementation by the states. HHS' regional office staff serve as
the local ILP contacts for the states, review and approve state
applications for ILP funds, and review the annual state ILP
reports. Regional staff also provide technical assistance to the
states and clarification on program requirements. In addition, the
University of Oklahoma's National Child Welfare Resource Center
for Youth Development, under cooperative agreement with HHS, is
responsible for providing ILP training and technical assistance to
the states in coordination with the regional offices. HHS issued
instructions to states in December 1993 outlining allowable ILP
services including education and employment assistance,
instruction in daily living skills, and other support services to
ease youths' transition to independent living. In addition, states
must provide written transitional independent living plans based
on an assessment of each youth's needs and may establish outreach
programs to attract individuals eligible to participate in the
program. Multiple Services Assist Youths in Achieving
Independence, but ILPs Fall Short in Key Areas To better ensure
that foster care youths are prepared to live on their own, state
ILPs provide an array of services using a combination of federal,
state, local, and private funds. These services include assistance
with completing education and finding employment; instruction in
the basic skills needed to live independently, such as money
management, hygiene, housekeeping, and nutrition; and transitional
services, such as supervised practice living arrangements (see
appendix II). However, state and local administrators told us that
their current ILPs fall short in key areas. For example, some
GAO/HEHS-00-13 Foster Care: Independent Living Page 5 B-283530
programs do not sufficiently seek out employment opportunities in
the community and offer few opportunities for youths to
participate in real- life practice opportunities or esteem-
building experiences. Moreover, some programs could not provide
enough housing or other transitional assistance to both youths
still in care and those who have left care. To address these
shortcomings, a few locations have added specialized stuff and
programs, such as developing partnerships with local businesses
for part- time youth employment. ILP Services Supported by
Federal, State, and Other Funds To provide ILP services, states
use federal annual ILP funds of $70 million, $25 million in state
matching funds, and additional dollars provided by a variety of
sources. For example, our survey showed that 35 states reported
spending additional state, local, and private funding on their
ILPs totaling at least $36.5 million (see table 1). 9 Also, 20
states reported receiving in- kind ILP donations such as mentoring
services, use of facilities for training, attorney services,
drivers' education training, college scholarships, books, school
supplies, clothing, computers, gift certificates, and household
supplies for youths. Table 1: Categories of Non- Federal ILP
Funding Type of funding Range of funding among reporting states
Total funding reported State (20 states) $75,000 to $11 million
$22.8 million Local (7 states) $1,000 to $6.5 million $13 million
Private (7 states) $1,500 to $295,000 $0.7 million Because federal
funds can only be used to serve youths aged 16 to 21, more than
one- third of the states reported using some additional funds to
provide services to some youths younger than 16. During federal
fiscal year 1998, the states served a total of 2,169 youths under
age 16. Our review of state annual ILP reports showed that
approximately 42,680 youths aged 16 or older only about 60 percent
of all eligible youths volunteered to receive ILP services in
1998, and officials in the states we visited noted that attracting
youths to participate in the program is a challenge. 10 9 Thirty-
five states reported spending additional dollars beyond the
federal funds and state match, but not all of these states
reported the amounts spent in each category. 10 Although not all
states included participation figures in their annual reports, we
determined that at least 42,680 youths in 40 states received some
type of independent living service during 1998. GAO/HEHS-00-13
Foster Care: Independent Living Page 6 B-283530 Education and
Employment Assistance Offered, but Few Pathways From Foster Care
Developed According to our review of annual state ILP reports, 41
states reported assisting youths with preparing for, or
completing, education or vocational training. 11 Of these 41
states, 26 offered assistance, such as tutoring or remedial
training, to help youths graduate from high school or receive a
GED; 28 states helped youths prepare for vocational school, for
instance through vocational testing or referral; and 33 states
helped youths pursue postsecondary education, such as through
educational planning or assessments, assistance in applying for
financial aid or college admission, or campus tours. 12 Further,
21 states awarded some tuition aid or scholarships for college or
vocational schools, and 20 helped pay for other educational
expenses such as books, training materials, uniforms, college
entrance exam fees, or college application fees. In total, 40
states reported providing employment services to youths. Of these,
28 states assisted youths with job readiness, including
instructing them in how to write resumes, how to interview for and
maintain a job, and how to complete job applications; and 24
states helped youths with job search. Moreover, 18 states helped
with job placement. For example, for several youths with
negligible work skills, the District of Columbia contracted for
job placement services that included a job coach, on- the- job
assistance with work problems, transportation assistance,
mentoring, and periodic group sessions. Although all four areas we
visited provided assistance with education and employment, we
found that the ILPs did not provide services that fully matched
foster care youths to appropriate employment pathways. For
example, officials in three of the sites told us that vocational
opportunities for youths were limited for several reasons. State
and local coordinators in Texas indicated that few apprenticeship
positions are available, while ILP coordinators in Baltimore City
and New York reported a lack of vocational education programs that
youths can afford and a lack of ILP funds to pay for such
programs. These officials also reported that culinary arts and
technology- related programs two programs popular with foster care
youths are relatively expensive. Of the four sites we visited,
only Texas 11 We reviewed 1998 annual state ILP reports from 45
states plus the District of Columbia. However, because no standard
report format exists, states do not consistently report services
offered during the previous year. We counted only those states
that specifically mentioned providing a particular service either
throughout, or in some portion of, the state in their 1998 report,
although others may have provided the service but not included
this information as part of their program description. According
to an HHS ILP official, annual reports from Alaska, California,
New York, South Carolina, and Wyoming were not available at the
time of our review. 12 Many of these states reported providing all
the educational services mentioned. GAO/HEHS-00-13 Foster Care:
Independent Living Page 7 B-283530 offers statewide tuition
waivers for all state- supported vocational, technical, and
postsecondary schools. Our field visits also revealed that
connections between the ILP and potential employers were not
thoroughly developed. For example, ILP coordinators in one
location told us they did not have time to establish relationships
with very many employers and that employment development efforts
in their location are largely informal. State officials in
California and Maryland indicated that they believe more public-
private partnerships are needed to provide youths with employment
opportunities. In addition, New York City officials told us that
they are just beginning to devise ways to link with employers to
enhance youths' job prospects. Several officials also pointed out
that more staff need to be assigned to this task if it is to be
accomplished. Some locations are attempting to address these
training and employment shortcomings. For instance, Maryland
established a partnership between the ILP, the United Parcel
Service (UPS), the Living Classroom Foundation, and the Annie E.
Casey Foundation. This program provides employment opportunities,
according to UPS officials, to expose youths to a significant and
demanding first job that teaches them invaluable, transferable
workplace skills. UPS supervisors work closely with youths to
identify barriers and access other resources if needed (such as
mentoring, counseling, or job readiness programs), and strive to
instill leadership skills and develop the youths' potential. For
example, the youths attend career and academic goal- setting
sessions with a UPS School- to- Work Specialist. Moreover, UPS
supervisors maintain close contact with youths after they have
been hired to ensure their success on the job. Transportation to
the work site is provided and on- site college- level classes are
available, as well as opportunities to combine working for UPS
with working for other area employers such as banks, grocery
stores, and drug stores. UPS planned to hire 75 foster care youths
during the first year of the partnership. States Provide
Assistance in Learning Daily Living Skills, but Opportunities to
Practice Skills Are Lacking In our review of annual state ILP
reports, we found that 46 states report training youths in daily
living skills such as money management, health and safety,
nutrition, housekeeping, parenting and sexual responsibility, and
interpersonal and other social skills. The four areas we visited
also offer training in daily living skills. For example, in Contra
Costa County, California, youths attend a series of living skills
workshops that cover, among other topics, how to prepare a budget
and how to open and use a GAO/HEHS-00-13 Foster Care: Independent
Living Page 8 B-283530 checking account. Likewise, life skills
classes in the San Antonio, Texas, area meet for 8 weeks and cover
core areas, including personal and interpersonal skills, health
and safety, money management, and planning for the future. In New
York City, life skills classes provide instruction on
housekeeping, health care, interpersonal skills, food management,
transportation, and family planning, among others. Although some
daily living skills are taught in a classroom setting, officials
in the four states we visited stressed the importance of
experiential learning, and independent living experts concurred
that youths benefit from activities in which they can practice the
skills learned. State and local program officials acknowledged the
importance of activities that allow youths to perform and perhaps
initially fail at daily tasks until they become proficient.
According to local officials and service providers, many foster
youths have learned to depend on the child welfare system for
their care and thus may not have been exposed to everyday
experiences other teens take for granted, such as cooking, grocery
shopping, driving, or taking excursions outside their communities.
To address this, Texas and California conduct a program called
Independent City a simulated community in which young persons are
assigned an income and must apply for jobs, sign leases for
apartments, arrange for utilities, open checking accounts, and buy
cars. In addition to the need to gain practical living experience,
officials in three of the locations we visited reported that
youths need to learn interpersonal skills, such as conflict
management, communication, and decision- making. Officials report
that youths who do not master these other skills may have
difficulty finding and maintaining employment. To learn these
skills, youths may participate in classroom- based training or in
recreational events. In New York City, for example, one service
provider takes youths to Broadway plays or restaurants to allow
them to learn how to interact in social situations, including how
to behave and how to order from a menu. After the activity, youths
meet with the coordinator to discuss lessons learned. Other
opportunities for youths to develop social skills, such as team-
building and leadership, are provided by teen conferences,
retreats, and youth advisory boards. For instance, Maryland holds
an annual statewide teen conference where youths attend workshops
on self- empowerment, conflict resolution, and goal achievement.
Texas offers wilderness challenge and ropes courses to strengthen
problem- solving and team- building abilities. Moreover, according
to our review of annual reports, 22 states have youth advisory
boards that work to improve policies and services affecting foster
youths. The Youth Advisory Board in GAO/HEHS-00-13 Foster Care:
Independent Living Page 9 B-283530 Massachusetts, for example,
meets with the commissioner of the social services department
quarterly to express concerns and recommendations regarding agency
foster care services and policies. Further, officials in the four
states we visited emphasized that youths need to be able to form
and maintain relationships with others. Establishing a connection
to an adult is so important, according to Texas state officials,
that one goal of the state's ILP is for every young adult to have
a significant adult in his or her life when he or she leaves
foster care. To help youths receive this type of social support,
many states use mentoring programs. According to a study of 29
child welfare programs' mentoring services, these services can
take many forms: some link adult mentors to youths to assist them
in making the transition from foster care to adult living, while
other programs involve workplace mentoring where the employer
provides jobs, monitors the work experience, and offers career
development opportunities to young persons. 13 Officials in all
the locations we visited viewed mentoring programs as one method
to provide youths with a vocational role model and opportunities
to practice independent living skills, as well as opportunities to
form connections to adults who serve as positive role models. We
found that opportunities to practice daily life tasks and to
develop self- esteem were limited in some of the locations we
visited. Program officials in two locations and foster care youths
in three locations told us that issues such as safety regulations
for group homes inhibit or prevent certain activities, such as
practicing cooking. In addition, esteem- building experiences are
often limited to a small number of youths. For example, local
officials in Texas reported that opportunities for foster care
youths to participate in postsecondary school conferences or
extended outdoor activities were limited. In addition, programs
offering adult mentors serve a small number of youths. For
example, a foster care service provider in Texas contracted by the
state specifically to develop mentor programs reported difficulty
finding mentors. 13 Edmund V. Mech and others, Mentors for
Adolescents in Foster Care, Child and Adolescent Social Work
Journal, Vol. 12, No. 4 (Aug. 1995). GAO/HEHS-00-13 Foster Care:
Independent Living Page 10 B-283530 Housing and Other Transitional
Support Services Provide Bridges to Adulthood, but Obstacles
Impede Self- Sufficiency Transitional living arrangements allow
youths to live on their own and practice becoming proficient at
managing their lives while still receiving supervision and
financial support. Our survey showed that more than 80 percent of
the states provided transitional practice living arrangements to
some youths while they are still in foster care to allow them an
opportunity to experience independent living for a period of time.
About 37 percent of the states offered housing to some youths
after they left the foster care system. In Baltimore County,
Maryland, for example, the Challengers Independent Living program
seeks to provide youths with the means to cope with independence
once they leave foster care. In this program, foster care youths
can reside for 18 to 24 months in apartments furnished and
supervised by the service provider and receive a weekly stipend to
purchase clothing, food, and household supplies. They are also
responsible for cleaning the apartments and doing their own
laundry. Each youth's foster care payment covers the cost of rent,
utilities, and administration of the program. Program staff also
offer educational, vocational, clinical, and home- life support,
including additional independent living skills training. Similar
programs, such as the Real Solutions Transitional Living Program
in San Antonio, Texas, are available to young adults who have left
foster care. This privately funded program provides youths with a
group living arrangement for up to 3 years, normally from ages 18
to 21, while they adjust to self- sufficiency. Additional
transitional support services provided by the states include
counseling, programs for youths with special needs and
disabilities, and after- care programs for youths who are no
longer in the foster care system. 14 Officials in the states we
visited said that many youths have mental health issues that need
to be addressed. Some states noted in their annual ILP reports
that individual or group counseling may help address issues that
act as barriers to independent living for the teen population,
such as drug abuse, or may increase the youths' ability to utilize
independent living skills they were taught. Thirty- one states
indicated in their annual reports that they offer some type of
counseling service, such as individual, group, or peer counseling.
In Illinois, for example, support groups provide a forum for
youths to express their feelings about being in foster care, as
well as to identify issues and fears about leaving it. Seven
states offered specialized programs for developmentally disabled
youths and four states offered services for those with emotional
or behavioral problems. 14 HHS data for 1998 identified 20 percent
of foster youths between the ages of 16 and 20 as having a
disability. GAO/HEHS-00-13 Foster Care: Independent Living Page 11
B-283530 To assist youths who have exited foster care, our survey
showed that, in federal fiscal year 1998, 30 states provided
formal services for a period of time after foster care, serving a
total of 7,830 youths between the ages of 11 and 24. The majority
of these states reported providing a full range of services,
including education and employment assistance, training in daily
living skills, and individual and/ or group counseling. In
addition, 21 states reported providing other services and
assistance such as mentoring, transportation assistance, medical
coverage, and clothing. Our field visits confirm that some states
offer after- care services. For example, Florida reports serving
former foster care youths through tuition assistance, counseling,
opportunities to attend conferences and receive skills training or
to serve as mentors or co- trainers, referrals to other agencies
for assistance in finding a job or housing, transportation
assistance, and opportunities to use the resource library.
However, we noted some concerns about these services. For example,
the number of transitional living arrangements is limited. Our
survey showed that 38 states served 6,320 current foster youths
and 12 states served 1,787 former foster youths. 15 Officials in
the four areas we visited confirmed that the number of supervised
transitional housing sites is very limited and that they could not
provide adequate housing for both youths in care and those who
have left the system. One transitional housing provider in Texas
indicated that the program has space for only 6 youths, while an
additional 80 to 100 youths with no place to live upon exiting
foster care could benefit from this type of housing program. A
transitional housing provider in a second location explained that
program staff carefully screen youths for readiness to handle the
responsibilities of managing their own place to live and, because
of limited capacity, accept only the most promising teens into the
program. In addition, some officials noted that their after- care
services are limited and that they believe youths could benefit
from more services than they can offer. For example, in Texas,
after- care services are available for only 6 months after the
youth exits care. The services consist mainly of referrals to
other service agencies, visits to colleges, and a small stipend
for 4 months. After- care services in Baltimore County and New
York City are limited to referring the youths to other agencies
that can assist them. 15 According to our survey, 43 states
reported providing transitional housing to current foster care
youths and 19 states reported providing this service to former
foster care youths in fiscal year 1998. Only 38 and 12 states,
respectively, provided the number of youths served. GAO/HEHS-00-13
Foster Care: Independent Living Page 12 B-283530 Information on
Program Effectiveness Is Limited Given the significant challenges
that youths face in moving from foster care to adulthood, it is
important to understand how effective the ILP is in better
ensuring outcomes for foster care youths. However, little
information is available to help in understanding the outcomes
these programs achieve. HHS has not taken an active role in
identifying whether state ILPs are providing services that
increase youths' chances of becoming self- sufficient once they
leave the foster care system or in sharing information among the
states. Few National and Local Studies on ILP Effectiveness Few
studies that address ILP effectiveness have been conducted on a
national or local level. Only one national study has been
completed since ILP was established in 1985. This study conducted
by Westat, Inc., with funding from HHS found that services
provided by ILPs have the potential to improve outcomes for
youths. The study found that skills training in particular areas
led to better outcomes (e. g., health training aided youths in
gaining access to health care), although no one skill area had a
consistent effect across all outcomes assessed. More comprehensive
effects were achieved when youths were taught a combination of
skills. Youths who received training in managing money, obtaining
a credit card, and buying a car, as well as help in how to find a
job and gain access to appropriate education opportunities, were
more likely to keep a job for at least a year. Two other studies
are currently under way; study results are due in fall 1999. The
Child Welfare League of America recently developed a state survey
on independent living services to gather comprehensive information
on ILP topics such as the population served, the type of foster
care placement and permanency plan for these youths, fiscal
information on ILP funds, ILP policies, transitional living
arrangements, and model programs. In 1997, the Annie E. Casey
Foundation awarded a grant to the National Child Welfare Resource
Center for Organizational Improvement at the University of
Southern Maine and the National Resource Center for Youth Services
at the University of Oklahoma to define the current knowledge base
regarding the transition of youths out of foster care and to
examine effective practices and policies which may improve
opportunities for youths to become fulfilled, productive adults.
In addition, 12 states told us they had conducted follow- up
studies of youths who had left foster care and 14 additional
states reported they had a follow- up study under way or were
planning such a study. Eight states provided a copy of completed
studies; only three of these studies asked GAO/HEHS-00-13 Foster
Care: Independent Living Page 13 B-283530 former foster care
youths about the effectiveness of independent living services they
received while in care. For example, an evaluation of the Wayne
County, Michigan, ILP attempted to contact former ILP participants
to obtain information on their current situations. 16 However,
none of the former clients could be located and the study was
changed to a survey of youths currently participating in an ILP or
those receiving after- care services. Of the 61 youths surveyed,
over 80 percent indicated that their quality of life improved
after they received independent living services. Youths judged
housing and health care services more effective than other
services, and judged employment services among the least
effective. A study of 26 youths in Nevada about 3 months after
leaving foster care showed that most of the respondents believed
the ILP helped prepare them to some extent for making the
transition to living on their own, including preparing them to
find a place to live, prepare meals, budget money, and locate
community resources. 17 However, 53 percent of the youths were not
satisfied with their independent living services. Finally, in a
1995 North Carolina study comparing 44 ILP participants and 32
nonparticipants who left foster care between 1992 and 1995, 65 to
73 percent of the participants felt that ILP services were helpful
to some extent in preparing them for independent living, although
no specific area of ILP assistance stood out. Fifty- five percent
of the ILP participants started living independently immediately
after leaving foster care, compared to only 12 percent of
nonparticipants. Similarly, 30 percent of the ILP participants
were paying all their housing expenses within 1 to 3 years after
leaving foster care, as compared to 19 percent of nonparticipants.
According to the study, these and other housing- related findings
indicate a definite, though gradual, movement toward independent
living that is more pronounced for ILP participants than for
nonparticipants. We identified three additional local studies that
show positive effects of ILP services and link participation in
ILP with improved education, housing, and other outcomes from
Baltimore County, Harris County (Houston, Texas), and New York
City. In the Baltimore County study, youths who received ILP
services were more likely to complete high school, have an
employment history, and be employed when they left foster care. 18
In the Harris County study, the author found that graduates of the
Texas ILP 16 Moore & Associates, Inc., Final Report: An Evaluation
of the Wayne County Independent Living Coalition, submitted to the
Michigan Family Independence Agency (Sept. 1998). 17 Hailu
Abatena, Independent Living Initiative Program: A Follow Up Survey
Report of the Youth Released from Foster Care in Nevada in 1996
(Henderson, Nev.: Nevada Research, Evaluation, and Planning
Consultants, undated). 18 Maria Scannapieco and others,
Independent Living Programs: Do They Make A Difference? Child and
Adolescent Social Work Journal, Vol. 12, No. 5 (Oct. 1995).
GAO/HEHS-00-13 Foster Care: Independent Living Page 14 B-283530
achieved full- time employment earlier and were more likely to
complete high school or a GED at a younger age than youths who did
not receive independent living services. 19 The New York City
study of independent living services provided by Green Chimneys
Children's Services showed that 75 percent of the youths had
completed high school or a GED, 72 percent had full- time
employment when they left care, and 65 percent had savings
accounts. 20 HHS Slow in Leading Efforts to Determine ILP
Effectiveness A 1994 HHS Office of the Inspector General (OIG)
report and a 1995 Harvard University study both recommended HHS
take a stronger role in managing ILPs. However, HHS has been slow
in leading efforts to determine if state ILPs improve the ability
of youths leaving the foster care system to live on their own. 21
The OIG report made two broad recommendations: (1) that HHS'
Administration for Children and Families (ACF) should restructure
its ILP application and program reporting procedures to more
adequately support state plans and to gain an accurate national
picture of independent living efforts, and (2) that ACF should
focus its management and program reporting efforts on sharing
information among the states. The OIG report noted that the lack
of accurate national information on independent living efforts
weakens basic accountability and hinders efforts to improve
programs and to determine effective practices. In addition, the
Harvard study recommended that greater emphasis be placed on
sharing information, with HHS' regional offices taking the lead in
exchanging information among these offices and the states for
which they are responsible. According to the study, only 3 of the
10 regional offices provided technical assistance to states beyond
policy interpretation. Currently, HHS has few strategies in place
to review the states' progress in helping youths in the transition
from foster care. HHS primarily relies on annual state ILP reports
and summary statistics from these reports for information about
ILP effectiveness. According to HHS staff, no additional
monitoring strategies are in effect. There are two problems with
relying on the annual reports to determine ILP effectiveness.
First, as the OIG report noted and we confirmed during our review
of annual state reports, states' approaches to program reporting
and the quality of their program reports 19 Jane T. Simmons, PAL
Evaluation Final Report, unpublished report submitted to Harris
County (Texas) Children's Protective Services (Mar. 6, 1990). 20
Gerald P. Mallon, After Care, Then Where? Outcomes of an
Independent Living Program, Child Welfare, Vol. 77 (Jan./ Feb.
1998). 21 Office of Inspector General, Independent Living Programs
for Foster Care Youths: Strategies for Improved ACF Management and
Reporting, HHS (# OEI- 01- 93- 00090, Nov. 1994); and Kari Burrell
and Valeria Perez Ferreiro, Policy Analysis Exercise (Cambridge,
Mass.: Harvard University, Apr. 12, 1995). GAO/HEHS-00-13 Foster
Care: Independent Living Page 15 B-283530 vary greatly. According
to the OIG report, many state reports do not adequately address
the intensity of services or the range of efforts made for youths
in various placement settings. Likewise, states use various
definitions of terms, which the OIG reported can result in
duplicate counts and inconsistent statistics. To illustrate, the
term to be served can mean in one state that a youth has received
an assessment, while in another state it means that the youth was
enrolled in a formal life skills course. Second, states are
required to report certain information to HHS on the status of ILP
participants 90 days after program completion such as whether the
youths are employed, have completed high school or a GED, or are
living independent of public assistance. However, states
inconsistently report this information and question the value of
the data because they believe that 90 days may be too soon to
judge youths' independence. For example, the OIG found that some
states provide information on youths 90 days after discharge from
foster care, while other states look at youths' status 90 days
after completing the discrete ILP. Our review of 1998 annual state
reports reveals that few reports address the effectiveness of
services and outcomes for youths, making these reports an
ineffective means of consolidating information on program
effectiveness across the nation. To illustrate the difficulty in
obtaining this outcome information, our nationwide survey showed
that while 29 states attempt to contact ILP youths in response to
the 90- day requirement, only four states reported success in
contacting more than half of the former foster care youths. The
majority of the states could locate only some or a few. HHS
officials told us that they recognize deficiencies in the annual
state ILP reports, and that the agency needs to improve its
monitoring of the program. However, because no other data
currently exist with which to determine program effectiveness, HHS
issued a contract in September 1998 to conduct an analysis of 10
years of annual state ILP reports so it can begin to fill the data
gaps. According to project staff, this analysis represents HHS'
first attempt since ILP began to summarize what states are doing
with their ILP funds. Project objectives include identifying which
states are producing ILP reports that could be used as models by
other states, as well as what measures HHS can take to improve
state reporting and evaluation. Conclusions The Congress has
identified adolescent foster youths as an important part of the
foster care population and raised questions about whether states
are doing enough to prepare youths to live self- sufficiently.
Unfortunately, serving the population of youths about to leave the
foster care system is GAO/HEHS-00-13 Foster Care: Independent
Living Page 16 B-283530 difficult. Research has shown that many
pitfalls are encountered by these youths once they are on their
own. Information on the services foster care youths need to help
them become independent is critical to the success of ILPs.
However, states do not routinely receive information on what has
worked best in other states and have inconsistently applied HHS
regulations on following up with youths. HHS has not analyzed
information from state ILPs to develop a national perspective on
what services are most needed and which services are less
important in preparing youths to live on their own once foster
care ends. We believe HHS should take steps to build a system of
reporting and monitoring tools that would provide policymakers and
program officials with the necessary information to assess the
effectiveness of ILPs. Recommendations To enhance HHS' and the
states' accountability in preparing youths to live on their own
after leaving the foster care system, the Secretary of HHS should
develop a uniform set of data elements and a report format for
state reporting on ILP so that analysis of ILP information can be
conducted using consistent data and the results shared with the
states; and concrete measures of effectiveness for assessing state
ILPs, such as the number of youths with stable employment and
housing at the time they leave foster care and at specific
intervals thereafter. Agency and Other Comments We requested
comments on this report from HHS and state ILP officials in the
four states we visited. HHS, New York, and Texas provided
technical comments, which we incorporated where appropriate. In
addition, New York's comments mentioned the need for additional
incentives to encourage youths' participation in the program.
California and Maryland did not comment. GAO/HEHS-00-13 Foster
Care: Independent Living Page 17 B-283530 We are sending copies of
this report to the Honorable Donna E. Shalala, Secretary of Health
and Human Services; state ILP coordinators; state child welfare
agencies; and other interested parties. Copies will also be made
available to others on request. If you or your staff have any
questions about this report, please call me at (202) 512- 7215.
Other major contributors to this report are listed in appendix
III. Sincerely yours, Cynthia M. Fagnoni, Director Education,
Workforce, and Income Security Issues GAO/HEHS-00-13 Foster Care:
Independent Living Page 18 GAO/HEHS-00-13 Foster Care: Independent
Living Page 19 Contents Letter 1 Appendix I Scope and Methodology
22 Appendix II Figures From Our Review of Annual State Reports 24
Appendix III GAO Contacts and Staff Acknowledgments 32 Related GAO
Products 33 Table Table 1: Categories of Non- Federal ILP Funding
6 Figures Figure II. 1: Specific Education Services Reported by
States During 1998 24 Figure II. 2: Specific Employment Services
Reported by States During 1998 26 Figure II. 3: Specific Daily
Living Skills Training Reported by States During 1998 28 Figure
II. 4: Specific Financial Assistance Provided by States During
1998 30 Abbreviations ACF Administration for Children and Families
GED General Educational Development HHS U. S. Department Health
and Human Service ILP Independent Living Program OIG Office of the
Inspector General UPS United Parcel Service GAO/HEHS-00-13 Foster
Care: Independent Living Page 20 GAO/HEHS-00-13 Foster Care:
Independent Living Page 21 Appendix I Scope and Methodology To
identify what is currently known about the services provided by
Independent Living Programs (ILP) and the effect of these services
on youths' ability to live on their own, we reviewed the relevant
literature on problems former foster care youths face in living
independently, 1998 annual ILP reports submitted by the states to
the Department of Health and Human Services (HHS) (see appendix
II) 22 , and studies showing the effectiveness of ILP services. We
also interviewed experts on independent living services. We
obtained the perspectives of representatives of the National Child
Welfare Resource Center for Youth Development, the National
Independent Living Association, the Child Welfare League of
America, and the Casey Family Program. In addition, we interviewed
officials of HHS' Children's Bureau and Family and Youth Services
Bureau. We developed a state survey to obtain national information
on additional services offered by state ILPs and on additional
funds spent beyond the federal dollars and required state matching
funds. In April 1999, we surveyed ILP coordinators in each of the
50 states and the District of Columbia. We received responses from
all states and the District of Columbia, and from these responses
we obtained general information on (1) additional state, local,
and private funds spent on ILPs, (2) the number of youths younger
than age 16 served who were served and the services provided to
them, (3) the extent of after- care programs, (4) the states'
ability to follow up with youths after leaving care, and (5) the
extent of transitional housing services. We also obtained
information on outcome studies conducted by the states. We did not
verify the information obtained through the survey. However, we
conducted telephone interviews with state respondents to clarify
answers, as needed. To obtain information on the services offered
by states to youths leaving care and the problems states face in
meeting their needs, we visited independent living programs in
four locations Contra Costa County, California; Baltimore City and
County, Maryland; New York City, New York; and the San Antonio
region, Texas. We chose these four locations because our analysis
of the literature and discussions with key independent living
experts identified these localities as having ILPs that provide
critical services to help youths become self- sufficient, such as
postsecondary tuition waivers and well- developed employment links
in the community. California and New York also have large
populations of foster 22 We reviewed 45 annual state reports, plus
the report from the District of Columbia. At the time of our
review, reports were not available from Alaska, California, New
York, South Carolina, and Wyoming. HHS subsequently received
reports from Alaska, California, New York, and South Carolina, but
these were received too late to be included in our analysis.
Wyoming did not submit an annual report because the state did not
use federal ILP funds in 1998. GAO/HEHS-00-13 Foster Care:
Independent Living Page 22 Appendix I Scope and Methodology care
youths. In each state, we met with state ILP officials to obtain
an overview of how the program is implemented throughout the
state. At the local sites, we met with a variety of staff and
clients, including ILP coordinators, case workers, private service
providers, and current and former foster care youths. Where
available, we met with youth advocacy organizations. GAO/HEHS-00-
13 Foster Care: Independent Living Page 23 Appendix II Figures
From Our Review of Annual State Reports Figure II. 1: Specific
Education Services Reported by States During 1998 Note: Delaware
and Missouri provided education services but did not specify the
type of services in their 1998 annual reports. GAO/HEHS-00-13
Foster Care: Independent Living Page 24 Appendix II Figures From
Our Review of Annual State Reports a High school or General
Educational Development (GED) services enable participants to seek
a high- school diploma or its equivalent. Tutoring is an example
of such services. b Vocational services enable youths to
participate in appropriate vocational training and may include
vocational testing or referral. c Postsecondary education services
enable youths to prepare for or attend college or university.
These services may include educational planning, assistance
obtaining financial aid or college admission, or college testing
preparation. Source: State annual ILP reports for 1998. GAO/HEHS-
00-13 Foster Care: Independent Living Page 25 Appendix II Figures
From Our Review of Annual State Reports Figure II. 2: Specific
Employment Services Reported by States During 1998 Note:
Louisiana, Nebraska, and Vermont provided employment services, but
did not specify which services. GAO/HEHS-00-13 Foster Care:
Independent Living Page 26 Appendix II Figures From Our Review of
Annual State Reports a Job readiness services can include
information on how to prepare for a job, such as how to prepare a
resume or complete job applications, or how to maintain
employment. Source: State annual ILP reports for 1998. GAO/HEHS-
00-13 Foster Care: Independent Living Page 27 Appendix II Figures
From Our Review of Annual State Reports Figure II. 3: Specific
Daily Living Skills Training Reported by States During 1998 a
Money management can include instruction in budgeting or opening a
bank or credit card account. GAO/HEHS-00-13 Foster Care:
Independent Living Page 28 Appendix II Figures From Our Review of
Annual State Reports b Health and safety can include information
about substance abuse, hygiene, parenting, first aid, and leisure.
c Food and nutrition can include information about how to shop for
groceries or prepare and cook food. d Community resources can
include information about access to resources such as medical
care, legal services, transportation, and recreation. e Social
skills can include activities to improve self- esteem,
interpersonal relationships, problem- solving, leadership, and
sexual responsibility. f Montana reported providing daily living
skills but did not identify specific training offered. Source:
State annual ILP reports for 1998. GAO/HEHS-00-13 Foster Care:
Independent Living Page 29 Appendix II Figures From Our Review of
Annual State Reports Figure II. 4: Specific Financial Assistance
Provided by States During 1998 GAO/HEHS-00-13 Foster Care:
Independent Living Page 30 Appendix II Figures From Our Review of
Annual State Reports a Financial incentives or stipends can
include incentives for completing training or units of training in
daily living skills. b These services include tuition waivers or
scholarships. c These services include books, training materials,
uniforms, college exam fees, and college application fees. d These
expenses can include fares for buses, trains, or airplanes; or gas
for youths' automobiles. e Start- up assistance includes items
such as utility deposits or household items (e. g., furniture,
dishes, and linens). Source: State annual ILP reports for 1998.
GAO/HEHS-00-13 Foster Care: Independent Living Page 31 Appendix
III GAO Contacts and Staff Acknowledgments GAO Contacts David D.
Bellis, Assistant Director, (202) 512- 7278 Diana M. Pietrowiak,
Evaluator- in- Charge, (202) 512- 6239 Staff Acknowledgments Ellen
Soltow, Suzanne Sterling, Jay Smale, and Joel Grossman also made
important contributions to this report. GAO/HEHS-00-13 Foster
Care: Independent Living Page 32 Related GAO Products Youth
Mentoring Programs: Fiscal Year 1998 (GAO/HEHS-99-129R, May 28,
1999). Foster Care: Challenges in Helping Youths Live
Independently (GAO/T-HEHS-99-121, May 13, 1999). Foster Care:
Increases in Adoption Rates (GAO/HEHS-99-114R, Apr. 20, 1999).
Juvenile Courts: Reforms Aim to Better Serve Maltreated Children
(GAO/HEHS-99-13, Jan. 11, 1999). Child Welfare: Early Experiences
Implementing a Managed Care Approach (GAO/HEHS-99-8, Oct. 21,
1998). Foster Care: Agencies Face Challenges Securing Stable Homes
for Children of Substance Abusers (GAO/HEHS-98-182, Sept. 30,
1998). Foster Care: Implementation of the Multiethnic Placement
Act Poses Difficult Challenges (GAO/HEHS-98-204, Sept. 14, 1998).
Child Protective Services: Complex Challenges Require New
Strategies (GAO/HEHS-97-115, July 21, 1997). Foster Care: State
Efforts to Improve the Permanency Planning Process Show Some
Promise (GAO/HEHS-97-73, May 7, 1997). Child Welfare: Complex
Needs Strain Capacity to Provide Services (GAO/HEHS-95-208, Sept.
26, 1995). (116033) GAO/HEHS-00-13 Foster Care: Independent Living
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