Foster Care: HHS Should Ensure That Juvenile Justice Placements Are
Reviewed (Letter Report, 06/09/2000, GAO/HEHS-00-42).
Pursuant to a congressional request, GAO provided information on the
Department of Health and Human Services' (HHS) approval of the Social
Security Act's title IV-E reimbursements for foster care placements,
focusing on: (1) the number of title IV-E foster care placements made by
juvenile justice agencies in fiscal year (FY) 1998 and the amount of
federal care funding expended for these placements; (2) how selected
states ensure that title IV-E funds are not used for placements in
detention facilities and ensure that procedural requirements to protect
the welfare of children in title IV-E funded juvenile cases are met; and
(3) HHS' processes for ensuring the appropriate use of funds and
compliance with these procedural requirements in title IV-E funded
juvenile justice placements.
GAO noted that: (1) in FY 1998, about $300 million in title IV-E funds
was used to support foster care placements of children in the juvenile
justice system; (2) almost half of the states used some portion of their
title IV-E funds in this way; (3) nearly 60 percent of the total amount
of title IV-E funding used for juvenile justice placements was used by
California; (4) the $300 million used for children in the juvenile
justice system is 10 percent of all FY 1998 title IV-E expenditures; (5)
to ensure that title IV-E funds are not being used for placements in
detention facilities, the 10 states that used the largest amount of such
funding in FY 1998 rely primarily on the requirements that a facility
must meet in order to be licensed as a child care institution; (6)
licensing regulations in those states establish standards designed
primarily to ensure a healthy and safe physical environment for the
children; (7) in some states, these regulations allow a facility to
engage in some restrictive practices that have been associated with
detention; (8) state licensing regulations also play a role with regard
to meeting title IV-E procedural requirements intended to protect the
welfare of children in foster care cases--namely, that case plans be
developed, administrative case reviews be conducted, and procedural
safeguards be in place; (9) states enforce their licensing regulations
through periodic on-site visits and facility inspections; (10) in
addition to their licensing regulations, the two states whose procedures
GAO examined more closely have administrative regulations for protecting
children in foster care, which address in detail the title IV-E
procedural requirements; (11) HHS has acknowledged that states have
sometimes encountered difficulty in determining whether the facilities
in which juvenile justice system children are placed qualify to receive
title IV-E funding and in meeting procedural requirements in these
cases; (12) HHS conducts two broad oversight reviews in each state, a
title IV-E eligibility review and a child and family services (CFS)
review; (13) title IV-E eligibility reviews primarily verify children's
and foster care providers' eligibility for title IV-E funding in random
sample of title IV-E funded foster care placements in each state; and
(14) CFS reviews assess systems states use to determine the eligibility
of foster care providers for title IV-E funding and systems states use
to ensure that procedural requirements are met in title IV-E funded
placements.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-00-42
TITLE: Foster Care: HHS Should Ensure That Juvenile Justice
Placements Are Reviewed
DATE: 06/09/2000
SUBJECT: Foster children
Federal/state relations
State-administered programs
Juvenile delinquency
Eligibility determinations
Federal funds
Detention facilities
Entitlement programs
IDENTIFIER: California
Texas
Title IV-E Foster Care Program
Illinois
Maryland
Michigan
Missouri
New York
North Carolina
Ohio
Pennsylvania
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GAO/HEHS-00-42
Appendix I: Scope and Methodology
24
Appendix II: Fiscal Year 1998 Title IV-E Funding Claimed and
Number of Placements, by State
27
Appendix III: Provisions of State Licensing Regulations for Child
Care Institutions Related to Physical Restriction of Residents
29
Appendix IV: Provisions in State Licensing Regulations That Relate
to Procedural Requirements in Title
IV-E Funded Foster Care Cases
32
Appendix V: Comments From the Department of Health and Human Services
42
46
Table 1: Number of Title IV-E Funded Juvenile Justice and Child Welfare
Placements in California and Cost per Day, by Setting and Level of Care
Received, Fiscal Year 1998 13
Table 2: Number of Title IV-E Funded Juvenile Justice and Child Welfare
Placements in Texas and Cost per Day, by Setting and Level of Care Received,
Fiscal Year 1998 14
CFS child and family services
DSS Department of Social Services
HHS Department of Health and Human Services
ISP individual services plan
JPC Juvenile Probation Commission
PRS Department of Protective and Regulatory Services
TYC Texas Youth Commission
Health, Education, and
Human Services Division
B-281545
June 9, 2000
The Honorable George Miller
Ranking Minority Member
Committee on Resources
House of Representatives
The Honorable Charles Rangel
Ranking Minority Member
Committee on Ways and Means
House of Representatives
The Honorable Henry A. Waxman
Ranking Minority Member
Committee on Government Reform
House of Representatives
The Honorable Pete Stark
Ranking Minority Member
Subcommittee on Health
Committee on Ways and Means
House of Representatives
The Honorable David R. Obey
Ranking Minority Member
Committee on Appropriations
House of Representatives
The Honorable John Conyers
Ranking Minority Member
Committee on the Judiciary
House of Representatives
The Honorable Barbara Lee
House of Representatives
Each year, the federal government spends over $3 billion to finance foster
care placements for about half a million children. Under title IV-E of the
Social Security Act, which authorizes federal foster care funding, foster
care placements may be based on a judicial determination that remaining in
the home would be contrary to the welfare of the child. These determinations
are made in both dependency (child welfare) and delinquency (juvenile
justice) cases. Although most foster care funds support child welfare
placements, they may also be used to support juvenile justice placements.
Since the early 1980s, the Department of Health and Human Services (HHS) has
been approving title IV-E reimbursements for foster care placements made by
juvenile justice agencies for children in the juvenile justice system.
However, the Social Security Act prohibits using foster care funds for
placements in facilities operated primarily for detention. In addition, the
act stipulates specific procedural requirements intended to protect the
welfare of all children in foster care placements supported by title IV-E
funds. These include developing a written case plan for each placement, a
court or administrative case review at least every 6 months, a permanency
hearing within 12 months of placement, and "procedural safeguards" to
protect parents' rights when a child is removed from the home. Concerned
that compliance with provisions of the law may be more difficult in juvenile
justice placements, you asked us to (1) determine the number of title IV-E
foster care placements made by juvenile justice agencies in fiscal year 1998
and the amount of federal care funding expended for these placements, (2)
describe how selected states ensure that title IV-E funds are not used for
placements in detention facilities and ensure that procedural requirements
to protect the welfare of children in title IV-E funded juvenile justice
cases are met, and (3) assess HHS' processes for ensuring the appropriate
use of funds and compliance with these procedural requirements in title IV-E
funded juvenile justice placements.
To conduct our work, we reviewed state licensing regulations for child care
institutions in the 10 states that HHS data showed had claimed the most
fiscal year 1998 title IV-E funding for all foster care maintenance
expenses--primarily food, shelter, and clothing: California, Illinois,
Maryland, Michigan, Missouri, New York, North Carolina, Ohio, Pennsylvania,
and Texas. To estimate the number of title IV-E funded juvenile justice
placements in fiscal year 1998 and the federal dollars expended for both
maintenance and administrative costs, we surveyed all 50 states and the
District of Columbia. We also did fieldwork at state and county child
welfare and juvenile justice agencies in California and Texas to determine
how they attempt to ensure that title IV-E procedural requirements are met.
However, we did not independently verify the effectiveness of these
activities. We reviewed a total of 18 cases during our fieldwork to obtain
some indication of how the systems that are in place to ensure facility
eligibility and procedural requirements operate and what issues arise
related to placement eligibility for title IV-E funds and compliance with
title IV-E procedural requirements in cases involving juvenile justice
placements. We did not determine, in these cases, if facilities in which
children were placed were eligible for title IV-E funding, if procedural
requirements were met, or if children received the services they required.
We also interviewed HHS officials and reviewed pertinent laws, regulations,
and documents, including regulations issued in January 2000 revising the
objective, scope, and methodology for HHS title IV-E eligibility and child
and family services review systems. (For a detailed description of our scope
and methodology, see app. I.) We conducted our work between January 1999 and
May 2000 in accordance with generally accepted government auditing
standards.
In fiscal year 1998, about $300 million in title IV-E funds was used to
support foster care placements of children in the juvenile justice system.
Almost half of the states used some portion of their title IV-E funds in
this way. Nearly 60 percent of the total amount of title IV-E funding used
for juvenile justice placements was used by California. The $300 million
used for children in the juvenile justice system is 10 percent of all fiscal
year 1998 title IV-E expenditures; however, the 15,000 juvenile justice
system children supported by those funds constituted only about 4 percent of
all children supported by foster care funds. The disproportionate spending
on juvenile justice system foster care children may be attributable, in
part, to the greater levels of--and thus more costly--supervision that,
according to juvenile justice officials, many children in the juvenile
justice system need.
To ensure that title IV-E funds are not being used for placements in
detention facilities, the 10 states that used the largest amount of such
funding in fiscal year 1998 rely primarily on the requirements that a
facility must meet in order to be licensed as a child care institution.
Licensing regulations in those states establish standards designed primarily
to ensure a healthy and safe physical environment for the children. In some
states, these regulations allow a facility to engage in some restrictive
practices that have been associated with detention; however, the regulations
permit such practices only under certain circumstances, such as when
children pose a threat to themselves or others or when such practices are
necessary in order to manage inappropriate behaviors. State licensing
regulations also play a role with regard to meeting title IV-E procedural
requirements intended to protect the welfare of children in foster care
cases--namely, that case plans be developed, administrative case reviews be
conducted, and procedural safeguards be in place. States enforce their
licensing regulations through periodic on-site visits and facility
inspections. In addition to their licensing regulations, the two states
whose procedures we examined more closely, California and Texas, have
administrative regulations for protecting children in foster care, which
address in detail the title IV-E procedural requirements.
HHS has acknowledged that states have sometimes encountered difficulty in
determining whether the facilities in which juvenile justice system children
are placed qualify to receive title IV-E funding and in meeting procedural
requirements in these cases. Consequently, HHS has provided guidance to
states on what constitutes detention and is currently in the process of
developing additional guidance on that subject. In addition, HHS conducts
two broad oversight reviews in each state, a title IV-E eligibility review
and a child and family services (CFS) review. Title IV-E eligibility reviews
primarily verify children's and foster care providers' eligibility for title
IV-E funding in a random sample of title IV-E funded foster care placements
in each state. CFS reviews, in part, assess systems states use to determine
the eligibility of foster care providers for title IV-E funding and systems
states use to ensure that procedural requirements are met in title IV-E
funded placements. CFS reviews collect information for this assessment
through interviews with state and community representatives and a review of
a random sample of title IV-E funded cases in each state. It is not clear
based on new regulations for eligibility and CFS reviews whether the results
of these reviews will enable HHS to determine if title IV-E funding is being
used for placement in appropriate facilities or if procedural requirements
are being met in juvenile justice cases--and, thus, whether these reviews,
as designed, constitute adequate oversight of the use of title IV-E funds in
these cases. Therefore, we are recommending that HHS review a sufficient
number of title IV-E funded juvenile justice placements in child care
institutions in those states having such placements to determine with a
reasonable degree of assurance whether facility eligibility and procedural
requirements are being met for such cases. In its comments on a draft of
this report, HHS agreed that more information is needed to understand and
address issues surrounding the use of title IV-E funding in juvenile justice
cases and suggested other means than those we recommended for collecting
this information. Therefore, we modified the language of our recommendations
to accommodate the use of alternative means of accomplishing their intended
effect.
Federal funds for foster care are authorized under title IV-E of the Social
Security Act. The foster care entitlement program provides matching funds to
states to cover the cost of maintaining neglected and abused children in
foster care placements, such as foster family homes or child care
institutions, also referred to as group homes.1 To receive title IV-E funds,
a state must submit to HHS for approval a plan that protects the rights of
foster care children and families and defines a statewide service delivery
system for the foster care maintenance program authorized by the act. These
state plans must include, in part, how agencies will ensure that (1) the
children and the foster homes or child care institutions in which the
children are placed meet title IV-E eligibility criteria and (2) procedural
requirements in the act are met in title IV-E funded placements.
Children qualify if they have been removed from the home pursuant to a
voluntary agreement entered into by their legal guardian or as the result of
a judicial determination that continuation in the home would be contrary to
their welfare, and their families meet eligibility criteria related to
income level.2 Title IV-E funded placements are typically for children in
the child welfare system. However, HHS has issued several policy statements
specifically allowing eligibility claims for title IV-E funding for foster
care placements for juveniles who are wards of the court.
Foster homes and child care institutions qualify for title IV-E funding if
they are licensed by the state and not operated primarily to detain children
who have been determined to be delinquent. In a policy statement issued in
1982, HHS stated that the term "child care institution" may not include
"detention facilities, forestry camps, training schools, or any other
facility operated primarily for the detention of children determined to be
delinquent." The statement also noted that "primarily" refers to the use of
the facility for detention purposes and that determining whether a facility
operates primarily for detention depends on who operates it, for what
purposes it exists, from whom it receives its major financial resources, the
circumstances of the children who reside there, and its economic viability
if it did not house children adjudicated delinquent. In 1988, HHS issued a
policy statement emphasizing that "the two factors that will be
determinative in identifying such a facility are (1) it must be a physically
restricting facility and (2) it would not be operational without a
population of children who have been adjudicated delinquent."
The nature and purpose of facilities' restrictive practices were addressed
in a 1988 Departmental Grant Appeals Board decision in which California
appealed HHS' decision to disallow IV-E payments for placements in a Rite of
Passage facility. HHS' Departmental Grant Appeals Board cited a number of
physically restrictive practices as indications that a facility's primary
purpose may be detention. These practices include location in a remote area,
confiscation of personal belongings, pursuit of runaways, constant
supervision of residents, and use of isolation as punishment. The board,
while drawing a distinction between restrictive practices for the purpose of
detention and restrictive practices for the purpose of treatment, recognized
that treatment is an integral part of a juvenile justice placement even when
the treatment's primary purpose is detention. According to current HHS
regulations, a detention facility, "in the context of the definition of
child care institution in section 472(c)(2) of the [Social Security] Act
means a physically restricting facility for the care of children who require
secure custody pending court adjudication, court disposition, execution of a
court order or after commitment."3
According to federal requirements related to state foster care plans, states
are responsible for establishing and maintaining licensing regulations for
facilities. These regulations must represent minimum standards related to
admission policies, safety, sanitation, and protection of the civil rights
of children placed in foster family homes and child care institutions and,
to a reasonable extent, be in accord with the standards recommended by
national organizations concerned with standards for such institutions or
homes. The Child Welfare League of America recommends that licensing
standards for child care institutions cover facility administration,
personnel qualifications, the personal rights of residents, services and
activities provided to residents, and provisions to ensure a healthy and
safe physical environment.
State child welfare agencies are also responsible for ensuring that
procedural requirements are met in title IV-E funded foster care placements.
The Social Security Act4 requires that there be a written case plan for each
title IV-E funded foster care placement and specifies that this plan address
such concerns as the appropriateness of the placement, the treatment and
services the child needs, meeting the child's health and educational needs,
and services needed to improve the conditions in the home. The act also
requires a court or administrative review in these cases at least every 6
months to monitor compliance with the case plan, the necessity for and
appropriateness of the placement, the progress made in improving the home,
and when the child is likely to return home or when an action to terminate
parental rights is likely to be initiated. A permanency hearing is also
required within 12 months of the child's entrance into foster care to decide
what the child's permanency goal should be--to return home, remain in foster
care, or be adopted. Finally, the act requires that "procedural safeguards"
be applied to protect a parent's rights when a child is removed from the
home, when there is a change in the child's placement, and when decisions
are made concerning the parent's right to visit the child.
States are responsible for carrying out specific monitoring and evaluation
activities; HHS has oversight responsibility for the title IV-E program in
general. Federal law requires states to monitor and periodically evaluate
their own activities to ensure that children and placements qualify for
title IV-E funding and that procedural requirements are met in IV-E funded
cases. States must also submit statistics to HHS on the legal status of
children in title IV-E funded placements and their demographic
characteristics, location, and length of stay in foster care. In addition to
reviewing state foster care plans and approving those that meet federal
requirements, HHS is required by the Social Security Act to evaluate and
periodically monitor states' compliance with these plans and to collect and
publish state data pertaining to the incidence and characteristics of foster
care in this country. In addition, according to its strategic plan, HHS has
identified the importance of supporting the state-administered title IV-E
program by ensuring that (1) procedures for monitoring the program allow for
a realistic examination of the experiences of families and children, (2)
best practices related to the program are disseminated, and (3) HHS'
technical assistance and training are relevant and useful to states and
localities in administering their title IV-E programs.
Title IV-E funds are meant to cover a portion of states' costs for food,
shelter, clothing, daily supervision, school supplies, general incidentals,
liability insurance for the child, and travel to the child's home for
visits. States set the basic rates they pay foster parents and child care
institutions for these maintenance costs.5 States set higher payment rates
for foster care placements that provide higher levels of care needed by
children with, for example, psychological or behavioral problems or
exceptional physical care needs. The higher rates correspond to the higher
levels of supervision that are needed. To determine the amount of
reimbursement states receive for a placement under title IV-E, a state's
payment rate for that placement (minus the costs not allowable under title
IV-E) is multiplied by its title IV-E matching rate, which is the same as
its Medicaid matching rate and based on per capita income. These matching
rates vary from 50 to 83 percent, averaging about 57 percent across all
states.
Placements, but These Placements Are More Costly
Of the more than $3 billion in title IV-E funding claimed in 1998, 10
percent was used to finance foster care placements for children in the
juvenile justice system. Nearly half of the states indicated they had used
title IV-E funds to finance juvenile justice placements in 1998, with three
states accounting for about 80 percent of total title IV-E funds expended
for juvenile justice placements. While title IV-E juvenile justice
placements consumed 10 percent of all title IV-E funds claimed nationwide,
they account for only about 4 percent of all title IV-E foster care
placements. One reason for this disproportion is that compared to child
welfare children, juvenile justice children were more often placed in
facilities that provided a higher level of supervision, which costs more.6
Justice Placements
We estimate that, in fiscal year 1998, about $318 million, or 10 percent, of
total title IV-E funds was used to finance placements for children in the
juvenile justice system.7 Of the 41 respondents to our survey, 23 states
indicated they had used title IV-E funds to finance juvenile justice
placements in fiscal year 1998.8 About 60 percent of the total amount of
title IV-E funding for juvenile justice placements by these states went to
California. New York and Pennsylvania combined accounted for another 24
percent. (See app. II for a state-by-state breakdown of title IV-E funds
used to finance juvenile justice placements and the number of these
placements in fiscal year 1998.)
Amount of Total Title IV-E Expenditures
While the juvenile justice placements reported nationwide consumed 10
percent of total title IV-E expenditures in fiscal year 1998, they accounted
for only about 15,000--or 4 percent--of all children placed in foster care.
Such disproportions occurred, to varying degrees, across the states that
used these funds--including California and Texas, which together accounted
for about 35 percent of all title IV-E funded juvenile justice placements
nationwide. For juvenile justice placements in California--where the
disproportion was most dramatic--24 percent of the fiscal year 1998 title
IV-E funds claimed was used for just 6 percent of all the state's title IV-E
funded placements. In Texas, 12 percent of the year's title IV-E funds was
used for juvenile justice placements, which represented about 8 percent of
the state's placements.
According to California and Texas officials, juvenile justice children
require higher levels of care or supervision than do children in the child
welfare system and, consequently, are placed in homes and child care
institutions in which care is more costly. In California, 69 percent of
juvenile justice placements--compared to 6 percent of child welfare
placements--were in child care institutions, which receive higher payment
rates than do foster homes. In addition, a greater percentage of juvenile
justice children were placed in child care institutions that provide higher
levels of care. (See table 1.) As the level of care (determined primarily by
staff-to-child ratios) increases, the state payment rate and, thus, the
title IV-E allowable amount increases. For example, the title IV-E allowable
amount for child care institutions with care levels 1 and 2 averages $44 per
day per child. At care levels 9 and 10--which may entail as many as four
full-time workers supervising six children (a two-to-three staff-to-child
ratio)--the title IV-E allowable amount averages $122 per child per day. In
fiscal year 1998, 54 percent of juvenile justice children in institutions
received care at levels 9 through 14, compared to 42 percent of child
welfare children. The levels of care in part explain why California's title
IV-E funded juvenile justice placements averaged about $120 a day per
child--five times the per diem cost for the state's child welfare placements
in that year.9
Juvenile Child welfare Cost per daya
justice
State
Title IV-E
Number Percent Number Percent payment allowable
rateb amountc
Foster family
homes 428 13% 47,301 72% $15 d
Foster family
agenciese 565 17 13,012 20 14f d
Child care
institutionsg
Care levels 1
and 2 650h 20 1,929h 3 47i $44j
Care levels 3
and 4 12 0 21 0 68i 66j
Care levels 5
and 6 78 2 66 0 89i 82j
Care levels 7
and 8 318 10 183 0 109i 101j
Care levels 9
and 10 788 24 470 1 133i 122j
Care levels 11
and 12 383 12 719 1 151i 134j
Care levels 13
and 14 60 2 423 1 172i 155j
Otherk 23 1 1,177 2 d d
Total 3,305 100% l 65,301 100% l m m
aThe monthly amount divided by 30 days, rounded to the nearest dollar.
bState payment rates include maintenance costs and the administrative costs
associated with maintenance as well as the cost of treatment and other
services. Rates vary by age of child. Amount represents the average of the
base rate for each age range.
cTitle IV-E funds cover only maintenance costs and the administrative costs
associated with maintenance.
dData not available.
eFoster family agencies provide homes or other living arrangements for
children who alternatively would be placed in a child care institution.
fAgencies can receive more--up to $51 per day for a child from 15 to 19
years of age--if they provide additional care and services.
gReferred to in California as group homes.
hThe data California provided to us placed these children in the child care
institution category. State officials, however, noted that for children
receiving levels of care 1 or 2, it could not be determined with certainty
whether the care was provided in child care institutions or through foster
family agencies.
iAmount represents the average of the rates for the two levels of care
indicated.
jIn California, there is a different IV-E allowable rate for each group
home; consequently, the allowable amount shown is the average of the
individual amounts for which the state could seek title IV-E reimbursement
for all placements in the two levels of care.
kOther placements include medical facilities and shelters.
lDue to rounding, total percentages do not add to 100.
mNot applicable.
Source: GAO analysis of statewide data provided by California.
Texas also bases its payment rates on the level of care provided in foster
family homes and child care institutions (see table 2). At care levels 5 and
6, for example, children have 24-hour supervision and staff-to-child ratios
are greater than those at care levels 3 and 4. In Texas, almost 70 percent
of the children in the juvenile justice system were placed in foster family
homes and child care institutions at care level 4, 5, or 6, compared to less
than 20 percent of child welfare placements. The levels of care in part
explain why Texas' cost per juvenile justice placement averaged $30 a day in
fiscal year 1998 while its cost per child welfare placement averaged $18 a
day.
Juvenile justice Child welfare Cost per daya
State
Number Percent Number Percent payment Title IV-E
allowable amountc
rateb
Foster family homes
Care
level 1 0 0% 2,967 45% $16 $13
Care
level 2 1 0 704 11 34 30
Care
level 3 3 1 669 10 58 52
Care
level 4 34 12 443 7 83 68
Care
level 5 0 0 1 0 100 85
Care
level 6 0 0 0 0 187 161
Foster group homes and child care institutions
Care
level 1 0 0 112 2 16 13
Care
level 2 11 4 106 2 34 30
Care
level 3 74 25 417 6 58 52
Care
level 4 95 32 457 7 83 68
Care
level 5 70 24 261 4 100 85
Care
level 6 4 1 89 1 188 161
Otherd 3 1 392 6 e e
Total 295 100% f 6,618 100% f e e
aThe daily rate rounded to the nearest dollar.
bState payment rates include maintenance costs and the administrative costs
associated with maintenance as well as the cost of treatment and other
services. Unlike rates in California, rates in Texas do not vary by age of
child.
cTitle IV-E funds cover only maintenance costs and the administrative costs
associated with maintenance.
dOther placements include medical facilities and shelters.
eNot applicable.
fDue to rounding, total percentages do not add to 100.
Source: GAO analysis of statewide data provided by Texas.
Title IV-E Funds and Compliance With Procedural Requirements
To ensure that title IV-E funds are used appropriately and that title IV-E
procedural requirements are met, the 10 states claiming the most fiscal year
1998 title IV-E funding rely on licensing regulations and other
administrative regulations. The states' licensing regulations establish
minimum standards for child care institutions, where many juvenile justice
children in title IV-E funded foster care are placed, to ensure the safety
and well-being of children. To qualify for title IV-E funds, facilities need
to be licensed or approved as child care institutions. Although title IV-E
prohibits the use of funds to finance placements for detention purposes,
some states' licensing regulations allow, under certain circumstances,
restrictive practices that could be associated with detention. States'
licensing regulations also address title IV-E procedural requirements
intended to protect the welfare of children, including requirements to
develop a case plan, conduct periodic administrative reviews, and follow
procedural safeguards. Each of these 10 states uses several monitoring
mechanisms to ensure child care institutions comply with licensing
regulations. California and Texas also have administrative regulations that
establish standard procedures--which mirror title IV-E procedural
requirements--as well as monitoring procedures to ensure these procedures
are followed in individual cases.
Detention and Address Most Title IV-E Procedural Requirements
Each of the 10 states' licensing regulations for child care institutions
establishes minimum standards regarding facility administration and
personnel qualifications, intake procedures and children's personal rights,
services and activities to be provided, and practices to ensure a healthy
and safe physical environment for children. Several provisions in these
regulations specifically address restrictive practices. Others establish
procedures that mirror title IV-E procedural requirements intended to
protect the welfare of children.
Child care institutions are eligible to receive title IV-E funds if they
meet the licensing standards set for these institutions by the state. While
facilities operating primarily for the detention of children determined to
be delinquent are ineligible to receive title IV-E funds, some provisions
governing the practices of licensed child care institutions allow for
certain restrictive practices. For example, although none of the 10 states
allow facilities to isolate or restrain a child as a form of punishment,
some allow facilities to use short-term isolation and physical restraint to
prevent children from posing a risk or threat to themselves, others, or
physical property, and to manage inappropriate behaviors.10 Maryland and
Michigan also allow locks to be used for reasons other than security.
Specifically, licensed child care institutions in Maryland are allowed to
lock doors as part of "secure care programs" for children who are deemed
delinquent, and licensed child care institutions in Michigan are permitted
to lock the doors of "behavior management rooms." Similarly, when we asked
staff in county probation departments in California and Texas about the
restrictive practices in 18 title IV-E funded juvenile justice cases we
reviewed in their states, we learned that in 7 of these cases the facility
served primarily children in the juvenile justice system. While this
information alone does not constitute sufficient evidence to disqualify
these facilities for title IV-E funding, it illustrates how difficult it may
be to distinguish between juvenile justice placements in detention and
nondetention facilities without more knowledge about the facilities in these
cases and the nature of the treatment they provide. This information also
emphasizes the importance of adequate oversight of the use of title IV-E
funds for juvenile justice placements.
Licensing standards for child care institutions in the 10 states also
contain provisions that address three procedural requirements under title
IV-E: (1) development and updating of case plans; (2) review by a court or
an administrative body of children's status at least every 6 months; and (3)
procedural safeguards for notifying parents about their child's placement,
any changes in the placement, and about reviews and hearings that take
place.11 None of the state licensing regulations we reviewed addressed
permanency hearings. All 10 states' licensing regulations require a case
plan for each child that includes an educational program and provides for
health care. All also require reviews of case plans on a regular basis,
ranging from once a month to once a year. Some states' regulations for case
plans require child care institutions to specify steps and time frames for
tracking progress toward long-range goals. Michigan's licensing regulations,
for example, require that case plan reviews evaluate progress toward family
reunification. All states' licensing regulations also contain procedural
safeguards regarding admission, visitation, and services to families.
All of the 10 states have systems in place to ensure licensed child care
institutions continue to comply with all provisions in licensing
regulations, including those covering restrictive practices and title IV-E
procedural requirements. For example, California and Texas officials told us
that, to enforce their licensing regulations, they conduct annual on-site
visits, which include reviews of case records and files to ensure that the
facility is providing required services, interviews with children and staff,
and a visual inspection of the facility.12 They also stated that they
investigate complaints and have procedures for levying penalties for
noncompliance, including denying renewal of, temporarily suspending, or
revoking a license.
Address Procedural Requirements in Title IV-E Funded Cases
When we looked more closely at how California and Texas ensure that title
IV-E procedural requirements are met, we found that in addition to their
licensing regulations, their child welfare agencies also have administrative
regulations that address title IV-E procedural requirements and contain
processes for enforcing these requirements. In California, the Department of
Social Services (DSS) is responsible for enforcing compliance with these
procedural requirements; in Texas, the Department of Protective and
Regulatory Services (PRS) has this responsibility.
DSS regulations require children in foster care in California to be visited
at least monthly; the child welfare agency in each county is responsible for
conducting these visits with children in its jurisdiction. For title IV-E
funded juvenile justice cases, the juvenile probation department in each
California county, through formal agreements with the county child welfare
agency, is required to conduct monthly visits with children in these cases,
monitor the services they receive, and ensure that title IV-E procedural
requirements are met. According to DSS officials, California has recognized
that juvenile justice agencies and the courts play key roles in ensuring
that title IV-E funded juvenile justice cases are managed in accordance with
the law. As a result, California is developing special training for
probation officers on procedural requirements that accompany title IV-E
funding. To address concerns related to the courts' role in ensuring that
procedural requirements are met in title IV-E funded juvenile justice cases,
California recently passed legislation placing into state law many of the
federal procedural requirements in the Social Security Act. According to DSS
officials, this legislation will better ensure that the procedural
requirements are met, particularly in title IV-E funded juvenile justice
cases. These officials stated that, as regulatory rather than legislative
requirements, courts that usually handle juvenile justice cases involving
title IV-E funded placements were not legally bound to follow them. As a
result of title IV-E requirements being placed into state law, the courts
must see to it that, in juvenile justice cases, procedural requirements are
met.
In Texas, PRS is responsible for ensuring that procedural requirements are
met in all title IV-E placements and that children receive the services they
require. To ensure that these requirements are met in juvenile justice
placements, PRS contracts with two state-level juvenile justice agencies:
(1) the Juvenile Probation Commission (JPC), which oversees county juvenile
probation agencies in the state, and (2) the Texas Youth Commission (TYC),
which handles juvenile justice cases statewide that require more resources
than local probation departments can provide. According to PRS officials, to
monitor compliance with these contracts, PRS annually reviews the case files
for a sample of title IV-E funded juvenile justice cases from each agency.
PRS officials also stated that the department contracts with a private
agency, Youth for Tomorrow, to monitor licensed child care institutions in
Texas in order to ensure that they are providing the types and level of
services that the children in their care require.
JPC and TYC each have a system in place to comply with the title IV-E
procedural requirements in their contracts with PRS. JPC officials told us
that the agency, through contracts with county probation departments,
requires probation department staff to review cases on a quarterly basis and
to contact on a monthly basis every child in title IV-E funded placements,
the parent or guardian, and the caregiver in each placement. Officials also
noted that JPC staff audit the caseload of title IV-E funded juvenile
justice placements twice per year. Similarly, TYC officials told us that the
agency contracts with placement service providers and requires them to
follow the agency's policies regarding procedural requirements, which mirror
title IV-E requirements. To monitor these contracts, TYC officials told us
that they regularly review each provider's service delivery processes and
periodically review provider performance in each case, relative to the needs
of the youth in the placement. TYC officials also noted that, for each case,
the agency reviews the case record and case plan every month for the
duration of a placement and conducts a 6-month administrative review and a
permanency hearing.
on Juvenile Justice Placements
According to HHS, some states have claimed title IV-E funds for children
placed in facilities not eligible for title IV-E reimbursement. HHS has
recognized that states might encounter difficulty in determining whether a
specific facility would qualify to receive title IV-E funding for the
placement of juvenile justice children. HHS has also found that states face
unique challenges in meeting title IV-E procedural requirements within a
juvenile justice framework. HHS is in the process of developing additional
guidance on what constitutes detention and on meeting procedural
requirements in juvenile justice placements. It began this initiative by
issuing in December 1998 a request for public comment on these issues.13 A
total of 17 states and 5 facilities responded along with several advocacy
and professional groups. The comments provided examples of the issues states
face in determining facility eligibility and meeting procedural requirements
in juvenile justice placements. Our review of the comments shows that states
differ on how they believe detention should be defined, and some have
explicitly asked HHS to clarify the definition. To address these facility
eligibility issues, HHS is continuing to review these comments and is
considering its options for creating more comprehensive guidance related to
title IV-E eligibility of facilities in juvenile justice placements. HHS
also addressed comments related to satisfying procedural requirements in
title IV-E juvenile justice cases in its new regulations for title IV-E
eligibility and CFS reviews.
HHS carries out its title IV-E oversight responsibilities primarily through
its title IV-E eligibility and CFS reviews. HHS recently revised the
regulations for these two reviews, in part, to respond to federal
legislation requiring the department to modify its approach to monitoring
state compliance with federal child welfare requirements, including title
IV-E eligibility and procedural requirements. The new regulations, which
went into effect on March 27, 2000, specify a new objective, scope, and
methodology for these reviews. Through statewide and on-site assessments,
CFS reviews are intended to ensure that individual states "substantially
conform" to their foster care requirements and other program requirements
under title IV-E, as well as title IV-B, of the Social Security Act.14 Title
IV-E eligibility reviews focus on verifying eligibility for title IV-E
funding by reviewing records for a random sample of title IV-E funded
placements in each state. The purpose of these reviews is to validate the
accuracy of a state's claims to ensure that payments are appropriate--that
is, they are made on behalf of eligible children, to eligible homes and
institutions, and at allowable rates. CFS reviews, as designed, focus
primarily on results or outcomes and, according to HHS, do not cover
eligibility requirements for children or facilities. They examine, state by
state, (1) indicators of safety, permanency, and child and family well-being
and (2) systems affecting a state's capacity to deliver services leading to
these outcomes. To obtain information for these assessments, HHS relies on
statewide data on outcome indicators, interviews with state and local
community representatives, and reviews of case records.
As part of its title IV-E eligibility reviews, HHS intends to randomly
sample in each state 80 cases from a sample of 88 cases in the primary
review from all title IV-E funded placements in the state; during the
on-site component of its CFS reviews, HHS intends to review a sample of 30
to 50 cases selected from a sample of 150 individual cases drawn from all
cases of children served by the state in foster care and in their own
homes.15 The remaining cases would be reviewed only in the event of a
discrepancy between the on-site findings and the statewide assessment. While
HHS looks at a sample of individual cases as part of each of its reviews,
the sample sizes are small, so relatively few juvenile justice cases will be
selected for review. Moreover, protocols for its title IV-E eligibility and
CFS reviews have not been finalized, and at this point it is not clear what
specific information related to eligibility and procedural issues in
juvenile justice cases will be collected.
Juvenile justice placements constitute a small proportion of all title IV-E
placements. However, states have on occasion claimed reimbursement for
juvenile justice placements at facilities that were not eligible for such
reimbursement and, in many of the title IV-E funded cases we reviewed, the
facility served primarily children in the juvenile justice system.
Furthermore, according to HHS, states find it particularly difficult in
juvenile justice cases to meet title IV-E procedural requirements intended
to protect the welfare of children. In light of these findings, we believe
it is important for HHS to exercise adequate oversight of title IV-E funded
juvenile justice placements to determine the extent to which title IV-E
funding is appropriately used and procedural requirements are met in these
cases. To do this, HHS needs sufficient information about
� facility eligibility and compliance with procedural requirements in
individual title IV-E funded juvenile justice cases and
� the state and county systems used to determine if the facilities in title
IV-E funded juvenile justice cases are eligible for title IV-E funding, as
well as systems used to ensure that procedural requirements are met in these
cases.
Although states have primary responsibility for making title IV-E facility
eligibility decisions and meeting procedural requirements in juvenile
justice placements, we believe that as the ultimate steward of title IV-E
funds, HHS has responsibility to exercise close oversight of the use of
those funds. Collection of such information will allow HHS to identify the
nature and magnitude of any problems that may exist in these cases.
We recommend that the Secretary of HHS direct the Assistant Secretary,
Administration for Children and Families, to review title IV-E funded
juvenile justice placements in child care institutions in states that have
such placements in order to collect information needed to determine whether
or not the facility in which the child was placed was a detention facility.
We also recommend that, in each state having title IV-E funded juvenile
justice placements in child care institutions, HHS review a sufficient
number of such placements to provide a reasonable degree of assurance that
detention facilities are not receiving title IV-E funds and that procedural
requirements intended to protect the welfare of children are being met in
juvenile justice placements. Depending on the results of the initial review
in a given state, HHS could decide whether it would be necessary to review
the same number of juvenile justice cases in that state in the future.
Finally, we recommend that for those states having title IV-E funded
juvenile justice cases, HHS ensure that the adequacy and effectiveness of
state and county systems used to (1) determine if the facilities in which
juvenile justice children are placed are licensed and otherwise eligible for
title IV-E funding and (2) ensure that procedural requirements are met in
title IV-E funded juvenile justice cases are examined.
We gave HHS an opportunity to review a draft of this report; its written
comments are reproduced in app. V. While HHS agreed that more information is
needed to understand and address issues related to placing juvenile justice
children under foster care, it did not agree with our suggestions on how to
obtain such information. HHS said that the disproportion we found--10
percent of title IV-E funds spent on juvenile justice placements that
constitute 4 percent of all title IV-E funded foster care placements--was
insufficient to justify revising its review systems for the foster care
program. We did not, however, base our recommendations on the disproportion
HHS cites. Rather, they were based on concern for the welfare of the
children involved, given that title IV-E funds have been claimed for
juvenile justice placements in ineligible facilities and that meeting
procedural requirements intended to protect the welfare of children can be
difficult in juvenile justice cases. Although the magnitude of federal
expenditures involved is certainly an important consideration, we believe
that ensuring the appropriateness of placements for and the welfare of
15,000 juvenile justice children is important as well. While there have been
inappropriate placements in the past, and difficulties have been encountered
in meeting procedural requirements, the extent to which these situations
exist now is unknown and needs to be determined.
HHS' comments to our draft report also indicated to us that the department
believed that our proposal to modify its title IV-E eligibility and CFS
reviews to sample enough juvenile justice cases to provide reasonable
assurance that the extent of problems with these cases was measured would
involve more work than necessary. HHS said that it had two mechanisms--the
partial CFS review and the partial review for state plan requirements
outside the scope of a CFS review--that could be used as an issue-specific,
targeted approach to identify and respond to problems with juvenile justice
placements. The intent of our proposed recommendation was to have HHS
determine the extent of problems with juvenile justice foster care
placements and to correct problems that may exist. HHS believes it can
adequately accomplish these objectives through alternative means, which we
found satisfactory. Therefore, we modified the language of our
recommendations to allow for the use of alternative means to accomplish
their intended effect.
California and Texas also commented on a draft of the report; HHS also
provided technical comments. These comments were incorporated where
appropriate.
We will send copies of this report to the Honorable Donna E. Shalala,
Secretary of HHS, and program officials in California and Texas. We will
also send copies to child welfare program directors in all other states and
make copies available to others on request.
If you have any questions concerning this report, please contact me at (202)
512-7215 or Clarita Mrena at (415) 904-2245. Susan Riggio, Cornelius
Williams, May Lee, Patrick DiBattista, and Traci Gleason Wright also made
important contributions to this report.
Cynthia M. Fagnoni
Director, Education, Workforce, and
Income Security Issues
Scope and Methodology
To determine the number of title IV-E funded juvenile justice and child
welfare placements nationwide, the amount of title IV-E funds used by each
state for juvenile justice and child welfare placements, and the ages of
children in title IV-E funded juvenile justice placements, we conducted a
survey of all 50 states and the District of Columbia. We asked each state to
provide this information statewide for their fiscal year 1998. We conducted
follow-up calls to encourage states to complete the survey and to clarify
responses when necessary.
In response to our survey, 23 states indicated that they had claimed title
IV-E funding for juvenile justice placements during fiscal year 1998; 16 17
states and the District of Columbia indicated they had not. The remaining 10
states did not respond to our survey.
While all of the 23 states that indicated they had financed juvenile justice
placements with title IV-E funding could provide the total amount claimed
that year, only 17 could provide the amount claimed for juvenile justice
placements alone. To determine what proportion of all title IV-E funding
nationwide during fiscal year 1998 was used for juvenile justice placements,
we used estimates of the amount each of the other five states claimed for
these placements.17 We estimated this amount in these states by multiplying
the total title IV-E funding each state indicated they claimed by 14.5
percent. We used this percentage because, across the 17 states that could
provide the amount claimed for juvenile justice placements, 14.5 percent of
the total title IV-E funding claimed was for juvenile justice placements.
For example, in Alabama we estimated that $991,543 in title IV-E funding, or
14.5 percent of the total $6,833,512 claimed, was for juvenile justice
placements.
Similarly, only 18 of the 23 states that indicated they had claimed title
IV-E funding for juvenile justice placements could provide the number of
juvenile justice placements for which these funds were claimed. To determine
what proportion of all title IV-E funded placements nationwide were juvenile
justice placements, we used estimates of the number of juvenile justice
placements in two of the four states that could not provide this number.18
We multiplied the total number of title IV-E funded placements in each state
by 6.4 percent because 6.4 percent of all title IV-E funded placements
across the 18 states that could provide this number were juvenile justice
placements. For example, in Alabama we estimated that 79 title IV-E funded
placements, or 6.4 percent of the total 1,235 placements for which the state
claimed title IV-E funding, were juvenile justice placements.
To determine what systems are in place in states to ensure title IV-E funds
are not used for placements in detention facilities and that procedural
requirements are met in title IV-E funded cases, we conducted in-depth
fieldwork in California and Texas. We visited state-level agencies in both
states and met with officials from county agencies in Los Angeles and San
Bernardino counties in California and Dallas and Harris counties in Texas.
As part of this fieldwork, we reviewed the case files of a total of 18
children in title IV-E funded juvenile justice placements. These reviews
examined case planning, administrative reviews, permanency planning, and
efforts to reunify the children in these cases with their parents. We also
obtained information on selected features of most of the facilities in these
cases from probation officers and title IV-E program staff in county
probation departments in Texas and county probation officers in
California.19 We did not independently determine in these cases if the
facilities in which children were placed were eligible for title IV-E
funding, if procedural requirements were met, or if children received the
services they required. We also obtained state administrative data relevant
to IV-E funded placements in 1998. These data included breakdowns of the
title IV-E funded juvenile justice and child welfare populations in these
states by level of care received, type of foster care placement or placement
setting, and the state payment rate and the title IV-E allowable amount paid
for such care. Finally, we conducted extensive interviews with officials in
the state and county agencies responsible for administering title IV-E
funding.
To determine how provisions in state licensing regulations for child care
institutions reflect eligibility criteria for title IV-E funding and address
title IV-E procedural requirements, we reviewed licensing regulations in the
10 states claiming the most federal foster care funding during 1998. In
addition to California and Texas, we reviewed licensing regulations in
Maryland, Ohio, North Carolina, Missouri, Illinois, New York, Michigan, and
Pennsylvania.
To identify the processes HHS has in place to ensure that title IV-E funds
are only used for placements that qualify for this funding and that title
IV-E procedural requirements are met in juvenile justice cases, we reviewed
pertinent laws, regulations, and other documents and interviewed program
officials from the department. We conducted our work between December 1998
and May 2000 in accordance with generally accepted government auditing
standards. We did not independently verify the data states provided to us.
Fiscal Year 1998 Title IV-E Funding Claimed and Number of Placements, by
State
Number of placements for
Amount of title IV-E funding which title IV-E funding
claimed
was claimed
For juvenile
State Total justice Total Juvenile
placements justice
Alabama $6,833,512 $991,543a 1,235 79b
Alaska 8,630,748 917,789 489 52
Arizona 39,781,393 0 4,224 0
Arkansas 20,167,765 0 c 0
Californiad 779,431,192 188,900,670 70,696 4,317
Colorado 27,760,609 3,419,368 4,432 416
Connecticutc -- -- -- --
Delaware 6,476,120 140,078 405 5
Washington, D.C. 31,141,626 0 2,350 0
Florida 111,048,387 0 10,130 0
Georgia 26,265,132 0 7,410 0
Hawaii 10,294,557 0 1,920 0
Idaho 3,830,200 0 497 0
Illinois 470,708,348 0 43,061 0
Indiana 28,454,479 4,128,745a 5,346 341b
Iowac -- -- -- --
Kansas 12,061,336 0 1,725 0
Kentucky 34,061,773 915,654 5,071 66
Louisiana 52,170,448 5,337,890 3,561 481
Maine 44,315,875 0 3,109 0
Maryland 74,320,191 1,361,650 1,941 327
Massachusettsc -- -- -- --
Michigan 185,380,873 0 9,080 0
Minnesota 27,657,424 4,013,093a c c
Mississippi 10,443,760 0 1,009 0
Missouri 61,145,850 0 10,507 0
Montanac -- -- -- --
Nebraskac -- -- -- --
Nevadac -- -- -- --
New Hampshire 9,604,538 960,454 1,002 225
New Jersey 43,100,000 0 c 0
New Mexico 3,699,023 0 1,100 0
New York 380,423,754 36,000,000e 58,655 2,456
North Carolina 35,825,085 0 7,726 0
North Dakota 8,618,741 1,356,542 1,121 83
Ohio 295,000,000 1,338,872 28,000 344
Oklahomac -- -- -- --
Oregonc -- -- -- --
Pennsylvania 269,864,495 39,157,339a 31,223 3,910
Rhode Island 15,837,832 160,416 2,115 41
South Carolina 17,424,000 0 2,160 0
South Dakota 2,851,781 40,642 564 2
Tennessee 28,856,741 12,737,366e 5,874 673
Texas 79,944,180 9,901,770 11,545 889
Utah 16,075,312 584,096 2,019 276
Vermontf -- -- -- --
Virginia 36,199,110 5,252,491a c c
Washington 20,974,310 0 4,882 0
West Virginiac -- -- -- --
Wisconsinc -- -- -- --
Wyoming 224,372 29,075 303 19
Total $3,336,904,872 $317,645,543 346,487 15,002
aState used title IV-E funds for juvenile justice placements but could not
provide statewide data on the amount claimed for juvenile justice
placements. Entry is our estimate of the amount based on the percentage of
title IV-E funds other states, in general, claimed for juvenile justice
placements.
bState used title IV-E funds for juvenile justice placements but could not
provide data on the number of these placements statewide. Entry is our
estimate of the number based on the percentage of all title IV-E funded
placements in other states, in general, for juvenile justice placements.
cState did not respond to our survey or could not provide the data we
requested.
d It should be noted that, in 1999, California no longer authorized
placements in (that is, decertified) three out-of-state facilities that
received title IV-E funds during 1998. The state has not determined whether
these decertifications should be retroactive to 1998, which would require
these facilities to return title IV-E funds they received for placements in
that year.
e State provided an approximate amount.
fState indicated that it claimed title IV-E funding for juvenile justice
placements but did not provide the data we requested.
Provisions of State Licensing Regulations for Child Care Institutions
Related to Physical Restriction of Residents
Discipline Isolation Locks Restraints
California
Any form of
discipline that
violates a
child's personal
rights is
prohibited.
Acceptable forms
of discipline Resident children (See discipline
include exclusion cannot be locked column.) Physical
in an unlocked in any room, restraining
living, sleeping, building, or devices may be
or play area; facility premises used for the
institution of by day or night. protection of a
fines under Facility is child with special
certain (See discipline permitted to use health care needs
conditions; column.) any other means during treatment
prohibition for securing and diagnostic
against exterior doors and procedures such
attendance at or windows or for as, but not
participation in protection of limited to,
planned residents provided intravenous
activities; and residents are able therapy or
prohibition to exit the catheterization
against use of facility. procedures.
entertainment
devices, such as
telephones,
televisions,
radios, and
phonographs.
Illinois
Discipline may
only be used to
help children Confinement is Physical restraint
develop limited to may be used only
self-control and children who pose as a therapeutic
learn to assume a threat of measure when a
responsibility physical harm to child presents a
for their themselves or threat of physical
actions. others. A child harm or dangerous
Acceptable may not be kept in behavior
discipline confinement more reasonably
includes than 30 minutes Key locks may not expected to lead
assigning special beyond the point be used on locked to physical harm
or additional at which the child confinement room to self or others.
tasks and/or ceases presenting doors. Automatic Physical
removing the specific mechanisms are to restraints are not
privileges for behavior for which release the child to be used until
periods not to the confinement from confinement after other less
exceed 1 month, was ordered or any in the event of a restrictive
restriction to other behavior for fire or other procedures or
the child's which confinement disaster. measures have been
sleeping quarters is an appropriate explored and found
or room for intervention. to be
periods not to Confinement may be inappropriate. No
exceed 3 hours used to prevent child is to be
per day, or runaway only when subjected to
restriction to the child presents mechanical
the premises or a threat of restraints unless
specified areas physical harm to prescribed by a
of the premises self or others. licensed
for periods not physician.
to exceed 3 days.
Maryland
Prohibited
disciplinary
measures include A child may not be Restraints can
assigning kept in a locked only be used when
physically room away from the Facility with (1) failure to do
strenuous general population "secure care so would result in
exercise or work unless it is program" may harm to self or
and the clearly necessary employ locked others or would
withholding of to prevent doors or other result in property
meals, sleep, imminent physical means to care for damage, (2)
mail, family harm to the child alleged or ordered by a
visits, or or other adjudicated physician or court
program individuals or to delinquent of competent
participation prevent imminent children. jurisdiction, and
other than and substantial (3) permitted by
recreation or destruction of state law.
leisure property.
activities.
Michigan
A child care
facility may The door to the
receive approval behavior
to use a management room
"behavior may be equipped
management" room with a
for a child who security-locking
is out of control device that
and is in danger (See discipline operates by means (See discipline
of harming self column.) of a key or is column.)
or others. The electrically
rooms are to be operated and has a
used only for the key override and
time needed to emergency
change the electrical backup
behavior in case of a power
compelling its failure.
use.
Missouri
Locked isolation
for the purpose of
discipline is not
to be used. A
Facilities are to facility with a
have written residential
policies and treatment program Restraints are to
procedures may use locked be used only to
prohibiting isolation when a end disturbances
discipline that child presents a (See isolation that threaten
may adversely danger to self or column.) physical injury to
affect a child's others or poses a the child or
health or threat of serious others or do
physical or property damage serious property
psychological and in the damage.
well-being. shortest intervals
possible until the
child regains
reasonable
self-control.
New York
Restraints are to
be used without
purposely
Discipline is to inflicting pain or
be prescribed, harm and only when
administered, and other forms of
supervised only intervention are
by adults. Room isolation as No child is to be either
Deprivation of a method of confined to a inappropriate or
meals, snacks, discipline is locked room for have been tried
mail, or visits prohibited. any reason. and proven
by family as unsuccessful.
methods of Restraint,
discipline are including room
prohibited. isolation, will
never be used for
punishment or for
the convenience of
staff.
North Carolina
Isolation or
locked custody is
to not be used as
punishment.
Appropriate work No locks are to be
tasks or denials installed on exits
of privileges are and on room doors
acceptable (See discipline that would prevent (Not specifically
methods of column.) occupants from addressed in state
discipline. getting out by the regulations.)
Corporal simple operation
punishment or of a single knob
denials of meals or lever.
are not to be
used as
punishment.
Ohio
All locks on doors
Facilities must to any room or
have disciplinary Isolation can be storage area in Isolation,
policy and used exclusively which a child physical,
procedures to for the behavior could be confined chemical, or
prohibit all management of a are to be of the mechanical
cruel, unusual child who is out type that permit restraint may not
practices and of control. the door to be be used as a means
punishments. unlocked from of punishment.
either side of the
door.
Pennsylvania
Use of mechanical
restraint is
prohibited. No
A licensed Placing a child in child is to be
facility may not a locked restrained for
use a method of room--including purposes of
physical rooms with any Locks may be used punishment or for
restraint, type of door as a means of the convenience of
isolation, locking device, external security others. Restraint
security, or such as a key to keep persons may be used only
physical barriers lock, spring lock, out or deny access in cases of
that would bolt lock, foot to an area but not emergency where
prevent a child pressure lock, or to exit. there is the
from leaving the physically holding occurrence or
facility. the door shut--is serious threat of
prohibited.
violence to self,
others, or
property.
Texas
Any discipline or
control must fit
the needs of each
child. Children
must not be
punished by
shaking or
striking; denied
food, mail, or
family visits as
punishment; or
subjected to
cruel, harsh,
unusual, or
unnecessary
punishment.
Physical
punishment (that A child must not
is, spanking) is be placed alone in
permitted only in a locked room.
basic care Children must not
facilities, not be placed in a
in facilities dark room.
serving mentally Children in a
retarded or behavior therapy Physical holding
emotionally program and for restraint or
disturbed required to be mechanical
children. If the placed in a locked restraints must be
facility has a time-out must not used only when
behavior therapy be placed in a necessary to
program, it must locked time-out protect the child
have clearly room for more than from injury to
written policies 15-minute self or others. If
and procedures intervals. physical restraint
for the program Children in a is to be used
and be approved locked time-out (See isolation other than in an
by the state's room must be column.) emergency, it can
Department of watched or be used only upon
Protective and visually monitored the orders of a
Regulatory on a continuous licensed
Service. If a basis by the physician. An
facility's policy foster parent or order for physical
permits physical child care worker. restraint must
punishment, a If a child in an designate the type
complete individual of restraint, the
description of behavior circumstances, and
any physical management program the duration of
punishment is restricted to its use.
administered must the facility for
be recorded. The more than 24
punishment must hours, the
be administered restriction must
by a staff member be recorded in the
and witnessed by child's record.
another staff
member. If a
child is
restricted to the
facility for more
than 24 hours,
the restriction
must be recorded
in the child's
record. Denial of
"edible treats"
may be used as
part of an
individual
behavior
management
program.
Source: State child care licensing regulations in each state cited.
Provisions in State Licensing Regulations That Relate to Procedural
Requirements in Title
IV-E Funded Foster Care Cases
Case/service plan Case reviews/program Procedural safeguards
progress reports
California
-- Plan development:
Needs and services
plans are to include
(1) reason for
placement; (2)
education and training
history; (3) ability to
care for and groom
oneself and to manage
money; (4) on- and
off-site visitation
privileges with family -- Resident visitation:
members and friends; Needs and services plans are
and (5) other specific to identify the child's
services, including needs regarding visitation,
those required by the including the frequency of
child's parent or and any other limitations on
guardian. visits to the family
Licensees must have residence and other visits
-- Services to family: procedures for inside and outside the
Licensees must have a reviewing and facility.
policy regarding evaluating needs and
participation of the services plans, which -- Services to family:
child and authorized are to be updated at Licensees must have a policy
representative in the least every 6 months regarding participation of
development of the to determine (1) the the child and authorized
needs and services child's need for representative in the
plan. continuing services development of the needs and
and (2) the facility's services plan.
-- Education: Licenseesrecommendation
are to ensure each regarding the -- Admission/intake
child's attendance at feasibility of the procedures and practices:
an educational program child's return home, Licensees are to develop,
in accordance with placement in another maintain, and implement
state law. facility, or move to intake procedures that will
independent living. specify (1) needs and
-- Health services: services plan requirements
Licensees are to obtain and (2) signature of child
and maintain in each and authorized
child's record medical representative that they (a)
and dental insurance were offered the opportunity
coverage information to participate in plan
and consent forms development and (b) approved
completed by the the plan.
child's authorized
representative.
Licensees are not to
accept any child with
special health care
needs unless the
licensee has obtained
an individualized
health care plan for
the child.
Illinois
-- Plan development:
Plans for services for
each child and family
must be in writing,
reviewed at least every
6 months, and signed by
all the parties
involved. Plans are to
describe the services
to be provided and how
these services (1) will
meet the needs of the
child and family and
(2) are directed toward
resolution of the need
for placement. Plans
also must establish a -- Resident visitation:
time frame for Children are not to be
termination of services deprived, as discipline, of
and care in the visits or weekly telephone
facility. contacts with family,
attorneys or legal
-- Education: Each assistants, assigned
child is to have the caseworkers, or other
opportunity and be persons who have established
encouraged to complete a parenting bond with the
high school or child. Children are to be
vocational training in allowed to visit families
accordance with other than their own and
aptitude. Those friends in the community
excluded from school or when the living conditions
unable to benefit from of the family to be visited
usual school attendanceLicensees are to are known and the visits are
are to be provided assess with the approved by the child care
education, training, orreferring agency, facility. The facility is to
work experience child, and/or family ensure that visits with the
consistent with their the child's need for child, on or off the
needs and abilities. placement, the purpose facility's premises, are in
Each child is to be for referral to the the child's best interests.
permitted and specific institution,
encouraged to and the institution's -- Services to family:
participate in ability to serve the Families are involved in
extracurricular child. Each child's developing and improving
activities. The group plan for services must service plans for the child
home must ensure that be reviewed at least and family.
each child has every 6 months and
available necessary signed by all parties -- Admission/intake
school supplies, involved. procedures and practices:
materials, and Children are to be admitted
equipment and must only upon written consent or
maintain contact with application of parent or
and seek cooperation of guardian; upon court order;
those serving the or, in emergency situations,
educational needs of upon authorization of an
its children. officer of the law or a
department child protective
-- Health services: services worker. No person
Each child is to be who has attained age 18 is
examined by a physician to be admitted unless
within 30 days before referred by a parent or a
placement and screened guardian, including an
for communicable agency having legal
diseases within 72 responsibility for the
hours. If an emergency, person under Illinois
the physical statute.
examination is to be
scheduled within 5 days
after placement and
completed within 15
days after placement.
Children must also be
examined annually, or
more frequently if
findings and medical
opinion indicate need,
and given a dental
examination at least
annually with diagnosed
dental defects treated
promptly.
Maryland
-- Plan development:
Licensees are to have
and follow written
policies regarding
individual service
planning. Service plans
are to be developed
within 30 days after
admission and are to
identify the child's
needs with respect to
(1) counseling and drug
and alcohol abuse, (2)
education, (3) family
relationships, (4)
health care, (5) life
skills development, (6)
recreation, (7) social
work, (8) program
goals, and (9) the time
planned to achieve -- Resident visitation:
goals. Licensees are to have and
follow a written policy
-- Services to family: regarding
Licensees are to invite communications--which
to participate in the include visitations,
admission process and telephone contacts,
in the development of correspondences, and
the individual service reports--between the child
plan and the discharge and others. When consistent
plan the (1) with the child's service
representative plan, family members are to
designated by the be encouraged to participate
placing agency and (2) in the program.
child's parent if
consistent with the -- Services to family:
child's permanency Licensees are to give the
plan. child's parent and, as
appropriate, the child a
-- Education: Licensees written description of the
are to (1) ensure that program that includes (1)
each child who is of the program mission and
mandatory school admission and discharge
attendance age and who Licensees are to policies, (2) daily
has not earned a review and update routines, (3) treatment
secondary school individual service strategies and disciplinary
diploma or a plans at least every practices, (4) visiting
certificate of 90 days. hours and other procedures
completion, and each related to communications
child who is eligible with the child, and (5)
for special education procedures for registering
services attends school grievances regarding the
or is provided with child's care.
appropriate education
services; (2) work -- Admission/intake
cooperatively with the procedures and practices:
local school system to Licensees are to have and
ensure that the follow written policies
children attend the regarding admission,
local school whenever individual service planning,
possible; and (3) when and discharge, and invite to
applicable, obtain a participate in the admission
certificate of approval process and in developing
for educational the individual service plan
programs in nonpublic and the discharge plan the
schools and child care representative designated by
and treatment the placing agency and the
facilities. child's parent if consistent
with the child's permanency
-- Health services: plan.
Licensees are to (1)
have and follow a
written plan for the
provision of
preventive, routine,
and emergency medical,
dental, and mental
health care for
children; (2) obtain
written authorization
from a parent or other
authorized individual
for nonemergency
medical, dental, or
mental health care; (3)
authorize emergency
medical, dental, or
mental health care if a
parent cannot be
reached.
Michigan
-- Plan development:
Service plans are to be
developed within 30
days of admission and
with resident, parents,
and the referral
source. Plans are to
include (1) an
assessment of the
resident's and family's
strengths and
weaknesses in the areas
of education,
economics, psychology,
society, and health as
they relate to the
resident's needs; (2)
parent and child -- Resident visitation:
visitation plans; (3) Facilities are to make
treatment goals to provisions for visits
remedy problems of the between each resident and
resident and family and the resident's parents,
time frames for Services plans are to except where parental rights
achieving the goals; be updated and have been terminated or the
(4) indicators of goal recorded by the social resident's record contains
achievement; (5) services worker for documentation that
persons responsible foreach child at least visitation is detrimental to
coordinating and once every 3 months the resident.
implementing the following the initial
resident and family plan. Updated service -- Services to family:
treatment goals; (6) plans are to be Facilities are to have a
staff techniques for developed with the program statement that
achieving the resident, the specifically addresses the
resident's treatment resident's parents, services that will be
goals; and (7) the and the referral provided to residents and
projected length of source, unless parents directly by the
stay and next documented as institution and the services
placement. inappropriate. Updated provided by outside
service plans are to resources.
-- Education: Licenseesinclude (1) progress
are not to admit a made toward achieving -- Admission/intake
child for care unless the goals established procedures and practices:
an appropriate in the previous plan; Service plans developed for
educational program can(2) any changes in the each child within 30 days of
be provided in plan, including new admission include (1) an
accordance with Act No.problems and new goals assessment of the child's
451 of the Public Acts to remedy the immediate and specific
of 1976, as amended problems; and (3) needs, (2) the specific
(sect.380.1 et seq of the indicators of goals services to be provided by
Michigan Compiled Laws,and time frames for the institution and other
known as the School achievement. resources to meet the
Code of 1976) not later child's needs, and (3) a
than 5 school days description of the child's
after admission and placement circumstances and
continuously thereafter general physical and
for each resident of emotional state at the time
school age. of admission.
-- Health services:
Licensees are to
establish and follow
written health service
policies and procedures
for (1) routine and
emergency medical and
dental care, (2) health
screening procedures,
(3) maintenance of
health records, and (4)
storage and dispensing
of medications and
personnel authorized to
dispense medications.
Missouri
-- Plan development:
From the time a child
is admitted, a
preliminary written
service plan must be
developed and
documented in the
child's record within -- Resident visitation:
15 days for each child agencies are to develop
admitted by plan for written visitation policies.
placement or within 72 An agency is to encourage
hours for emergency and support contacts between
placement admissions. a child and the family while
The service plan must the child is in care, unless
identify and include the rights of the parent to
(1) the child's contact the child have been
individual needs in terminated or restricted by
addition to basic needsThe service plan court order.
for food, shelter, review with the date
clothing, routine care,and signature of the -- Services to family: The
and supervision; (2) treatment team admission assessment must be
specific strategies andcoordinator and a in writing and include
their frequency to meetsigned and dated specific information on (1)
the child's needs, attendance sheet of the circumstances that led
including instructions all other participants to the child's referral; (2)
to staff; (3) specific in the review must be the immediate and long-range
strategies and documented in the goals of placement; and (3)
frequencies for family child's record. the parent's or legal
involvement, including Reports of the guardian's expectations for
a defined plan for evaluations in placement, family
visitation and engagingsummarized form are to involvement, and duration of
the family in services be included in the the child's stay in care.
for the child; (4) child's record and
specific strategies to shared with the -- Admission/intake
meet the recreational parent, guardian, or procedures and practices:
and developmental needslegal custodian. The Intake policies are to be in
of the child; (5) the service plan review writing and are to identify
estimated length of must include (1) an services and programs
stay; and (6) the date evaluation of progress offered. Whenever possible,
and signature of the toward meeting the an agency is to arrange for
treatment team child's needs; (2) an one or more preplacement
coordinator and a evaluation of progress visits by the child (except
signed and dated toward family in emergency placements)
attendance sheet of allreunification; (3) any and, when appropriate,
other participants. needs identified since arrange for at least one or
the plan was developed more preplacement visits by
-- Services to family: or last reviewed and the child's parent,
The service plan must strategies to meet the guardian, or legal
also identify and needs, including custodian. When a child is
include time-limited instructions to staff; self-referred, efforts are
goals and preliminary and (4) an update of to be made to contact the
plans for discharge, the estimated length child's parent, guardian, or
including plans for of stay and discharge legal custodian within 24
reintegration into plans, if changed. hours. If the parent,
family and community. guardian, or legal custodian
cannot be contacted, the
-- Education: The agencies are to notify the
facility administrator appropriate public agency.
is responsible for All efforts to notify the
ensuring compliance appropriate public agency,
with Missouri statutes parent, guardian, or legal
pertaining to a child's custodian are to be
education. documented in the child's
case record.
-- Health services: The
facility is to have a
written health care
program plan that
addresses preventive
medical eye, hearing,
and dental care.
New York
-- Plan development: A
case planner is
assigned to each child
and is responsible for
assessing the need for,
providing or arranging
for, and coordinating
and evaluating the
provision of services
to children in foster
care and services to
parents of children in
foster care.
-- Services to family:
Casework contacts are
defined as individual
or group face-to-face
contacts between the During the first month
case planner and a of placement, casework
child's parents or contacts are to be
relatives for the held with the child's
purpose of guiding parents or relatives -- Resident visitation: For
parents and relatives as often as is children with a permanency
toward a course of necessary to implement planning goal of returning
action aimed at the tasks in the to parents or relatives,
resolving problems or family and children's contacts between the
needs of a social, services plan but, at caseworker and the child's
emotional, a minimum, are to parents or relatives are to
developmental, or occur at least twice, be scheduled to occur in the
economic nature that unless compelling home of the parents or
are contributing to thereasons are documented relatives to whom the child
need for foster care. why such contacts are will be discharged as often
not possible. After as is necessary to implement
-- Education: Licenseesthe first month of the tasks in the family and
are to take such steps placement, casework children's services plan.
as may be necessary to contacts are to be
make certain that all held with the child's -- Services to family:
children receive parents or relatives Social service officials
education appropriate at least once every must provide care and
to their needs and in month if the permanent services as directed by the
accordance with the planning goal for the family court judge to
requirements of the child is to return to encourage and strengthen the
state's Education Law the parents or parental relationship when
and are to make certainrelatives and the court finds that such
that each child quarterly if the efforts will not be
receives appropriate child's permanent detrimental to the best
educational and planning goal is for interests of the child.
vocational guidance. adult residential care
or to prepare for -- Admission/intake
-- Health services: independent living. procedures and practices
Each child must have Casework contacts may (see case reviews).
complete medical include either
examinations and is to face-to-face contacts
be provided, when or telephone
necessary, with consultations.
eyeglasses, hearing
aids, and prosthetic or
other adaptive devices.
Food is to be of good
quality, properly
prepared, served at
regular hours,
sufficient in quantity,
and meet nutritional
standards recommended
by the National
Research Council. To
the extent possible,
nutritional
requirements based on a
child's religious
beliefs are to be met.
North Carolina
-- Plan development: A
written plan of care
for each child is to be
developed at the time
of admission and
reviewed at least
semiannually by -- Resident visitation:
facility staff; parents Resident visitation and
and legal custodians; telephone calls are to be
and the child, where planned on an individual
appropriate. This plan basis. Visitation policies
of care is to include are to be developed through
(1) the expectations consultation with and the
and goals for the child approval of the legal
and (2) the tasks and custodian of the child.
activities of facility
staff, parents, and -- Services to family: Each
legal custodian to meet facility is to provide
the needs of the child services that it stated it
while in care. will provide in children's
written plans of care. In
-- Services to family: reviews of each child's
Each facility is to placement needs, licensees
provide those services are to include the parents,
to children and their relatives, and the agency
families that it has with legal responsibility
stated it will provide for the child.
in each child's plan of
care. Licensees are to -- Admission/intake
evaluate each child's procedures and practices:
placement needs on a Each child's plan of Admission policies are to be
regular basis and are care is to be reviewed clearly defined in writing
to include in this at least semiannually and are to be reviewed
review the parents, by facility staff, annually and changed as
relatives, and the parents, legal needs and conditions in the
agency with legal custodian, and, when community change. A written
responsibility for the appropriate, the plan of care for each child
child. child. is to be developed at the
time of admission and
-- Education: Children reviewed at least
are to attend the semiannually by the group
public school to which home staff, parents, legal
they are assigned, custodian, and, when
unless an alternative appropriate, the child.
education plan is Written placement
agreed upon by the agreements, signed by
child, the facility, authorized persons, are to
and the responsible include the services to be
person or placement provided by the facility and
agency. the responsibilities of
parents and legal
-- Health services: custodians, indicating
Facilities are to have responsibility for (1) the
a planned program of child's financial and
medical care. No child medical needs and fees to be
is to be accepted into paid; (2) consent for
a program without emergency medical treatment;
having had a physical and (3) determining length
examination within 90 of stay, visitation
days prior to expectations and
admission, which is to limitations, and the
include a signed schedule of review
statement by a licensed conferences.
medical provider
specifying the child's
current medical
condition and
prescribed medications.
Ohio
-- Plan development:
Service plans are to be
in writing and contain,
at a minimum, (1) goals
and objectives; (2) the
time frame projected
for meeting placement
goals and objectives
and projected placement
plans upon discharge;
(3) the educational,
counseling,
recreational,
vocational, and medical -- Resident visitation:
activities or services Service plans are to contain
that will be provided specifications for
by facility; (4) any visitations between the
specialized services child and family or friends.
that will be provided Facilities are to develop a
or arranged; (5) handbook for residents and
frequency of progress At least every 90 days their families, which
reports; and (6) after the initial contains visiting hours and
specifications for review of a child's communication policies.
visitation between service plan, all
child and family or individuals involved -- Services to family: The
friends. in the development and facilities' handbooks must
implementation of the also describe the roles and
-- Services to family: plan are to review and responsibilities of the
The facility is to (1) make any necessary family in the care and
develop and review a amendments. Such treatment of the child.
service plan for each reviews are to be
child with authorized documented in case -- Admission/intake
representative, parent,records and are to procedures and practices:
or guardian and (2) include an assessment Facilities are to have
keep the parent, of the current written individual child
guardian, or custodian adjustment of the care agreements for each
informed of health carechild and a child with the person or
provided to the child determination of agency holding custody of
while at the facility. whether the child the child. Facilities are to
should remain in the document, at the time of
-- Education: The childfacility. admission, a physical
has the right to description of each child or
participate in an teenage mother, any
appropriate educational available medical
program. information, the name and
authority or relationship of
-- Health services: the person placing the
Within 5 working days child, and the reason for
of admission, the placement.
facility is to secure a
placement medical
screening of the child
conducted by a licensed
physician, registered
nurse, licensed
practical nurse, or
physician's assistant.
Health care is to
include dental and
optical examinations by
licensed practitioners.
Pennsylvania
-- Plan development:
Licensees are to
develop and begin
implementing an
individual service plan
(ISP) for each child
within 30 days of
admission. The plan is
to include (1) service
goals; (2) time-limited
objectives to be used
for evaluating progress
toward these goals; (3)
specialized activities
or services that the
facility will provide,
arrange for, or
coordinate, and methods
for measuring
accomplishment; (4) a
schedule of the child's
visits by or with a -- Resident visitation:
parent or guardian; (5) Licensees are to arrange
anticipated duration of family visitations that are
stay; and (6) the convenient for the family
persons responsible forLicensees are to and the facility.
and their role in review each child's Visitations and
implementing the plan, ISP at least once communications between a
and methods of every 6 months to child and the child's
assessing progress. determine progress in parents, attorney, clergy,
achieving the plan's or placing agency may not be
-- Education: Children goals and objectives. restricted or terminated
of compulsory school The first ISP review without a written court
age are to be enrolled is to occur no later order.
in or have access to a than 6 months from the
basic education. date the child was -- Services to family:
Children beyond the ageplaced in the facility Licensees are to provide the
of compulsory school or, for certain child's parents or guardian
age are to have an children, no later (1) an opportunity to
opportunity to access than 6 months from the participate in the ISP
career counseling and initiation date of the development and reviews and
continuing education. ISP. Subsequent to sign the initial or
Academic and vocationalreviews are to be held revised or modified ISP and
programs operated on no later than 6 months (2) a copy of the initial
facility grounds are tofrom the date of the and each amended ISP.
meet applicable previous review. If
requirements of the appropriate, ISPs are -- Admission/intake
state's Department of to be modified or procedures and practices:
Education. revised as a result of Licensees may accept a child
these reviews. ISP for care if it receives in
-- Health services: review results are to writing (1) a description of
Licensees are to ensurebe recorded in the the circumstances that make
each child receives a child's record. placement necessary, (2) the
health screening within needs of the child that the
24 hours of admission. facility must address, and
The screening may be (3) the child's legal
conducted by a licensed status.
physician, nurse
practitioner,
registered nurse,
licensed practical
nurse, physician's
assistant, or a
specially trained
direct care staff
person. Licensees are
to establish written
policies and procedures
governing the provision
of health care,
including preventive,
routine, and emergency
medical and dental
care; the
administration of
medication; and staff
training.
Texas
-- Plan development:
Licensees are to
complete an intake
study for each child
accepted for placement -- Resident visitation:
(see admission/intake Contacts between the child
procedures and and family are to be allowed
practices) and, within unless the rights of the
30 days of admission, parents have been terminated
develop an initial plan by court order or family
of service after contact is not in the
conferring with the child's best interest. If
child and the child's limits are put on
parents or managing communication or visits for
conservator. The plan practical reasons (such as
of service is to expense), such limitations
specify the objectives are to be determined with
of placement, how the the participation of the
child's needs will be child and family. Children
met, and the estimated may not be denied visits
length of stay. with their families as
punishment.
-- Services to family:
The parents or guardian -- Services to family: A
cooperate with the written plan of service must
child-placing agency in be developed and documented
developing and carrying in the child's record within
out the plan of servicePlans of service are 30 days of admission for
for each child. to be reviewed and each child in care. The plan
updated by conference must be based on the
-- Education: Licenseesevery 6 months. admission assessment. A copy
are to arrange an Conferences are to or summary of the plan must
education appropriate include a be given to the child, when
for each child. The representative from appropriate, and the child's
facility is to provide the group home who parents. Staff who work with
for the social and meets the same the child must implement and
educational needs of qualifications as the follow the plan.
each child; each child person doing the
is to be permitted to intake study, the -- Admission/intake
attend the public free child's parents, and procedures and practices:
schools in the districtthe child. Updated Facilities may not accept a
in which the foster plans are to note child for care until an
parents reside free of achieved or changed intake study has been made
charge to the foster objectives. The and a determination that the
parents. child's parents are placement meets the needs
provided copies of and best interests of the
-- Health services All updated plan child and family. In
children are to be summaries. addition to the parents' or
examined each year by a managing conservator's
licensed physician and expectations of placement,
at least once a year by the intake study is to
a licensed dentist or a describe the child's (1)
dental hygienist family circumstances and
working under the relationships that make
supervision of a placement necessary; (2)
licensed dentist. developmental and medical
Provisions are to be history; (3) understanding
made for emergency of placement; (4)
medical and dental personality, behavior, and
care. All medications interests; (5) school
are to be given by history; (6) previous
foster parents or an placements; (7) legal
adult staff member, status; and (8) needs. The
except when a child is study is also to describe
participating in a the immediate and long-range
medically approved goals of the placement and
self-medication the family member or
program. Prescription managing conservator who
medications are to be will be responsible for the
in the original relationship between the
container, labeled with home and the child.
the child's name, a
date, instructions, and
the prescribing
physician's name.
Source: State child care licensing regulations in each state cited.
Comments From the Department of Health and Human Services
Related GAO Products
Foster Care: States' Early Experiences Implementing the Adoption and Safe
Families Act (GAO/HEHS-00-1 , Dec. 22, 1999).
Federal Reimbursement for Foster Care (GAO/HEHS-95-197R , Aug. 11, 1995).
Residential Care: Some High-Risk Youth Benefit, but More Study Needed
(GAO/HEHS-94-56 , Jan. 28, 1994).
Foster Care: State Agencies Other Than Child Welfare Can Access Title IV-E
Funds (GAO/HRD-93-6 , Feb. 9, 1993).
Child Welfare: Monitoring Out-of-State Placements (GAO/HRD-91-107BR , Sept.
3, 1991).
Youth Camps: Nationwide and State Data on Safety and Health Lacking
(GAO/HRD-89-140 , Sept. 20, 1989).
Foster Care: Use of Funds for Youths Placed in the Rite of Passage Program
(HRD-87-23BR , Dec. 9, 1986).
Review of Certain Aspects of Group Home Care for Children in California
(GAO/HRD-85-62 , July 19, 1985).
(116025)
Table 1: Number of Title IV-E Funded Juvenile Justice and Child Welfare
Placements in California and Cost per Day, by Setting and Level of Care
Received, Fiscal Year 1998 13
Table 2: Number of Title IV-E Funded Juvenile Justice and Child Welfare
Placements in Texas and Cost per Day, by Setting and Level of Care Received,
Fiscal Year 1998 14
1. These include private nonprofit or for-profit child care institutions and
public child care institutions housing up to 25 residents.
2. Specifically, the criteria in effect are those in the Aid to Families
with Dependent Children program--precursor to the Temporary Assistance to
Needy Families program--on July 16, 1996.
3. 45 C.F.R.
4. Sections 471(a)(16) of the Social Security Act require states to develop
case plans for title IV-E eligible children. Section 475(1) of the act sets
forth the requirements regarding the content of such plans.
5. According to the American Public Human Services Association, the basic
rate for foster care varies across states because the expenses states factor
into their basic rate vary by state. In addition to the cost of room and
board, clothing, supervision, and child care, for example, a state's rate
can include the costs of school supplies, liability insurance for the child,
reasonable travel to the child's home for visits, personal allowances,
recreational activities, and other general incidentals.
6. It should be noted that, according to HHS, many juvenile justice children
in title IV-E placements are placed in out-of-state facilities, which
increases cost. Because we did not obtain data from states that
distinguished between in- and out-of-state placements, we could not
determine what effect out-of-state placements have on the disproportion of
title IV-E funds expended on child welfare versus juvenile justice children.
According to California officials, 15 percent of their title IV-E funded
juvenile justice placements in November 1998 were in out-of-state
facilities.
7. Not all states could provide both the dollars claimed and the number of
juvenile justice placements made. We estimated these numbers for those
states.
8. Eighteen states could provide the amount claimed for and/or the number of
juvenile justice placements funded under title IV-E. For a few additional
states, we were able to develop estimates.
9. Children in juvenile justice placements in California also tend to be
older than those in the state's child welfare placements, and the IV-E
allowable amount increases as the age of the child increases.
10. See app. III for a description of the specific provisions related to
each of these restrictive practices in the licensing regulations for child
care institutions in each of these 10 states.
11. See app. IV for a description of the specific provisions related to
title IV-E procedural requirements in the licensing regulations for child
care institutions in each of these 10 states.
12. California and Texas also conduct prelicensing inspections.
13. 63 Fed. Reg. 67484-67485 (Dec. 7, 1998).
14. Title IV-B of the Social Security Act authorizes funds to states for a
broad range of child welfare services, including family preservation and
family support services.
15. For CFS reviews, case samples will be drawn from all title IV-E funded
foster care placements and cases that receive services funded under title
IV-B of the Social Security Act.
16. See app. II for state-by-state information on the amount of title IV-E
funding claimed for juvenile justice placements and the number of these
placements.
17. These states include Alabama, Indiana, Minnesota, Pennsylvania, and
Virginia.
18. We estimated this number for Alabama and Indiana. Minnesota and Virginia
could provide neither the number of juvenile justice placements nor the
total number of placements for which title IV-E funding was claimed, so
there was no basis for estimating the number of juvenile justice placements
in these states.
19. Features included whether the facility was located in an isolated or
remote area, whether the facility was locked, facility policies regarding
visitation and telephone calls and pursuit of runaways, and whether the
facility primarily serves youth in the juvenile justice system.
*** End of document. ***