Child Welfare: States' Progress in Implementing Family Preservation and
Support Services (Letter Report, 02/18/97, GAO/HEHS-97-34).

Pursuant to a congressional request, GAO reviewed the status of states'
use of funds for family preservation and support (FPS) services,
focusing on: (1) the nature and extent of states' use of federal funds
for new and expanded FPS services; and (2) states' plans to assess the
impact of these services on children and their families and impacts
identified to date.

GAO found that: (1) all states reported that they are using federal
funds to increase the availability of family preservation and family
support services either by creating new programs or expanding existing
programs; (2) 44 states said that they introduced new programs; (3) 47
states reported enhancing their existing programs or expanding them to
serve more clients; (4) as required by the law, GAO's analysis shows
that states appear to be allocating a significant portion of their
federal funds to both family preservation and family support services:
(5) in the last 2 years, states budgeted 56 percent of their service
dollars to family support and 44 percent to family preservation; (6) the
somewhat greater emphasis on family support services reflects priorities
established through state and community planning efforts; (7) moreover,
many states already had family preservation programs in place and
decided to bolster family support services; (8) to determine whether
this infusion of federal funds improves services for children and
families, GAO identified a number of efforts that are underway or
planned to assess programs providing FPS services; (9) states plan to
track the results of their federally funded services, for example, by
measuring the number of clients served and the extent to which their
needs are met, improvements in parent-child relationships, the degree
that services are coordinated, and indicators of community well-being,
such as child abuse rates; (10) although not required to do so, at least
11 states are also planning formal evaluations to determine whether the
services actually improve outcomes for families; (11) two federally
sponsored evaluations are underway to assess the effectiveness of family
preservation and family support services; (12) early results from 10
states indicate some successes, such as preventing child removal and
continued maltreatment; and (13) while it is too early to determine the
impact of these programs, federal and state officials report that the
extensive community and interagency collaboration required by the law
has resulted in improved identification of service needs, setting of
priorities, and receipt of services by at-risk families otherwise
overlooked.

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

 REPORTNUM:  HEHS-97-34
     TITLE:  Child Welfare: States' Progress in Implementing Family 
             Preservation and Support Services
      DATE:  02/18/97
   SUBJECT:  State-administered programs
             Families
             Child abuse
             Foster children
             Block grants
             Grants to states
             Program evaluation
             Federal/state relations
             State budgets
IDENTIFIER:  HHS Family Preservation and Support Services Program
             HHS Child Welfare Services Program
             Social Services Block Grant
             HHS Emergency Assistance Demonstration Program
             Food Stamp Program
             Oregon
             Oregon Intensive Family Services Program
             Texas
             Arkansas
             Maryland
             Idaho
             Kentucky
             Arizona
             San Diego County (CA)
             Hawaii
             Philadelphia (PA)
             Louisville (KY)
             Memphis (TN)
             New Jersey
             Albuquerque (NM)
             San Jose (CA)
             Cleveland (OH)
             Denver (CO)
             Pensacola (FL)
             Florida Full Service Schools Program
             Louisiana
             Louisiana Intensive Home Based Services Program
             Michigan
             
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Cover
================================================================ COVER


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

February 1997

CHILD WELFARE - STATES' PROGRESS
IN IMPLEMENTING FAMILY
PRESERVATION AND SUPPORT SERVICES

GAO/HEHS-97-34

Implementing FPS Services

(105826)


Abbreviations
=============================================================== ABBREV

  ACF - Administration for Children and Families
  ASPE - Office of the Assistant Secretary for Planning and
     Evaluation
  FPS - family preservation and support
  HHS - Department of Health and Human Services
  OBRA - Omnibus Budget Reconciliation Act

Letter
=============================================================== LETTER


B-272396

February 18, 1997

The Honorable E.  Clay Shaw, Jr.
Chairman
Subcommittee on Human Resources
Committee on Ways and Means
House of Representatives

In the late 1980s, increases in illegal drug use, homelessness, and
poverty contributed to dramatic increases in the rates of child abuse
and neglect and the number of children in foster care.  Intent on
improving services for children and their families as well as
reducing foster care costs, states began to reconsider their approach
to child welfare.  Rather than waiting until families reached the
crisis stage, they began to focus more on early intervention and
preventive services designed to strengthen and support families.  By
the early 1990s, however, the child welfare system was overwhelmed by
the needs of an increasing number of at-risk families and children.\1
States argued that additional federal funding was needed to
supplement current state and federally funded programs.  Therefore,
to assist states in providing services designed to support families
and help keep them together, the Congress enacted legislation as part
of the Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) that
authorized $930 million in federal funds to states over a 5-year
period for family preservation and support (FPS) services.  Family
preservation services typically target families already in crisis
whose children would otherwise be removed from home.  Family support
services are community-based activities intended to prevent the kinds
of crises that family preservation services are aimed at alleviating. 
To receive federal funds for these services, each state had to submit
a grant application in 1994 and a 5-year plan in 1995 that set
quantifiable goals and methods for measuring outcomes. 

In response to your request concerning the status of states' use of
funds for FPS services, this report describes (1) the nature and
extent of states' use of federal funds for new and expanded FPS
services and (2) states' plans to assess the impact of these services
on children and their families and impacts identified to date.  This
report builds on our prior work that assessed early federal and state
implementation efforts. 

To collect information on states' use of federal funds for and the
impact of FPS services, we conducted a nationwide survey of state
child welfare agencies; held in-depth interviews with officials in
nine states and five localities; interviewed Department of Health and
Human Services (HHS) officials in its headquarters office; and
reviewed related federal and state budget, summary, guidance,
planning documents, and progress reports.  (See app.  I for more
details of our scope and methodology.)


--------------------
\1 See our prior reports, Child Welfare:  Opportunities to Further
Enhance Family Preservation and Support Activities (GAO/HEHS-95-112,
June 15, 1995) and Child Welfare:  Complex Needs Strain Capacity to
Provide Services (GAO/HEHS-95-208, Sept.  26, 1995). 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

All states reported to us that they are using federal funds to
increase the availability of family preservation and family support
services either by creating new programs or expanding existing
programs.  Forty-four states said that they introduced new programs. 
For example, some states launched new programs in which counselors
are available 24 hours a day to work with families that have a
history of child abuse.  Forty-seven states reported enhancing their
existing programs or expanding them to serve more clients.  For
example, adding a service like childcare could enhance a family
resource center that already provides an array of services, such as
parenting classes, afterschool activities, and family counseling. 

As required by the law, our analysis shows that states appear to be
allocating a significant portion of their federal funds to both
family preservation and family support services.  In the last 2
years, states budgeted 56 percent of their service dollars to family
support and 44 percent to family preservation.  The somewhat greater
emphasis on family support services reflects priorities established
through state and community planning efforts.  Moreover, many states
already had family preservation programs in place and decided to
bolster family support services. 

To determine whether this infusion of federal funds improves services
for children and families, we identified a number of efforts that are
underway or planned to assess programs providing FPS services. 
States plan to track the results of their federally funded services,
for example, by measuring the number of clients served and the extent
to which their needs are met, improvements in parent-child
relationships, the degree that services are coordinated, and
indicators of community well-being such as child abuse rates. 
Although not required to do so, at least 11 states are also planning
formal evaluations to determine whether the services actually improve
outcomes for families.  Further, two federally sponsored evaluations
are underway to assess the effectiveness of family preservation and
family support services. 

Early results from 10 states indicate some successes, such as
preventing child removal and continued maltreatment.  While it is too
early to determine the impact of these programs, federal and state
officials report that the extensive community and interagency
collaboration required by the law has resulted in improved
identification of service needs, setting of priorities, and receipt
of services by at-risk families otherwise overlooked. 


   BACKGROUND
------------------------------------------------------------ Letter :2

We previously reported that states originally funded most FPS
services themselves or with nonfederal funds.  As the demand for
services increased and available resources became more constrained,
states sought additional funding from federal sources, such as Title
IV-B Child Welfare Services, Title XX Social Services Block Grant,
and Title IV-A Emergency Assistance.  However, funding levels were
still insufficient to keep pace with service needs.  By the early
1990s, over half the programs we surveyed reported that they were not
able to serve all families who needed services primarily due to the
lack of funds and staff. 

OBRA 1993 created the Family Preservation and Support Services
program under Title IV-B, Subpart 2, of the Social Security Act. 
Administered by HHS' Administration for Children and Families (ACF),
OBRA 1993 authorized $930 million over a 5-year period.  Through
fiscal year 1997, Congress appropriated $623 million for grants to
states to conduct planning activities and fund FPS services for the
first time.\2 The grants are based on each state's percentage of
children receiving Food Stamps, a federal food subsidy program for
low-income households.  State child welfare agencies are responsible
for administering the FPS program in each of the 50 states and the
District of Columbia. 

OBRA 1993 allowed states to use up to $1 million of their grant
amount for planning purposes during the first year, with no required
state match.  Funds used for FPS services and other allowable
activities, such as additional planning or evaluation, require a
25-percent state match.  The law also requires states to spend a
significant portion of service dollars for each type of service,
which HHS has defined as at least 25 percent each for family
preservation services and for family support services.  Further,
state administrative costs are limited to 10 percent. 

To receive FPS funds, states submitted grant applications to HHS by
June 1994 and comprehensive plans a year later.  These plans were
based on a needs assessment; developed with community groups; and
coordinated with health, education, and other agencies that serve
children and families.  As required, the plans described goals that
states expect to achieve by 1999 and methods that they will use to
measure their progress.  Federal guidance also encourages states to
continue their collaborative planning activities, improve service
delivery, and leverage additional funding from other sources for FPS
services. 

Family preservation programs generally serve families where child
abuse or neglect has occurred or where children have been identified
as representing a danger to themselves or others.  These families
risk having their children temporarily or permanently placed outside
the home in foster care, juvenile detention, or mental health
facilities.  Most family preservation programs provide specific
services tailored to the family's needs to help ameliorate the
underlying causes of dysfunction.  These services may include, for
example, family counseling and training in parenting skills.  The
intensity, duration, and packaging of services differentiates these
programs from the traditional delivery of child welfare services,
which also share the goal of placement prevention and family
reunification.  Even among family preservation programs, however,
service delivery varies.  In the widely used Homebuilders intensive
crisis intervention model, caseworkers typically carry small
caseloads of two families at a time and are available to families on
a 24-hour basis for 4 to 6 weeks.  In other program models,
caseworkers may carry caseloads of up to 20 families, with one or two
personal contacts per week for a period of 7 or more months.  (See
app.  II for a description of various family preservation program
models.)

Family support programs include a broad spectrum of community-based
activities that promote the safety and well-being of children and
families.  In general, the purpose is to reach families before child
abuse or neglect occurs.  Often provided in a community center or a
school, family support programs may include services outside the
traditional scope of the child welfare agency, such as health care,
education, and employment.  Some family support programs offer a
comprehensive array of services to an entire community, including
parenting classes, health clinics, and counseling.  Other programs
are more narrow in scope and may focus only on family literacy or
provide information and referral services.  Compared to family
preservation, eligible participants may be more broadly or narrowly
defined; for example, all families in a community or only teenage
mothers in a community.  In practice, the distinction between family
preservation and family support services may be blurred. 


--------------------
\2 An additional $52 million was set aside for court enhancement
studies; FPS services grants to Indian tribes; and federal
evaluation, research, training, and technical assistance.  For fiscal
year 1998, OBRA 1993 authorized $255 million, which had not been
appropriated at the time of our review. 


   STATES ARE USING FEDERAL FUNDS
   FOR BOTH NEW AND EXISTING
   SERVICES
------------------------------------------------------------ Letter :3

The federal FPS services legislation provides states with the
flexibility to meet the needs of children and families through family
preservation and community-based family support services.  Exercising
this flexibility, states have reported choosing to fund an array of
services and, in many cases, strategies for improving the ways in
which services are delivered.  Almost all states appear to be
introducing new family preservation and family support services.  Our
analysis shows that states are allocating somewhat more funds to
family support services. 


      NEW AND EXPANDED SERVICES
      VARY
---------------------------------------------------------- Letter :3.1

Forty-four states reported that they used federal funds to create new
family preservation programs, family support programs, or both.  For
example, Oregon has had one model of a family preservation
program--the Intensive Family Services Program--since 1980; however,
concerns about the high numbers of African-Americans in foster care
in one community prompted this state to initiate a new family
preservation program.  This program is based on the Homebuilders
service-delivery model but refined to better meet the cultural needs
of this population.\3

Although almost all the states reported starting new programs, the
size and service levels of these programs vary across states and
programs.  Some are quite small.  For example, in a low-income
neighborhood in Maryland, a new family preservation component was
added to a community-based substance abuse treatment program.  There,
$40,000 pays for one caseworker to provide family preservation
services for as many as five families at a time to prevent the need
to remove children from their homes while the parents are treated for
substance abuse.  Another new family support program in this same
community provides information and coordinates communitywide
activities to ensure families have knowledge of and access to all
available community resources.  About $75,000 is being spent for this
program that plans to serve 200 persons by telephone or in-person and
make 600 contacts by mail a month. 

By contrast, another community in Texas implemented a larger-scale
program spending $971,000 in federal funds over the last 2 years to
create a family resource center in each of three school districts. 
This new family support program offers an array of services at each
school-based center, including parent education, counseling, adult
education, childcare, some health care, and family support workers
for families in need of more intensive services.  As of August 1996,
over 3,000 households containing 8,600 individuals had registered
since the program's inception. 

In addition to introducing new programs, almost every state used
federal funds to fill gaps in existing FPS services.  Forty-seven
states reported expanding existing family preservation services,
family support services, or both by making them available to more
clients within existing service areas, by adding more program sites,
or enhancing programs by increasing the intensity of existing
services or adding new services as illustrated by the following
cases: 

  -- Texas expanded its intensive placement prevention program to
     additional locations to reach new clients as well as more
     clients within existing service areas.  This family preservation
     program is designed to prevent the need for placing abused and
     neglected children in foster care.  The existing 18
     service-delivery units are being expanded to 38 units and about
     115 new workers are being hired to serve an additional 520
     families per year. 

  -- Arkansas expanded its Intensive Family Services program from 10
     to 20 counties.  This family preservation program was also
     enhanced by adding emergency cash assistance for participating
     families.  This new service will enable families in crisis to
     address some of their immediate needs, such as covering back
     rent to avoid becoming homeless. 

  -- One Maryland community enhanced a neighborhood recreation
     program by adding new activities and increasing its hours of
     operation.  Community members voiced concern that the lack of
     recreational activities was a factor in the adolescent crime
     rate.  This family support program is designed to give young
     people a safe place to congregate and recreate, especially in
     the late afternoon and evening hours, to keep them off the
     streets and away from the influence of illegal and drug-related
     activities. 

The likelihood of states creating new or expanding existing programs
appeared unaffected by whether states had previously provided family
preservation or family support services, how long states have had
service dollars available, or whether service decisions were made at
the state or local level.  Our analysis of state survey responses
showed no clear patterns regarding the circumstances that might
result in states funding certain types of services. 


--------------------
\3 Compared with the Homebuilders model, Oregon's state family
preservation program relies less on the provision of concrete and
supportive services and more on family therapy; moreover, treatment
is less intensive. 


      STATES PLACE SOMEWHAT MORE
      EMPHASIS ON FAMILY SUPPORT
      SERVICES
---------------------------------------------------------- Letter :3.2

As the law requires, most states are spending a significant portion
of their federal funds for family preservation services and family
support services.  Of the federal funds used for services in fiscal
year 1996, states allocated an average of 56 percent to family
support services and 44 percent to family preservation.\4

In 1996, over half the states allocated a majority of their service
dollars for family support services, as shown in table 1.  Four of
these states are using all their service dollars for family support
activities, which is allowable as long as the state justifies this
distribution. 



                          Table 1
          
           Type of Service Receiving Majority of
            Funding, by Number of States, Fiscal
                         Year 1996

                                                 Number of
Type of service                                     states
------------------------------------------  --------------
Family support services\a                               29
Family preservation services                            11
Equal funding for both services                         11
==========================================================
Total                                                   51
----------------------------------------------------------
\a Four states--District of Columbia, Iowa, Massachusetts, and
Tennessee--are using all their service dollars for family support
services. 

Source:  GAO analysis of HHS summary of state budget requests. 

While every state is initiating or expanding family support services,
family preservation services, or both, slightly more states are using
federal funds for family support services.  Forty-one states reported
introducing new family support programs, while 34 states initiated
new family preservation programs.  Forty-three states expanded
existing family support services, compared to 38 states for family
preservation. 

Several reasons may explain why states have placed somewhat more
emphasis on family support services.  According to federal and state
officials, some states had already spent considerable state or other
federal funds for family preservation services and decided--either at
the onset or based on planning results--to place greater emphasis on
family support services.  Further, many states delegated to counties
or communities the responsibility for conducting localized planning
and making service decisions.  Localities were apt to be more
familiar with support services and to play a larger role in program
decisions than the child welfare agencies familiar with family
preservation. 


--------------------
\4 Amounts for family preservation and support services are based on
budget information that states submit to HHS each year.  Data on
actual expenditures are not readily available. 


      FEDERALLY FUNDED SERVICES
      WERE IMPLEMENTED WITHIN LAST
      2 YEARS
---------------------------------------------------------- Letter :3.3

States have had 1 to 2 years to initiate or expand family
preservation and family support services, depending on how they used
their first year's funds.  All states spent at least a year doing
collaborative community-based planning to develop their 5-year plans,
in accordance with HHS guidance.  Nineteen states elected to
implement services while simultaneously conducting planning
activities resulting in these states having had about 2 years to
implement services.  The majority of the states, however, began to
implement federally funded services a year later, after they had
completed their 5-year plans.\5

For those states that have had a year to initiate or expand services,
most reported that implementation of family preservation and family
support services has been slower than they expected.  In total, 25
states indicated being behind schedule primarily due to the magnitude
and complexity of the implementation effort.  Most of these states
said that they experienced delays in designing or developing FPS
services.  Moreover, the competitive process to select communities or
programs that would receive federal funds also caused delays in
several states.  Officials had not anticipated the time required to
solicit and review proposals, respond to challenges, and award
contracts.  Many states also reported that an extended period of time
was required to change their service-delivery system to facilitate
implementation, such as training staff on procedural changes and
collaborating with other service providers.  In addition to these
procedural factors, many states attributed their receipt of federal
funds later than expected as a reason for being behind schedule. 


--------------------
\5 First-year funds were available to all states by Sept.  1994.  The
next year's funds--triggered by states' submittal of their 5-year
plans--were available a year later. 


      OTHER ACTIVITIES ARE
      DESIGNED TO IMPROVE SERVICE
      DELIVERY
---------------------------------------------------------- Letter :3.4

While states appear to be using most of their federal FPS funds to
initiate or expand family preservation or family support services,
many states are also undertaking a variety of activities to enable
the service-delivery system to serve vulnerable children and families
more effectively and efficiently.  According to estimates provided by
each state at the time of our study, an average of 83 percent of
federal funds had been spent on direct services, such as the new and
expanded family preservation and family support services already
described.  The remaining federal dollars were used for other
allowable activities, including additional planning,
administration,\6 and capacity-building such as training and
technical assistance. 

Five states dedicated all their FPS funds to the provision of direct
services, while 46 states used a portion of their funds for other
activities as well as direct services.  Thirty-eight of these states
conducted activities designed to enhance the capacity of state and
local agencies to provide family preservation and support services. 
These activities included staff training in cultural awareness or
procedural changes, technical assistance to service providers,
research or evaluation activities, and management information system
development and improvement.  For example, Arkansas held two
conferences, which were attended by over 1,000 individuals, to
educate the public on prevention issues, encourage collaboration
among providers, and provide technical assistance and training to
staff of community-based organizations.  Several states contracted
with universities or private research firms to conduct outcome
evaluations.  In Idaho, local panels were established to review
closed child protection cases to identify service gaps and
improvements to the service-delivery system responsible for
investigating allegations of child abuse and neglect. 

In addition, 17 states reported that planning activities will
continue beyond 1995.  For example, Maryland is taking more time to
allow its 19 local management boards representing the state's 24
counties to develop their own community-based plans.  At the time of
our study, the state had provided federal funds to 11 boards for
localized planning.  Eventually every local management board in the
state will have the opportunity to develop its own plan. 


--------------------
\6 According to federal guidance, administrative costs include costs
for procurement, payroll processing, management, data processing and
computer services, and other indirect services. 


   RESULTS AND IMPACT WILL BE
   MONITORED IN VARIOUS WAYS
------------------------------------------------------------ Letter :4

Midway into this 5-year program, it is too early to identify what
impact the federally funded family preservation and family support
services have had on the lives of vulnerable children and their
families.  Several efforts, however, are underway to monitor results
and assess impact.  By law, states must track results and report on
their progress in achieving the goals set in their 5-year plans. 
Some states will also conduct formal evaluations to examine outcomes
and processes.  To determine the impact of federally funded services,
however, requires rigorous evaluation.  Eleven states plan to conduct
such evaluations.  In addition, federal efforts are underway to
assess the effectiveness of family preservation and family support
services. 


      STATES WILL USE VARIOUS
      MEASURES AND METHODS TO
      TRACK RESULTS
---------------------------------------------------------- Letter :4.1

States plan to track the results of federally funded services by
using a variety of measures.  At a minimum, all states report that
they will track the number of children and families served and most
will measure the extent to which their needs are being met. 
Specifically, 45 states will look for evidence of changes in
parent-child relationships, family functioning, or participants'
satisfaction with services delivered.  Many states will also assess
the well-being of children by using appropriate measures, such as the
number of infants discharged from community care who receive
follow-up care within 48 hours.  More than half the states told us
that they expect to determine the program's cost effectiveness, the
efficacy of certain services for particular client groups, or both. 
Finally, at least 45 states plan to monitor traditional indicators of
child welfare, such as the number of child abuse and neglect reports,
and changes over time in one or more aspects of the service-delivery
system.  For example, one state plans to examine the extent to which
consumers are participating in service planning groups and services
are provided in conjunction with community and neighborhood
organizations. 

Having set goals and measurable objectives in their 5-year plans,
states are expected to annually report on outcomes and progress
towards achieving these goals.  At the time of this report, HHS and
its contractor responsible for evaluating state implementation were
reviewing states' first progress reports and expected to complete
their initial analyses in December 1996.  In addition, some states
will conduct formal evaluations that examine processes and outcomes,
in many cases in conjunction with schools of social work at state
universities.  For example, Kentucky has contracted with the
University of Kentucky to develop an evaluation program to assess the
extent to which the state's FPS services program reaches the target
population, monitor the frequency of service delivery and client
participation, tabulate the cost of implementing the program, and
assess the extent that program goals are achieved.  In Arizona, the
state's evaluation will track multiple child, family, and community
outcome measures over time and compare results to baseline
indicators.  Data sources include family questionnaires, agency
reports, and worker assessments. 

State plans for monitoring and evaluating FPS programs should yield
useful information on the size, nature, and outcomes of funded
activities as well as changes in the well-being of communities,
families, and children.  Because these efforts will not necessarily
confirm that the programs caused improved outcomes, 11 states plan to
conduct their own rigorous evaluations--even though such evaluations
are not required--that will yield more conclusive results.  For
example, a research contractor will conduct a 3-year randomized
clinical trial of a home visitation program in San Diego County,
California, that is based on Hawaii's Healthy Start model.\7
Researchers will randomly assign 500 families to one of two
groups--about half the families will receive program services and the
other families will not--and evaluate the effectiveness of the
program model as it is implemented in San Diego.  Primary study
objectives include testing whether implementation of this model
results in improved outcomes and determining what cost-benefits are
derived. 


--------------------
\7 The Healthy Start model uses home visitors to provide supportive
services to families at risk of becoming abusive.  New mothers are
screened and interviewed at the hospital and can voluntarily receive
family support services until their children are 5 years old. 


      FEDERAL EVALUATIONS ARE
      DESIGNED TO ASSESS IMPACT
---------------------------------------------------------- Letter :4.2

Two federal evaluations are underway to rigorously assess the impact
of FPS programs on children and families--one for family preservation
and the other for family support services.  Each evaluation is
comprised of multiple studies of mature programs--initiated before
the federal FPS services law--that span a range of program models and
methods for targeting services.  At the time that we prepared this
report, the research contractors were expected to begin data
collection in the fall of 1996 and issue interim reports a year
later. 

The family preservation evaluation is reviewing four programs that
aim to prevent out-of-home placement and one program that tries to
reunite foster children with their families.\8 Two of these programs
use the Homebuilders crisis intervention model, while the other three
use less intensive service models.  Each program evaluation is
designed to assign families to treatment and control groups. 
Families in the treatment group receive services from the family
preservation program.  Families in the control group receive services
that they would have received if the program was not available. 
Outcomes to be measured include changes in foster care placement
rates, recidivism, and duration in stay, as well as family
functioning and subsequent child abuse and neglect. 

The family support evaluation consists of multiple studies of eight
different programs, including several comprehensive community family
support programs as well as those that focus on economic
self-sufficiency, family literacy, or preventing substance abuse.\9
Five programs are being evaluated using treatment and control groups. 
The remaining three programs will compare families that receive
program services with families in other programs or similar settings. 
For example, families that participate in Florida's Full Service
Schools program will be compared with families in comparable schools
where the program is not offered.\10 Outcomes to be measured include
family functioning, child and family well-being, instances of child
abuse and neglect, and satisfaction with services delivered. 


--------------------
\8 The family preservations programs are in New York City,
Philadelphia, the Louisville area of Kentucky, the Memphis area of
Tennessee, and selected counties in New Jersey. 

\9 The family support programs are in Albuquerque, New Mexico; San
Jose, California; Cleveland, Ohio; Denver, Colorado; Pensacola,
Florida; New York City; several cities in Wisconsin; 11 counties in
Iowa; and 6 school districts in Kentucky. 

\10 The Full Service Schools model is a school-based family support
program that integrates education, medical, and human services for
general and certain at-risk populations in predominantly low-income
communities.  Primary objectives include helping children to be
better prepared for school, reducing teenage pregnancy rates, and
reducing the need for mental health and substance abuse services. 


      EARLY RESULTS ARE FEW, BUT
      SERVICE-DELIVERY APPROACHES
      HAVE BEEN AFFECTED
---------------------------------------------------------- Letter :4.3

Although it is too early to identify service impacts on children and
families, 10 states reported that program results were available on
federally funded FPS services.  Most of these states collected data
on the number of children and families served, changes in child abuse
and childhood mortality rates, as well as changes in their approaches
to delivering services.  For example, Louisiana reported on the
results of federally funded projects after the first year of
implementation.  To contribute to future planning efforts related to
the configuration of family preservation and family support services
in Louisiana, the evaluation described the services and population
characteristics in three programs and assessed the relationship
between services and short-term outcomes.  In particular, the
Intensive Home Based Services program, which is a family preservation
program, met its goal of preventing child removal and continued
maltreatment.  A family support program, designed to prevent child
abuse and neglect, resulted in few reports of child maltreatment even
though a majority of cases had had one or two child abuse or neglect
reports before receiving program services.  In another example for
another family support program operating at a child development
center whose primary service population is teenage parents and their
children, individual service needs were summarized based on
participants' and workers' completion of a new needs assessment form. 

While not much is known yet about the impact of federally funded
services, the legislation appears to have affected the ways in which
states and localities develop and administer services for children
and their families.  According to federal and state officials, the
primary impact to date has been to forge links between state agencies
and the communities they serve.  The process of developing states'
5-year plans resulted in public agencies, organizations, service
providers, and consumers working together for the well-being of
children and families.  Many states departed from their traditional
method of administering child welfare services at the state level. 
In particular, 27 states reported distributing federal funds to
counties and other local entities, such as community groups and local
coalitions, to develop their own plans and make service decisions. 
Several states took additional steps to better identify the service
needs of children and families.  For example, Michigan is investing
an additional $10 million in state funds to supplement federal funds
and enable each of its 83 counties to participate in the process of
improving services to better meet local needs.  State officials
credit this process with ensuring that at-risk families now have
greater access to needed services and contributing significantly to
the broader goal of positive system reform. 


   CONCLUSION
------------------------------------------------------------ Letter :5

Before the enactment of OBRA 1993, FPS programs throughout the
country were unable to meet the demand for services to strengthen and
support families.  Since then, states have begun to both initiate and
expand programs of family preservation and support services to
achieve the purpose of the FPS legislation.  Early results indicate
that these services are being offered to families and children who
might otherwise have fallen through the cracks and that some programs
supported with federal funds have met their goals of strengthening
families and reducing child abuse and neglect.  Information being
gathered by states, universities, and research firms should increase
our understanding of the outcomes of funded activities as well as
changes over time in the well-being of communities, families, and
children.  Moreover, the community-based collaborative planning
process undertaken seems to be having beneficial effects on the
service-delivery system.  While there has been service innovation and
services have been expanded, it is still too early to tell what will
be the ultimate impact of these programs on children and families. 


   AGENCY COMMENTS AND OUR
   EVALUATION
------------------------------------------------------------ Letter :6

In commenting on a draft of this report, HHS agreed with our findings
that implementation has been slower than expected but has achieved
several positive outcomes.  In particular, HHS emphasized the
availability of new and expanded programs for both family
preservation and support services, the focus on family support as a
balance to family preservation, and the extension of services to
families otherwise overlooked.  Further, HHS noted that the use of
FPS funds has encouraged collaboration among programs and levels of
government and has attracted additional funds to meet community
needs. 


---------------------------------------------------------- Letter :6.1

We are providing copies of this report to the Secretary of Health and
Human Services, state child welfare directors, and state FPS
coordinators.  We will also make copies available to other interested
parties upon request.  Should you or your staff have any questions or
wish to discuss the information provided, please call me at (202)
512-7125.  Other GAO contacts and staff acknowledgements are listed
in appendix IV. 

Sincerely yours,

Mark V.  Nadel
Associate Director, Income Security Issues


SCOPE AND METHODOLOGY
=========================================================== Appendix I

We had previously assessed federal and state efforts to implement the
FPS provisions during the first 18 months after OBRA 1993 was enacted
and highlighted areas in which those efforts could be enhanced.\11 To
update this information, we interviewed officials from HHS' ACF,
which is responsible for overseeing this program, and reviewed
related federal guidelines.  Recognizing that it might be too early
to identify service impacts on children and families, we also
reviewed several states' 5-year plans and first annual progress
reports to determine the availability of information related to our
objectives and to document states' plans for assessing impact. 

To obtain information about the status of federal evaluation efforts,
we interviewed officials from HHS' Office of the Assistant Secretary
for Planning and Evaluation (ASPE) and ACF who are responsible for
overseeing the three national evaluation contracts that will
collectively assess state implementation and the effectiveness of FPS
programs. 


--------------------
\11 See GAO/HEHS-95-112, June 15, 1995. 


   GAO SURVEY INSTRUMENT
--------------------------------------------------------- Appendix I:1

We designed a survey instrument to obtain information about states'
use of federal funds for FPS services, plans for assessing impact,
and impacts identified to date.  We discussed development of the
instrument with HHS headquarters staff and several state child
welfare agency officials. 

We pretested the instrument by telephone with the Title IV-B agency's
FPS coordinator in two states--Indiana and New Jersey.  We chose
these states for our pretest because they had distributed their
federal funds in different ways--one to counties to do their own
planning and make service decisions and the other to programs
directly based on state-level decisionmaking.  We revised the
instrument based on the results of the pretest. 

In late June and early July 1996, we sent a copy of the instrument to
the appropriate official of the child welfare agency in each of the
50 states and the District of Columbia.  We offered the officials the
option of completing the instrument in writing and returning it to us
within 2 weeks.  We interviewed by telephone those officials who did
not return a completed instrument. 

We did not verify the information obtained through the survey
instrument.  However, we conducted in-depth interviews in nine states
to supplement information collected in the survey.  In particular, we
obtained additional information about (1) the programs that these
states initiated or expanded with federal funds, (2) how federal
funds were distributed within the state, and (3) plans for rigorous
evaluation, if any.  We conducted seven interviews by telephone and
two in person--one in Anne Arundel County, Maryland, and one in
Sacramento County, California.  In each state, we interviewed the
same state-level individual(s) who responded to our survey.  In five
of these states--California, Iowa, Maryland, Texas, and Wisconsin--we
also interviewed knowledgeable staff from a locality that had
received federal funds.  We selected these nine states because of
their different size, location, and method for distributing federal
funds.\12

We conducted our work between May and September 1996, in accordance
with generally accepted government auditing standards. 


--------------------
\12 We conducted in-depth interviews in Arkansas, California, Iowa,
Maryland, New Hampshire, North Carolina, Oregon, Texas, and
Wisconsin. 


GAO SURVEY OF STATE CHILD WELFARE
AGENCIES
========================================================== Appendix II

This appendix presents our survey of state child welfare agencies
regarding their use of Title IV-B, Subpart 2, funds for services. 
Each question includes the summary statistics and the actual number
of respondents that answered the question.  In each case, we use the
format that we believe best represents the data, including
frequencies, means, and ranges. 



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(See figure in printed edition.)Appendix III
COMMENTS FROM THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES
========================================================== Appendix II



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GAO CONTACT AND ACKNOWLEDGMENTS
========================================================== Appendix IV

GAO CONTACT

Karen E.  Lyons, Evaluator-in-Charge, (916) 486-6442

ACKNOWLEDGMENTS

In addition to those named above, the following individuals made
important contributions to this report:  Patricia L.  Elston
conducted both the nationwide survey and in-depth interviews for a
portion of the states and coauthored the report; Deborah A.  Moberly
performed these same tasks and conducted computerized analyses of the
survey data; and
Joel I.  Grossman assisted in developing, pretesting, and finalizing
the survey instrument. 


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