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    Subject Term: "Child welfare"

    5 publications with a total of 8 open recommendations
    Director: Kay E. Brown
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To help states effectively address ongoing challenges related to ensuring the appropriate use of psychotropic medications for children in foster care, the Secretary of HHS should consider cost-effective ways to convene state child welfare, Medicaid, and other stakeholders to promote collaboration and information sharing within and across states on psychotropic medication oversight.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation and provided examples of the virtual convening of contingency groups they employed to provide technical assistance and peer to peer networking in child welfare. The agency plans to offer additional technical assistance that is specifically related to the topic of mental health and psychotropic medication. GAO will consider closing the recommendation when the agency completes these efforts.
    Director: Kay Brown
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To help improve tribes' ability to maintain safe, stable, and permanent care for children, the Secretary of Health and Human Services should direct the Children's Bureau to explore the reasons for low tribal participation and identify actions to increase this participation in the title IV-E Guardianship Assistance Program.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation. The agency noted that some tribal-state agreements might predate 2008, when GAP was established. HHS also said that regional office staff participate annually in joint planning for the title IV-B and IV-E programs with their respective states and tribes and that participation in GAP is a topic covered in joint planning activities. In addition, HHS said that regional office staff are available to assist states and tribes with discussions about GAP participation when tribal-state agreements are renegotiated and that technical assistance is available to tribes, if needed. According to HHS, the agency plans to add information to the Children's Bureau website about direct federal funding for tribal title IV-E agencies and about tribal-state partnership agreements and plans to distribute issue briefs on GAP and best practices for tribal-state agreements. We agree that HHS has the planning process, technical assistance resources, and regional staff in place to discuss GAP participation with title IV-E state and tribal agency officials. However, our review found that tribal participation in GAP remains low, which suggests that HHS needs to identify actions to increase participation in this program. We believe that the additional actions HHS plans to take - providing information on the Children's Bureau website about direct funding and distributing issue briefs on GAP and best practices for tribal - state partnerships and agreements - could support tribes' participation in GAP either by helping tribes to directly operate a title IV-E program or to negotiate a tribal-state agreement that includes a provision for GAP participation. Because some tribes reported challenges at the state level to participating in GAP and several tribes reported that the state where they are located does not participate in the program, we encourage HHS to engage title IV-E state agency officials in discussions about tribal participation in GAP during the annual review of the their title IV-E state plan. HHS could identify ways that regional office staff might help state agencies resolve any challenges to GAP participation that tribes experience at the state level. HHS has taken several steps over the past few years to help tribes with their title IV-E programs, including hiring a tribal coordinator to facilitate communication between regional offices and tribal title IV-E agencies. Taking additional steps to ensure that tribes have the opportunity to participate in GAP could go a long way toward helping tribes gain more resources for children under their care and better support tribes' efforts to care for children exiting foster care to permanent homes.
    Director: Kay Brown
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To improve the consistency of assistance provided to tribes, the Secretary of Health and Human Services should take steps to provide consistent title IV-E guidance to tribes across its regional offices.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In May 2015, HHS hired a tribal coordinator who will work in the Office of the Associate Commissioner of the Children's Bureau. The tribal coordinator's primary functions will include facilitating communication across the regions and with tribes to share experiences and information, so as to ensure greater consistency and clarity. While this hire represents an initial step towards improving communication with tribal title IV-E agencies, more time is needed for the tribal coordinator to implement policies and procedures that will ensure consistent title IV-E guidance to tribes across HHS regional offices. In May 2017, the agency reported that tribal coordinator position was ultimately elevated to the Office of the ACYF Commissioner and became the Commissioner's representative to the Tribes. We await documentation on any guidance provided to the regional offices that would help with consistency.
    Recommendation: To improve the timeliness of assistance provided to tribes, the Secretary of Health and Human Services should establish procedures to ensure reviews of draft title IV-E plans are conducted by regional office staff in a timely manner.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of May 2017, HHS stated that it does not anticipate taking action in response to this recommendation because of its existing protocols for communicating with and responding to tribal title IV-E grantees. We maintain that establishing procedures, including but not limited to timeframes for responses, would help ensure that tribes receive timely feedback from regional offices regarding their draft title IV-E plans.
    Director: Brown, Kay E
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: In order to help inform federal, state, and local initiatives to prevent and respond to child sexual abuse by school personnel, the Secretary of Education should lead an effort, in collaboration with the Secretary of HHS and the Attorney General, to leverage resources, expertise, and capacities across the departments to determine the most cost-effective way to disseminate federal information so that relevant state and local educational agencies, child welfare agencies, and criminal justice entities are aware of and have access to it.

    Agency: Department of Education
    Status: Open

    Comments: In May 2016, the Department of Education reported that on November 16, 2015, the Office of Safe and Healthy Students within the Office of Elementary and Secondary Education convened a meeting with federal partners to explore ways in which the agencies can better support states and to devise dissemination strategies for sharing information and providing technical assistance in the most cost- effective ways to state and local educational agencies and child welfare agencies, and ensure that resources are accessible to the various stakeholders. It noted several next steps including creating and implementing a Federal dissemination plan for the new adult sexual misconduct guidance, repository of federal resources, and for information on all state-level mandates and policies addressing adult sexual misconduct in schools. GAO will consider this recommendation closed when the department provides timelines for the completion of these activities and documentation of their completion.
    Recommendation: In order to help inform federal, state, and local initiatives to prevent and respond to child sexual abuse by school personnel, the Secretary of Education should lead an effort, in collaboration with the Secretary of HHS and the Attorney General, to leverage resources, expertise, and capacities across the departments to identify mechanisms to better track and analyze the prevalence of child sexual abuse by school personnel through existing federal data collection systems, such as the School Survey on Crime and Safety, the National Child Abuse and Neglect Data System, and the National Crime Victimization Survey.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education reported that experts within the National Center for Education Statistics (NCES) consulted with research partners in the Department of Justice and academic research experts to determine if an effective item or item set about this important issue could be derived. After review of extant sources and consultation with item development experts, a clear question that would result in meaningful information from school administrator respondents could not be developed. They also noted that they understand there is continuing interest on this issue and will continue studying item possibilities for the next School Survey on Crime and Safety (SSOCS) provided the collection is funded. As of May 2016, NCES does not have funds to field SSOCS after 2016, but there is a request in the 2016 budget to support a 2018 collection. GAO will consider this recommendation closed when the department has taken the above mentioned action to continue studying item possibilities for the next SSOCS if the collection is funded.
    Director: Iritani, Katherine M
    Phone: (206)287-4820

    2 open recommendations
    Recommendation: In light of the need for accurate and complete information on children's access to health services under Medicaid and CHIP, the requirement that states report information to CMS on certain aspects of their Medicaid and CHIP programs, and problems with accuracy and completeness in this state reporting, the Administrator of CMS should establish a plan, with goals and time frames, to review the accuracy and completeness of information reported on the CMS 416 and CHIP annual reports and ensure that identified problems are corrected.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: In September 2016, CMS said that it was taking new steps to review data on children's access and quality of care by reviewing required reports that evaluate states' Medicaid managed care plans; however, these reports do not represent a consistent set of measures used by all states that CMS can use for oversight purposes. Accurate, complete, and reliable data for both Medicaid and CHIP are necessary for CMS's oversight of children's access to services. GAO considers this recommendation open.
    Recommendation: In light of the need for accurate and complete information on children's access to health services under Medicaid and CHIP, the requirement that states report information to CMS on certain aspects of their Medicaid and CHIP programs, and problems with accuracy and completeness in this state reporting, the Administrator of CMS should work with states to identify additional improvements that could be made to the CMS 416 and CHIP annual reports, including options for reporting on the receipt of services separately for children in managed care and fee-for-service delivery models, while minimizing reporting burden, and for capturing information on the CMS 416 relating to children's receipt of treatment services for which they are referred.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: In September 2016, CMS said that it had changed the instructions for completing the CMS 416 to provide more detailed guidance for states on capturing required information on the total number of children who were referred for treatment services. However, CMS is not planning to require states to submit information on whether children received the treatment services for which they were referred. We maintain that having ability to monitor receipt of treatment services, receipt of services in managed care separate from fee-for-service, and having data from all states is important to CMS oversight. GAO considers this recommendation open.