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Testimony:

Before the Subcommittee on Human Resources, Committee on Ways and 
Means, House of Representatives:

United States General Accounting Office:

GAO:

For Release on Delivery Expected at 10:30 a.m. EST:

Wednesday, January 28, 2004:

CHILD WELFARE:

Improved Federal Oversight Could Assist States in Overcoming Key 
Challenges:

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

GAO-04-418T:

GAO Highlights:

Highlights of GAO-04-418T, a testimony before the Subcommittee on 
Human Resources, Committee on Ways and Means, House of Representatives 

Why GAO Did This Study:

Title IV-B of the Social Security Act, comprised of two subparts, is 
the primary source of federal funding for services to help families 
address problems that lead to child abuse and neglect and to prevent 
the unnecessary separation of children from their families; however, a 
number of challenges exist that impair statesí ability to deliver and 
track these services. This testimony is based on findings from three 
reports issued in 2003 and addresses the following: (1) statesí use of 
Title IV-B funds in providing a wide array of services to prevent the 
occurrence of abuse, neglect, and unnecessary foster care placements, 
as well as in providing other child welfare services; (2) factors that 
hinder statesí ability to protect children from abuse and neglect; and 
(3) the Department of Health and Human Servicesí (HHS) role in helping 
states to overcome these challenges. Findings are based on multiple 
methodologies, including a survey to child welfare directors on 
statesí use of Title IV-B funds; an analysis of nearly 600 exit 
interview documents completed by staff who severed their employment 
from 17 state, 40 county, and 19 private child welfare agencies; and a 
survey of all 50 states and the District of Columbia regarding their 
experiences in developing and using information systems and their 
ability to report data to HHS. In each case, GAO also conducted 
multiple site visits to selected states and interviewed child welfare 
experts and HHS headquarters and regional officials. 

What GAO Found:

States use of Title IV-B funds to provide a wide variety of services 
to prevent the occurrence of abuse, neglect, and foster care 
placements, as well as to provide other child welfare services. 
According to GAOís Title IV-B survey data for fiscal year 2002, states 
spent about 60 percent of subpart 1 funds on the salaries of child 
welfare agency staff, administration and management expenses, and 
child protective services, while about 10 percent were used to provide 
family support and family preservation services. In comparison, states 
spent about 62 percent of their subpart 2 funds on family support and 
preservation services. 

Child welfare agencies face a number of challenges related to staffing 
and data management that impair their ability to protect children from 
abuse and neglect. Low salaries hinder agenciesí ability to attract 
potential child welfare workers and retain those already in the 
profession. According to caseworkers GAO interviewed, high turnover 
rates and staffing shortages leave remaining staff with insufficient 
time to establish relationships with families and make the necessary 
decisions to ensure safe and stable permanent placements. States also 
face challenges developing appropriate information systems needed to 
track abuse or neglect reports and monitor children in foster care. In 
addition, several factors affect statesí ability to collect and report 
reliable adoption, foster care, and child abuse and neglect data, 
including insufficient caseworker training, inaccurate and incomplete 
data entry, and technical challenges reporting the data.

HHS plays a role in helping states overcome some of the challenges 
they face in operating their child welfare programs, but additional 
oversight or technical assistance could assist states in meeting the 
needs of children served by child welfare agencies. HHSís oversight of 
Title IV-B focuses primarily on statesí overall child welfare systems 
and outcomes, but the agency provides relatively little oversight 
specific to Title IV-B subpart 1. In addition, HHS plays a limited 
role in statesí workforce activities by offering partial reimbursement 
for training expenses and managing discretionary grant programs. The 
agency monitors statesí information systems development and data 
reporting, but despite the availability of technical assistance, 
states reported ongoing challenges reporting reliable data.

In the related reports, GAO made several recommendations to HHS. GAO 
recommended that HHS provide the necessary guidance to ensure that 
regional offices monitor statesí use of Title IV-B subpart 1 and to 
consider gathering additional information on its use. GAO also 
recommended that HHS take actions that may help child welfare agencies 
address recruitment and retention challenges. Last, GAO recommended 
that HHS consider ways to enhance the guidance and assistance offered 
to help states overcome key data challenges. HHS generally agreed with 
GAOís findings and recommendations, except that it noted that its 
level of oversight of Title IV-B was commensurate with the programís 
scope and intent.

www.gao.gov/cgi-bin/getrpt?GAO-04-418T.

To view the full product, including the scope and methodology, click 
on the link above. For more information, contact Cornelia M. Ashby at 
(202) 512-8403 or ashbyc@gao.gov.

[End of section]

Mr. Chairman and Members of the Subcommittee:

Thank you for inviting me here today to discuss several issues related 
to the oversight of child welfare programs across the nation. As you 
are aware, state child welfare agencies determined that over 900,000 
children had been the victims of abuse or neglect by their parents or 
other caretakers in 2001. Additionally, more than 800,000 children are 
estimated to spend some time in foster care each year, with the federal 
government allocating approximately $7 billion each year to investigate 
abuse and neglect, provide placements to children outside their homes, 
and deliver services to help keep families together. Title IV-B of the 
Social Security Act, comprised of two subparts, is the primary source 
of federal funding for services to help families address problems that 
lead to child abuse and neglect and to prevent the unnecessary 
separation of children from their families. Funding under Title IV-E of 
the Social Security Act is used primarily to pay for the room and board 
of children in foster care. Since 1994, designated federal matching 
funds have been available to states to develop and implement 
comprehensive case management systems--statewide automated child 
welfare information systems (SACWIS)--to manage their child welfare 
cases as well as to report child abuse and neglect, foster care, and 
adoption information to the federal government.

In addition to this funding, the Department of Health and Human 
Services' (HHS) Administration for Children and Families (ACF) monitors 
states' compliance with key federal goals, specified in part by the 
Adoption and Safe Families Act (ASFA) of 1997, to keep children safe 
and ensure their placement in stable and permanent homes. Through its 
formal review process, known as the Child and Family Services Review 
(CFSR), HHS uses specific assessment measures, such as agencies' 
ability to conduct timely abuse and neglect investigations and 
regularly visit children in their homes, to assess the performance of 
states' child welfare systems.

My testimony today will focus on three key issues: (1) states' use of 
Title IV-B funds in providing a wide array of services to prevent the 
occurrence of abuse, neglect, and foster care placements, as well as 
other child welfare services; (2) factors that hinder states' ability 
to protect children from abuse and neglect; and (3) HHS's role in 
helping states to overcome the challenges they face in protecting 
children from abuse and neglect. My comments are based primarily on the 
findings from three reports:[Footnote 1] U.S. General Accounting 
Office, Child Welfare: HHS Could Play a Greater Role in Helping Child 
Welfare Agencies Recruit and Retain Staff. GAO-03-357. Washington, 
D.C.: March 31, 2003; Child Welfare: Most States Are Developing 
Statewide Information Systems, but the Reliability of Child Welfare 
Data Could Be Improved. GAO-03-809. Washington, D.C.: July 31, 2003; 
and Child Welfare: Enhanced Federal Oversight of Title IV-B Could 
Provide States Additional Information to Improve Services. GAO-03-956. 
Washington, D.C.: September 12, 2003. Those findings were based on 
multiple methodologies, including a survey of child welfare directors 
on states' use of Title IV-B funds; an analysis of 600 exit interview 
documents completed by staff who severed their employment from 17 
state, 40 county, and 19 private child welfare agencies; and a survey 
of all 50 states and the District of Columbia regarding their 
experiences in developing and using information systems and their 
ability to report data to HHS. In each case, we supplemented these 
surveys and analyses by conducting multiple site visits to selected 
states and by interviewing child welfare experts and HHS headquarters 
and regional officials.

In summary, we found that states use Title IV-B funds to provide a wide 
variety of services to prevent the occurrence of abuse, neglect, and 
foster care placements, as well as to provide other child welfare 
services. Subpart 1 dollars were most frequently used to fund staff 
salaries, with almost half of these funds designated for the salaries 
of child protective services (CPS)[Footnote 2] social workers. In 
comparison, states spent half of their subpart 2 funds on family 
support or prevention programs and another 12 percent on family 
preservation services. CFSR results for the past 2 years, however, 
indicate that states have not performed strongly in terms of assessing 
the services families need and providing those services. Child welfare 
agencies face a number of issues related to staffing and data 
management that impair their ability to protect children from abuse and 
neglect. In particular, low salaries hinder agencies' ability to 
attract potential child welfare workers and to retain those already in 
the profession. Our analysis of CFSRs in 27 states indicated that large 
caseloads and worker turnover delay the timeliness of investigations 
and limit the frequency of worker visits with children, hampering 
agencies' attainment of some key federal safety and permanency 
outcomes. Furthermore, states face challenges developing appropriate 
information systems needed to track abuse or neglect reports and 
monitor children in foster care, with many states reporting development 
delays. In addition, several factors affect the states' ability to 
collect and report reliable adoption, foster care, and child abuse and 
neglect data, including insufficient caseworker training, inaccurate 
and incomplete data entry, and technical challenges reporting the data. 
Although HHS plays a role in monitoring child welfare programs, 
additional oversight or technical assistance could assist states in 
meeting the needs of children served by child welfare agencies. For 
example, HHS's oversight of Title IV-B focuses primarily on states' 
overall child welfare systems and outcomes, but the agency provides 
relatively little oversight specific to the services provided under 
Title IV-B subpart 1.[Footnote 3] In addition, HHS plays a limited role 
in states' workforce activities by offering partial reimbursement for 
training expenses and managing discretionary grant programs. The agency 
monitors SACWIS development and data reporting, but despite the 
availability of technical assistance, states reported ongoing 
challenges reporting reliable data.

Background:

ACF is responsible for the administration and oversight of federal 
funding to states for child welfare services under Titles IV-B and IV-
E. HHS headquarters staff are responsible for developing appropriate 
policies and procedures for states to follow in terms of obtaining and 
using federal child welfare funds, while staff in HHS's 10 regional 
offices and 10 national resource centers provide guidance and technical 
assistance to improve child welfare services nationwide. HHS compiles 
state-reported child welfare data in two databases: the Adoption and 
Foster Care Analysis and Reporting System (AFCARS) and the National 
Child Abuse and Neglect Data System (NCANDS). HHS relies on the 
information available in its databases to analyze and track children's 
experiences in the child welfare system, to determine states' 
performance on federal child welfare outcome measures, and to report to 
Congress on children's well being and child welfare experiences. 
However, the monitoring of children served by state child welfare 
agencies is the responsibility of the state agencies that provide the 
services to these children and their families. Child welfare 
caseworkers at the county or local level are the key personnel 
responsible for documenting the wide range of services offered to 
children and families, such as investigations of abuse and neglect; 
treatment services offered to families to keep them intact and prevent 
the need for foster care; and arrangements made for permanent or 
adoptive placements when children must be removed from their homes. 
Most states and counties provide some child welfare services directly 
and provide others through contracts with private agencies. National 
survey data confirm that both state and private child welfare agencies 
are experiencing similar challenges recruiting and retaining qualified 
caseworkers. For instance, turnover of child welfare staff has been 
estimated at between 30 percent and 40 percent annually nationwide, 
with the average tenure for child welfare workers being less than 2 
years.

In 2000, HHS established a new federal review system to monitor state 
compliance with federal child welfare laws. One component of this 
system is the CFSR, which assesses state performance in achieving 
safety and permanency for children, along with well-being for children 
and families. The CFSR process includes a self-assessment by the state, 
an analysis of state performance in meeting national standards 
established by HHS, and an on-site review by a joint team of federal 
and state officials. Based on the results of this process, HHS 
determines whether a state achieved substantial conformity with (1) 
outcomes related to safety, permanency, and well-being, such as keeping 
children protected from abuse and neglect and achieving permanent and 
stable living situations for children and (2) key systemic factors, 
such as having an adequate case review system and an adequate array of 
services. States are required to develop program improvement plans to 
address all areas of nonconformity.

Federal Funding of Child Welfare Services and Programs:

Two titles of the Social Security Act provide federal funding targeted 
specifically to foster care and related child welfare 
services.[Footnote 4] Title IV-E[Footnote 5] provides an open-ended 
individual entitlement for foster care maintenance payments to cover a 
portion of the food, housing, and incidental expenses for all foster 
children whose parents meet certain federal eligibility 
criteria.[Footnote 6] Title IV-E also provides payments to adoptive 
parents of eligible foster children with special needs.[Footnote 7] To 
qualify for federal IV-E funding for SACWIS, states must prepare and 
submit an advance planning document (APD) to ACF's Children's Bureau, 
in which they describe the state's plan for managing the design, 
development, implementation, and operation of a SACWIS that meets 
federal requirements and state needs in an efficient, comprehensive, 
and cost-effective manner. Since the administration and structure of 
state child welfare agencies vary across the nation, states can design 
their SACWIS to meet their state needs, as long as states meet certain 
federal requirements.

Title IV-B of the Social Security Act, established in 1935, authorizes 
funds to states to provide a wide array of services to prevent the 
occurrence of abuse, neglect, and foster care placements.[Footnote 8] 
In 1993, the Congress created a new program as subpart 2 of Title IV-B 
(now known as Promoting Safe and Stable Families), which funds similar 
types of services but is more prescriptive in how states can spend the 
funds.[Footnote 9] No federal eligibility criteria apply to the 
children and families receiving services funded by Title IV-B.

Title IV-B subpart 1 provides grants to states for child welfare 
services, which are broadly defined. Subpart 1 funds are intended for 
services that are directed toward the accomplishment of the following 
purposes: (1) protect and promote the welfare of all children; (2) 
prevent or remedy problems that may result in the abuse or neglect of 
children; (3) prevent the unnecessary separation of children from their 
families by helping families address problems that can lead to out-of-
home placements; (4) reunite children with their families; (5) place 
children in appropriate adoptive homes when reunification is not 
possible; and (6) ensure adequate care to children away from their 
homes in cases in which the child cannot be returned home or cannot be 
placed for adoption.

In 1980, the Congress enacted legislation that limited the total 
subpart 1 funds states could use for three categories of services: 
foster care maintenance payments, adoption assistance payments, and 
child care related to a parent's employment or training.[Footnote 10] 
The total of subpart 1 funds used for these purposes cannot exceed a 
state's total 1979 subpart 1 expenditures for all types of services. 
The intent of this restriction, according to a congressional document, 
was to encourage states to devote increases in subpart 1 funding as 
much as possible to supportive services that could prevent the need for 
out-of-home placements.[Footnote 11] However, this restriction applies 
only to the federal portion of subpart 1 expenditures, as the law notes 
that states may use any or all of their state matching funds for foster 
care maintenance payments.

Subpart 2 authorizes grants to states to provide four categories of 
services, which are defined below:

* Family preservation services: Services designed to help families at 
risk or in crisis, including services to (1) help reunify children with 
their families when safe and appropriate; (2) place children in 
permanent homes through adoption, guardianship, or some other permanent 
living arrangement; (3) help children at risk of foster care placement 
remain safely with their families; (4) provide follow-up assistance to 
families when a child has been returned after a foster care placement; 
(5) provide temporary respite care; and (6) improve parenting skills.

* Family support services: Community-based services to promote the 
safety and well-being of children and families designed to increase the 
strength and stability of families, to increase parental competence, to 
provide children a safe and supportive family environment, to 
strengthen parental relationships, and to enhance child development. 
Examples of such services include parenting skills training and home 
visiting programs for first time parents of newborns.

* Time-limited family reunification services: Services provided to a 
child placed in foster care and to the parents of the child in order to 
facilitate the safe reunification of the child within 15 months of 
placement. These services include: counseling, substance abuse 
treatment services, mental health services, and assistance to address 
domestic violence.

* Adoption promotion and support services: Services designed to 
encourage more adoptions of children in foster care when adoption is in 
the best interest of the child, including services to expedite the 
adoption process and support adoptive families.

States Spend IV-B Funds on A Variety of Services, With Subpart 2 
Focusing More on Prevention:

In our September 2003 report on Title IV-B, we found that states use 
these funds to provide a wide variety of services to prevent the 
occurrence of abuse, neglect, and foster care placements, as well as 
services to help children in foster care and their parents; however, 
relatively few subpart 1 dollars are used to provide family support and 
family preservation services, while the majority of subpart 2 funds are 
used for these purposes. According to our survey data for fiscal year 
2002,[Footnote 12] states spent subpart 1 funds most frequently on the 
salaries of child welfare agency staff, administration and management 
expenses, CPS services, and foster care maintenance payments. In 
comparison, states spent half of their subpart 2 funds on family 
support or prevention programs and another 12 percent on family 
preservation services. CFSR results for the past 2 years, however, 
indicate that states have not performed strongly in terms of assessing 
the services families need and providing those services.

States Use Subpart 1 Funds Primarily for Staff Salaries:

Relatively few subpart 1 dollars were used for family support or family 
preservation services; instead, they were most frequently used to fund 
staff salaries, with almost half of these funds designated for the 
salaries of CPS social workers. Another 20 percent of these funds were 
used for the salaries of other social workers.[Footnote 13] During a 
site visit to the state of Washington for the Title IV-B 
report,[Footnote 14] child welfare officials told us that they used 
over 50 percent of the state's subpart 1 funds for salaries of staff 
providing direct services, including CPS social workers, other types of 
social workers, social work supervisors, and clerical support staff. 
Administration and management comprised the second largest category of 
service, accounting for almost 17 percent of subpart 1 dollars. This 
category included rent and utilities for office space, travel expenses 
for agency staff, and staff training.[Footnote 15]

CPS represents the third largest category of services that states 
funded with subpart 1. States used about 16 percent of their subpart 1 
funds to provide a variety of CPS services, such as telephone hotlines 
for the public to report instances of child abuse and neglect, 
emergency shelters for children who needed to be removed from their 
homes, and investigative services. During our site visit to California, 
for example, officials reported using about 40 percent of their subpart 
1 dollars to fund staff salaries and operating expenses associated with 
a variety of shelter care services provided by counties, such as 
emergency shelters and foster homes. A child is placed in one of these 
shelters when no other placement option is immediately available--for 
example, when an investigation in the middle of the night determines 
that the child is at immediate risk of harm. States also used nearly 11 
percent of their subpart 1 funds to make recurring payments for the 
room and board of foster children who are not eligible for 
reimbursement through Title IV-E. About 10 percent of subpart 1 dollars 
were used to provide family support and family preservation services.

Subpart 2 Most Frequently Funds Family Support and Family Preservation 
Services:

In contrast to subpart 1, states used over 80 percent of their subpart 
2 dollars to fund services in its four mandated service categories--
family support, family preservation, family reunification, and adoption 
promotion and support services (see app. I for additional information 
on states' comparative expenditures on subparts 1 and 2). For example, 
states reported using half of their subpart 2 dollars to fund family 
support and prevention services. These services included mentoring 
programs to help pregnant adolescents learn to be self-sufficient; 
financial assistance to low-income families to help with rent and 
utility payments; and parenting classes, child care, and support groups 
provided by a community-based resource center. Washington funded a 
network of public health nurses and social service agencies to provide 
support services to families that are the subject of a report of abuse 
or neglect--these services are provided in lieu of, or following, a 
formal investigation when the level of risk to the child is not 
considered high.

Family preservation services--designed to keep families together and 
prevent the need to place a child in foster care--represented the 
second largest service category funded by subpart 2. Washington used 
subpart 2 funds for its statewide family preservation program, which 
offers counseling and parent training services for up to 6 months to 
families with children who are at risk of being placed in foster care.

In addition, states reported using about 11 percent of their subpart 2 
funds for adoption support and preservation services. With these funds, 
states provided services such as counseling for children who are going 
to be adopted, family preservation services to adoptive families, and 
respite care[Footnote 16] for adoptive families. Officials in Ohio 
reported using almost half of its subpart 2 dollars for adoption 
services, including post adoption services and services to recruit 
families for children in need of adoptive homes.

Finally, states spent about 9 percent of their subpart 2 dollars on 
family reunification services. States funded a diverse array of family 
reunification programs, such as supervised visitation centers for 
parents to visit with their children and coordinators for alcohol and 
drug treatment services for families whose primary barrier to 
reunification is substance abuse. New Jersey funded a supervised 
visitation program that offers parenting education, counseling, 
transportation, and support groups and is located in a private home, 
allowing families to visit together in a homelike setting and engage in 
more natural interactions.

CFSRs Find States Are Weak in Assessing Families' Service Needs:

While states are using Title IV-B funds to provide this array of 
services, CFSR results for the past 2 years indicate that states have 
not performed strongly in terms of assessing the services families need 
and providing those services. When HHS reviewed case files it 
determined that 31of the 32 states that underwent a CFSR in 2001 or 
2002 needed improvement in terms of assessing family needs and 
providing services to meet those needs. While 21 of the 32 states were 
considered to have an appropriate array of services for families, HHS 
found that the accessibility of services was a particular weakness in 
that many services were either not available statewide or had long 
waiting lists or other barriers to accessibility.

Staff and Data Issues Affect States' Ability to Protect Children From 
Abuse and Neglect:

Child welfare agencies face a number of issues related to staffing and 
data management that impair their ability to protect children from 
abuse and neglect. In particular, low salaries hinder agencies' ability 
to attract potential child welfare workers and to retain those already 
in the profession. Additionally, caseworkers in the four states we 
visited for the March 2003 child welfare workforce report[Footnote 17] 
cited high caseloads and a lack of supervisory support as issues 
impacting their ability to work effectively. According to these 
caseworkers, high turnover rates and staffing shortages leave remaining 
staff with insufficient time to establish relationships with children 
and families and make the necessary decisions to ensure safe and stable 
permanent placements. Furthermore, our July 2003 report found that 
states face challenges developing appropriate information systems 
needed to track abuse or neglect reports and monitor children in foster 
care. While 47 states are developing or operating a SACWIS, many 
states[Footnote 18] reported that the development of their SACWIS is 
delayed. Most states responding to our survey faced challenges to 
SACWIS development, such as obtaining state funding and developing a 
system that met the child welfare agency's needs statewide. In 
addition, several factors affect states' ability to collect and report 
reliable adoption, foster care, and child abuse and neglect data, 
including insufficient caseworker training, inaccurate and incomplete 
data entry, and technical challenges reporting the data.

Recruitment and Retention Challenges May Hamper Agencies' Attainment of 
Federal Child Welfare Outcomes:

In our report on the child welfare workforce, we found that public and 
private child welfare agencies face a number of challenges recruiting 
and retaining qualified caseworkers and supervisors. Low salaries, in 
particular, hinder agencies' ability to attract potential staff and to 
retain those already in the profession. For example, caseworkers in 
each of the four states we visited said that many of their former child 
welfare colleagues pursued positions in the education field where they 
could not only make more money but also work with children without 
risking their own safety. For example, the Bureau of Labor Statistics' 
national wages survey[Footnote 19] reports that elementary and middle 
school teachers earn, on average, about $42,000 annually while social 
workers earn about $33,000.[Footnote 20]

Additionally, high caseloads, administrative burdens, limited 
supervision, and insufficient training reduce the appeal of child 
welfare work. Caseworkers and supervisors in all four states we visited 
cited demanding and complex caseloads and related administrative 
requirements, such as casework documentation, as factors affecting 
retention. Some of the caseworkers we interviewed handled double the 
number of cases recommended by advocacy organizations,[Footnote 21] and 
one study found that caseloads for individual child welfare workers 
ranged from 10 to 110 children,[Footnote 22] with workers handling an 
average of about 24 to 31 children each. Furthermore, some of the 
caseworkers we interviewed told us that they spent between 50 and 80 
percent of their time completing paperwork, thereby limiting their time 
to assist children and families.

Caseworkers told us that their desire to stay in the child welfare 
profession was influenced by high-quality supervision and adequate on-
the-job training; however, these elements were often lacking. According 
to supervisors in one city we visited, about half of new trainees left 
their jobs before completing 1 year, in part, because these newly hired 
caseworkers were not sufficiently trained to do their jobs. 
Furthermore, some newly promoted supervisors have requested demotions 
because they felt unprepared to meet job demands, and the caseworkers 
they supervised complained of poor management and insufficient support.

There is some evidence to suggest how recruitment and retention 
challenges affect the safety and permanency of children in care, but 
the magnitude of this effect is unknown. Caseworkers in the four states 
that we visited said that high turnover rates and staffing shortages 
leave remaining staff with insufficient time to conduct the types of 
home visits necessary to assess children's safety and to make well-
supported decisions to ensure safe and stable permanent placements. For 
example, when staff change, caseworkers may have to reestablish 
information to update the case record and families may become hesitant 
to work with unfamiliar caseworkers, making it difficult to learn the 
history of the case. Worker turnover also disrupts the continuity of 
services, particularly when newly assigned caseworkers have to conduct 
or reevaluate educational, health, and safety assessments due to poor 
or insufficient information in case files left behind by others. 
Furthermore, caseworkers explained that high caseloads require them to 
limit the number and quality of the home visits they conduct, forcing 
them to focus only on the most serious circumstances of abuse and 
neglect. One caseworker in Texas noted that when she does make a home 
visit, the visit is quick and does not enable her to identify subtle or 
potential risks to the child's well-being.

Our analysis of federal CFSRs corroborated caseworker 
accounts,[Footnote 23] showing that large caseloads and worker turnover 
delay the timeliness of investigations and limit the frequency of 
worker visits with children, thereby hampering agencies' attainment of 
some key federal safety and permanency goals. Although identifying 
workforce deficiencies is not an objective of the CFSR process, in all 
27 CFSRs we analyzed, HHS explicitly cited workforce deficiencies--high 
caseloads, training deficiencies, and staffing shortages--that 
affected the attainment of at least one assessment measure. While the 
number of affected assessment measures varied by state, we found that 
HHS cited these factors for an average of nine assessment measures per 
state, with more than half of the 27 states exceeding this average. For 
example, in New Mexico's CFSR, reviewers cited staff turnover and 
vacancies as impairing workers' ability to investigate child 
maltreatment reports, provide appropriate services for families, and 
establish timely permanency goals. Furthermore, the District of 
Columbia's CFSR describes heavy workloads, high staff turnover, and a 
climate in which supervisors often call new workers out of training to 
handle ongoing caseload activities.

Delays in SACWIS Completion and Challenges with Data Collection Affect 
States' Ability to Ensure Reliable Data on Children's Experiences:

In addition to performing a wide range of services to protect children, 
child welfare caseworkers are the key personnel who collect and 
document information on children and families served by children 
welfare agencies. Case file documentation is generally captured in 
state computer systems. In our July 2003 report, HHS reported that 47 
states are using targeted federal funds to develop or operate their 
child welfare computer systems--known as SACWIS--but many continue to 
face challenges completing their systems. In our November 2003 
testimony on SACWIS,[Footnote 24] we reported on the costs associated 
with developing SACWIS and the associated barriers, such as development 
delays and difficulties in receiving state funding approval, creating a 
system that reflects child welfare work processes, and securing 
contractors knowledgeable about child welfare. Many state officials 
said that they recognize the benefit their state will achieve by 
developing SACWIS, such as contributing to the timeliness of child 
abuse and neglect investigations. In Oklahoma, for example, caseworkers 
and state officials noted that they believe their children are safer 
since the implementation of SACWIS simply because the information on 
the children is easily accessible to the caseworkers and their 
supervisors. According to our survey results, automated systems 
provided easier access to data and allowed caseworkers to better 
monitor children in their care, which may contribute to additional 
child welfare and administrative benefits, such as decreased incidences 
of child abuse and neglect, shortened length of time to achieve 
adoption, timeliness of payments to foster families, and timeliness of 
payments to foster facilities.

Some of the data captured in case file records are reported to two HHS 
databases that compile child welfare data--AFCARS and NCANDS. We found 
that several factors affect states' ability to collect and report 
reliable data to HHS on children served by state child welfare 
agencies. Almost all of the states responding to our survey[Footnote 
25] reported that insufficient caseworker training and inaccurate and 
incomplete data entry into their information system affect the quality 
of AFCARS and NCANDS data. Although most states reported these as 
separate factors, HHS and the states we visited found that insufficient 
training and inaccurate and incomplete data entry are often linked. 
Caseworkers, supervisors, and managers in the five states that we 
visited reported that additional factors, such as difficulties 
balancing data entry with the time that they spend with the families 
and children, contributed to inaccurate or incomplete data entry. 
Supervisors in Iowa explained that since caseworkers are responsible 
for ensuring that children and their families receive the services they 
need, the caseworkers tend to initially limit data entry to the 
information that is necessary to ensure timely payment to foster care 
providers, and complete all other data elements when the caseworkers 
have time. In addition, caseworkers in Colorado said that they are 
between 30 and 60 days behind in their data entry, so the information 
in the automated system may not accurately reflect the current 
circumstances of children in care.

We also reported in our July 2003 report and November 2003 testimony 
that many states experienced technical challenges reporting their data 
to HHS. The problems reported by states are typically a result of 
challenges associated with data "mapping"--matching state data elements 
to the federal data elements. For example, 36 states reported in our 
survey that matching their state-defined data to HHS's definitions 
affected the quality of the data reported to NCANDS and AFCARS. In 
addition to the challenges reported in our survey, HHS reported that 
transferring data from older data systems into SACWIS affects the 
quality of the data reported to AFCARS and NCANDS.

Improvements in HHS'S Oversight of Child Welfare Programs Could Help 
States Overcome Some Challenges:

HHS plays a role in helping states implement their child welfare 
programs, but in some cases, additional federal oversight or technical 
assistance could help states provide more effective services. In terms 
of child welfare funding, HHS focuses its programmatic oversight on the 
overall child welfare system in each state and provides relatively 
little oversight specific to Title IV-B subpart 1. HHS's role in 
assisting states overcome the child welfare workforce challenges is 
limited to partial federal reimbursement for training expenses and 
management of discretionary grant programs, such as the Child Welfare 
Training Program. HHS also monitors SACWIS development and data 
reporting and provides assistance to states to address some of the 
associated challenges; however, states reported ongoing challenges, 
such as the lack of clear and documented guidance on how to report 
child welfare data, despite the availability of this assistance.

HHS Focuses Oversight on the Overall Child Welfare System, but Has 
Limited Knowledge about States' Use of Subpart 1 Funds:

HHS focuses much of its programmatic oversight on the overall child 
welfare system in each state, rather than focusing specifically on 
subpart 1 or any other federal funding source. A major component of 
HHS's subpart 1 oversight is having the regional offices actively work 
with states to develop appropriate goals for their child welfare 
systems and ensure that available funds are used to support those 
goals. To receive Title IV-B funding, HHS requires states to submit a 
Child and Family Services Plan, which covers a 5-year period and 
describes the state's goals and objectives toward improving outcomes 
related to the safety, permanency, and well-being of children and 
families, as well as the services and programs the state will pursue to 
achieve these goals. In addition to the 5-year plan, HHS requires 
states to submit an update each year to discuss their progress in 
meeting the goals outlined in their plans. Some regional officials 
noted that states are still struggling to use these documents 
appropriately for planning purposes and frequently just describe their 
current programs, rather than focusing on outcomes and collecting data 
to measure progress toward those outcomes.

The CFSR process is an additional tool HHS uses to ensure that states 
conform to federal child welfare requirements and to help states 
improve their child welfare services. Staff at one regional office 
described the CFSR as a thorough review of the services funded by 
different federal programs, such as Title IV-B, providing an 
opportunity to determine whether states are providing the services they 
report in their planning documents and whether those services are 
adequate and appropriate to meet the needs of the state's children and 
families. When asked about HHS's role in guiding states' use of subpart 
1 funds to address weaknesses identified by the CFSRs, an HHS official 
told us that the agency provides technical assistance to states to help 
them determine the most effective use of their resources, while giving 
states much latitude to determine the most appropriate use of their 
subpart 1 funds.

HHS does not require states to provide any data about their use of 
subpart 1 funds, such as their subpart 1 expenditures for specific 
services.[Footnote 26] As a result, several regional offices noted that 
they have no way of knowing how states actually spend their subpart 1 
funds. Instead, HHS requires states to submit annual estimates of the 
amount of subpart 1, subpart 2, and other federal funds the state plans 
to spend in the upcoming year on different categories of services (such 
as family support or CPS). However, these estimates may not provide 
reliable data as to how states are using subpart 1 funds. HHS officials 
explained that states' actual expenditures may vary from these 
estimates, as they address unforeseen circumstances. In addition, HHS 
requires states to submit their estimates before the final spending 
amounts have been appropriated.[Footnote 27]

The descriptions provided by regional office staff of their review of 
these estimates indicate that they review them for relatively limited 
purposes. As a result, most HHS regional offices do not review the 
annual estimates for compliance with the statutory limits. In addition, 
HHS's annual program instruction, which details what information states 
must include in their estimates and serves as the basis for the 
regional offices' review of subpart 1 spending, does not mention the 
subpart 1 limits. Five regional offices were unaware that any limits on 
the use of subpart 1 funds existed. Four other regional offices were 
aware of the limits, but did not ensure that states complied with the 
limits.

This lack of review led HHS to approve spending plans for 15 states 
that reported fiscal year 2002 planned subpart 1 expenditures for 
foster care maintenance and adoption assistance payments that exceeded 
the statutory limits.[Footnote 28] The dollar amounts by which the 
subpart 1 spending estimates surpassed the limits were small in some 
cases, but large in others. For example, Georgia reported that it 
planned to spend $1,497,000 of subpart 1 funds for these purposes in 
2002, which would exceed its statutory limit by $1,558. At the other 
extreme, Florida's estimate indicated that it planned to spend over $9 
million, which was more than $7 million over the maximum allowable 
spending of $1.9 million. In total, these 15 states submitted planned 
subpart 1 spending estimates for foster care maintenance and adoption 
assistance payments that would exceed the statutory limits by over $30 
million.

Several regional offices said that they are not concerned about a state 
planning to spend significant proportions of its subpart 1 funds on 
foster care maintenance and adoption assistance payments if they 
believed the state had a strong child welfare system with an 
appropriate array of services. Regional office staff said that they 
would, however, ask a state to reconsider its funding strategy if the 
state were performing poorly. However, many of the states with approved 
subpart 1 estimates above the statutory ceilings did not achieve strong 
outcomes on their CFSR evaluations with regard to providing needed 
services and having an appropriate array of services. HHS has conducted 
CFSRs on 13 of the 15 states with approved annual estimates over the 
subpart 1 spending limits and determined that appropriately assessing 
family needs and providing services to address those needs was an area 
needing improvement in 12 of the 13 states. In addition, 7 of the 13 
states were also determined to need improvement in terms of having an 
appropriate array of services to meet the needs of families in the 
state.[Footnote 29]

In discussing the current structure of Title IV-B, officials in all of 
HHS's regional offices told us that they believe states need some 
flexibility to use Title IV-B funds to address state-specific child 
welfare needs as is currently the case under subpart 1. At the same 
time, officials in 8 of HHS's 10 regional offices also stressed the 
importance of subpart 2 to ensure that states use some funds on family 
support services and prevention activities to help preserve families 
and keep children from entering foster care. Several regional offices 
expressed concern that, in the absence of the minimum spending 
requirements outlined in subpart 2, states would neglect preventive 
services, while using Title IV-B funds for more urgent services, such 
as CPS or foster care. State and local child welfare officials in one 
state we visited, along with officials at 2 HHS regional offices, said 
that states need more federal funds to provide services to prevent 
foster care placements, such as an increase in funds available under 
Title IV-B or more flexibility to use Title IV-E funds to provide 
services. HHS is currently developing a legislative proposal to give 
states more flexibility in using Title IV-E foster care funds for such 
preventive services.[Footnote 30]

HHS's Involvement with States' Child Welfare Workforce Is Limited:

HHS's primary connection to the child welfare workforce has been 
through partial federal reimbursement--75 percent--of states' training 
funds to implement educational programs for current child welfare staff 
and to enhance the child welfare curriculum of undergraduate and 
graduate social work programs to better educate and prepare potential 
caseworkers.[Footnote 31] This funding may also be used for curriculum 
development, materials and books, support for current workers to obtain 
a social work degree, and incentives to induce entry to the child 
welfare field. During fiscal year 2002, 49 states received $286 million 
in title IV-E training reimbursements.[Footnote 32] These 
reimbursements ranged from a low of approximately $10,400 in Alaska to 
a high of more than $79 million in California, with the median 
reimbursement approximating $2.7 million.

In addition, ACF's Children's Bureau manages six discretionary grant 
programs through which it funds various activities related to 
improvements in the child welfare system. One of these programs--the 
Child Welfare Training Program, authorized by Section 426 of Title IV 
of the Social Security Act--awards grants to public and private 
nonprofit institutions of higher learning to develop and improve the 
education, training, and resources available for child welfare service 
providers.[Footnote 33] This is the only program of the six with a 
specific emphasis on staff training;[Footnote 34] however, in fiscal 
year 2003, it received the second smallest share--8 percent--of the 
Children's Bureau's total discretionary funds.

According to HHS officials, HHS has no authority to require states to 
address caseload issues in their CFSR-related program improvement plans 
or to enforce any caseload standards. Furthermore, HHS officials said 
that states have made few requests of HHS's national resource centers 
for assistance with child welfare staff recruitment and retention. 
Although HHS officials told us that they plan to examine the CFSRs to 
better understand the relationship between recruitment and retention 
and safety and permanency outcomes across the states, the agency is 
still conducting these reviews and is not expected to complete them 
until March 2004.

HHS Offers Assistance to Help States Develop SACWIS and Improve Their 
Data, but States Report Ongoing Challenges with Some of HHS's Efforts:

In response to some of the challenges states face in developing SACWIS 
and collecting and reporting child welfare data, HHS has conducted on-
site reviews of information systems and provided technical assistance 
from a variety of sources. For example, at the time of our review, HHS 
had conducted on-site reviews in 26 states with operational SACWIS to 
ensure that the systems met all federal requirements and to offer 
assistance to states that faced challenges completing the development 
of their SACWIS. Few systems have been determined complete after an on-
site review because of unresolved issues, such as not being able to 
build links to other state information systems or not implementing 
certain eligibility determination functions. To help states address 
some of these development challenges, the SACWIS review team provides 
the state with recommendations for complying with SACWIS requirements 
and schedules a conference call with the state officials to walk 
through the system's deficiencies and offer guidance on how the state 
can move forward. In addition, in an attempt to help states comply with 
the reporting standards and address some of the factors that contribute 
to data quality problems, HHS performs comprehensive reviews of state 
information systems' ability to capture AFCARS data to identify 
problems associated with data collection and reporting and to ensure 
that the information in the automated system correctly reflects 
children's experiences in care.

Other technical assistance is available to states in a variety of 
formats. HHS facilitates the sharing of information between states 
developing SACWIS through an automated system users' group that allows 
state and federal officials to exchange information, ideas, and 
concerns. In addition to the users' group, HHS officials sponsor a 
Listserv--an electronic mailing list--that allows state officials to 
exchange information, a monthly conference call with state information 
technology directors,[Footnote 35] an annual technical assistance 
meeting, and an NCANDS state advisory group. The National Resource 
Center for Information Technology in Child Welfare, which opened in 
1999, also provides assistance to states on SACWIS development and data 
issues.

HHS has also made available to states the software it uses to examine 
states' AFCARS and NCANDS submissions for inconsistencies and invalid 
data. Officials in all the states that we visited said that they 
regularly use this software, and an HHS official said that nearly every 
state has used the software at least once. HHS officials reported that 
these tests help them to identify some data quality errors, such as 
missing data, and said that they believe that, in general, data have 
improved in recent years. However, the officials indicated that the 
tests cannot pinpoint the underlying problems contributing to these 
errors. Furthermore, one official reported that no specific efforts 
have been conducted to track the individual data elements and, 
therefore, HHS cannot report on how data quality has changed over time.

Although the states we visited appreciated some of HHS's efforts to 
assist with improving state data quality, they and most states 
responding to our survey agreed that the assistance is not always 
consistent or easily accessible. The primary concerns reported by the 
states we visited were delays in receiving clear written guidance on 
defining and reporting certain data elements and the lack of state 
input in suggesting changes to AFCARS. Despite the written guidance 
available to states in the form of regulations and an online policy 
manual, states reported that the variation in state policies and 
practices makes it difficult to interpret how to apply the general 
guidance. As a result, states consult with HHS to ensure they are 
applying the regulations appropriately. However, in commenting on a 
draft of the July 2003 report, officials in Oklahoma told us that a 
common concern among the states is the lack of timely response from HHS 
when seeking guidance on how to report data. In commenting on a draft 
of the same report, HHS explained that it first refers states to its 
Web site for information and believes that the available guidance 
addresses states' concerns in most instances. In addition, the states 
that have had an AFCARS review experienced delays in obtaining guidance 
on how to proceed following the on-site review. An HHS official told us 
that since the review process is relatively new, the agency is still 
developing a process to respond to the states and recognizes that it 
has not been responsive to the states already reviewed. In addition, 
HHS is taking steps to gather feedback from states and other users of 
AFCARS data to determine how to improve the system to make the data 
more accurate and usable. As a part of these efforts, HHS has published 
a Federal Register notice soliciting comments and held focus group 
meetings at national conferences. The difficulties states face in 
receiving federal guidance and assistance, as well as the other 
challenges they face in reporting data, may negatively affect the 
reliability of the data available in AFCARS and NCANDS.

Concluding Observations:

Despite its relatively small funding level compared to other funding 
sources for child welfare services, Title IV-B represents an important 
federal commitment to states' efforts to protect children from abuse 
and neglect. However, HHS does not provide in-depth oversight specific 
to Title IV-B subpart 1. Two key issues further compound states' 
ability to prevent abuse and neglect. For example, given the 
difficulties that public and private child welfare agencies are 
experiencing in hiring, training, and retaining their workforces, these 
agencies' ability to provide services to children is threatened. In 
addition, states face challenges in completing their SACWIS systems and 
in ensuring that caseworkers input complete and accurate case data in a 
timely manner.

We recommended in our September 2003 report on Title IV-B that the 
Secretary of HHS provide the necessary guidance to ensure that HHS 
regional offices monitor states' use of Title IV-B subpart 1 funds for 
compliance with statutory restrictions on the use of these funds. We 
also recommended that the Secretary consider the feasibility of 
collecting basic data on states' use of these funds to facilitate its 
oversight of the program and to provide guidance to help states 
determine appropriate services to fund. In commenting on a draft of 
that report, HHS agreed with our first recommendation but noted that 
the statutory limitations on Title IV-B funds no longer serve a useful 
purpose and are incompatible with its current proposal to offer states 
much more flexibility in using other federal child welfare dollars. HHS 
disagreed with our second recommendation, stating that it believes that 
its level of oversight is commensurate with the scope and intent of the 
program and minimizes states' reporting requirements.

We recommended in our March 2003 report on child welfare worker 
recruitment and retention that, because of the reported impact staffing 
shortages and high caseloads have on the attainment of federal outcome 
measures, that the Secretary of HHS take actions that may help child 
welfare agencies address the recruitment and retention challenges they 
face. In commenting on a draft of that report, HHS generally agreed 
with our findings and concurred with our recommendation, saying that it 
has begun to explore the effectiveness of child welfare training 
programs, with an emphasis on lessons learned and best practices. 
However, HHS stressed that it has no authority to require states to 
address caseload issues in their CFSR program improvement plans or to 
enforce any caseload standard.

To improve the reliability of state-reported child welfare data, we 
recommended in our July 2003 SACWIS report that the Secretary of HHS 
consider, in addition to HHS's recent efforts to improve AFCARS data, 
ways to enhance the guidance and assistance offered to states to help 
them overcome the key challenges in collecting and reporting child 
welfare data. HHS generally agreed with our findings and, in response 
to our recommendation, noted that the data definitions need to be 
updated and revised and said it is currently in the process of revising 
the AFCARS regulations to further standardize the information states 
are to report. More recently, HHS said that it would be creating policy 
guidance that will delineate what will happen if a state fails to 
complete its SACWIS within a reasonable time frame.

Mr. Chairman, this concludes my prepared statement. I would be pleased 
to respond to any questions that you or other members of the 
Subcommittee may have.

GAO Contact and Acknowledgments:

For further information regarding this testimony, please call Cornelia 
M. Ashby at (202) 512-8403. Individuals making key contributions to 
this testimony include Diana Pietrowiak, Joy Gambino, Sara Schibanoff, 
and Michelle St. Pierre.

[End of section]

Appendix I: Subparts 1 and 2 Expenditures:

Table 1: Fiscal Year 2002 Expenditures for Subparts 1 and 2 Service 
Categories:

Service category: Staff positions; 
Subpart 1: Number of states: 25; 
Amount of subpart 1 funding[A]: $70,965,578; 
Percentage of subpart 1 funding: 27.6; 
Subpart 2: Number of States: 17; 
Amount of subpart 2 funding[A]: $6,229,058; 
Percentage of subpart 2 funding[B]: 2.4.

Service category: Administration and management; 
Subpart 1: Number of states: 16; 
Amount of subpart 1 funding[A]: 43,143,097; 
Percentage of subpart 1 funding: 16.8; 
Subpart 2: Number of States: 18; 
Amount of subpart 2 funding[A]: 11,614,667; 
Percentage of subpart 2 funding[B]: 4.5.

Service category: Child protective services; 
Subpart 1: Number of states: 17; 
Amount of subpart 1 funding[A]: 40,543,000; 
Percentage of subpart 1 funding: 15.8; 
Subpart 2: Number of States: 5; 
Amount of subpart 2 funding[A]: 2,248,690; 
Percentage of subpart 2 funding[B]: 0.9.

Service category: Foster care maintenance payments; 
Subpart 1: Number of states: 17; 
Amount of subpart 1 funding[A]: 27,890,783; 
Percentage of subpart 1 funding: 10.8; 
Subpart 2: Number of States: 2; 
Amount of subpart 2 funding[A]: 647,154; 
Percentage of subpart 2 funding[B]: 0.3.

Service category: Multiple responses[C]; 
Subpart 1: Number of states: 8; 
Amount of subpart 1 funding[A]: 25,806,347; 
Percentage of subpart 1 funding: 10.0; 
Subpart 2: Number of States: 4; 
Amount of subpart 2 funding[A]: 3,503,585; 
Percentage of subpart 2 funding[B]: 1.4.

Service category: Family support/prevention; 
Subpart 1: Number of states: 17; 
Amount of subpart 1 funding[A]: 19,840,891; 
Percentage of subpart 1 funding: 7.7; 
Subpart 2: Number of States: 28; 
Amount of subpart 2 funding[A]: 127,430,496; 
Percentage of subpart 2 funding[B]: 49.8.

Service category: Counseling and mental health services; 
Subpart 1: Number of states: 2; 
Amount of subpart 1 funding[A]: 8,350,562; 
Percentage of subpart 1 funding: 3.2; 
Subpart 2: Number of States: 5; 
Amount of subpart 2 funding[A]: 1,354,763; 
Percentage of subpart 2 funding[B]: 0.5.

Service category: Family preservation; 
Subpart 1: Number of states: 7; 
Amount of subpart 1 funding[A]: 5,986,045; 
Percentage of subpart 1 funding: 2.3; 
Subpart 2: Number of States: 23; 
Amount of subpart 2 funding[A]: 30,308,896; 
Percentage of subpart 2 funding[B]: 11.8.

Service category: Adoption subsidy payments; 
Subpart 1: Number of states: 7; 
Amount of subpart 1 funding[A]: 4,657,546; 
Percentage of subpart 1 funding: 1.8; 
Subpart 2: Number of States: 2; 
Amount of subpart 2 funding[A]: 737,412; 
Percentage of subpart 2 funding[B]: 0.3.

Service category: Family reunification; 
Subpart 1: Number of states: 4; 
Amount of subpart 1 funding[A]: 2,446,570; 
Percentage of subpart 1 funding: 1.0; 
Subpart 2: Number of States: 26; 
Amount of subpart 2 funding[A]: 23,625,973; 
Percentage of subpart 2 funding[B]: 9.2.

Service category: Recruitment and training for foster/adoptive 
parents; 
Subpart 1: Number of states: 9; 
Amount of subpart 1 funding[A]: 2,260,061; 
Percentage of subpart 1 funding: 0.9; 
Subpart 2: Number of States: 16; 
Amount of subpart 2 funding[A]: 6,828,885; 
Percentage of subpart 2 funding[B]: 2.7.

Service category: Adoption support and preservation services; 
Subpart 1: Number of states: 2; 
Amount of subpart 1 funding[A]: 446,877; 
Percentage of subpart 1 funding: 0.2; 
Subpart 2: Number of States: 27; 
Amount of subpart 2 funding[A]: 28,481,585; 
Percentage of subpart 2 funding[B]: 11.1.

Service category: Other; 
Subpart 1: Number of states: 11; 
Amount of subpart 1 funding[A]: 4,817,180; 
Percentage of subpart 1 funding: 1.9; 
Subpart 2: Number of States: 15; 
Amount of subpart 2 funding[A]: 12,795,915; 
Percentage of subpart 2 funding[B]: 5.0.

Total[D]; 
Subpart 1: 
Amount of subpart 1 funding[A]: $257,154,537; 
Percentage of subpart 1 funding: 100.0; 
Subpart 2: 
Amount of subpart 2 funding[A]: $255,807,079; 
Percentage of subpart 2 funding[B]: 100.0. 

Source: GAO survey.

Notes: Percentages do not always total to 100 due to rounding.

Data on subpart 1 expenditures are based on survey responses from 46 
states and data on subpart 2 expenditures are based on survey responses 
from 44 states. While Pennsylvania responded to our survey, it did not 
provide expenditure data for subparts 1 or 2.

[A] When providing data for our survey, states were asked to indicate 
the single service category that best described the type of program 
funded by subparts 1 and 2. Thus, programs that fall into multiple 
service categories may not be fully captured. For example, one state 
indicated it funded a family support program, which includes some 
family preservation and reunification services. In addition, states may 
not have been consistent in categorizing services. For example, several 
HHS officials told us that the delineation between family support and 
family preservation services is not clear, so that two states providing 
the same services to the same types of families may report them in 
different categories. Inconsistencies such as these could have an 
effect on any measured differences among service categories.

[B] States may spend less than 20 percent of their subpart 2 funds on 
any of the required service categories if they have a strong rationale. 
Some HHS regional officials said that they approve exceptions to the 20 
percent requirement if a state is spending a significant amount of 
nonfederal funds on a subpart 2 service category.

[C] Although states were asked to indicate the single service category 
that best described the type of program funded by subparts 1 and 2, 
several states selected multiple program categories when responding to 
our survey. For example, Rhode Island reported that it funded a home 
visitation program and indicated that this program includes family 
support, health, and family reunification services. Thus, the responses 
from states that reported multiple categories for a program are 
represented by this category.

[D] The aggregate dollars reported in the service categories do not 
match the total allocations for subparts 1 and 2 in fiscal year 2002. 
States have 2 years to spend their Title IV-B allocations; as a result, 
expenditures in fiscal year 2002 may include dollars from a state's 
fiscal year 2001 Title IV-B allocation, as well as its fiscal year 2002 
Title IV-B allocation. Similarly, some fiscal year 2002 allocations may 
not have been spent until fiscal year 2003.

[End of table]

[End of section]

Related GAO Products:

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

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

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

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

D.C. Child and Family Services: Key Issues Affecting the Management of 
Its Foster Care Cases. GAO-03-758T. Washington, D.C.: May 16, 2003.

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

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

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

Foster Care: Recent Legislation Helps States Focus on Finding Permanent 
Homes for Children, but Long-Standing Barriers Remain. GAO-02-585. 
Washington, D.C.: June 28, 2002.

District of Columbia Child Welfare: Long-Term Challenges to Ensuring 
Children's Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000.

Child Welfare: New Financing and Service Strategies Hold Promise, but 
Effects Unknown. GAO/T-HEHS-00-158. Washington, D.C.: July 20, 2000.

Foster Care: States' Early Experiences Implementing the Adoption and 
Safe Families Act. GAO/HEHS-00-1. Washington, D.C.: December 22, 1999.

Foster Care: HHS Could Better Facilitate the Interjurisdictional 
Adoption Process. GAO/HEHS-00-12. Washington, D.C.: November 19, 1999.

Foster Care: Effectiveness of Independent Living Services Unknown. GAO/
HEHS-00-13. Washington, D.C.: November 5, 1999.

Foster Care: Kinship Care Quality and Permanency Issues. GAO/HEHS-99-
32. Washington, D.C.: May 6, 1999.

Juvenile Courts: Reforms Aim to Better Serve Maltreated Children. GAO/
HEHS-99-13. Washington, D.C.: January 11, 1999.

Child Welfare: Early Experiences Implementing a Managed Care Approach. 
GAO/HEHS-99-8. Washington, D.C.: October 21, 1998.

Foster Care: Agencies Face Challenges Securing Stable Homes for 
Children of Substance Abusers. GAO/HEHS-98-182. Washington, D.C.: 
September 30, 1998.

FOOTNOTES

[1] We also recently testified on one of these reports. See U.S. 
General Accounting Office, Child Welfare: States Face Challenges in 
Developing Information Systems and Reporting Reliable Child Welfare 
Data. GAO-04-267T. (Washington, D.C.: Nov. 19, 2003).

[2] Child protective services activities typically include reviewing 
reports of alleged child abuse and neglect, investigating those that 
meet the state's criteria as a potential incident of abuse or neglect 
to determine if the alleged incident occurred, and, in some cases, 
referring families to needed services and removing the child from the 
home, if necessary.

[3] Our September 2003 report on Title IV-B focused primarily on 
subpart 1 because little, if any, research has been conducted on how 
subpart 1 funds have been spent on child welfare services. In contrast, 
a number of studies have been conducted on the services provided under 
subpart 2.

[4] In addition, Title XX provides funds under the social services 
block grant that may be used for many purposes, including child 
welfare.

[5] In fiscal year 2002, total Title IV-E spending was approximately 
$6.1 billion. The state matching rate for these payments is based on a 
state's per capita income and ranges from 50 percent to 83 percent. 

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

[7] Special needs are characteristics that can make it difficult for a 
child to be adopted and may include emotional, physical, or mental 
disabilities, emotional disturbance, age, or being a member of a 
minority race. To qualify for an adoption subsidy under Title IV-E, a 
state must determine that the child cannot or should not return home; a 
state must make a reasonable, but unsuccessful effort to place the 
child without the subsidy; and a specific factor or condition must 
exist that makes it difficult to place the child without a subsidy. 

[8] In fiscal year 2003, the Congress appropriated $292 million for 
subpart 1 and $405 million for subpart 2. These federal funds cover 75 
percent of states' total Title IV-B expenditures because states must 
provide an additional 25 percent using nonfederal dollars.

[9] States must spend a "significant portion" of their subpart 2 funds 
on each of the four service categories. HHS program instructions 
require states to spend at least 20 percent of their subpart 2 funds on 
each of the four service categories, unless a state has a strong 
rationale for some other spending pattern.

[10] For our September 2003 report on Title IV-B and in this testimony, 
we mention only foster care maintenance and adoption assistance 
payments when referring to subpart 1 limits, although we did include 
planned spending on child care in our analyses of states' planned 
subpart 1 spending.

[11] Staff of the House Committee on Ways and Means, 106th Congress, 
Background Material and Data on Programs Within the Jurisdiction of the 
Committee on Ways and Means (Comm. Print 2000).

[12] To obtain a breakdown of state spending for subparts 1 and 2 for 
the Title IV-B report, we sent a survey to all 50 states and the 
District of Columbia and received responses from 47 states. 

[13] The survey data reported in this category reflect the salaries of 
staff affiliated with the child welfare agency. These figures do not 
include the salaries of child welfare agency staff dedicated to a 
specific program, which may be embedded within some of the other direct 
service categories, such as family support and family preservation. In 
addition, a state may use Title IV-B funds to contract with an 
organization to provide a particular program, which may include salary 
expenses as well as direct service expenditures.

[14] For the Title IV-B report, we conducted site visits in California, 
New Jersey, Ohio, and Washington to obtain more in-depth information on 
the services provided and the types of children and families served. 
These states represent both geographic diversity and diversity in how 
states used subpart 1 funds.

[15] This amount may be underestimated, since some states may not have 
separately reported administrative expenses associated with a specific 
program. For example, officials in one state reported that the total 
spending for a family support program included salaries for agency 
staff, overhead expenses, and related staff travel.

[16] Respite care refers to the temporary care of children that can 
provide a break for the families from the daily demands of caring for 
their children or respite during times of emergencies.

[17] For this report, we conducted site visits in California, Illinois, 
Kentucky, and Texas to obtain more in-depth information on workforce 
issues and their effect on children's safety and permanency outcomes. 
Among other factors, these states represent geographic diversity and 
diversity in the practices they have implemented to address their 
recruitment and retention challenges. 

[18] These reports were obtained through both site visit interviews and 
survey responses. For the child welfare information systems and data 
report, we conducted site visits in Colorado, Iowa, New York, North 
Carolina, and Oklahoma to obtain more in-depth information on states' 
experiences developing SACWIS and reporting data to HHS. These states 
represent both geographic diversity and different stages of SACWIS 
implementation. In addition, we surveyed all 50 states and the District 
of Columbia regarding their experiences in developing and using 
information systems and their ability to report data to HHS. We 
received responses from 49 states and the District of Columbia, 
although some states did not respond to every question. Forty-six of 
these states reported that they are developing or operating a SACWIS. 
Nevada, which HHS reported has an operational SACWIS, did not respond 
to our survey. Throughout this testimony, references to state survey 
responses for our July 2003 report include the District of Columbia.

[19] U.S. Department of Labor, Bureau of Labor Statistics, 2000 
National Occupational Employment and Wage Estimates.

[20] This amount is specific to child, family, and school social 
workers (the occupation under which caseworkers would likely be 
classified).

[21] The Child Welfare League of America suggests a caseload ratio of 
12 to 15 children per caseworker, and the Council on Accreditation for 
Children and Family Services suggests that caseloads not exceed 18 
children per caseworker.

[22] American Public Human Services Association, Report from the Child 
Welfare Workforce Survey: State and County Data and Findings, May 2001.

[23] At the time of the original study, CFSR final reports were 
available for only 27 states; as of January 28, 2004, HHS had released 
reports for an additional 14 states. 

[24] See U.S. General Accounting Office, Child Welfare: States Face 
Challenges in Developing Information Systems and Reporting Reliable 
Child Welfare Data, GAO-04-267T (Washington, D.C.: Nov. 19, 2003).

[25] The analysis of survey responses about reporting data to HHS is 
based on responses from 49 states and the District of Columbia. All 
states, regardless of SACWIS development, were asked to complete these 
questions.

[26] States are required to submit general reports on their total 
subpart 1 expenditures, but these provide no data on how the funds are 
actually used. Per instructions from the Office of Management and 
Budget, agencies must require states receiving federal grants to 
complete a financial status report (SF 269), providing general 
information on state expenditures. For example, the form might indicate 
that a state spent $10 million in subpart 1 funds in a specific fiscal 
quarter, but it provides no details on how the $10 million was used. 

[27] HHS requires states to submit their annual estimates for the 
upcoming fiscal year on a form CFS-101. For example, for fiscal year 
2002, the CFS-101 was due by June 30, 2001. Because they are submitted 
before final appropriations have been enacted, a state might not 
request the full amount of funds to which it is entitled, if the final 
appropriation is greater than the state's initial estimate. States must 
submit a revised CFS-101 by June 30, 2002, to request any additional 
fiscal year 2002 Title IV-B funds that might be available to them once 
appropriations are finalized. In addition, states can request 
additional Title IV-B funds if other states do not use the total funds 
to which they are entitled. 

[28] In most cases, we reviewed the final revised CFS-101 approved by 
HHS. For 1 state, however, we used the initial CFS-101 approved by HHS 
because it included planned subpart 1 expenditures that exceeded the 
limits for foster care and adoption assistance payments. Although the 
revised CFS-101 did not show that the state planned to exceed the 
limit, we used the initial CFS-101 to show that HHS had previously 
approved a spending plan that did not comply with the statutory limits. 


[29] Ten of the 13 states were also cited as needing improvement in 
ensuring that needed services are accessible to families in all areas 
of the state and 9 of the 13 states were categorized as needing 
improvement in terms of individualizing services to meet the unique 
needs of individual families.

[30] Under this new proposal, states could voluntarily choose to 
receive a fixed IV-E foster care allocation, which could be used for 
any services provided under Titles IV-B and IV-E.

[31] As authorized under Title IV-E of the Social Security Act, the 
federal government reimburses 75 percent of states' training 
expenditures related to foster care and adoption services. States 
providing training for contracted private agency staff can receive 50 
percent federal reimbursement for this purpose.

[32] Fiscal year 2002 data are the most recent data available at the 
time of this testimony. The District of Columbia, Massachusetts, and 
Puerto Rico have not participated in title IV-E reimbursements for the 
last three fiscal years.

[33] In fiscal year 2003, among other child welfare training project 
activities, HHS awarded grants to eight recipients for developing 
models of effective child welfare staff recruitment and retention 
training.

[34] Although the other discretionary grant programs fund initiatives 
that can involve caseworker training, caseworker training and 
development is not their primary focus. 

[35] In commenting on a draft of the July 2003 report, HHS indicated 
that a Web resource is available to states interested in learning 
about other states' efforts to develop human services--child welfare, 
food stamps, Temporary Assistance to Needy Families, child care, and 
child support enforcement--information systems at 
http://www.acf.hhs.gov/nhsitrc.