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Report to the Ranking Minority Member, Subcommittee on Human Resources, 
Committee on Ways and Means, House of Representatives: 

United States Government Accountability Office: 

GAO: 

October 2006: 

Child Welfare: 

Improving Social Service Program, Training, and Technical Assistance 
Information Would Help Address Long-standing Service-Level and 
Workforce Challenges: 

Child Welfare: 

GAO-07-75: 

GAO Highlights: 

Highlights of GAO-07-75, a report to Minority Member, Subcommittee on 
Human Resources, Committee on Ways and Means, House of Representatives 

Why GAO Did This Study: 

Despite substantial federal and state investment, states have not been 
able to meet all outcome measures for children in their care. Given the 
complexity of the challenges that state child welfare agencies face, 
GAO was asked to determine (1) the primary challenges state child 
welfare agencies face in their efforts to ensure the safety, well-
being, and permanent placement of the children under their supervision; 
(2) the changes states have made to improve the outcomes for children 
in the child welfare system; and (3) the extent to which states 
participating in the Department of Health and Human Services (HHS) 
Child and Family Services Reviews (CFSR) and technical assistance 
efforts find the assistance to be helpful. GAO surveyed child welfare 
agencies in 50 states, the District of Columbia, and Puerto Rico and 
visited 5 states, interviewed program officials, and reviewed laws, 
policies, and reports. 

What GAO Found: 

In response to a GAO survey, state child welfare agencies identified 
three primary challenges as most important to resolve to improve 
outcomes for children under their supervision: providing an adequate 
level of services for children and families, recruiting and retaining 
caseworkers, and finding appropriate homes for certain children. State 
officials also identified three challenges of increasing concern over 
the next 5 years: children's growing exposure to illegal drugs, 
increased demand to provide services for children with special needs, 
and changing demographic trends or cultural sensitivities in providing 
services for some groups of children in the states’ child welfare 
systems. 

Figure: Chila Welfare Challenges Reported by States, in Fiscal Year 
2006, as the Top Three Most Important Challenges to Resolve: 

[See PDF for Image] 

Source: GAO analysis of state child welfare survey responses. 

[End of Figure] 

Most states reported that they had implemented initiatives to address 
challenges associated with improving the level of services, recruiting 
and retaining caseworkers, and finding appropriate homes for children. 
These initiatives, however, did not always mirror the major challenges. 
For example, with respect to services, states most frequently 
identified that they were challenged by the lack of mental health and 
substance abuse services for children and families, yet only a fourth 
of the dissatisfied states reported having initiatives to improve the 
level of these services. In states where evaluations of their 
initiatives had been completed under a federal demonstration project, 
the evaluations generally showed that states had achieved mixed results 
across child welfare outcomes. States we visited reported that HHS 
reviews of their child welfare systems and training and technical 
assistance efforts helped them improve their child welfare programs. 
For example, officials in three of the five states we visited reported 
that the CFSRs prompted them to develop interagency strategies for 
providing an array of needed services to children and families. 
Similarly, nearly all states in our survey reported that HHS-sponsored 
technical assistance was helpful to some degree. However, HHS officials 
said that several factors limited their ability to use their technical 
assistance tracking system as a management tool. For example, not all 
service providers are included in the tracking system, and some 
providers inconsistently enter required data into the system. As a 
result, HHS may be limited in its ability to determine how best to 
allocate technical assistance resources to help maximize states’ 
ability to address child welfare issues. 

What GAO Recommends: 

GAO recommends that HHS develop a strategy to centralize federal 
program information, record all technical assistance to states in its 
Technical Assistance Tracking Internet System, and ensure that these 
data are complete, accurate, and timely. HHS agreed that data should be 
complete, accurate, and timely, but disagreed that centralized program 
information and recording all technical assistance would adequately 
address states’ child welfare challenges or improve their ability to 
more effectively allocate technical assistance to states. GAO continues 
to support these recommendations. 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-75]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Cornelia M. Ashby at 
(202) 512-7215 or ashbyc@gao.gov. 

[End of Section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

States Identified Several Long-standing and Emerging Challenges to 
Ensuring Child Safety, Well-Being, and Permanency: 

Emerging Challenges Include Children's Exposure to Illegal Drugs, 
Caring for Special Needs Children, and Responding to Changing 
Demographics of the Child Welfare Population: 

State Initiatives Insufficiently Address State Challenges to Improve 
Child Outcomes, and Evaluations Showed Mixed Results: 

States Generally Found HHS Reviews and Technical Assistance Helpful, 
but HHS's Monitoring System Has Limitations: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: Federal Funding for State Child Welfare Programs: 

Appendix III: Type, Description, and Status of Title IV-E Waiver 
Demonstration Programs, as of August 2006: 

Appendix IV: Department of Health and Human Services Child Welfare 
National Resource Centers and whether They Are Included in the 
Technical Assistance Tracking Internet System Database: 

Appendix V: Comments from the Department of Health and Human Services: 

Appendix VI: GAO Contacts and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Child and Family Services Review Results Related to the Three 
Most Important Child Welfare Challenges Reported by States: 

Table 2: State-Reported Use and Assessment of HHS Training and 
Technical Assistance: 

Figures: 

Figure 1: Child Welfare Challenges Reported by States as the Three Most 
Important Challenges to Resolve: 

Figure 2: States Reporting Dissatisfaction with the Level of Services 
Provided to Children in the Child Welfare System: 

Figure 3: States Reporting Dissatisfaction with the Level of Services 
Provided to Parents of At-Risk Families in the Child Welfare System: 

Figure 4: States Reporting Dissatisfaction with the Level of Services 
Provided to Children and to Parents of At-Risk Families in the Child 
Welfare System: 

Figure 5: States Reporting Dissatisfaction with Factors That Could 
Affect the State's Ability to Recruit and Retain Caseworkers: 

Figure 6: States Reporting Factors of Greatest Concern in Making 
Appropriate Placements for Children: 

Figure 7: State-Reported Emerging Issues That Are Likely to Affect 
Children in Child Welfare System over the Next 5 Years: 

Figure 8: State-Reported Initiatives to Improve Services to Children 
and Families: 

Figure 9: State-Reported Initiatives to Recruit and Retain Caseworkers: 

Figure 10: State-Reported Initiatives to Find Appropriate Homes for 
Children: 

Abbreviations: 

ACF: Administration for Children and Families: 
CAPTA: Child Abuse Prevention and Treatment Act: 
CFDA: Catalog of Federal Domestic Assistance: 
CFSR: Child and Family Services Reviews: 
CHA: Children's Health Act: 
CPS: Child Protective Services: 
CWLA: Child Welfare League of America: 
HHS: Health and Human Services: 
NRC: national resource center: 
PIP: program improvement plan: 
TANF: Temporary Assistance for Needy Families: 
TATIS: Technical Assistance Tracking Internet System: 
VCAA: Victims of Child Abuse Act: 

United States Government Accountability Office: 
Washington, DC 20548: 

October 6, 2006: 

The Honorable Jim McDermott: 
Ranking Minority Member: 
Subcommittee on Human Resources: 
Committee on Ways and Means: 
House of Representatives: 

Despite substantial federal and state investment in various social 
services, states continue to receive more than 2 million reports of 
child maltreatment each year and report having more than half a million 
children in state foster care systems. While children in foster care 
were removed from their homes to protect them from harm or neglect, 
states have struggled to meet established federal child welfare 
standards for ensuring the safety and well-being of these children in 
their care. Between March 2001 and March 2004, in its first round of 
Child and Family Services Reviews (CFSR) evaluating each 
state's[Footnote 1] child welfare program, the U.S. Department of 
Health and Human Services (HHS) found that no state had achieved all of 
the federal outcome measures for ensuring the safety, well-being, and 
permanency[Footnote 2] of children. 

For fiscal year 2006, Congress appropriated about $8 billion to support 
the ability of state child welfare systems to provide services that 
protect children from abuse and neglect, promote their physical and 
mental well-being, find them a permanent home, and enable families to 
successfully care for their children, including those children with 
special needs.[Footnote 3] At the federal level, HHS's Children's 
Bureau under the Administration for Children and Families (ACF) 
establishes federal policy, oversees states' child welfare programs in 
part through its CFSRs, and provides technical assistance to states 
primarily through its national resource centers (NRCs) and HHS regional 
offices. State child welfare agencies administer the programs and 
monitor the children and their families. States use federal funds to 
support all aspects of the child welfare program, including helping 
families stay together; providing financial support for families 
fostering children who had been removed from their homes; finding 
adoptive or other permanent homes for children; and recruiting, hiring, 
and training child welfare employees. 

Given the complexity of the challenges facing state child welfare 
agencies, you asked us to determine (1) the primary challenges state 
child welfare agencies face in their efforts to ensure the safety, well-
being, and permanency of the children under their supervision; (2) the 
changes states have made since January 1, 2002[Footnote 4], to improve 
the outcomes for children in the child welfare system; and (3) the 
extent to which states participating in HHS's Child and Family Services 
Reviews and technical assistance efforts find the assistance to be 
helpful. As part of this work, GAO also examined the extent to which 
states had developed written child welfare disaster plans for dealing 
with the dispersion of children under state care to other counties or 
states, because of disasters. In July 2006, GAO issued the report Child 
Welfare: Federal Action Needed to Ensure States Have Plans to Safeguard 
Children in the Child Welfare System Displaced by Disasters (GAO-06-
944) in response to the disaster planning part of your request. 

We used multiple data collection methods to obtain this information. 
First, we surveyed state child welfare directors in 50 states, the 
District of Columbia, and Puerto Rico to obtain information on the most 
important challenges that their agencies faced, the changes that their 
agencies had made since 2002 to improve the outcomes for children, the 
extent to which their states participated in HHS's oversight and 
technical assistance efforts, and the extent to which they viewed the 
assistance as helpful. We achieved a 96 percent response rate. Second, 
we interviewed child welfare officials in five states: California, New 
York, North Carolina, Texas, and Utah. These states were selected for 
variance in program administration (state-administered, state- 
supervised/county-administered, state-and county-administered), the 
predominance of urban or rural characteristics, the achievement of 
child welfare standards on the CFSRs, changes in the number of children 
reported to be in foster care, and geographic location. We interviewed 
federal child welfare officials and representatives from national child 
welfare organizations concerning state child welfare programs, the 
changes that states had made since 2002 to improve the outcomes for 
children, and the extent to which states participated in HHS's CFSRs 
and technical assistance efforts. In addition, we reviewed several 
national studies and our previous child welfare reports to determine 
the challenges that states face in their efforts to ensure the safety, 
well-being, and permanency of the children under their supervision. 
Finally, we analyzed agency documentation, legislation, and other 
documentation related to child welfare programs and requirements. We 
conducted our work between October 2005 and August 2006 in accordance 
with generally accepted government auditing standards. 

Results in Brief: 

State child welfare agencies identified three primary challenges as 
most important to resolve to improve outcomes for children under their 
supervision: providing an adequate level of services for children and 
families, recruiting and retaining caseworkers, and finding appropriate 
homes for certain children. Specifically, most states expressed 
dissatisfaction with the level of mental health and substance abuse 
services for both parents and children, the high average number of 
child welfare cases per worker, and their ability to find homes for 
children with special needs, such as those with developmental 
disabilities. GAO, child welfare organizations, and the Administration 
have consistently shown these issues to be long-standing challenges for 
most states and have pointed to the need for a multi-agency approach to 
addressing them. For example, to address the lack of information on 
available services, the White House Task Force for Disadvantaged Youth 
recommended in 2003 that the Catalog of Federal Domestic Assistance 
(CFDA)--a repository of information on all federal assistance programs-
-be modified to provide a search function of the locations where more 
than 300 federal programs are operating to assist youth and families. 
State officials also identified three challenges of increasing concern: 
children's growing exposure to illegal drugs; increased demand to 
provide services for children with special needs; and changing 
demographic trends or cultural sensitivities in providing services for 
some groups of children in the states' child welfare systems. 

Most states reported that they had implemented initiatives to address 
challenges associated with improving the level of services, recruiting 
and retaining caseworkers, and finding appropriate homes for children. 
The frequency of these initiatives, however, did not always mirror the 
levels of dissatisfaction with the major challenges. For example, with 
respect to services, state child welfare agencies responding to our 
survey most frequently identified that they were challenged by the lack 
of mental health and substance abuse services for children and 
families, yet only a fourth of the states reporting dissatisfaction in 
these areas also reported having initiatives to improve the level of 
these services. One reason may be that these services are typically 
provided outside of the child welfare system, and about half of the 
states reporting this challenge also reported initiatives to improve 
collaboration with other agencies. Most states reported that they had 
implemented initiatives to improve recruitment and retention of child 
welfare caseworkers, but states reported little or no action to address 
two of the most frequently reported factors underlying this challenge. 
For example, while most states reported dissatisfaction with caseworker 
supervision, only two states reported specific initiatives to address 
this challenge, and no states reported initiatives to address 
caseworker administrative burden. Similarly, most states reported 
initiatives to find appropriate homes for children, including finding 
and supporting kinship homes, but only three states had initiatives to 
find appropriate homes for older youth and four to find homes for 
children with special needs. In states where evaluations of their 
initiatives had been completed under a federal demonstration project, 
the evaluations generally showed that states had achieved mixed results 
across child welfare outcomes. 

States we visited reported that HHS's Child and Family Services Reviews 
and training and technical assistance efforts helped them assess their 
efforts and ability to achieve safety, permanence, and well-being for 
the children and families under their care and develop the necessary 
program improvement plans to meet federal requirements for improving 
their child welfare programs. For example, officials in three of the 
five states we visited reported that the CFSRs prompted them to develop 
interagency strategies for providing an array of needed services to 
children and families. Nearly all states in our survey reported that 
HHS-sponsored technical assistance was helpful to some degree. However, 
HHS officials said that its technical assistance tracking system has 
several limitations that hinder its use as a management tool. For 
example, only 8 of the 11 NRCs are required to report to the tracking 
system, and those that do inconsistently enter information into the 
system. As a result, HHS officials told us that it is difficult to 
determine how best to allocate technical assistance resources to help 
maximize states' ability to address child welfare issues. 

We are making three recommendations to the Secretary of Health and 
Human Services for improving awareness of, and access to, various 
social services, and improving the department's ability to manage 
technical assistance. HHS agreed that technical assistance data should 
be complete, accurate, and timely, but disagreed that centralized 
program information and recording all technical assistance would 
adequately address states' child welfare challenges or improve their 
ability to effectively allocate technical assistance to states. GAO 
continues to believe that implementing these recommendations would help 
states address their long-standing child welfare challenges. 

Background: 

The well-being of children and families has traditionally been 
understood as a primary duty of state governments, and state and local 
governments are the primary administrators of child welfare programs 
designed to protect children from abuse or neglect. Child welfare 
caseworkers investigate allegations of child maltreatment and determine 
what services can be offered to stabilize and strengthen a child's own 
home. If remaining in the home is not a safe option for the child--he 
or she may be placed in foster care while efforts to improve the home 
are made. In these circumstances, foster care may be provided by a 
family member, also known as kinship care; caregivers previously 
unknown to the child; or a group home or institution. In those 
instances where reuniting the child with his or her parents is found 
not to be in the best interest of the child, caseworkers must seek a 
new permanent home for the child, such as an adoptive home or 
guardianship. Some children remain in foster care until they "age out" 
of the child welfare system. Such children are transitioned to 
independent living, generally at the age of 18 years. 

Federal Funding for State Child Welfare Programs: 

States use both dedicated and nondedicated federal funds for operating 
their child welfare programs and providing services to children and 
families. In fiscal year 2006, the federal government provided states 
with about $8 billion in dedicated child welfare funds, primarily 
authorized under Title IV-B and Title IV-E of the Social Security Act. 
(See app. II.) Nearly all of this funding is provided under Title IV-E, 
which provides matching funds to states for maintaining eligible 
children in foster care, providing subsidies to families adopting 
children with special needs, and for related administrative and 
training costs.[Footnote 5] About 9 percent of funding is provided 
under Title IV-B, which provides grants to states primarily for 
improving child welfare services, including a requirement that most 
funds be spent on services to preserve and support families. 

A significant amount of federal funding for child welfare services also 
comes from federal funds not specifically dedicated for child welfare-
-including the Temporary Assistance for Needy Families (TANF) block 
grant, Medicaid, and the Social Services Block Grant. These and 
hundreds of other federal assistance programs for children and 
families, including many that serve low-income populations, are listed 
in a centralized database administered by the General Services 
Administration that has a search feature by type of assistance and 
eligible population. The Congressional Research Service conservatively 
estimated that the median share of total federal child welfare spending 
derived from nondedicated federal funding equaled nearly half of all 
the federal dollars (47 percent) expended by state child welfare 
agencies,[Footnote 6] based on state child welfare agency data reported 
to the Urban Institute for state fiscal year 2002.[Footnote 7] 

Despite the large amount of federal funds spent on child welfare from 
nondedicated sources, the Congressional Research Service reported that 
attention to federal child welfare financing has focused almost 
exclusively on dedicated child welfare funding streams and is driven in 
part by the belief that the current structure hampers the ability of 
state child welfare agencies to achieve positive outcomes for children. 
Common charges are that the current structure does not grant states the 
flexibility needed to meet the needs of children and their families, 
and encourages states to rely too heavily on foster care. Congress 
authorized HHS to conduct demonstration projects whereby states were 
allowed to waive certain funding restrictions on the use of Title IV-B 
and Title IV-E funds under the condition that the flexible use of funds 
would be cost-neutral to the federal government. HHS reported that 24 
states had participated in demonstration projects across eight child 
welfare program areas, such as caseworker training and services to 
caretakers with substance abuse disorders. States were required to 
conduct an evaluation of project success in terms of both improving 
children and family outcomes and cost neutrality. 

HHS Child and Family Services Reviews and Technical Assistance: 

As Congress authorized funds for state child welfare programs, it has 
also required states to enact policies and meet certain standards 
related to those programs. HHS evaluates how well state child welfare 
systems achieve federal standards for children through its child and 
family services reviews. The CFSR process begins with a state 
assessment of its efforts, followed by an on-site review by an HHS team 
that interviews various stakeholders in the child welfare system and 
usually reviews a total of 50 child welfare case files for compliance 
with federal requirements. After receiving the team's assessment and 
findings, the state develops a program improvement plan (PIP) to 
address any areas identified as not in substantial conformity. Once HHS 
approves the PIP, states are required to submit quarterly progress 
reports. Pursuant to CFSR regulations, federal child welfare funds can 
be withheld if states do not show adequate PIP progress, but these 
penalties are suspended during the PIP implementation term. 

HHS provides training and technical assistance to help states develop 
and implement their PIPs through its training and technical assistance 
network. This training and technical assistance focuses on building 
state agency capacity and improving the state child welfare system. 
Technical assistance providers in this network include HHS's Children's 
Bureau and regional offices, as well as NRCs and the department's Child 
Welfare Information Gateway.[Footnote 8] 

States Identified Several Long-standing and Emerging Challenges to 
Ensuring Child Safety, Well-Being, and Permanency: 

State child welfare agencies identified three primary challenges as the 
most important to resolve to improve outcomes for children under their 
supervision: providing an adequate level of services for children and 
families, recruiting and retaining caseworkers, and finding appropriate 
homes for children. HHS, GAO, and child welfare organizations have 
consistently shown these issues to be long-standing challenges for most 
states. In addition, state officials identified three challenges of 
increasing concern: children's exposure to illegal drugs; increased 
demand to provide services for children with special needs, such as 
those with developmental disabilities; and changing demographic trends 
or needs for cultural sensitivity for some groups of children in care 
and their families. 

Long-standing Challenges Include Providing Adequate Services, 
Recruitment and Retention of Caseworkers, and Placement Issues: 

In responding to our survey, states most frequently identified the 
following three child welfare challenges as the most important to 
resolve in order to improve the safety, permanency, and well-being of 
children under states' care: providing adequate services to children 
and families, recruiting and retaining caseworkers, and finding 
appropriate homes for children. (See fig. 1.) 

Figure 1: Child Welfare Challenges Reported by States as the Three Most 
Important Challenges to Resolve: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[End of figure] 

GAO and child welfare organizations have previously reported on the 
long-standing nature of these challenges. For example, GAO previously 
reported that gaps in the availability and access to services delayed 
states' ability to file for a petition to terminate parental rights--a 
necessary step in obtaining a permanent home for children who cannot 
live with their parents--because parents were unable to obtain timely 
access to substance abuse treatment and other services, such as mental 
health services and housing.[Footnote 9] GAO and other organizations 
have also previously reported that public and private child welfare 
agencies face a number of challenges recruiting and retaining qualified 
caseworkers and supervisors.[Footnote 10] For example, we reported that 
high caseloads, poor supervision, and the burden of administrative 
responsibilities have, in some cases, prompted caseworkers to 
voluntarily leave their employment with child welfare agencies. We also 
reported difficulties in recruiting adoptive parents for children with 
special needs. [Footnote 11] 

The most important challenges identified by state child welfare 
agencies are consistent with HHS's CFSR findings and states' self- 
assessments of their programs. For example, according to the 
Congressional Research Service, HHS reviewers found that 43 states 
needed improvement in providing accessible services to children and at- 
risk families in all jurisdictions of the state and 31 states needed 
improvement in conducting diligent recruitment of foster and adoptive 
parents.[Footnote 12] The number of states needing improvement in 
performance indicators related to child welfare services, recruitment 
and retention of caseworkers, and placement of children in appropriate 
homes is shown in table 1. 

Table 1: Child and Family Services Review Results Related to the Three 
Most Important Child Welfare Challenges Reported by States: 

Child welfare challenge: Services; 
Performance Indicator: Providing accessible services to children and at-
risk families in all jurisdictions within a state; 
Number of states needing improvement: 43. 

Child welfare challenge: Services; 
Performance Indicator: Responsiveness of services to the needs of 
children and at-risk families; 
Number of states needing improvement: 27. 

Child welfare challenge: Services; 
Performance Indicator: Tailoring services to the unique needs of 
children and at-risk families; 
Number of states needing improvement: 22. 

Child welfare challenge: Recruitment and retention of caseworkers; 
Performance Indicator: Providing ongoing training for staff that 
addresses the skills and knowledge needed to carry out their duties; 
Number of states needing improvement: 25. 

Child welfare challenge: Recruitment and retention of caseworkers; 
Performance Indicator: Providing initial training for all staff who 
provide child welfare services; 
Number of states needing improvement: 18. 

Child welfare challenge: Placement of children in appropriate homes; 
Performance Indicator: Ensuring the diligent recruitment of foster and 
adoptive parents; 
Number of states needing improvement: 31. 

Source: GAO analysis of Congressional Research Service data. 

[End of table] 

A Large Array of Specific Services Needed by Children and Families, 
Especially in the Area of Mental Health and Substance Abuse, Underlie 
the Challenge: 

State child welfare agencies identified specific services underlying 
their challenge to serve children and families, citing constraints on 
federal funding and limited awareness of services among eligible 
families as contributing factors. Regarding children, more than half of 
states reported that they were dissatisfied with the level of mental 
health services, substance abuse services, housing for foster youth 
transitioning to independence, and dental care. (See fig. 2.) 

Figure 2: States Reporting Dissatisfaction with the Level of Services 
Provided to Children in the Child Welfare System: 

[See PDF for image] 

Source: GAO analysis of 

[End of figure] 

States also reported that they were dissatisfied with the level of 
services provided to at-risk families in the child welfare system. 
These services are needed to help prevent the removal of children from 
their homes or help facilitate the reunification of children with their 
parents after removal. Specifically, more than half of states responded 
that they were dissatisfied with mental health services, substance 
abuse services, transportation services, and housing for parents of at- 
risk families. (See fig. 3.) 

Figure 3: States Reporting Dissatisfaction with the Level of Services 
Provided to Parents of At-Risk Families in the Child Welfare System: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[End of figure] 

For some types of services, states expressed more dissatisfaction with 
services available to at-risk families than with services available to 
children. For example, more states reported dissatisfaction with the 
level of at-risk family services than with children's services in the 
areas of assessment of their service needs, legal services, and 
advocacy or case management. (See fig. 4.) 

Figure 4: States Reporting Dissatisfaction with the Level of Services 
Provided to Children and to Parents of At-Risk Families in the Child 
Welfare System: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[End of figure] 

States we visited reported that funding constraints were among the 
reasons maintaining an adequate level of services was difficult. For 
example, while maintenance payments to foster families for children 
under state care is provided as an open-ended entitlement for federal 
funding under Title IV-E, federal funding for family support services 
is capped at a much lower level under Title IV-B. In addition, because 
the proportion of children in foster care who are eligible for federal 
support has been declining, states had to provide a greater share of 
funding at a time when many states were experiencing budget deficits 
that adversely affected overall funding for social services. In 
prioritizing funding needs, child welfare officials in 40 states 
responding to our survey reported that family support services, such as 
those that could prevent removal of a child or help with reunification 
of a family, were the services most in need of greater federal, state, 
or local resources. Officials from 29 states responded that child 
protective services such as investigation, assessment of the need for 
services, and monitoring were next in need of additional resources. 

Officials in a state we visited indicated that some caseworkers and 
families may be unaware of the array of existing services offered by 
numerous public and private providers. In North Carolina, for example, 
state officials reported that about 70 percent of children and families 
in the child welfare system received services from multiple public 
agencies, and the CFDA--a repository of information on all federal 
assistance programs that is periodically updated--lists over 300 
federal programs that provide youth and family services. However, 
caseworkers and families are not always aware of the range of services 
that are available to support them, and child welfare officials cited 
the need for additional information to help link children and families 
with needed services. In October 2003, the White House Task Force for 
Disadvantaged Youth recommended that the CFDA be modified to provide a 
search feature linked to locations where federally funded programs were 
operating. A similar model may be found on an HHS Web link, 
http://ask.hrsa.gov/pc/, where users can enter a ZIP code to find the 
closest community health center locations offering medical, mental, 
dental, and other health services on a sliding fee scale. 

Large Caseloads, Administrative Burden, and the Effectiveness of 
Supervision Underlie the Caseworker Recruitment and Retention 
Challenge: 

State child welfare officials most frequently reported dissatisfaction 
with the current status of three underlying factors that affect the 
state's ability to recruit and retain caseworkers. Specifically, more 
than half of the states reported dissatisfaction with the average 
number of cases per worker, administrative responsibilities of 
caseworkers, and effectiveness of caseworker supervision. (See fig. 5.) 

Figure 5: States Reporting Dissatisfaction with Factors That Could 
Affect the State's Ability to Recruit and Retain Caseworkers: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[End of figure] 

Child welfare officials in each of the states we visited reported 
having trouble recruiting and retaining caseworkers because many 
caseworkers are overwhelmed by large caseloads. According to a 2006 
Child Welfare League of America (CWLA) report, some programs lack 
caseload standards that reflect time needed to investigate allegations 
of child maltreatment, visit children and families, and perform 
administrative responsibilities. The report also cites CWLA's caseload 
standards of no more than 12 cases per caseworker investigating 
allegations of child maltreatment, and no more than 15 cases for 
caseworkers responsible for children in foster care. However, according 
to the report, most states, average caseloads in some areas are often 
more than double the CWLA standards. 

State child welfare officials we interviewed also reported that 
increasing amounts of time spent on administrative duties made it 
difficult to recruit and retain staff and limiting the amount of time 
caseworkers could spend visiting families. For example, child welfare 
officials in three states we visited estimated that some caseworkers 
spent a significant amount of time on administrative duties such as 
entering case data in automated systems, completing forms, and 
providing informational reports to other agencies. This administrative 
burden has limited caseworker ability to ensure timely investigations 
of child maltreatment and to make related decisions concerning the 
removal of children from their homes, according to officials, and 
influenced caseworker decisions to seek other types of employment. 

Some states we visited reported that the lack of effective supervision 
also adversely affected staff retention and sometimes resulted in 
delays providing appropriate services to children and families. Lack of 
supervisory support was cited as a problem in terms of supervisor 
inexperience and inaccessibility. For example, a Texas state official 
said that because of high turnover, caseworkers are quickly promoted to 
supervisory positions, with the result that the caseworkers they 
supervise complain of poor management and insufficient support. In 
Arizona, caseworkers have expressed dissatisfaction in the support they 
received from their supervisors, and this has negatively affected 
recruitment and retention. Child welfare officials reported that lack 
of access to supervisors was frustrating to caseworkers because it 
delayed their ability to specify appropriate permanency goals for 
children and to develop case plans to meet the needs of children and 
families in their care. 

Recruiting and Retaining Foster Parents for All Kinds of Children, but 
Especially for Children Who Are Older or Have Special Needs, Are Some 
of the Underlying Placement Challenges for States: 

Relative to other challenges, state child welfare officials most 
frequently identified four factors underlying the challenge to find 
appropriate homes for children. (See fig. 6.) Recruiting and retaining 
foster parents and serving children with special needs were at the top 
of the list. Also, more than half of the states reported that finding 
homes for children with special needs, older youth, and youth 
transitioning into independent living, and finding and supporting 
kinship homes, were among their greatest concerns. 

Figure 6: States Reporting Factors of Greatest Concern in Making 
Appropriate Placements for Children: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[End of figure] 

Child welfare officials in two states we visited said that the lack of 
therapeutic foster care homes that can properly care for children who 
have significant physical, mental, or emotional needs makes it 
challenging to find them an appropriate home. In addition, these 
officials said that some of the existing facilities are inappropriate 
for child placement because they are old and in poor condition or 
provide outmoded treatment services. Because of the absence of high- 
quality therapeutic settings, child welfare officials said that it has 
become increasingly difficult to place children in homes that can 
appropriately address their individual needs. 

Recruiting and retaining foster and adoptive parents has become an 
increasingly difficult aspect of placement for a variety of reasons, 
such as the lack of a racially and ethnically diverse pool of potential 
foster and adoptive parents, and inadequate financial support. For 
example, child welfare officials said that some locations have 
relatively small populations of certain races and ethnicities, making 
it difficult to recruit diverse foster and adoptive parents.[Footnote 
13] Inadequate financial support also hinders recruiting and retaining 
foster and adoptive families. Financial support for foster and adoptive 
families varies widely among states and local areas, and may not keep 
up with inflation. According to a California child advocacy 
organization, for example, the state's payments to foster parents of 
$450 per month per child have not been adjusted for inflation since 
2001. As a result, according to the organization, the supply of foster 
care providers has not increased markedly during this time. 

Obtaining permanent homes for older youth and for youth aging out of 
foster care is a continuing placement challenge for states. For 
example, Texas child welfare officials said that it is difficult to 
place adolescents with adoptive parents because older youth can choose 
not to be adopted. Finding housing for youth transitioning into 
independence also can be difficult in high-cost areas or in areas where 
special arrangements have not been made with housing agencies and 
landlords that typically require a cosigner on the rental application 
or a large deposit before moving in.[Footnote 14] 

More than half of the states also reported that limitations in their 
ability to identify and support placements with family members or legal 
guardians limited opportunities to place children in appropriate homes. 
For example, child welfare officials in Ohio reported a lack of 
resources to conduct outreach to family members that may be able to 
provide a stable home for children in foster care with less disruption 
to the child. Michigan officials also reported that the lack of 
financial resources made it difficult for the state to meet its 
placement goals for those children who had been removed from their home 
and who had been directed by the court to be placed with other family 
members. 

Emerging Challenges Include Children's Exposure to Illegal Drugs, 
Caring for Special Needs Children, and Responding to Changing 
Demographics of the Child Welfare Population: 

While states have experienced child welfare challenges for many years, 
states identified several emerging issues that are of increasing 
concern because of their impact on the well-being of children in the 
child welfare system. Most states reported a high likelihood that three 
issues will affect their systems over the next 5 years: children's 
exposure to illegal drugs, caring for special or high-needs children, 
and changing demographics and cultural sensitivities. (See fig. 7.) 

Figure 7: State-Reported Emerging Issues That Are Likely to Affect 
Children in Child Welfare System over the Next 5 Years: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[End of figure] 

Although the overall percentage of drug-related child welfare cases has 
not increased, officials in the states we visited reported that the 
type and location of drug abuse underlying maltreatment cases is 
changing, requiring increased attention by child welfare agencies in 
certain areas. For example, child welfare officials reported an 
increasing number of children entering state care as a result of 
methamphetamine use by parents, primarily in rural areas. Child welfare 
agencies in these areas may need to train caseworkers on how this drug 
is likely to affect parents or caregivers who use it in order to safely 
investigate and remove children from homes, as well as assess the 
service needs of affected families to develop an appropriate case 
plan.[Footnote 15] 

State child welfare officials in all five states we visited said that 
finding homes for special needs children is a growing issue because it 
is hard to find parents willing to foster or adopt these children and 
who live near the types of services required to meet the children's 
needs. For example, child welfare officials in one of the states we 
visited reported that the state does not have a sufficient number of 
adoptive homes for children with special needs. As a result, these 
children generally stay in foster care for longer periods of time. 

Child welfare officials we interviewed also said that the growing 
cultural diversity of the families who come in contact with the child 
welfare system has prompted the need for states to reevaluate how they 
investigate allegations of maltreatment and the basis on which they 
make decisions that could result in the removal of children from their 
homes. Child welfare officials in several states reported that the 
current protocols for investigating and removing children from their 
homes do not necessarily reflect the cultural norms of some immigrant 
and other minority families. These differences include limitations in 
family functioning that may be caused by poverty, the environment, or 
culture as opposed to those that may be due to unhealthy family 
conditions or behaviors. In response to growing cultural diversity, 
several states we visited stated that they are revising their protocols 
to account for religious and language differences among families who 
come in contact with the child welfare system. 

State Initiatives Insufficiently Address State Challenges to Improve 
Child Outcomes, and Evaluations Showed Mixed Results: 

Most states reported that they had implemented initiatives since 
January 2002 to address challenges associated with maintaining an 
adequate level of services, recruiting and retaining caseworkers, and 
finding appropriate homes for children. However, these initiatives did 
not address all of the key factors states reported being associated 
with these challenges. In states where evaluations of their initiatives 
had been completed under a federal demonstration project, the 
evaluations generally showed that states had achieved mixed results 
across child welfare outcomes. 

State Initiatives Did Not Address All the Key Factors Related to the 
Three Challenges Cited as Most Important to Improve Child Outcomes: 

States reported implementing various initiatives to improve child 
outcomes, but these initiatives did not always mirror those factors 
states reported as most necessary to address in overcoming their 
primary challenges. For example, with respect to services, states most 
frequently identified that they were challenged by the lack of mental 
health and substance abuse services for children and families, yet only 
a fourth of the 32 states dissatisfied with these services reported 
having initiatives to improve the level of these services. (See fig. 
8.) This may be because these services are typically provided outside 
the child welfare system by other agencies. About half of the states 
reporting dissatisfaction also reported initiatives to improve 
collaboration with other agencies.[Footnote 16] 

Figure 8: State-Reported Initiatives to Improve Services to Children 
and Families: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[A] Other initiatives include court-required changes of services, 
focusing on children 0-3 years of age, and creating a family division 
in the court system. 

[End of figure] 

Similarly, most states reported that they had implemented initiatives 
to improve recruitment and retention of child welfare caseworkers, but 
states reported little or no action to address two of the most 
frequently reported factors underlying this challenge. (See fig. 9.) 
While most states reported dissatisfaction with the supervision of 
caseworkers, only two reported specific initiatives to address this 
challenge. Similarly, while over half of the states reported 
dissatisfaction with the administrative responsibilities of 
caseworkers, no state reported an initiative to address this challenge. 
One way of streamlining administrative responsibilities--through new 
technology--may be difficult for many states because nearly half of the 
states reported that they did not have an operational statewide 
automated child welfare information system. 

Figure 9: State-Reported Initiatives to Recruit and Retain Caseworkers: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[A] Other initiatives include developing a child welfare leadership 
program, centralizing hiring processes, and expanding community-based 
services. 

[End of figure] 

Almost all states reported implementing initiatives to improve their 
ability to find appropriate homes for children, but few states 
addressed two of the three most frequently reported factors underlying 
this challenge (see fig. 10). For example, three states reported 
initiatives to find appropriate homes for older youth transitioning to 
independence and four states reported initiatives to find appropriate 
homes for children with special needs.[Footnote 17] 

Figure 10: State-Reported Initiatives to Find Appropriate Homes for 
Children: 

[See PDF for image] 

Source: GAO analysis of state child welfare survey responses. 

[A] Other initiatives include working with Native American groups on 
child placement, implementing team decision making, and ensuring that 
children in out-of-region placements are seen regularly. 

[End of figure] 

States implementing initiatives under federal demonstration projects 
were required to conduct evaluations, and these evaluations showed 
mixed results. In general, the demonstration projects offered states 
the flexibility to use federal funding under Title IV-B and Title IV-E 
in eight different program areas in an effort to improve services and 
placements--addressing the three primary challenges reported by states 
(see app. III). As of 2006, 24 states had implement 38 child welfare 
waiver demonstrations. However, evaluation results were mixed across 
child welfare outcomes. For example, while Illinois found strong 
statistical support for the finding that funding for assisted 
guardianships increased attainment of permanent living arrangements, 
none of the other four reporting states found similar conclusive 
evidence of this finding. Similarly, among four states using Title IV- 
E funds to fund services and supports for caregivers with substance 
abuse disorders, Illinois was the only state that demonstrated success 
in connecting caregivers to treatment services. States can no longer 
apply for participation in federal demonstration projects because the 
program authorization expired in March 2006. 

States Generally Found HHS Reviews and Technical Assistance Helpful, 
but HHS's Monitoring System Has Limitations: 

States we interviewed reported that HHS's CFSR and technical assistance 
efforts were helpful in implementing federal child welfare 
requirements. Similarly, nearly all states in our survey reported that 
HHS-sponsored technical assistance was helpful to some degree. However, 
HHS officials said that limitations in their technical assistance 
tracking system made it difficult to maximize its use as a management 
tool. 

HHS Child and Family Services Reviews Helped States Assess Needs and 
Make Improvements: 

State child welfare officials generally reported that HHS's CFSR 
reviews have assisted them in assessing their efforts and ability to 
achieve the safety, permanence, and well-being for the children under 
their care and develop the necessary program improvement plans to meet 
federal requirements in this regard. Specifically, state officials 
responding to our survey reported that the reviews had helped them to 
implement system wide child welfare reform, improve their quality 
assurance systems, and increase their collaboration with other child 
welfare-related agencies. Additionally, child welfare officials in 
three of the five states we visited reported that the reviews prompted 
them to develop interagency strategies for providing an array of needed 
services, such as mental health services and education for children and 
families. 

Most states reported that there was not much need to improve the 
usefulness of the CFSR process to help the state ensure safety, 
permanence, and well-being of children in the child welfare system, but 
some state officials expressed concern about the outcome measures used. 
Of the 48 states responding to our survey question about the CFSR 
process, 33 states reported that the usefulness of the CFSR process 
needed little to none or some improvement. Some state officials we 
interviewed were concerned, however, that the outcomes being measured 
in the reviews may not accurately reflect their child welfare program 
performance. In addition, officials in three of the five of the states 
we visited expressed concern about the small number of sample cases 
used by the reviewers to evaluate their state's performance. 
Specifically, officials in one state reported that evaluating only 50 
cases left the state with uncertainty about how pervasive problems are 
in the state and what its priority areas should be.[Footnote 18] 

Although the first round of HHS's reviews showed that no state had 
reached substantial conformity on all of the federal outcome goals for 
state child welfare systems, HHS officials said that states had made 
progress in implementing federal requirements and improving their child 
welfare systems. For example, HHS officials said that the quality of 
data has improved because states have put a greater focus on having 
accurate and reliable data and many states are examining their data in 
greater detail than before in an effort to identify problems in their 
child welfare systems and to figure out how to meet the CFSR 
requirements. The next round of reviews is scheduled to begin at the 
end of fiscal year 2006, when HHS officials will once again measure 
states' progress in meeting federal child welfare requirements. 

States Generally Viewed Federal Technical Assistance as Helpful, but 
HHS's Monitoring System Has Limitations as a Management Tool: 

Nearly all states reported in our survey that the federal technical 
assistance they received to improve their child welfare programs was 
helpful to some degree,[Footnote 19] although some resources were given 
higher ratings than others, as shown in table 2. States generally 
reported the highest levels of satisfaction with assistance provided by 
two of HHS's national resource centers that had primary responsibility 
for helping with child protective service and organizational 
improvement. The federal resources providing technical assistance in 
the areas of substance abuse, community-based child abuse prevention, 
and abandoned infants received the fewest requests from states. 

Table 2: State-Reported Use and Assessment of HHS Training and 
Technical Assistance: 

National child welfare resource centers: Center for Child Protective 
Services; 
Number of states using technical assistance: 33; 
Number of states finding assistance very or extremely helpful: 31; 
Number of states finding assistance somewhat or moderately helpful: 2. 

National child welfare resource centers: Center for Organizational 
Improvement; 
Number of states using technical assistance: 36; 
Number of states finding assistance very or extremely helpful: 32; 
Number of states finding assistance somewhat or moderately helpful: 3. 

National child welfare resource centers: Center for Youth Development; 
Number of states using technical assistance: 27; 
Number of states finding assistance very or extremely helpful: 22; 
Number of states finding assistance somewhat or moderately helpful: 5. 

National child welfare resource centers: Collaboration to AdoptUsKids; 
Number of states using technical assistance: 37; 
Number of states finding assistance very or extremely helpful: 30; 
Number of states finding assistance somewhat or moderately helpful: 6. 

National child welfare resource centers: Center for Family-Centered 
Practice and Permanency Planning; 
Number of states using technical assistance: 34; 
Number of states finding assistance very or extremely helpful: 26; 
Number of states finding assistance somewhat or moderately helpful: 8. 

National child welfare resource centers: Center for Adoption; 
Number of states using technical assistance: 24; 
Number of states finding assistance very or extremely helpful: 18; 
Number of states finding assistance somewhat or moderately helpful: 5. 

National child welfare resource centers: Center on Legal & Judicial 
Issues; 
Number of states using technical assistance: 26; 
Number of states finding assistance very or extremely helpful: 19; 
Number of states finding assistance somewhat or moderately helpful: 5. 

National child welfare resource centers: Center for Child Welfare Data 
& Technology; 
Number of states using technical assistance: 31; 
Number of states finding assistance very or extremely helpful: 20; 
Number of states finding assistance somewhat or moderately helpful: 11. 

Other federal resources: National Adoption Information Clearinghouse; 
Number of states using technical assistance: 29; 
Number of states finding assistance very or extremely helpful: 23;
Number of states finding assistance somewhat or moderately helpful: 6. 

Other federal resources: National Clearinghouse on Child Abuse and 
Neglect Information; 
Number of states using technical assistance: 33; 
Number of states finding assistance very or extremely helpful: 22; 
Number of states finding assistance somewhat or moderately helpful: 11. 

Other federal resources: HHS regional offices; 
Number of states using technical assistance: 47; 
Number of states finding assistance very or extremely helpful: 31; 
Number of states finding assistance somewhat or moderately helpful: 16. 

Other federal resources: Center on Substance Abuse and Child Welfare; 
Number of states using technical assistance: 17; 
Number of states finding assistance very or extremely helpful: 11; 
Number of states finding assistance somewhat or moderately helpful: 4. 

Other federal resources: Center for Community-Based Child Abuse 
Prevention Programs; 
Number of states using technical assistance: 11; 
Number of states finding assistance very or extremely helpful: 7; 
Number of states finding assistance somewhat or moderately helpful: 4. 

Other federal resources: National Abandoned Infants Assistance Resource 
Center; 
Number of states using technical assistance: 6; 
Number of states finding assistance very or extremely helpful: 1; 
Number of states finding assistance somewhat or moderately helpful: 4. 

Source: GAO analysis of state child welfare survey responses. 

[End of table] 

HHS's Technical Assistance Tracking Internet System (TATIS) monitors 
federal training and technical assistance requested and provided to 
states, but several limitations that hinder its use as a management 
tool. One limitation is that the system was designed to capture only 
assistance provided by eight NRCs. (See app. IV.) Because TATIS does 
not capture training and technical assistance provided by the remaining 
three NRCs, other federal resource centers, and HHS's regional offices, 
HHS officials do not have a complete picture of the assistance 
requested by states and provided to them. For example, the NRC for 
substance abuse is not required to enter data into TATIS, but NRC 
records show that it provided 47 on-site technical assistance visits to 
16 states in fiscal year 2005, making it among one of the most frequent 
providers of on-site federal assistance. A second limitation is that 
the eight NRCs do not always enter information into TATIS as required, 
raising concerns about the ability of HHS to determine how often states 
use its various resources and for what purpose. For example, an 
official from one of the eight NRCs we interviewed said that his center 
is not as conscientious as it should be about entering all of the 
required data into TATIS. HHS officials said that without this 
information, it is difficult to determine how best to allocate 
technical assistance resources to help maximize states' ability to 
address child welfare issues. 

Conclusions: 

States have been facing some of the same child welfare challenges for 
many years, and predict that some emerging challenges will have impacts 
in the next several years. The federal government has funded hundreds 
of programs to meet families' mental health, substance abuse treatment, 
and other social service needs that could help prevent child 
maltreatment and keep families together. However, the inability to 
query the federal government's central source of information--the CFDA-
-to identify which services across program and agencies are available 
in various locations makes it difficult to determine the extent of 
services available at the local level to serve children and families in 
the child welfare system. 

HHS has provided state child welfare systems an array of training and 
technical assistance that states report as helpful for improving their 
child welfare programs. Maximizing the value of its training and 
technical assistance is compromised, however, because HHS's information 
system does not capture all training and technical assistance provided 
to states from various HHS-sponsored providers, and compliance with the 
reporting requirements has not been enforced. In the absence of 
complete and timely information, HHS may be limited in its ability to 
determine how best to allocate technical assistance resources to help 
maximize states' ability to address child welfare issues. 

Recommendations for Executive Action: 

We are making the following three recommendations to the Secretary of 
Health and Human Services for improving awareness of and access to 
various social services, and improving the department's ability to 
manage technical assistance provided to state child welfare agencies. 

* Develop a strategy to centralize information on federal assistance 
programs that are available to meet child welfare program and service 
needs and that can be accessed by state and local child welfare staff 
and providers. This strategy could follow a previous Administration 
recommendation to develop an Internet-based search for services through 
the Catalog of Federal Domestic Assistance (CFDA) that is linked to 
grantees by ZIP code. 

* Require all HHS technical assistance providers, including HHS 
regional offices and all national resource centers, to enter training 
and technical assistance data into the department's Technical 
Assistance Tracking Internet System. 

* Establish policies and procedures to ensure that complete and 
accurate data are timely reported to the Technical Assistance Tracking 
Internet System. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to HHS for review and comment. HHS's 
written comments are reprinted in appendix V, and the Department's 
technical comment was incorporated into the report. In its written 
comments, HHS stated that the report substantially supports many of the 
findings of the CFSRs, and agreed with one of our three 
recommendations. The department agreed with our recommendation to 
establish policies and procedures to ensure complete and accurate 
reporting of data into TATIS and said it intended to provide written 
guidance to the resource centers requiring this reporting. However, the 
department stated that the report misconstrued the intent of the CFSRs 
and that the remaining recommendations do not adequately match the 
articulated needs of state welfare agencies. 

HHS disagreed with GAO's reference that no state had achieved all of 
the federal outcome measures for ensuring the safety, well-being, and 
permanency of children. The department stated that it makes separate 
determinations regarding substantial conformity for each of the seven 
outcome measures and each of the seven systemic factors reviewed. We 
revised the text to reflect that no state had reached substantial 
conformity on all of the federal outcome goals for state child welfare 
systems in lieu of stating that no state had achieved all of the 
federal performance goals. 

HHS disagreed with our recommendation to increase awareness of federal 
assistance programs by modifying the CFDA, stating that it was 
misleading to assume that state challenges could be significantly met 
or appreciably altered by a list of resources, in part because the 
recommendation incorrectly implies that local child welfare agencies 
are not aware of many valuable services; underestimates the substantive 
knowledge of resources currently being utilized by caseworkers; child 
welfare staff need access to actual services or service providers 
rather than general information on federal assistance programs; 
resource lists quickly become outdated with state and county programs 
and service providers changing annually based on their budgets; and 
certain federal programs are designed to meet the needs of very 
specific, and sometimes very small, populations. 

We acknowledge that increasing awareness of available federal resources 
is not the only action needed to address the various challenges facing 
state child welfare agencies, but believe that caseworker awareness and 
referral of children and families to existing resources is an important 
first step in meeting the challenge to provide an adequate level of 
services to them. As our report states, our current and past work has 
found that some caseworkers were unaware of the full array of federal 
resources, such as health and housing services, available in their 
locales, or had not coordinated with other agencies and organizations 
to access them. We continue to support the view that modifying the CFDA 
would allow caseworkers and others to more easily identify services and 
service providers funded by federal agencies in closest proximity to 
the families they serve. As the department points out, modifying the 
CFDA would not address issues related to outdated listings of state or 
local resources; however, the CFDA is updated biweekly or more often in 
response to new or changing information regarding federal assistance. 
Further, while it is true that some federal programs target specific 
populations, these populations are often low-income or minority groups 
that are also served by the child welfare system. 

The department also disagreed with our recommendation to require all 
HHS technical assistance providers to enter data into TATIS, stating 
that the system was not designed to monitor all technical assistance 
provided to states, nor would it be an effective stand-alone mechanism 
to determine how best to allocate technical assistance resources to 
states; the recommendation does not give sufficient weight to the CFSR 
process; including training and technical assistance by regional 
offices in TATIS would be superfluous as these activities are in 
regional office job descriptions; and the recommendation does not 
recognize that training and technical assistance is provided to a 
variety of audiences beyond the state child welfare agencies, and 
including more information would confuse the tracking of technical 
assistance. 

Our report recognizes that TATIS was designed to monitor on-site 
training and technical assistance provided by 8 of the 11 resource 
centers. However, we continue to believe that expanding TATIS to 
capture the substantial on-site assistance provided by the remaining 
resource centers and other HHS providers would enhance its contribution 
to the department in determining how best to allocate training and 
technical assistance resources to states. We acknowledge the benefit of 
the CFSRs in identifying states' technical assistance needs. However, 
state implementation of program improvement plans in response to the 
CFSR findings is only a part of training and technical assistance 
requested and provided to states. In addition, while regional office 
job descriptions may include training and technical assistance 
responsibilities, we do not believe that capturing the amount and type 
of this assistance actually provided to states would be superfluous, 
but rather provide a more complete picture of the on-site assistance 
received by states. Further, our recommendation was not intended to 
include training and technical assistance provided to audiences beyond 
the state child welfare agencies, and we modified the report text to 
clarify this point. 

Copies of this report are being sent to the Secretary of Health and 
Human Services, relevant congressional committees, and other interested 
parties. We will also make copies available to others upon request. In 
addition, the report will be made available at no charge on GAO's Web 
site at [hyperlink, http://www.gao.gov]. Please contact me on (202) 512-
7215 if you or your staff have any questions about this report. Other 
contacts and major contributors are listed in appendix VI. 

Sincerely yours, 

Signed by: 

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

[End of section] 

Appendix I: Objectives, Scope, and Methodology: 

We were asked to examine (1) the primary challenges state child welfare 
agencies face in their efforts to ensure the safety, well-being, and 
permanency of the children under their supervision; (2) the changes 
states have made since January 1, 2002, to improve the outcomes for 
children in the child welfare system; and (3) the extent to which 
states participating in the Department of Health and Human Services 
(HHS) Child and Family Services Reviews (CFSR) and technical assistance 
efforts find the assistance to be helpful. As part of this work, GAO 
also examined the extent to which states had developed written child 
welfare disaster plans for dealing with the dispersion of children 
under state care to other counties or states, because of disasters. In 
July 2006, GAO issued the report Child Welfare: Federal Action Needed 
to Ensure States Have Plans to Safeguard Children in the Child Welfare 
System Displaced by Disasters (GAO-06-944) in response to the disaster 
planning part of your request. 

To learn more about these objectives, we conducted a Web-based survey 
of state child welfare directors and conducted site visits in five 
states where we interviewed state officials. We also interviewed 
federal child welfare officials and representatives from national child 
welfare organizations concerning state child welfare programs, the 
changes that states had made since 2002 to improve the outcomes for 
children, and the extent to which states participated in HHS's CFSR and 
technical assistance efforts. In addition, we reviewed several national 
studies and our previous child welfare reports to determine the 
challenges that states face in their efforts to ensure the safety, well-
being, and permanency of the children under their supervision. Finally, 
we analyzed agency documentation, legislation, and other documentation 
related to child welfare programs and requirements. We conducted our 
work between October 2005 and August 2006 in accordance with generally 
accepted government auditing standards. 

Web-Based Survey: 

To obtain state perspectives on our objectives and the relative 
priority state child welfare agencies place on the challenges they 
face, we conducted a Web-based survey of child welfare directors in the 
50 states, the District of Columbia, and Puerto Rico. The survey was 
conducted using a self-administered electronic questionnaire posted on 
the Web. We contacted directors via e-mail announcing the survey and 
sent follow-up e-mails to encourage responses. The survey data were 
collected between February and May 2006. We received completed surveys 
from 48 states, the District of Columbia, and Puerto Rico (a 96 percent 
response rate). The states of Massachusetts and Nebraska did not return 
completed surveys. 

To develop the survey questions, we reviewed several national studies 
and our previous child welfare reports to determine the challenges that 
states face in their efforts to ensure the safety, well-being, and 
permanency of the children under their supervision. We analyzed agency 
documentation to identify HHS's oversight and technical assistance 
efforts. In November 2005, we also held two discussion groups with 
representatives from child welfare stakeholder groups to identify any 
additional issues that may not be covered in the published documents we 
reviewed. The stakeholders included representatives from the 
Association of Administrators of the Interstate Compact on the 
Placement of Children, the Child Welfare League of America, the 
National Association of Public Child Welfare Administrators, the AARP 
Grandparent Information Center, the Pew Commission on Children in 
Foster Care, the Urban Institute, American Bar Association Center on 
Children and the Law, the Center for the Study of Social Policy, the 
American Public Human Services Association, and Casey Family Services. 

We worked to develop the questionnaire with social science survey 
specialists. Because these were not sample surveys, there are no 
sampling errors. However, the practical difficulties of conducting any 
survey may introduce errors, commonly referred to as nonsampling 
errors. For example, differences in how a particular question is 
interpreted, in the sources of information that are available to 
respondents, or how the data are entered into a database can introduce 
unwanted variability into the survey results. We took steps in the 
development of the questionnaires, the data collection, and data 
analysis to minimize these nonsampling errors. For example, prior to 
administering the survey, we pretested the content and format of the 
questionnaire with several states to determine whether (1) the survey 
questions were clear, (2) the terms used were precise, (3) respondents 
were able to provide the information we were seeking, and (4) the 
questions were unbiased. We made changes to the content and format of 
the final questionnaire based on pretest results. In that these were 
Web-based surveys in which respondents entered their responses directly 
into our database, there was a reduced possibility of data entry error. 
We also performed computer analyses to identify inconsistencies in 
responses and other indications of error. In addition, an independent 
analyst verified that the computer programs used to analyze the data 
were written correctly. 

Site Visits: 

We visited five states--California, New York, North Carolina, Texas, 
and Utah. We selected these states because they represent different 
types of program administration (state-administered, state-supervised 
and county-administered, state-and county-administered), the 
predominance of urban or rural characteristics, the achievement of 
child welfare standards on the CFSR, changes in the number of children 
reported to be in foster care, and are geographically diverse. During 
these visits, we interviewed state child welfare officials and 
collected relevant state agency policies and procedures and reports. 

Information that we gathered on our site visits represents only the 
conditions present in the states and local areas at the time of our 
site visits. We cannot comment on any changes that may have occurred 
after our fieldwork was completed. Furthermore, our fieldwork focused 
on in-depth analysis of only a few selected states. On the basis of our 
site visit information, we cannot generalize our findings beyond the 
states we visited. 

[End of section] 

Appendix II: Federal Funding for State Child Welfare Programs: 

Program: Child welfare total; 
Fiscal year: 2004: 7,756; 
Final funding (in millions of dollars): Fiscal year 2005: 7,764; 
Final funding (in millions of dollars): Fiscal year: 2006: 7,676; 
President's budget request: Fiscal year: 2007: 7,989.  

Program: Title IV-E of the Social Security Act: Title IV-E subtotal; 
Final funding (in millions of dollars): Fiscal year: 2004: 6,866.2; 
Final funding (in millions of dollars): Fiscal year: 2005: 6,861.9; 
Final funding (in millions of dollars): Fiscal year: 2006: 6,772; 
President's budget request: Fiscal year: 2007: 7,048.9. 

Program: Title IV-E of the Social Security Act: Foster care--Open-ended 
reimbursement of eligible state claims for maintaining children in 
foster care and for related administrative and training costs; 
Final funding (in millions of dollars): Fiscal year: 2004: 4,974; 
Final funding (in millions of dollars): Fiscal year: 2005: 4,896; 
Final funding (in millions of dollars): Fiscal year: 2006: 4,685; 
President's budget request: Fiscal year: 2007: 4,786. 

Program: Title IV-E of the Social Security Act: Adoption assistance--
Open-ended reimbursement of eligible state claims for providing 
subsidies to special needs adoptees and for related administrative and 
training costs; 
Final funding (in millions of dollars): Fiscal year: 2004: 1,700; 
Final funding (in millions of dollars): Fiscal year: 2005: 1,770; 
Final funding (in millions of dollars): Fiscal year: 2006: 1,883; 
President's budget request: Fiscal year: 2007: 2,047. 

Program: Title IV-E of the Social Security Act: Foster care 
independence--Formula grants to states for provision of independent 
living services to youth expected to age out of foster care and to 
youth who have aged out of care; 
Final funding (in millions of dollars): Fiscal year: 2004: 140; 
Final funding (in millions of dollars): Fiscal year: 2005: 140; 
Final funding (in millions of dollars): Fiscal year: 2006: 140; 
President's budget request: Fiscal year: 2007: 140. 

Program: Title IV-E of the Social Security Act: Education and training 
vouchers--Formula grants to states to provide education and training 
vouchers to youth who have aged out of foster care; 
Final funding (in millions of dollars): Fiscal year: 2004: 44.7; 
Final funding (in millions of dollars): Fiscal year: 2005: 46.6; 
Final funding (in millions of dollars): Fiscal year: 2006: 46.2; 
President's budget request: Fiscal year: 2007: 46.2. 

Program: Title IV-E of the Social Security Act: Adoption incentives--
Bonus funds to states that increase the number of foster children 
adopted; 
Final funding (in millions of dollars): Fiscal year: 2004: 7.5; 
Final funding (in millions of dollars): Fiscal year: 2005: 9.3; 
Final funding (in millions of dollars): Fiscal year: 2006: 17.8; 
President's budget request: Fiscal year: 2007: 29.7.  

Program: Title IV-B of the Social Security Act: IV-B subtotal; 
Final funding (in millions of dollars): Fiscal year: 2004: 700.4; 
Final funding (in millions of dollars): Fiscal year: 2005: 701.4; 
Final funding (in millions of dollars): Fiscal year: 2006: 708.3; 
President's budget request: Fiscal year: 2007: 748.3. 

Program: Title IV-B of the Social Security Act: Promoting safe and 
stable families--Formula grants to states for four kinds of services: 
family preservation, family support, time- limited reunification, and 
adoption promotion and support; 
Final funding (in millions of dollars): Fiscal year: 2004: 404; 
Final funding (in millions of dollars): Fiscal year: 2005: 404; 
Final funding (in millions of dollars): Fiscal year: 2006: 394; 
President's budget request: Fiscal year: 2007: 434. 

Program: Title IV-B of the Social Security Act: Child welfare services--
Formula grants to states to improve public child welfare services; 
Final funding (in millions of dollars): Fiscal year: 2004: 289; 
Final funding (in millions of dollars): Fiscal year: 2005: 290; 
Final funding (in millions of dollars): Fiscal year: 2006: 287; 
President's budget request:Fiscal year: 2007: 287. 

Program: Title IV-B of the Social Security Act: Court improvement--
Formula grants to states' highest courts to strengthen handling of 
court child welfare proceedings; 
Final funding (in millions of dollars): Fiscal year: 2004: NA; 
Final funding (in millions of dollars): Fiscal year: 2005: NA; 
Final funding (in millions of dollars): Fiscal year: 2006: 20; 
President's budget request: Fiscal year: 2007: 20.0. 

Program: Title IV-B of the Social Security Act: Child welfare training--
Competitive grants to private nonprofit institutions of higher 
education to develop and improve education and training programs for 
child welfare workers; 
Final funding (in millions of dollars): Fiscal year: 2004: 7.4; 
Final funding (in millions of dollars): Fiscal year: 2005: 7.4; 
Final funding (in millions of dollars): Fiscal year: 2006: 7.3; 
President's budget request: Fiscal year: 2007: 7.3.  

Program: Child Abuse Prevention and Treatment Act (CAPTA): CAPTA 
subtotal; 
Final funding (in millions of dollars): Fiscal year: 2004: 89.5; 
Final funding (in millions of dollars): Fiscal year: 2005: 101.8; 
Final funding (in millions of dollars): Fiscal year: 2006: 95.2; 
President's budget request: Fiscal year: 2007: 95.2. 

Program: Child Abuse Prevention and Treatment Act (CAPTA): Community-
based grants for child abuse prevention--Formula grants to lead entity 
in each state to support community-based services designed to prevent 
child abuse and neglect; 
Final funding (in millions of dollars): Fiscal year: 2004: 33.2; 
Final funding (in millions of dollars): Fiscal year: 2005: 42.9; 
Final funding (in millions of dollars): Fiscal year: 2006: 42.4; 
President's budget request: Fiscal year: 2007: 42.4. 

Program: Child Abuse Prevention and Treatment Act (CAPTA): Basic state 
grants--Formula grants to states to improve their child protection 
services; 
Final funding (in millions of dollars): Fiscal year: 2004: 21.9; 
Final funding (in millions of dollars): Fiscal year: 2005: 27.3; 
Final funding (in millions of dollars): Fiscal year: 2006: 27.0; 
President's budget request: Fiscal year: 2007: 27.0. 

Program: Child Abuse Prevention and Treatment Act (CAPTA): 
Discretionary activities--Competitive grants for research and 
demonstration programs related to preventing or treating child 
maltreatment; 
Final funding (in millions of dollars): Fiscal year: 2004: 34.4; 
Final funding (in millions of dollars): Fiscal year: 2005: 31.6; 
Final funding (in millions of dollars): Fiscal year: 2006: 25.8; 
President's budget request: Fiscal year: 2007: 25.8. 

Program: Victims of Child Abuse Act (VCAA): VCAA subtotal; 
Final funding (in millions of dollars): Fiscal year: 2004: 26.9; 
Final funding (in millions of dollars): Fiscal year: 2005: 28.6; 
Final funding (in millions of dollars): Fiscal year: 2006: 28.8; 
President's budget request: Fiscal year: 2007: 25.8. 

Program: Victims of Child Abuse Act (VCAA): Court-appointed special 
advocates--Competitive grants to support advocacy in court for child 
victims of abuse and neglect; 
Final funding (in millions of dollars): Fiscal year: 2004: 11.6; 
Final funding (in millions of dollars): Fiscal year: 2005: 11.7; 
Final funding (in millions of dollars): Fiscal year: 2006: 11.7; 
President's budget request: Fiscal year: 2007: 11.8. 

Program: Victims of Child Abuse Act (VCAA): Children's advocacy 
centers--Competitive grants for services to child victims of abuse (and 
nonoffending family members), to coordinate child abuse investigations 
in ways that reduce their trauma, and for related training and 
technical assistance; 
Final funding (in millions of dollars): Fiscal year: 2004: 13.0; 
Final funding (in millions of dollars): Fiscal year: 2005: 15.0; 
Final funding (in millions of dollars): Fiscal year: 2006: 14.8; 
President's budget request: Fiscal year: 2007: 11.7. 

Program: Victims of Child Abuse Act (VCAA): Training for judicial 
practitioners and personnel-- Competitive grant to improve court 
handling of child abuse and neglect cases; 
Final funding (in millions of dollars): Fiscal year: 2004: 2.3; 
Final funding (in millions of dollars): Fiscal year: 2005: 1.9; 
Final funding (in millions of dollars): Fiscal year: 2006: 2.3; 
President's budget request: Fiscal year: 2007: 2.3. 

Program: Children's Health Act (CHA): CHA subtotal; 
Final funding (in millions of dollars): Fiscal year: 2004: 12.8; 
Final funding (in millions of dollars): Fiscal year: 2005: 12.8; 
Final funding (in millions of dollars): Fiscal year: 2006: 12.7; 
President's budget request: Fiscal year: 2007: 12.7. 

Program: Children's Health Act (CHA): Infant adoption awareness--
Competitive grants to train staff in non-profit health centers about 
adoption; 
Final funding (in millions of dollars): Fiscal year: 2004: 9.8; 
Final funding (in millions of dollars): Fiscal year: 2005: 9.8; 
Final funding (in millions of dollars): Fiscal year: 2006: 9.7; 
President's budget request: Fiscal year: 2007: 9.7. 

Program: Children's Health Act (CHA): Special needs adoption awareness--
Competitive grants for a public campaign about adoption of children 
with special needs; 
Final funding (in millions of dollars): Fiscal year: 2004: 3.0; 
Final funding (in millions of dollars): Fiscal year: 2005: 3.0; 
Final funding (in millions of dollars): Fiscal year: 2006: 3.0; 
President's budget request: Fiscal Year: 2007: 3.0. 

Program: Other programs: Subtotal (other); 
Final funding (in millions of dollars): Fiscal year: 2004: 59.3; 
Final funding (in millions of dollars): Fiscal year: 2005: 59.1; 
Final funding (in millions of dollars): Fiscal year: 2006: 58.6; 
President's budget request: Fiscal year: 2007: 58.6. 

Program: Other programs: Adoption opportunities--Competitive grants to 
eliminate barriers to adoptions--especially to special needs adoptions; 
Final funding (in millions of dollars): Fiscal year: 2004: 27.2; 
Final funding (in millions of dollars): Fiscal year: 2005: 27.1; 
Final funding (in millions of dollars): Fiscal year: 2006: 26.8; 
President's budget request: Fiscal year: 2007: 26.8. 

Program: Other programs: Children's Justice Act grants--Formula grant 
to states to improve the handling, investigation, and prosecution of 
child abuse and neglect cases; 
Final funding (in millions of dollars): Fiscal year: 2004: 20.0; 
Final funding (in millions of dollars): Fiscal year: 2005: 20.0; 
Final funding (in millions of dollars): Fiscal year: 2006: 20.0; 
President's budget request: Fiscal year: 2007: 20.0. 

Program: Other programs: Abandoned infants assistance--Competitive 
grants to prevent abandonment of infants exposed to HIV/AIDS or drugs 
and for services and programs to address needs of abandoned children; 
Final funding (in millions of dollars): Fiscal year: 2004: 12.1; 
Final funding (in millions of dollars): Fiscal year: 2005: 12.0; 
Final funding (in millions of dollars): Fiscal year: 2006: 11.8; 
President's budget request: Fiscal year: 2007: 11.8. 

Source: Congressional Research Service documents. 

[End of table] 

[End of section] 

Appendix III: Type, Description, and Status of Title IV-E Waiver 
Demonstration Programs, as of August 2006: 

Project type and description: Assisted guardianship/ kinship 
permanence: Relatives/other caregivers who assume legal custody of 
children are eligible for a monthly subsidy equal or comparable to 
foster care payments; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: Montana (2006); New Mexico (2005); 
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty]; 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: Illinois (2008); North Carolina, Oregon (2009); 
Status of demonstration by state: Completed demonstrations: On time: 
Delaware (2002); Maryland (2004); 
Status of demonstration by state: Completed demonstrations: Terminated 
early: [Empty]; 
Status of demonstration by state: Approved, not implemented: Minnesota; 
Wisconsin; 
Evaluation progress: Completed: Delaware, Illinois, Maryland, North 
Carolina, Oregon, New Mexico; Expected: Montana March 2007. 

Project type and description: Capped IV-E allocations and flexibility 
to local agencies: States give counties or other local entities 
flexibility in spending child welfare dollars for new services and 
supports in exchange for a capped per child/per family allocation of 
Title IV-E funds; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: [Empty]; 
Status of demonstration by state: Active demonstrations: Under short-
term extension: Indiana (2005); 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: North Carolina, Ohio, Oregon (2009); 
Status of demonstration by state: Completed demonstrations: On time: 
[Empty]; 
Status of demonstration by state: Completed demonstrations: Terminated 
early: [Empty]; 
Status of demonstration by state: Approved, not implemented: [Empty]; 
Evaluation progress: Completed: Indiana, North Carolina, Ohio, Oregon. 

Project type and description: Services to caretakers with substance use 
disorders: States use Title IV-E dollars to fund services and supports 
for caregivers with substance abuse disorders; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: Illinois (2005); 
Status of demonstration by state: Active demonstrations: Under short-
term extension: New Hampshire (2005); 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: [Empty]; 
Status of demonstration by state: Completed demonstrations: On time: 
Delaware (2002); 
Status of demonstration by state: Completed demonstrations: Terminated 
early: Maryland (2002); 
Status of demonstration by state: Approved, not implemented: [Empty]; 
Evaluation progress: Completed: Delaware, Illinois; Expected: New 
Hampshire Pending Exemption: Maryland. 

Project type and description: Managed care payment systems: States use 
alternative managed care financing mechanisms to reduce child welfare 
costs while improving permanency, safety, and well-being outcomes for 
targeted families; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: [Empty]; 
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty]; 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: [Empty]; 
Status of demonstration by state: Completed demonstrations: On time: 
Michigan (2003); 
Status of demonstration by state: Completed demonstrations: Terminated 
early: Colorado, Washington (2003), Connecticut, Maryland (2002); 
Status of demonstration by state: Approved, not implemented: [Empty]; 
Evaluation progress: Completed: Colorado, Connecticut, Michigan, 
Washington; Exemption: Maryland. 

Project type and description: Intensive service options: States 
increase the variety and intensity of services and supports to reduce 
out-of-home placement rates and improve other permanency and safety 
outcomes; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: [Empty]; 
Status of demonstration by state: Active demonstrations: Under short-
term extension: California (2005); 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: [Empty]; 
Status of demonstration by state: Completed demonstrations: On time: 
[Empty]; 
Status of demonstration by state: Completed demonstrations: Terminated 
early: Mississippi (2004); 
Status of demonstration by state: Approved, not implemented: [Empty]; 
Evaluation progress: Completed: California, Mississippi. 

Project type and description: Adoptions and post-permanency services: 
States strengthen existing or provide new post-adoption and 
postpermanency services and supports; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: [Empty]; 
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty]; 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: [Empty]; 
Status of demonstration by state: Completed demonstrations: On time: 
Maine (2004); 
Status of demonstration by state: Completed demonstrations: Terminated 
early: [Empty]; 
Status of demonstration by state: Approved, not implemented: Minnesota; 
Evaluation progress: Completed: Maine. 

Project type and description: Tribal administration of IV-E funds: 
Tribes develop administrative and financial systems to administer Title 
IV-E foster care programs independently and directly claim federal 
reimbursement; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: New Mexico (2005); 
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty]; 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: [Empty]; 
Status of demonstration by state: Completed demonstrations: On time: 
[Empty]; 
Status of demonstration by state: Completed demonstrations: Terminated 
early: [Empty]; 
Status of demonstration by state: Approved, not implemented: [Empty]; 
Evaluation progress: Completed: New Mexico. 

Project type and description: Enhanced training for child welfare 
staff: Training for public and private sector child welfare 
professionals serving children and their families to improve permanency 
and safety outcomes; 
Status of demonstration by state: Active demonstrations: Under original 
waiver: Illinois (2007); 
Status of demonstration by state: Active demonstrations: Under short-
term extension: [Empty]; 
Status of demonstration by state: Active demonstrations: Under 5-year 
extension[A]: [Empty]; 
Status of demonstration by state: Completed demonstrations: On time: 
[Empty]; 
Status of demonstration by state: Completed demonstrations: Terminated 
early: [Empty]; 
Status of demonstration by state: Approved, not implemented: [Empty]; 
Evaluation progress: Expected: Illinois June 2008. 

Source: GAO analysis of HHS information on child welfare waiver 
demonstrations. 

[A] Evaluations will be submitted by the four states with 5-year 
extensions. 

[End of table] 

[End of section] 

Appendix IV: Department of Health and Human Services Child Welfare 
National Resource Centers and whether They Are Included in the 
Technical Assistance Tracking Internet System Database: 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): 
National Child Welfare Resource Center for Organizational Improvement; 
Description: Assists with strategic planning, CFSRs, outcome evaluation 
and workforce training and development; facilitates the involvement of 
stakeholders; and monitors the technical assistance progress; 
Web site: http://www.nrcoi.org. 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): 
National Resource Center for Child Protective Services (CPS); 
Description: Works to build state and local CPS capacity, assists in 
determining eligibility for the Child Abuse Prevention and Treatment 
Act (CAPTA) grant, and provides support to state liaison officers; 
Web site: http://www.nrccps.org. 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): 
National Child Welfare Resource Center on Legal and Judicial Issues; 
Description: Provides states legal and judicial issue analysis for the 
CFSRs, assists in action planning and implementation of program 
improvement plans; 
Web site: http://www.abanet.org/child/rclji. 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): 
National Resource Center for Family-Centered Practice and Permanency 
Planning; 
Description: Provides assistance through all stages of the CFSRs, 
emphasizes family-centered principles and practices, and builds 
knowledge of foster care issues; 
Web site: http://www.nrcfcppp.org. 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): 
National Resource Center for Child Welfare Data and Technology; 
Description: Provides support for technical issues, conducts data use 
and management training, and helps in preparation and use of state data 
profiles; 
Web site: http://www.nrccwdt.org. 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): 
National Child Welfare Resource Center for Adoption; 
Description: Analyzes adoption and permanency options, provides support 
for increasing cultural competency, and examines systematic problems 
and solutions; 
Web site: http://www.nrcadoption.org. 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): 
National Child Welfare Resource Center for Youth Development; 
Description: Supports youth participation in child welfare policy, 
program development and planning, offers assistance for foster care 
independence and education voucher program implementation; 
Web site: http://www.nrcys.ou.edu/nrcyd. 

National resource center: National Resource Centers Included In the 
Technical Assistance Tracking Internet System Database (TATIS): The 
Collaboration to AdoptUsKids; 
Description: Provides training and technical assistance on quality 
recruitment and retention services for foster and adoptive families; 
Web site: http://www.adoptuskids.org. 

National resource center: National resource centers not included In 
TATIS: National Center on Substance Abuse and Child Welfare 
(cosponsored with the Substance Abuse and Mental Health Services 
Administration); 
Description: Works to develop knowledge and provides assistance to 
child welfare agencies on substance abuse related disorders in the 
child welfare and family court systems; 
Web site: http://www.ncsacw.samhsa.gov. 

National resource center: National resource centers not included In 
TATIS: National Abandoned Infants Assistance Resource Center; 
Description: Works to enhance the quality of social and health services 
for children abandoned because of the presence of drugs or HIV in the 
family; 
Web site: http://aia.berkeley.edu/. 

National resource center: National resource centers not included In 
TATIS: National Resource Center for Community-Based Child Abuse 
Prevention Programs; 
Description: Focuses on primary child abuse and neglect prevention, 
assists in implementation for family support strategies; 
Web site: http://www.friendsnrc.org. 

Source: HHS training and technical assistance documents. 

[End of table] 

[End of section] 

Appendix V: Comments from the Department of Health and Human Services: 

Office of the Assistant Secretary for Legislation:  
Department Of Health & Human Services: 
Washington, D.C. 20201: 

Sep 22 2006: 

Cornelia M. Ashby: 
Director, Education, Workforce, and Income Security Issues: 
U.S. Government Accountability Office: 
Washington, DC 20548: 

Dear Ms. Ashby: 

Enclosed are the Department's comments on the U.S. Government 
Accountability Office's (GAO) draft report entitled, "Child Welfare: 
Access to Information About Federal Social Service Programs Needed to 
Help States Address Long-Standing Challenges " (GAO-06-964), before its 
publication. 

The Department provided several technical comments directly to your 
staff. 

These comments represent the tentative position of the Department of 
Health and Human Services and are subject to reevaluation when the 
final version of this report is received. 

Sincerely, 

Signed by: 

Vincent J. Ventimiglia, Jr. 
Assistant Secretary for Legislation: 

Comments Of The Department Of Health And Human Services On The 
U.S.Government Accountability Office's Draft Report Entitled, "Child 
Welfare: Access To Information About Federal Social Service Programs 
Needed To Help States Address Long-Standing Challenges" (GAO-06-964): 

The Department appreciates the opportunity to comment on the Government 
Accountability Office (GAO) draft report, which addresses the 
challenges faced by Child Welfare Agencies and substantially supports 
many of the findings of the Child and Family Services Reviews (CFSRs). 
The report clearly outlines in the findings three key challenges facing 
State agencies: lack of adequate child and family services, 
difficulties with recruitment and retention of caseworkers, and the 
struggle to identify appropriate placement for children. However, the 
recommendations fail to adequately match the articulated needs. 

The Department appreciates GAO's acknowledgement of the importance of 
the CFSRs in assisting States to focus funding, resources and long-term 
planning to address the barriers States face in providing effective 
services to families and children in the Child Welfare system. However, 
the intent of the first round of CFSRs is misconstrued in the repeated 
reference that no State had achieved all of the Federal outcome 
measures for ensuring the safety, well-being and permanency of 
children. 

It should be noted that the CFSR is not a pass or fail review. The 
Department makes separate determinations regarding substantial 
conformity for each of the seven outcomes and each of the seven 
systemic factors reviewed. All States reviewed during the first round 
of CFSRs were found to be in substantial conformity on some of these 
areas, and not in substantial conformity on others. The design of the 
reviews provides an opportunity for States to enter into Program 
Improvement Plans (PIPS) to move towards improving performance in 
identified outcomes and systemic factors. It is by focusing States on 
long-term strategic and active program improvement that the reviews 
achieve their objective. The awareness cited in the GAO report on the 
part of State Administrators of the challenges faced by their States 
and the need to vigorously address these challenges also demonstrates 
the positive impact of the reviews. 

GAO Recommendations: 

We are making the following two recommendations to the Secretary of 
Health and Human Services for improving awareness of and access to 
various social services, and improving the Department's ability to 
manage technical assistance. 

* Develop a strategy to centralize information on Federal assistance 
programs that are available to meet child welfare program and service 
needs and that can be accessed by state and local child welfare staff 
and providers. This strategy could follow a previous Administration 
recommendation to develop an Internet-based search for services through 
the Catalog of Federal Domestic Assistance that is linked to grantees 
by ZIP code. 

HHS Comment: 

We do not believe that cataloging and making available Federal 
resources would be a primary solution to the Child Welfare Agencies' 
current concerns, nor would it help States address their increasing 
concerns of changing demographic trends in the Child Welfare system, or 
the needs of children with special needs or those exposed to illegal 
drugs. To assume that these expressed challenges or concerns could be 
significantly met or appreciably altered by a list of resources is 
misleading. What Child Welfare Agencies might tell you would be that 
resource lists quickly become outdated or services unavailable due to 
fiscal restraints. In addition, certain Federal programs are designed 
to meet the needs of very specific, and sometimes very small, 
populations. The recommendation also appears to underestimate the 
substantive knowledge of resources currently being utilized by 
caseworkers, and incorrectly implies that local Child Welfare Agencies 
are not aware of many valuable services in their own districts or 
within the Federal system. 

It is not clear how this recommendation could be achieved effectively 
at the Federal level since State and county programs and service 
providers change annually based on their budgets. Many localities 
maintain their own listing of service providers, which must be updated 
regularly. Individual Child Welfare staff generally need access to the 
actual services or service providers rather than general information on 
Federal assistance programs. 

GAO Recommendation: 

* Require all HHS technical assistance providers, including HHS 
regional offices and all national resource centers, to enter training 
and technical assistance data into the department's Technical 
Assistance Tracking Internet System. 

HHS Comment: 

The GAO report incorrectly states that the Technical Assistance 
Tracking Internet System monitors Federal training and technical 
assistance (T/TA) requested and provided to States. There is a 
Technical Assistance Tracking Information System (TATIS) developed 
specifically to track the days that the Children's Bureau-funded 
National Resource Centers are on-site in States providing technical 
assistance on a specific Federal requirement. This system was never 
meant to monitor all technical assistance provided to States, nor would 
TATIS be an effective stand-alone mechanism to determine how best to 
allocate technical assistance resources to maximize States' ability to 
address Child Welfare issues. 

TATIS was designed to be one of many management tools in responding to 
and coordinating technical assistance needs. A complex multi-level 
strategy brings together the knowledge of the Federal project officers 
and regional office representatives in regular meetings to address 
technical assistance needs and resources. The decisions involved in the 
design and current distribution of T/TA responsibilities was the result 
of a two-year project with multiple subcommittees reviewing technical 
assistance use, needs and availability. There is currently a specific 
evaluation of the technical assistance of the Children's Bureau-funded 
National Resource Centers, which has been funded for the current grant 
cycle that will inform future allocations of T/TA resources. 
Additionally, the CFSR findings are invaluable in pointing out States' 
T/TA needs and challenges. 

The recommendation is targeted at increasing technical assistance 
training and implementation of policies and procedures for ensuring the 
accuracy of data entry, but by doing so, it fails to give sufficient 
weight to the work of the regional offices and the CFSR process. 
Through the CFSRs, the Children's Bureau is able to tailor any 
subsequent PIP to the individual State findings; specifically, matching 
those findings to technical assistance needs. In fact, the GAO report 
documents that the Department of Health and Human Services (HHS) 
officials agree that the quality of data has improved since the first 
round of CFSRs. A trend that we expect will continue. 

The recommendation suggests that HHS regional offices should enter T/TA 
into TAXIS. In the course of daily work activities, HHS regional staff 
provides extensive program guidance to States in meeting Federal 
requirements. The staff frequently provide clarification of laws and 
regularly monitor States' compliance with Federal requirements. These 
activities are a regular part of their job descriptions and would be 
superfluous to TATIS. 

The GAO report acknowledged the need for coordination across program 
lines in order to develop adequate services for children and families. 
Specifically, actual direct services such as mental health, health, 
education and substance-abuse treatment are not actually provided by 
Child Welfare Agencies on a broad scale. Instead the Child Welfare 
Agencies refer to community services, contract for some limited 
specialized services and utilize existing Medicaid and insurance to pay 
providers for services. ACF's Children's Bureau is actively involved in 
collaborative activities with other HHS programs to provide a wide 
variety of technical assistance to respond to the needs of children and 
families who require Child Welfare Agency intervention for the 
children's safety and well-being. The Children's Bureau directly funds 
T/TA entities to provide assistance directly to the State Child Welfare 
Agencies and to the court systems that oversee those agencies. However, 
the Children's Bureau maximizes impact by entering into Memorandums of 
Understanding with other HHS programs to ensure that as service systems 
are developed by other Federal programs; those systems maintain an 
awareness of the service needs of families and children who are served 
by the State Child Welfare systems. 

By stating that all technical assistance that may benefit Child Welfare 
populations and outcomes be entered into one central TATIS, there is a 
failure to recognize that T/TA is provided to a variety of audiences 
beyond the State Child Welfare Agencies. 

In the GAO report T/TA providers that respond to different audiences 
are compiled in one list. For example, the National Clearinghouses 
respond not only to requests from State Child Welfare Agencies but also 
to individuals. It would only confuse the tracking of technical 
assistance to include their responses to the general public or specific 
caseworkers in TATIS. 

GAO Recommendation: 

* Establish policies and procedures to ensure that complete and 
accurate data are timely reported to the Technical Assistance Tracking 
Internet System. 

HHS Comment: 

The Department agrees with this GAO recommendation for the Children's 
Bureau-funded National Resource Centers that currently enters 
information into the TATIS, and intends to provide written guidance to 
the resource centers requiring this reporting. 

[End of section] 

Appendix VI: GAO Contacts and Staff Acknowledgments: 

GAO Contact: 

Cornelia M. Ashby, (202)512-7215, ashbyc@gao.gov: 

Staff Acknowledgments: 

Cindy Ayers (Assistant Director) and Arthur T. Merriam Jr. (Analyst-in- 
Charge) managed all aspects of the assignment. Mark E. Ward made 
significant contributions to this report, in all aspects of the work. 
Christopher T. Langford and Kathleen L. Boggs analyzed the results of 
the GAO survey of child welfare challenges and assisted in the report 
development. In addition, Carolyn M. Taylor contributed to the initial 
design of the engagement, Carolyn Boyce provided technical support in 
design and methodology, survey research, and statistical analysis; 
James Rebbe provided legal support; and Charles Willson assisted in the 
message and report development. 

[End of section] 

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FOOTNOTES 

[1] In this report, we use the term states to refer collectively to the 
50 states plus the District of Columbia and Puerto Rico. 

[2] Permanency is defined as providing a lifetime commitment to a child 
in a setting where he or she is safe, can have a sense of belonging and 
well-being, and can live to adulthood. 

[3] Special needs are factors that can include medical, emotional, 
mental, or behavioral needs that will require ongoing assistance and 
support, age, or membership in a minority group. 

[4] The first round of HHS's Child and Family Services Reviews began in 
March 2001. By January 2002, states had begun to develop programs 
improvement plans and implement changes to address the child welfare 
areas that were identified as needing improvement during the reviews. 

[5] Title IV-E also provides grants to states for providing independent 
living services to youth who are expected to age out of foster care or 
who have already aged out of care. Grants are also provided to states 
for providing education and training vouchers for youth aging out of 
care. 

[6] States' use of nondedicated federal funding varied considerably 
from a high of 75 percent of total federal child welfare funds expended 
in Alabama to less than 2 percent of total federal child welfare funds 
expended in North Carolina. 

[7] The Congressional Research Service reported that this is likely an 
understatement of nondedicated federal funding states used for their 
child welfare programs. 

[8] The Information Gateway provides consolidated access to information 
on a Web site about a range of child welfare topics, including 
international adoption, foster care, family preservation, and child 
abuse. 

[9] One provision of the Adoption and Safe Families Act of 1997 
requires states to file a termination of parental rights with the 
courts if the child has been in foster care for 15 of the most recent 
22 months unless, among other reasons, the state has not provided 
services needed to make the home safe for the child's return. For 
additional information, see GAO, 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). 

[10] See GAO, D.C. Child and Family Services Agency: More Focus Needed 
on Human Capital Management Issues for Caseworkers and Foster Parent 
Recruitment and Retention, GAO-04-1017 (Washington, D.C.: Sept. 24, 
2004), and 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). 

[11] See GAO-02-585, and GAO, Child Welfare: Better Data and 
Evaluations Could Improve Processes and Programs for Adopting Children 
with Special Needs, GAO-05-292 (Washington, D.C.: June 13, 2005) 

[12] See Congressional Research Service, Child Welfare: State 
Performance on Child and Family Services Reviews, (Washington, D.C.: 
June 29, 2005). 

[13] Generally, states and other entities involved in adoption or 
foster care are prohibited by law from delaying or denying the 
placement of a child for adoption or into foster care, on the basis of 
the race, color, or national origin of the adoptive or foster parent, 
or the child, involved. 42 U.S.C. § 1996b. 

[14] See GAO, Foster Youth: HHS Actions Could Improve Coordination of 
Services and Monitoring of States' Independent Living Programs, GAO-05-
25 (Washington, D.C.: Nov. 18, 2004). 

[15] Methamphetamine users often exhibit poor judgment, confusion, 
irritability, paranoia, and increased violence. 

[16] We previously reported on how problems requiring interagency 
solutions often go unaddressed in such areas as transportation and 
housing. See GAO-05-25 and GAO, Child Welfare: Improved Federal 
Oversight Could Assist States in Overcoming Key Challenges. GAO-04-418T 
(Washington, D.C.: Jan. 28, 2004). 

[17] GAO previously reported that child welfare agencies focused on 
preparing youth for independent living while they were in foster care, 
but were less apt to work with other agencies--such as the local 
housing authority--to transition youth out of care because of 
conflicting policies and a lack awareness about needed services. See 
GAO-05-25. 

[18] See GAO, Child and Family Services Reviews: Better Use of Data and 
Improved Guidance Could Enhance HHS's Oversight of State Performance. 
GAO-04-333 (Washington, D.C.: Apr. 20, 2004). 

[19] States responded to a survey question and said that HHS technical 
assistance was most often either helpful, very helpful, or extremely 
helpful. 

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