HHS Should Improve Monitoring and Information Sharing Policies to Enhance Child Advocate Program Effectiveness
GAO-16-367: Published: Apr 19, 2016. Publicly Released: Apr 19, 2016.
What GAO Found
In fiscal year 2015, the Department of Health and Human Services' (HHS) Office of Refugee Resettlement (ORR) expanded the child advocate program from two locations to five and added three more locations in fiscal year 2016. The child advocate program—operated by a contractor—was developed in 2004 to promote the best interests of especially vulnerable unaccompanied children in ORR custody. Advocates meet with children regularly and develop recommendations regarding their care and custody. Approximately 336 children were assigned an advocate in fiscal year 2015—97 of them in the three new locations. ORR expects the contractor to provide advocates to an increasing number of children in locations with larger numbers of children in ORR custody, and plans to monitor progress through monthly reports from the contractor.
Child Advocate Program Sites
Children are referred to the program primarily by shelter staff (care providers), who are expected to use a set of criteria established by ORR to determine eligibility. Once the program contractor receives the referral, it decides if an advocate is available to work with a child and then sends a recommendation to ORR to officially appoint an advocate. However, ORR does not receive a copy of referrals that the contractor is unable to serve. Further, GAO's data analysis shows and the program's contractor reported inconsistent referral practices. Contrary to federal internal control standards, ORR does not monitor referrals by care providers or contractor decisions about which children it serves. As a result, ORR cannot know whether eligible vulnerable children are overlooked.
Stakeholders GAO interviewed said the advocate program gives children a voice during the immigration process and aids decision making regarding their care and custody. However, the contractor said their efforts are hampered by ORR's information sharing policy. GAO found that from fiscal years 2012-2015, more than 70 percent of the 493 recommendations made by advocates were adopted by ORR, immigration courts, and others. However, the contractor said ORR does not provide them with some key information on children. For example, they do not receive significant incident reports that describe behavioral incidents while in ORR care, past abuse or neglect, or other concerns. The William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 states that child advocates “shall be provided access to materials necessary to effectively advocate.” The contractor said creating recommendations without complete information limits their effectiveness. ORR officials told GAO that they are considering providing the contractor with copies of all significant incident reports and other key information; but as of April 6, 2016 the policy had not changed.
Why GAO Did This Study
Thousands of unaccompanied children arrive in the United States each year. For a small number of especially vulnerable children—about 1 percent in fiscal year 2015—ORR provides an independent child advocate to develop safety and well-being recommendations to stakeholders, such as immigration judges. The Violence Against Women Reauthorization Act of 2013 directed HHS to expand the program and included a provision for GAO to review the child advocate program.
This report examines (1) the extent to which ORR increased the number of program locations, (2) the extent to which ORR ensured vulnerable children received advocate services, and (3) the program's benefits and challenges. GAO reviewed relevant federal laws and regulations; analyzed data from fiscal years 2012-2015 on the number and characteristics of child advocate cases served and recommendations made to stakeholders; and interviewed officials at ORR and the Department of Justice's immigration judges, and child advocate service providers in Chicago, Ill.; Brownsville, Tex.; and Washington, D.C.—selected to obtain variation in the number of children served and amount of time the program was operational, among other factors.
What GAO Recommends
GAO recommends that ORR improve its efforts to monitor care provider referrals and contractor decisions, and ensure that the contractor has timely access to key information on the children. HHS agreed with GAO's recommendations.
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Recommendations for Executive Action
Comments: In June 2016, the Office of Refugee Resettlement (ORR) reported that it is working with the child advocate contractor to develop standard operating procedures (SOP) to assign child advocates for children as well as address issues identified in the report and monitor the referral and selection process. ORR also reported that its field staff are working with care providers to ensure that care providers are making referrals for child advocates where a local program exists. In July 2017, ORR reported that new SOPs are under development and the program continues to deny cases when child advocates are unavailable due to the limited number of child advocates. In June 2018, ORR reported that it continues to develop procedures with its contractor, but the process has not been fully implemented. Finalizing and implementing standard operating procedures for program referrals and developing a process to review information on the children the program contractor determines it is unable to serve would be positive steps towards addressing the recommendation.
Recommendation: To help ensure vulnerable unaccompanied children receive child advocate services, the Secretary of the Department of Health and Human Services should direct ORR to develop a monitoring process that includes: (1) regularly reviewing referrals to the program contractor, including identifying which care providers in locations with a child advocate program do not make referrals; and (2) reviewing information on the children the program contractor determines it is unable to serve.
Agency Affected: Department of Health and Human Services
Status: Closed - Implemented
Comments: In August 2016, ORR published its child advocate policy in the online Unaccompanied Children Policy Guide. The policy describes the role of child advocates and their access to information about their clients. The new policy explicitly provides child advocates access to all information necessary to effectively advocate for their clients, including entire case files and significant incident reports. In addition, the new policy allows for child advocate participation in case staffings.
Recommendation: To help the program's contractor improve its recommendations on behalf of vulnerable unaccompanied children, the Secretary of Health and Human Services should direct ORR to work with the program's contractor to ensure access to key information is provided in a timely manner. For example, this could include providing the program contractor with direct access to significant incident reports or exploring ways to streamline access to home studies without compromising the privacy of potential sponsors or other individuals.
Agency Affected: Department of Health and Human Services