Foster Care: Further Assistance from HHS Would be Helpful in Supporting Youth's LGBTQ+ Identities and Religious Beliefs

GAO-22-104688 Published: Apr 20, 2022. Publicly Released: May 20, 2022.
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Fast Facts

A majority of states have nondiscrimination protections for youth in foster care. But selected states and stakeholders identified challenges supporting youth with LGBTQ+ identities, and those who belong to various religious groups. Challenges include addressing bias among child welfare staff and caregivers, as well as recruiting foster families from religious minority groups.

The information Health and Human Services provides to states to help them support these youth doesn't fully address these challenges. HHS therefore can't assure states will effectively promote the well-being of such young people.

Our 2 recommendations address these issues.

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Highlights

What GAO Found

A majority of all states had some protections from discrimination in place for youth in foster care on the basis of sexual orientation, gender identity, and religion as of February 2021, based on state survey responses that GAO corroborated. The sources of these protections ranged from state laws to child welfare agency policies or practices. Officials in several states indicated that their protections on the basis of sexual orientation and gender identity for youth and parents continue to evolve. While some states are expanding protections, other states are debating the appropriateness of certain services for LGBTQ+ youth.

Literature GAO reviewed and interviews with officials from five selected states and stakeholder groups highlighted several promising practices for supporting lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) youth in foster care (see figure). Promising practices for supporting youth of various religious beliefs are generally limited to enabling youth to practice their beliefs.

Selected Promising Practices for Supporting LGBTQ+ Youth in Foster Care

Selected Promising Practices for Supporting LGBTQ+ Youth in Foster Care

Selected states and stakeholders identified several challenges with supporting LGBTQ+ youth and the religious beliefs of youth in foster care, and information provided by the Department of Health and Human Services (HHS) to help states support youth does not fully address states' challenges. According to officials in selected states, one challenge with supporting LGBTQ+ youth is limited data on youth's sexual orientations and gender identities and difficulties collecting these data. Another challenge is providing appropriate placements for transgender youth.

HHS helps states support LGBTQ+ youth in foster care by funding research and providing information, according to officials from the Administration for Children and Families (ACF) within HHS. In March 2022, ACF also issued an Information Memorandum on LGBTQ+ youth, but it did not fully address states' challenges related to data collection and how youth's gender identity should inform placement decisions. Regarding youth's religious beliefs, selected states and stakeholders noted a lack of specific practices or services to support this aspect of youth identity, and identified challenges with recruiting foster families from religious minority groups. ACF officials said they do not provide assistance to states specifically related to supporting youth in foster care of various religious beliefs. Without providing information that specifically addresses challenges with supporting LGBTQ+ youth in foster care and the religious beliefs of youth in foster care, ACF will not have assurance that states are equipped to promote the wellbeing of these youth, as called for in HHS's strategic plan.

Why GAO Did This Study

Studies suggest that LGBTQ+ youth are over-represented in foster care. Further, youth in foster care may not be placed with families who share their religious beliefs. GAO was asked to review related protections and supports for foster youth.

This report examines (1) state protections against discrimination on the basis of sexual orientation, gender identity, and religion in foster care; (2) promising practices for providing supportive care to LGBTQ+ youth and youth of various religious beliefs in foster care; and (3) challenges selected states reported facing in supporting LGBTQ+ identities and religious beliefs among foster youth, and how HHS assists states in supporting these youth.

To address these objectives, GAO surveyed child welfare agencies in 53 states and territories and interviewed officials and reviewed documentation in five states selected for their variation in reported discrimination protections, state child welfare framework, and region. GAO also conducted a literature review that included peer-reviewed studies by a range of experts, reviewed HHS documentation and relevant federal laws and regulations, and interviewed HHS officials.

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Recommendations

GAO is making two recommendations that ACF provide additional information to states on (1) data collection for LGBTQ+ foster youth and how youth's gender identity should inform placement decisions; and (2) supporting the religious beliefs of youth in foster care. HHS agreed with the recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
Administration for Children and Families The Assistant Secretary for ACF should provide additional information to state child welfare agencies on addressing challenges related to data collection for LGBTQ+ foster youth, and how youth's gender identity should inform placement decisions. (Recommendation 1)
Open
HHS concurred with this recommendation and identified actions the agency is taking to address it. We will monitor the agency's progress to implement this recommendation.
Administration for Children and Families The Assistant Secretary for ACF should develop, identify, and disseminate information to state child welfare agencies on ways to support youth of various religious beliefs in foster care. (Recommendation 2)
Open
HHS agreed with this recommendation. The agency noted that ACF's Child Welfare Capacity Building Center for States provides assistance to states and jurisdictions on supporting youth of various religious beliefs in foster care, typically upon request. For example, the Capacity Building Center can identify existing resources on ways to support youth of various religious beliefs, and disseminate these resources through its webpage and email listservs, among other methods. HHS also stated that it collects data on youth's religious attendance through the National Survey of Child Adolescent Well-being, and that it will continue to disseminate research findings from studies that use its survey data. As HHS implements this recommendation, we maintain it is also important for the Department to proactively provide information to states on ways to support youth of various religious beliefs, in addition to providing assistance upon request. Providing such information would help HHS assist states in better promoting the well-being of all youth in foster care.

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