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Pursuant to a congressional request, GAO reviewed a variety of child abuse programs, focusing on: (1) the extent to which child abuse prevention strategies have been evaluated and shown to be effective; (2) obstacles inhibiting program implementation and alternative approaches to overcome these obstacles; and (3) the types of programs providing services to prevent child abuse in families, and how those programs are coordinated at the federal and state levels.

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Matter for Congressional Consideration

Matter Status Comments
To provide incentives to states to implement and sustain child abuse prevention programs, Congress should amend Title IV of the Social Security Act to give the Secretary of Health and Human Services authority to reimburse states, at foster care matching rates, for the costs of implementing prevention programs. The reimbursements would be provided to states where prevention programs have been demonstrated, through sound evaluations, to pay for themselves through reductions in the incidence of child abuse and the related foster care placements.
Closed - Implemented
Legislation was passed (P.L. 103-66) in August 1993 that addressed the related recommendation made in a companion report, "Foster Care: Services to Prevent Out-of-Home Placements Are Limited by Funding Barriers," (GAO/HRD-93-76). This legislation amended Title IV-B of the Social Security Act by funding a new program for family preservation and support services. This legislation gives the states, among other things, the ability to fund prevention programs such as those recommended in this report as they relate to family preservation as well as for evaluations.
To encourage states to develop and implement state prevention plans based on comprehensive needs assessments, Congress should give the Secretary of Health and Human Services the authority to direct any future increases in National Center on Child Abuse and Neglect (NCCAN) Challenge Grants to states that are putting such plans in place.
Closed - Implemented
In 1994, Congress replaced the Challenge Grants program with a broader Community-Based Family Resources Program (CBFRP). CBFRP's purpose is to help states develop systems of family resource services and support a broad range of child abuse and neglect prevention activities. Under CBFRP, states must develop a strategic plan, but there is no requirement for a comprehensive needs assessment. However, the 1993 Family Preservation and Support (FPS) legislation requires each state to develop a 5-year plan; federal rules require that these plans be based on a comprehensive needs assessment. States may use the FPS plan to satisfy the CBFRP plan requirement. According to HHS officials, states have linked their CBFRP and FPS planning efforts. Thus, while Congress did not take action on this recommendation, GAO is closing it because Congress' alternative actions are designed to achieve the same desired result of basing funding and service decisions on child and family needs.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should provide funding incentives, such as through NCCAN, to encourage states to establish and rigorously evaluate programs with the potential for statewide implementation, and promote statewide adoption of strategies that have demonstrated effectiveness and cost benefits.
Closed - Implemented
Citing two new federal programs with broader implications, HHS did not take action on this recommendation. The CBFRP, enacted in 1994, provides incentive funds for a broad range of child abuse and prevention activities and family resource programs. To receive these funds, states must develop a strategic plan for establishing a network of family resource programs and describe methods for evaluating its implementation. At the same time, the 1993 Family Preservation and Support legislation gives states the flexibility to target new funding where most needed--including prevention activities. In developing their mandated 5-year plans, federal rules require states to conduct a comprehensive needs assessment, set priorities, establish goals, and determine methods--such as rigorous evaluation--for measuring progress in achieving goals.

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