In 2008, the Fostering  Connections Act was enacted, which amended title IV-E. In 2000,  HHS issued regulations that established a systematic review process to  monitor states’ child welfare programs to determine whether the programs  are in compliance with federal law, regulations, and the relevant approved  state plan. States Reported Implementing Suggested Practices but Continue to Face Challenges with Certain Requirements

		States Reported Requiring Caseworkers to Employ Multiple Practices to Implement the Fostering Connections Act

According to our survey, to implement the various provisions of the  Fostering Connections Act, many states required child welfare workers to  employ multiple practices suggested by HHS and other child welfare- focused organizations. (See app. Further, 19 states reported in our  survey that the lack of a requirement for educational agencies to  coordinate with child welfare agencies is a major challenge they face in  ensuring school stability for foster youth. These challenges to maintaining family connections, ensuring school  stability, and assisting older youth are not new; states have faced many of  them since before the Fostering Connections Act was enacted. Only Twenty-One States We Surveyed Reported Calculating Savings From Adoption Assistance Income Eligibility Changes for Fiscal Year 2012

Regarding implementation of the Fostering Connections Act provision  directing states to reinvest any savings due to the elimination of income  eligibility criteria for adoption assistance payments, only 21 states we  surveyed reported performing calculations of these savings from this  change for fiscal year 2012, and 20 states reported performing the  calculations for fiscal year 2011. HHS Has Not Yet Systematically Monitored State Implementation of the Fostering Connections Act

To date, HHS’s main oversight of state implementation of the Fostering  Connections Act has consisted of reviewing states’ title IV-E plans to  ensure they comply with federal requirements; however, the agency has  not yet systematically reviewed actual state implementation of the act. HHS regulations provide that states must  undergo a complete review of child welfare programs—including title IV- E—every 5 years, and HHS implements this requirement using the CFSR  process. In March 2014, HHS announced plans to conduct the next round  of CFSRs beginning in fiscal year 2015. HHS also lacks adequate data to assess if states are complying with the  policies they outlined in their title IV-E plans or the effectiveness of states’  actions. Internal control standards state that management should obtain  data on a timely basis for effective monitoring. Additionally, while some states may voluntarily collect information  about the outcomes of their programs, many do not. HHS has an  important role in helping assess what states have done and what else is  needed to improve outcomes for children in foster care. At  the same time, HHS has not yet updated data reporting requirements to  reflect the new provisions of the Fostering Connections Act. To help identify areas where states may need additional support or  guidance in their efforts to provide children in foster care with services  and assistance under title IV-E, as amended by the Fostering  Connections Act, the Secretary of Health and Human Services should  proceed with and expeditiously finalize plans to:  systematically monitor state practices for compliance with policies  outlined in their title IV-E plans that cover the new provisions  established by the Fostering Connections Act, and update AFCARS to collect relevant data from states about provisions  established by the Fostering Connections Act. HHS provided formal comments that  are reproduced in appendix V. HHS also provided technical comments  that we incorporated, as appropriate. Education did not have comments. HHS concurred with our recommendations and outlined steps it is taking  to implement them. In response to our recommendation to provide guidance on how states  could calculate savings from the changes to the federal adoption  assistance income eligibility criteria, HHS said the department will gather  examples of how savings are being calculated and documented by some  states and develop a document to provide as technical assistance to  other states.
Why GAO Did This Study

Approximately 400,000 children were living in foster care in fiscal year 2012, according to the most recent data available. HHS oversees states' implementation of federal child welfare requirements under title IV-E of the Social Security Act. In 2008, the Fostering Connections Act amended title IV-E to improve the outcomes for children in foster care, such as maintaining family and school connections. GAO was asked to review implementation of the act.
GAO examined (1) steps states have taken to implement selected provisions of the act and challenges they have faced, and (2) the extent to which HHS has monitored states' efforts. GAO reviewed relevant federal laws, regulations, and guidance and surveyed 52 state child welfare agencies, achieving a 100 percent response rate. GAO also interviewed HHS officials and state and local child welfare and educational agency officials; caseworkers; court officials, and foster youth and parents in four states, selected to ensure variety of program characteristics and geographic dispersion.

What GAO Found

To implement the Fostering Connections to Success and Increasing Adoptions Act of 2008 (Fostering Connections Act), many states GAO surveyed (which included the District of Columbia and Puerto Rico) reported requiring caseworkers to employ multiple practices to improve outcomes for children in foster care; however, states continue to face challenges that can undermine progress. Among the practices that the Department of Health and Human Services (HHS) and others suggested states use, survey respondents reported requiring caseworkers to use group decision-making to maintain family connections, consult with schools, and facilitate adult connections for older youth. At the same time, a majority of surveyed states reported facing challenges, especially related to foster placements (see fig. below).
Note: Responses do not sum to 52 if states selected “do not know/not applicable” or did not respond.
Further, the Fostering Connections Act made additional children eligible for federal adoption assistance payments thereby potentially freeing up state funds previously used for this purpose. Although states are required to spend any resulting savings on child welfare services, only 21 states reported calculating these savings for fiscal year 2012, and 20 states reported difficulties performing the calculations. HHS has not provided states guidance in this area, and without it states may continue to struggle with the calculations, leading to potential lost program funding.
HHS approved states' plans to implement the Fostering Connections Act; however, the agency has not yet monitored states' actions. HHS regulations specify that states must undergo a complete review of child welfare programs every 5 years, yet HHS's last review cycle began in 2007—using a tool developed before the act was passed. Internal control standards emphasize using timely data for effective monitoring, but data collected by HHS do not reflect the act's provisions. In March 2014, HHS announced plans to begin a review cycle in fiscal year 2015, but details about how it would address changes from the act were unavailable. Without adequate monitoring or updated data, HHS lacks information about the implementation of the act and the effectiveness of states' actions.

What GAO Recommends

GAO recommends that HHS (1) provide guidance on how states could calculate savings resulting from changes to federal adoption assistance eligibility criteria, (2) systematically monitor states' implementation of the act, and (3) update data reporting requirements related to the act. HHS concurred with our recommendations. HHS also provided technical comments that were incorporated, as appropriate. The Department of Education had no comments.