On September 30,  2002—the latest date for which HHS figures were available for our review,  532,000 children were in foster care in the United States. Families who adopt children with special needs can receive monthly  subsidies. States Reported That Limited Resources, Court-Related Processes, and Interstate Placement Delays Impede the Adoption of Special Needs Children

States we visited reported that limited resources, court-related processes,  and delays in completing interstate placements were the major challenges  to special needs adoption. Officials also reported that  delays in completing home studies hindered adoptions that involved  interstate placements. State Adoption Officials Report That Limited Resources Impede Adoptions

In part because of resource limitations, adoptive parents in many states  received lower subsidies and fewer services than foster parents. Nearly half of the 49 states  responding to a relevant question in our survey indicated that difficulty  recruiting families was a great or very great challenge to the adoption of  special needs children. States and HHS Have Promoted Special Needs Adoption, but Few Evaluations Measure Program Effectiveness

States and HHS have developed strategies and implemented programs to  promote special needs adoptions, but few evaluations measure their  effectiveness. This event has showcased  professional photographs of children waiting to be adopted. Over the  years, HHS has administered programs, sponsored campaigns, funded a  resource center, and taken steps to disseminate information about  adoptions. The Adoption Promotion Programs Have Supported Special Needs Adoption, but Data Are Lacking to Determine if Changes Are Needed

The adoption assistance and adoption incentive programs have supported  the adoption of special needs children, but data are lacking to determine if  changes are needed to better facilitate adoption. However, the income measure used to assess the standards of need in the  AFDC program, as it existed in 1996, is outdated and in many states more  restrictive than other programs’ standards of need, such as the measure  used for TANF cash assistance eligibility. Data Are Lacking to Assess Interstate Placement Challenges and Credit States for Collaborating

In addition, the program does not provide a specific inducement for  interstate placements. Interstate placements have delayed adoptions, but data to assess the  timeliness of these placements are not available. Although states and HHS have  developed strategies and innovative programs to promote and support  special needs adoptions, HHS has done little to assess the effectiveness of  its programs and funded projects. Appendix I: Objectives, Scope, and Methodology

	Objectives

The objectives of our study were to (1) identify the major challenges to  placing and keeping special needs children in adoptive homes, (2) examine  what states and the Department of Health and Human Services (HHS)  have done to facilitate special needs adoptions, and (3) assess how well  the Adoption Assistance Program and the Adoption Incentives Program  have worked to facilitate special needs adoptions and what changes, if any  might be needed to further facilitate adoptions.
Why GAO Did This Study

On September 30, 2002, the most recent date for which Department of Health and Human Services (HHS) data were available, about 126,000 foster children were waiting to be adopted. Estimates suggest that a significant portion of these children had one or more special needs, such as a medical condition or membership in a minority group, that may discourage or delay their adoption. Federal support in the form of adoption subsidies and incentive payments to states is available to promote special needs adoption. This report (1) identifies the major challenges to placing and keeping special needs children in adoptive homes, (2) examines what states and HHS have done to facilitate special needs adoptions, and (3) assesses how well the Adoption Assistance Program and the Adoption Incentives Program have worked to facilitate special needs adoptions, and determines if changes might be needed.

What GAO Found

According to state child welfare officials, limited resources, court processes, and delays in completing interstate placements challenged the adoption of children with special needs by hindering recruitment of adoptive families and delaying the adoption process. In particular, adoptive parents in many states received lower subsidies and fewer services than foster parents. In addition, child welfare officials, court staff, and judges said that the adoption process can take months to complete because hearings to terminate parents' rights are hard to schedule and may involve appeals. Further, officials said that interstate placements are often hampered by delays in completing home studies of prospective families, although no data exist to assess the timeliness of such placements. States and HHS have developed and implemented strategies and programs to promote special needs adoptions, but few evaluations measure their effectiveness. Four of the 5 states we visited sponsored post adoption resource centers. However, only 9 of 49 states responding to a relevant question in our survey indicated that they had evaluated the effectiveness of their services. At the federal level, HHS supported and promoted local innovation, provided technical assistance, and disseminated information, but the agency has done little to assess the effectiveness of the programs it has funded. When HHS has taken steps to have states assess funded projects, the agency has not ensured sufficient rigor to assess effectiveness. The Adoption Assistance and Adoption Incentives Programs have provided support for special needs adoptions, but data are lacking to determine if changes are needed to better facilitate adoption. The former uses an income eligibility threshold that is more restrictive than other cash assistance programs' standards of need and may not include all who might otherwise qualify. Since 1998, the Adoption Incentives Program has provided financial awards to almost all states for increasing adoptions, but does not provide a specific inducement for interstate placements. Data to track and credit states for collaborating on interstate placements are not available.