Current and Future Issues That Challenge States’ Ability to Improve Child Outcomes

States reported that their ability to improve child outcomes was  challenged most by inadequate levels of mental health and substance  abuse services available to children and families, too few caseworkers for  too many child welfare cases, and a lack of homes that can meet the needs  of certain children, such as those with developmental disabilities. Challenges are expected to grow in future years related to serving children  with special needs or who have been exposed to illegal drugs, and  changing demographic trends that will require greater multicultural  sensitivity in providing services to an increasingly diverse child welfare  population. Inadequate Levels of Mental Health, Substance Abuse, and Other Services Challenge States’ Ability to Meet the Needs of Children and Families

State child welfare agencies identified specific services underlying their  challenge to serve children and families, citing constraints on federal  funding, service gaps, and limited awareness of services outside the child  welfare system as contributing factors. 1.) 2.) 3.) 4.) 5.) For  example, child welfare officials in Texas reported that the state does not  have a sufficient number of adoptive homes for children with special  needs. As a result, these children generally stay in foster care for longer  periods of time. For example, with respect to services, states most frequently  reported that they were challenged by the lack of mental health and  substance abuse services for children and families, yet only four states  reported having initiatives to improve the level of these services. Recent legislation supports  states’ efforts to improve substance abuse services. Most states also reported that they had implemented initiatives to improve  recruitment and retention of child welfare caseworkers, but few states  reported initiatives to address two of the most frequently reported factors  underlying this challenge—the administrative burden on caseworkers and  effective supervision. Recent law supports states’ efforts in  this area as well. In addition, the law  reorganized the Child Welfare Services program funded under Title IV-B,  adding a purpose section to the law that  included: “providing training,  professional development, and support to ensure a well-qualified child  welfare workforce.”
Almost all states reported implementing initiatives to improve their ability  to find appropriate homes for children, but few states reported initiatives  that addressed two of the three most frequently reported factors  underlying this challenge (see fig. Some states implemented initiatives under federal demonstration projects,  and evaluations of outcomes states were required to conduct under these  projects showed mixed results. Federal Action Taken To Ensure States Develop Plans to Serve Children and Families Displaced by Disaster

Several actions have been taken by HHS and the Congress to better ensure  that states are prepared to continue child welfare services for children and  families displaced by disaster across county or state lines. We reported in  July 2006 that although 29 states, plus Puerto Rico, experienced a federally  declared disaster in 2005, only 8 of these states reported having a written  child welfare disaster plan. HHS took action that addressed states’ concerns and our report  recommendations including updating its 1995 disaster plan guidance,  providing technical assistance, and asking states to voluntarily submit  copies of their disaster plans for review by December 2006. The deadline set by HHS  for submission of these plans is June 30, 2007. As funding fluctuates or declines, full awareness of  resources outside the child welfare system becomes especially important,  and we recommended in our October 2006 report that the Secretary of  HHS improve awareness of and access to various social services funded by  the federal government. Recent federal  action has been taken to establish requirements and dedicate funding to  states to help address these specific problems now and in the future. GAO-07-75. GAO-06-944. Hurricanes Katrina and Rita: Provision of Charitable Assistance,   GAO-06-297T.
Why GAO Did This Study

Despite substantial federal and state investment, states have had difficulty ensuring the safety, well-being, and permanency of children in foster care. Ensuring these outcomes becomes even more difficult in the event of disasters such as Hurricanes Katrina and Rita, when children and families may become displaced across state lines. This testimony discusses (1) the issues that states reported as most important to resolve now and in the future to improve outcomes for children under their supervision (2) initiatives states reported taking to address these issues and how recent law provides support for additional state efforts and (3) federal action taken to assist states' efforts in developing child welfare disaster plans. This testimony is primarily based on our October 2006 report on state child welfare challenges (GAO-07-75) and our July 2006 report on state child welfare disaster planning (GAO-06-944). The Department of Health and Human Services (HHS) and the Congress took action that addressed our July report recommendations. However, HHS disagreed with our October report recommendation to improve awareness of and access to federal social services by modifying the Catalog of Federal Domestic Assistance or other means. We continue to believe that taking such action would help improve services to children and families.

What GAO Found

States reported in our survey that inadequate levels of mental health and substance abuse services, the high average number of child welfare cases per worker, and the difficulty finding homes for children with special needs were the most important challenges to resolve in order to improve outcomes for children under states' care. Child welfare officials cited various reasons these challenges existed in their states, such as a lack of funding for family support services and a lack of caseload standards. Over the next 5 years, major challenges for state child welfare systems were cited as serving a growing population of children with special needs or who have been exposed to illegal drugs, and changing demographic trends that will require greater multicultural sensitivity in providing services to some groups of children and their families. States have some initiatives in place to address these challenges, but these initiatives do not always address areas of states' greatest concern. For example, only 4 of 31 states dissatisfied with substance abuse services reported initiatives to improve the level of these services. Similarly, states reported little or no action to address two of the most frequently reported factors underlying the challenge to recruit and retain caseworkers - the administrative burden on caseworkers and effective supervision. Recent law provides additional requirements and funding to help states address these challenges. Some states implemented initiatives under federal demonstration projects, including those to improve substance abuse services and permanent homes for children. However, outcome evaluations of these initiatives have shown mixed results. Several actions have been taken by HHS and the Congress to better ensure that states are prepared to continue child welfare services for children displaced by disaster. Our earlier work showed that although 29 states, plus Puerto Rico, experienced a federally declared disaster in 2005, only 8 of these states reported having a written child welfare disaster plan. Since that time, HHS has updated its guidance to states and provided technical assistance. In addition, the Congress passed the Child and Family Services Improvement Act of 2006, requiring that states have procedures in place concerning how state child welfare agencies would respond in the event of a disaster. The deadline set by HHS for submission of these plans is June 30, 2007.