Among  other things, the title IV-E program requires that states and tribes: make reasonable efforts, consistent with the health and safety of the  child, to preserve and reunify families (1) prior to a child’s placement  in foster care, to prevent the need for removing the child; and (2) to  make it possible for the child to safely return home; prepare a written case plan for each child receiving foster care  maintenance payments and ensure periodic court or administrative  review of each such case; and,  regularly hold a permanency hearing to determine the case goal for  the child (to be held at least every 12 months) and make reasonable  efforts to finalize the case goal—reunification, adoption, legal  guardianship, placement with a fit and willing relative, or, where  appropriate, another planned permanent living arrangement. Tribes that receive title IV-B funding and operate foster care  programs must also comply with certain title IV-E requirements, including  those related to case goals. The Preventing Sex Trafficking and  Strengthening Families Act, enacted in 2014, restricted the use of APPLA  as a case goal to children age 16 and older, although it delayed  implementation for children in foster care under the responsibility of an  Indian tribe. Data Show That the Use of APPLA Was Lower for Indian Children than Non- Indian Children and Children in Both Groups Had A Similar Number of Foster Care Placements

		A Lower Percentage of Indian Children Had APPLA as a Case Goal Compared to Non-Indians, though a Higher Percentage of Indians Were Younger than 16

Available data from HHS show that a lower percentage of Indian children  were assigned APPLA as a case goal at the end of fiscal year 2014  compared to non-Indian children. According to AFCARS data, about 6.1  percent of Indian children were assigned APPLA as a case goal  (approximately 1,200 children) compared to 8.3 percent of non-Indian  children (approximately 33,000 children). Indian and Non-Indian Children with APPLA as a Case Goal Had a Similar Number of Placements while in Foster Care, but a Lower Percentage of Indian Children Were Placed in Institutional Care

On average, Indian and non-Indian children with APPLA as a case goal  moved among foster care homes about the same number of times (see  table 3). Most Selected Tribes Did Not Anticipate Challenges Implementing APPLA Changes, yet Some Reported Other Challenges in Establishing Permanency

		Most Selected Tribes We Interviewed Did Not Anticipate Challenges in Limiting APPLA to Older Children and Reported Using APPLA Infrequently

Most tribal officials we interviewed reported that they did not anticipate  challenges associated with limiting the use of the APPLA case goal to  children aged 16 and older. However, these tribes told us that they assign APPLA rarely  and only after determining that other case goals, such as reunification,  adoption, or guardianship—which are required to be considered before  APPLA is used—were not possible or appropriate. These tribal officials told  us that APPLA is sometimes used for children who are placed in  therapeutic foster homes where they receive specialized care. Of these tribes, two reported using the APPLA case goal extensively for  children in tribal foster care. The tribal official we  spoke with said that when the APPLA restriction takes effect, they will  have to pursue guardianships for children younger than 16 who had  previously been assigned an APPLA case goal. HHS Has Provided Information and Some Assistance to Tribes on APPLA and on Establishing Permanent Homes, but Tribes Reported Low Participation in GAP

HHS has provided information and some assistance to tribes on  implementing the change to APPLA, including policy guidance and  technical assistance through HHS regional offices, and some support for  establishing permanency for children in tribal foster care. Officials from 5 tribes reported that because GAP  was not included as an option in their title IV-E tribal-state agreements,  families with guardianship arrangements do not receive GAP payments. As part of its overarching goal to support  underserved and underrepresented populations, ACF’s 2015-2016  strategic plan includes a goal for working with tribes to increase their  capacity to promote child safety, permanency, and well-being. However, most tribes we interviewed were not participating in  the program. Recommendation for Executive Action

To help improve tribes’ ability to maintain safe, stable, and permanent  care for children, the Secretary of Health and Human Services should  direct the Children’s Bureau to explore the reasons for low tribal  participation and identify actions to increase this participation in the title  IV-E Guardianship Assistance Program. Through such discussions, HHS could identify ways that regional office  staff might help state agencies resolve any challenges to GAP  participation that tribes experience at the state level. Appendix I: Objectives, Scope, and Methodology

This report examines: (1) what available data show about Indian children  in foster care compared to all other children in foster care; (2) the extent  to which selected tribal child welfare agencies face challenges in  addressing recent changes to APPLA and in establishing permanent  homes for children in tribal foster care; and (3) the extent to which HHS  has assisted tribal child welfare agencies in implementing the APPLA  change and addressing any challenges to establishing permanent homes. Because the fiscal year 2014  AFCARS dataset does not have a measure for the APPLA case goal, we  used long-term foster care and emancipation as proxy measures for  APPLA. Data  for certain other children under the care and custody of tribal child welfare  agencies are not submitted into AFCARS.
Why GAO Did This Study

The Preventing Sex Trafficking and Strengthening Families Act, enacted in 2014, limited the use of APPLA as a case goal to children aged 16 and older. The Act made this provision effective 3 years after enactment for children under tribal responsibility. Some experts raised concerns that tribes may use the APPLA case goal to retain tribal connections for hard-to-place children, such as younger children with special needs. GAO was asked to explore tribes' views on these matters.
This report examines: (1) data comparing Indian and non-Indian children in foster care; (2) challenges selected tribal child welfare agencies may face in addressing changes to APPLA and establishing permanent homes for children in tribal foster care; and (3) HHS assistance to tribes in implementing the APPLA change and addressing any challenges to establishing permanent homes. GAO reviewed relevant federal laws, regulations, and HHS guidance; analyzed HHS's fiscal year 2014 data on child welfare agencies' foster care case plans; and interviewed officials from 36 tribes that receive federal child welfare funding from six states with high numbers of tribes receiving this funding. GAO also interviewed HHS officials and officials at six state child welfare agencies.

What GAO Found

To receive federal child welfare funding, state and tribal child welfare agencies must comply with certain requirements, including developing a permanency plan for the child that identifies how the child will exit the foster care system to a permanent home (“case goal”). If other case goals, such as reunifying with parents, adoption, or guardianship are not possible or appropriate, a child may be assigned “another planned permanent living arrangement” (APPLA) as a case goal. Unlike other case goals, children assigned an APPLA case goal are normally expected to remain in foster care until they reach adulthood, which could result in young children remaining in foster care for many years. Because available foster care data do not include a measure for the APPLA case goal, GAO used long-term foster care and emancipation as proxy measures for this case goal. These data show that in 2014 about 6.1 percent of Indian children had APPLA as a case goal, compared to 8.3 percent of non-Indian children. Of the approximately 1,200 Indian children who were assigned an APPLA case goal, 41 percent were younger than 16, while of the approximately 33,000 non-Indian children with this case goal, 23 percent were younger than 16. These data also show, on average, that Indian and non-Indian children with APPLA as a case goal moved among foster homes about the same number of times.
Most tribal officials GAO interviewed reported that they did not anticipate challenges in implementing the limitation on the use of APPLA to children age 16 and older, but many reported other challenges to establishing permanent homes for children in tribal foster care. Some organizations expressed the view that the APPLA age restriction would compel tribes to pursue other arrangements with non-Indian homes if they could not allow a child to remain in foster care with an Indian family. However, tribal officials GAO interviewed said that they rarely use APPLA and instead pursue reunification with family members or other case goals, such as guardianship. At the same time, tribal officials reported challenges with licensing foster family homes and resource constraints that may make establishing permanent homes—including guardianships—difficult.
The Department of Health and Human Services (HHS) has provided information on APPLA through a listserv and information memoranda and some assistance to tribes in establishing permanent homes for children in foster care. However, many tribes GAO interviewed indicated that they were not receiving Guardianship Assistance Program funds under title IV-E of the Social Security Act which provide support for children exiting foster care to relative guardianships. Guardianship can be a useful alternative to APPLA when reunification and adoption are not viable options. Of the 36 tribes that GAO contacted, 14 reported that they did not participate in the program because it was not included in their title IV-E tribal-state agreements or the tribe faced challenges at the state level, among other reasons. One of HHS's strategic goals is to work with tribes to increase their capacity to promote child safety, permanent homes, and well-being. By taking actions to support tribes' participation in the Guardianship Assistance Program, HHS could help them receive funds to help establish permanent homes for children in tribal foster care, including those who might be affected by the APPLA change.

What GAO Recommends

GAO recommends that HHS explore the reasons for low tribal participation in the federal guardianship program and identify actions to increase tribal participation. HHS agreed with our recommendation.