Title IV-B of the Social Security Act, established in 1935, authorizes funds  to states to provide a wide array of services to prevent the occurrence of  abuse, neglect, and foster care placements. Subpart 1 funds are intended for services that  are directed toward the accomplishment of the following purposes: (1)  protect and promote the welfare of all children; (2) prevent or remedy  problems that may result in the abuse or neglect of children; (3) prevent  the unnecessary separation of children from their families by helping  families address problems that can lead to out-of-home placements; (4)  reunite children with their families; (5) place children in appropriate  adoptive homes when reunification is not possible; and (6) ensure  adequate care to children away from their homes in cases in which the  child cannot be returned home or cannot be placed for adoption. States Spend IV-B Funds on A Variety of Services, With Subpart 2 Focusing More on Prevention

In our September 2003 report on Title IV-B, we found that states use these  funds to provide a wide variety of services to prevent the occurrence of  abuse, neglect, and foster care placements, as well as services to help  children in foster care and their parents; however, relatively few subpart 1  dollars are used to provide family support and family preservation  services, while the majority of subpart 2 funds are used for these purposes. According to our survey data for fiscal year 2002, states spent subpart 1  funds most frequently on the salaries of child welfare agency staff,  administration and management expenses, CPS services, and foster care  maintenance payments. In addition, states reported using about 11 percent of their subpart 2 funds  for adoption support and preservation services. Staff and Data Issues Affect States’ Ability to Protect Children From Abuse and Neglect

Child welfare agencies face a number of issues related to staffing and data  management that impair their ability to protect children from abuse and  neglect. In particular, low salaries hinder agencies’ ability to attract  potential child welfare workers and to retain those already in the  profession. According to these caseworkers, high turnover rates and  staffing shortages leave remaining staff with insufficient time to establish  relationships with children and families and make the necessary decisions  to ensure safe and stable permanent placements. Furthermore, our July  2003 report found that states face challenges developing appropriate  information systems needed to track abuse or neglect reports and monitor  children in foster care. In addition, several factors  affect states’ ability to collect and report reliable adoption, foster care, and  child abuse and neglect data, including insufficient caseworker training,  inaccurate and incomplete data entry, and technical challenges reporting  the data. We  found that several factors affect states’ ability to collect and report reliable  data to HHS on children served by state child welfare agencies. Improvements in HHS’S Oversight of Child Welfare Programs Could Help States Overcome Some Challenges

HHS plays a role in helping states implement their child welfare programs,  but in some cases, additional federal oversight or technical assistance  could help states provide more effective services. In terms of child welfare  funding, HHS focuses its programmatic oversight on the overall child  welfare system in each state and provides relatively little oversight specific  to Title IV-B subpart 1. HHS’s role in assisting states overcome the child  welfare workforce challenges is limited to partial federal reimbursement  for training expenses and management of discretionary grant programs,  such as the Child Welfare Training Program. HHS Offers Assistance to Help States Develop SACWIS and Improve Their Data, but States Report Ongoing Challenges with Some of HHS’s Efforts

In response to some of the challenges states face in developing SACWIS  and collecting and reporting child welfare data, HHS has conducted on-site  reviews of information systems and provided technical assistance from a  variety of sources. We recommended in our September 2003 report on Title IV-B that the  Secretary of HHS provide the necessary guidance to ensure that HHS  regional offices monitor states’ use of Title IV-B subpart 1 funds for  compliance with statutory restrictions on the use of these funds. HHS disagreed with our second  recommendation, stating that it believes that its level of oversight is  commensurate with the scope and intent of the program and minimizes  states’ reporting requirements. To improve the reliability of state-reported child welfare data, we  recommended in our July 2003 SACWIS report that the Secretary of HHS  consider, in addition to HHS’s recent efforts to improve AFCARS data,  ways to enhance the guidance and assistance offered to states to help  them overcome the key challenges in collecting and reporting child  welfare data. Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare  Agencies Recruit and Retain Staff.
Why GAO Did This Study

Title IV-B of the Social Security Act, comprised of two subparts, is the primary source of federal funding for services to help families address problems that lead to child abuse and neglect and to prevent the unnecessary separation of children from their families; however, a number of challenges exist that impair states' ability to deliver and track these services. This testimony is based on findings from three reports issued in 2003 and addresses the following: (1) states' use of Title IV-B funds in providing a wide array of services to prevent the occurrence of abuse, neglect, and unnecessary foster care placements, as well as in providing other child welfare services; (2) factors that hinder states' ability to protect children from abuse and neglect; and (3) the Department of Health and Human Services' (HHS) role in helping states to overcome these challenges. Findings are based on multiple methodologies, including a survey to child welfare directors on states' use of Title IV-B funds; an analysis of nearly 600 exit interview documents completed by staff who severed their employment from 17 state, 40 county, and 19 private child welfare agencies; and a survey of all 50 states and the District of Columbia regarding their experiences in developing and using information systems and their ability to report data to HHS. In each case, GAO also conducted multiple site visits to selected states and interviewed child welfare experts and HHS headquarters and regional officials.

What GAO Found

States use of Title IV-B funds to provide a wide variety of services to prevent the occurrence of abuse, neglect, and foster care placements, as well as to provide other child welfare services. According to GAO's Title IV-B survey data for fiscal year 2002, states spent about 60 percent of subpart 1 funds on the salaries of child welfare agency staff, administration and management expenses, and child protective services, while about 10 percent were used to provide family support and family preservation services. In comparison, states spent about 62 percent of their subpart 2 funds on family support and preservation services. Child welfare agencies face a number of challenges related to staffing and data management that impair their ability to protect children from abuse and neglect. Low salaries hinder agencies' ability to attract potential child welfare workers and retain those already in the profession. According to caseworkers GAO interviewed, high turnover rates and staffing shortages leave remaining staff with insufficient time to establish relationships with families and make the necessary decisions to ensure safe and stable permanent placements. States also face challenges developing appropriate information systems needed to track abuse or neglect reports and monitor children in foster care. In addition, several factors affect states' ability to collect and report reliable adoption, foster care, and child abuse and neglect data, including insufficient caseworker training, inaccurate and incomplete data entry, and technical challenges reporting the data. HHS plays a role in helping states overcome some of the challenges they face in operating their child welfare programs, but additional oversight or technical assistance could assist states in meeting the needs of children served by child welfare agencies. HHS's oversight of Title IV-B focuses primarily on states' overall child welfare systems and outcomes, but the agency provides relatively little oversight specific to Title IV-B subpart 1. In addition, HHS plays a limited role in states' workforce activities by offering partial reimbursement for training expenses and managing discretionary grant programs. The agency monitors states' information systems development and data reporting, but despite the availability of technical assistance, states reported ongoing challenges reporting reliable data. In the related reports, GAO made several recommendations to HHS. GAO recommended that HHS provide the necessary guidance to ensure that regional offices monitor states' use of Title IV-B subpart 1 and to consider gathering additional information on its use. GAO also recommended that HHS take actions that may help child welfare agencies address recruitment and retention challenges. Last, GAO recommended that HHS consider ways to enhance the guidance and assistance offered to help states overcome key data challenges. HHS generally agreed with GAO's findings and recommendations, except that it noted that its level of oversight of Title IV-B was commensurate with the program's scope and intent.