Over  675,000 children were found to be the victims of abuse or neglect. Many  of the children (both victims and non-victims) who were referred to child  welfare agencies, as well as their caregivers and families, received some  child welfare services, such as in-home services and counseling or other  mental health services. Another way child  welfare agencies secure services is by relying on partner agencies, such  as behavioral health agencies and public housing authorities. Federal Funds Dedicated to Child Welfare

Title IV-B is the primary source of federal child welfare funding available  for child welfare services, representing about 9 percent of dedicated  federal child welfare appropriations ($730 million of $8 billion) in fiscal  year 2012. Funds authorized under Title IV-E of the Social Security Act make up the  large majority of federal funding dedicated to child welfare, with funds  chiefly available for specific foster care and adoption expenses, but not for  services. Selected States Used Title IV-B Funds to Support a Wide Array of Services, and Strategies for Using These Funds Varied

Officials from the four states we studied reported spending Title IV-B  CWS funds in state fiscal year 2011 to support a variety of services and  other activities, and they told us they largely spent PSSF funds for  services in the program’s four required expenditure categories. Most States Rely on Flexible Federal Funding to Provide Additional Support for Child Welfare Services

		States Use TANF, SSBG, and Medicaid to Fund Services Also Covered by Title IV-B

Nationally, most states supplement Title IV-B funds with other federal  funding that is not dedicated to child welfare, according to expenditure  data states reported to ACF. As seen in figure 2  below, our selected states each used different combinations of federal  funds not dedicated to child welfare to support services and other  activities covered under Title IV-B in state fiscal year 2011. Moreover, nationally states reported spending these funds for a variety of  purposes. For example, 16 states reported using TANF funds for in-home  services, family preservation services, or both. For fiscal year 2012, Congress appropriated $1.7 billion in SSBG funds. One of our  selected states, Minnesota, claimed $24 million in federal reimbursement  for Medicaid targeted case management for children at risk of placement  in foster care and their families in calendar year 2011. Another selected  state, Virginia, reported claiming $1.9 million in federal Medicaid  reimbursement for targeted case management activities related to  children in foster care in state fiscal year 2011. Some States Have Waivers that Permit Them to Use Title IV-E Funding for Services Covered under Title IV-B

Although states are generally prohibited from funding services, such as  parenting classes and substance abuse treatment, with Title IV-E funds,  ACF has granted waivers permitting some states to do so. Child Welfare Agencies Have Difficulty Securing Many Services Due to a Variety of Challenges

		Gaps in Child Welfare Services Include Substance Abuse and Mental Health Services

Data from a national survey conducted by ACF indicate that not all  children and families in the child welfare system receive the services they  need. In  response to a GAO data collection instrument, most of these localities  reported key service gaps in the areas of substance abuse assessment  and treatment services; assistance with material needs, such as housing  and transportation; and in-home services (see figure 4). Officials in one of these localities noted that  clients often wait 2 to 3 months for these services. Officials in several of our selected localities also said it could be difficult  for families experiencing substance abuse to achieve reunification within   Delays in receiving treatment can make it difficult  mandated deadlines. In 6 of 13 localities,  officials cited lack of health insurance as a factor contributing to difficulty  securing medical services for families. For instance, local officials in New  Mexico described challenges in securing resources to provide services to  children and families at risk of foster care placement. For  example, one ACF official we interviewed noted that most states have  experienced budget cuts in social services, which affect both child welfare  and substance abuse services. There are also other opportunities on the federal, state, and local level for  child welfare and partner agencies to coordinate to improve service  delivery for children and families in the child welfare system. According to  agency officials, 14 grantees were coordinating with child welfare  agencies to address service development, funding, and access to  care for children and youth in the child welfare system and those at  risk of abuse or neglect. Agency Comments and Our Evaluation

We provided a draft of this report to the Secretary of Health and Human  Services for review and comment.
Why GAO Did This Study

In fiscal year 2011, over 675,000 children were found to be victims of abuse or neglect. To help ensure that such children have safe and permanent homes, state and local child welfare agencies secure child welfare services, such as parenting classes and substance abuse treatment. Title IV-B of the Social Security Act is the primary source of federal funding designated for child welfare services that is available to states. In fiscal year 2012, Congress appropriated $730 million under Title IV-B. Although states augment these funds with state, local, and other federal funds, some children and families may not receive the services they need. Congress mandated that GAO provide information about the funding and provision of child welfare services. This report addresses: (1) how selected states use funds provided under Title IV-B, (2) what alternative sources of federal funding states use to fund child welfare services and other activities covered under Title IV-B, and (3) what services, if any, child welfare agencies have difficulty securing for children and their families. To answer these questions, GAO reviewed relevant laws, regulations, guidance, and reports; analyzed HHS expenditure data and program evaluations; and interviewed HHS officials, child welfare experts, and state and local child welfare officials in 4 states and 13 localities selected to illustrate a variety of approaches to financing and delivering services. GAO also reviewed state fiscal year 2011 expenditure data from selected states and administered a data collection instrument to selected localities.

What GAO Found

The four states GAO selected used funds provided under Title IV-B of the Social Security Act for a variety of child welfare services and other activities, and had different strategies for spending these funds. For instance, in fiscal year 2011 Virginia provided funding to all local child welfare agencies to spend on their own priorities, such as parenting classes. New Mexico targeted certain counties for services, such as intensive in-home services for families at risk of foster care.
States nationwide also use other federal funds, such as Temporary Assistance for Needy Families (TANF) and Social Services Block Grant (SSBG) funds, as well as Medicaid, for purposes covered under Title IV-B. In the spring of 2011, 31 states reported spending TANF funds, and in fiscal year 2010, 44 states reported spending SSBG funds on these purposes. Some states also claim federal Medicaid reimbursement for activities covered under Title IV-B. One selected state, Minnesota, claimed reimbursement for case management for children at risk of foster care placement in 2011. Funds authorized under Title IV-E of the Social Security Act make up the large majority of federal child welfare funds, but are designated for purposes such as providing room and board payments for children in foster care and subsidies to adoptive parents, and generally cannot be used for child welfare services. However, 14 states have waivers allowing them to use these funds more flexibly to improve child and family outcomes. Among GAO's selected states, Florida had a waiver allowing it to use some Title IV-E funds for in-home services designed to prevent foster care placement.
Many services, including substance abuse treatment and assistance with material needs, such as housing, are difficult for child welfare agencies to secure due to a variety of challenges. A 2008-2009 U.S. Department of Health and Human Services (HHS) survey that sampled children and families in the child welfare system found that many did not receive needed services. For example, an estimated 58 percent of children age 10 and under at risk of emotional, behavioral, or substance abuse problems had not received related services in the past year. Local child welfare officials in four selected states reported service gaps in multiple areas. Service gaps may harm child wellbeing and make it more difficult to preserve or reunite families. For example, officials from one locality noted 2- to 3-month wait times for substance abuse services. Due to the chronic nature of the disease, delays in receiving services may make it more difficult to reunify families within mandated deadlines. Officials cited factors contributing to service gaps that included provider shortages and lack of transportation. Additionally, officials noted difficulty securing services from partner agencies, such as housing authorities. State fiscal constraints, which affect both child welfare and partner agencies, contribute to such difficulties.