Oversight and Monitoring of Child Welfare Programs

HHS provides oversight and monitoring of states in a variety of ways to  ensure their child welfare programs are in compliance with federal law,  regulations, and relevant approved state plans. HHS conducts statewide periodic assessments known as the Child  and Family Services Reviews (CFSR) that involve case-file reviews  and stakeholder interviews to ensure conformity with federal  requirements for child welfare services. According to the most recent data available, nationally, 14 percent of  children in foster care were in congregate care placements at the end of  fiscal year 2013, although the rates of congregate care use varied among  the states (see fig. Eight Selected States Reduced the Use of Congregate Care Substantially Using Multiple Approaches, but the Rates of Use Varied Widely

		The Eight Selected States Averaged a 47 Percent Reduction in Congregate Care Use, Although the Current Rates of Use Still Varied among These States

From September 30, 2004, to September 30, 2013, the share of all foster  care children in congregate care in the eight states we reviewed declined  47 percent on average, with reductions ranging from 7 to 78 percent,  according to the most recent data available from HHS. However, the states’ percentages of congregate  care placements ranged from approximately 5 percent in Washington to  34 percent in Colorado (see fig. In addition, caseworkers may  also recruit or train foster families to serve as treatment or therapeutic  foster families. The goals of the “Place Matters” initiative  include: (1) providing more in-home support to help maintain children with  their families; (2) placing children in family settings (either with relatives or  family-based care); and (3) reducing the length of stay in foster care and  increasing the number of reunified families. HHS Has Recently Taken Steps to Encourage States to Examine Their Use of Congregate Care, but Could Enhance Its Support to States

HHS’s Administration for Children and Families (ACF) recently took steps  to examine how states were using congregate care and as previously  mentioned issued a report in May 2015 to help inform states and  policymakers about the use of congregate care for foster children. For  example, consistent with the challenges we identified, states could benefit  from HHS’s assistance in the areas of increasing capacity for specialized  foster family placements and working with congregate care providers to  diversify their services. HHS has taken an important first step by issuing its report  on congregate care and recognizing that additional information is needed  on how states use congregate care and what changes are appropriate. Recommendation for Executive Action

We recommend that HHS take steps to enhance its support of state  actions to reduce the use of congregate care as appropriate. These steps  could include:  collecting additional information on states’ efforts to reduce their use  of congregate care; and  identifying and sharing best practices with the states and providing  technical assistance that states could use to address challenges in  the areas of building capacity for family placements, addressing  shortages of needed services, improving assessments, and retaining  sufficient numbers of congregate care providers, or other areas as  needed. HHS also noted that to assist states  in reducing their use of congregate care, the fiscal year 2016 President’s  budget request includes a proposal to amend title IV-E to provide support  and funding to promote family based care for children with behavioral and  mental health needs as well as provide oversight of congregate care  placements, as we noted in the report. These homes have  no more than 16 beds.
Why GAO Did This Study

About 14 percent of the more than 400,000 children in foster care nationwide lived in congregate care at the end of fiscal year 2013, according to HHS data. Given the importance of family-based care to foster children's well-being, GAO was asked to review state use of congregate care.
This report examines (1) how selected states have reduced their use of congregate care; and (2) some challenges with reducing congregate care placements, and efforts HHS has taken to help states reduce congregate care. GAO analyzed child welfare data from HHS; reviewed relevant federal laws, regulations, and documents; and interviewed state child welfare officials in eight states--Connecticut, Colorado, Kansas, Louisiana, Maryland, Minnesota, New Jersey, and Washington. In four of these states, GAO also visited and spoke with local child welfare officials and congregate care providers. The selected states varied in their use of congregate care and geographic location, but cannot be generalized nationwide. GAO also spoke with child welfare experts.

What GAO Found

Eight states GAO reviewed had a variety of efforts under way to help ensure they placed foster children in family-based settings rather than in group homes or institutions, also known as congregate care. Federal law requires that foster children have a case plan designed to achieve placement in the least restrictive (most family like) and most appropriate setting available, consistent with their needs. States' efforts to ensure appropriate placements included more oversight of decisions to place children in congregate care and the length of stay; enhanced recruiting and training for specialized foster families to care for children with serious emotional, behavioral, or medical problems; and increased supports for families in crisis. Officials in the eight states generally credited these efforts with declines in their use of congregate care—on average a 47 percent decline from fiscal years 2004 through 2013, based on the most recent available data from the Department of Health and Human Services (HHS). However, these states' percentages of foster children in congregate care still ranged from 5 percent to 34 percent, mirroring the variation nationwide in fiscal year 2013.
Selected stakeholders (state officials, service providers, and experts) cited challenges to more appropriate use of congregate care, such as providing specialized training to foster families, addressing shortages in mental health and other community services, and working with congregate care providers to focus more on providing services in family settings. In a May 2015 report, HHS said that states' progress in reducing congregate care was inconsistent and recognized that additional information was needed. HHS also proposed some relevant legislative changes. Stakeholders identified other HHS actions, such as additional data analysis and sharing of best practices that would help states facing challenges to transform their use of congregate care. HHS currently does not have plans to take further actions to support states.

What GAO Recommends

GAO recommends that HHS take steps to enhance its support of state actions to reduce use of congregate care as appropriate, by, for example, collecting additional information on state efforts and sharing best practices. HHS concurred with this recommendation.