If the child welfare  agency places a child with a foster family working with a private provider,  the private provider may also be responsible for activities that can help  retain foster families, such as conducting regular visits with the family (in  addition to visits from child welfare agency caseworkers) and helping  them access needed services. States Employ a Range of Strategies to Recruit Foster Families and Nearly All Use Private Providers to Recruit, Particularly for Therapeutic Foster Care

		States Recruit Foster Families by Searching for Relatives, Conducting Outreach, Targeting Certain Populations, and Obtaining Referrals

			Searching for Relatives or Fictive Kin

In addition to the diligent recruitment requirements under title IV-B of the  Social Security Act, states receiving federal foster care funds under title  IV-E are generally required to search for relatives when a child enters  foster care. Almost All States Reported Using Private Providers to Recruit Foster Families, Particularly for Therapeutic Foster Care

In our survey, 49 states reported using private providers to recruit foster  families, including 44 that use private providers to recruit families who can  provide therapeutic foster care services for children who need a higher  level of care. They said responsibilities of  private providers can include helping families become licensed,  suggesting possible matches between children and available families,  and providing support to help families access services needed to care for  children in foster care (see fig. States Reported Various Recruitment and Retention Challenges, Including Difficulties Prioritizing Recruitment Efforts and Supporting Foster Families

		In Recruiting Foster Families, States Reported Challenges with Prioritizing Efforts, Extensive Licensing Processes, and Finding Families Who Can Meet the Needs of Children Difficulties Prioritizing Recruitment Efforts

In response to our survey, 34 states reported that limited resources to  focus on foster family recruitment made their recruitment efforts  moderately or very challenging. HHS Supports States’ Recruitment and Retention Efforts with Technical Assistance, Guidance, and Funding, though Private Providers Were Unaware of Some Supports

HHS’s Administration for Children and Families (ACF) provides a number  of supports to help state child welfare agencies in their efforts to recruit  and retain foster families, according to ACF officials we interviewed and  agency documents we reviewed. These supports include technical  assistance, guidance and information, and funding. However, similar to concerns raised by all 14 private providers in the  three selected states about communication issues with child welfare  agencies, several private providers told us they have not received  guidance or information from these agencies about recruiting and  retaining foster families, and most were unaware of some of the supports  provided by ACF. ACF officials said they encourage states to involve all relevant  stakeholders in their efforts to recruit and retain foster families. This could help HHS better achieve its goals in  supporting states’ efforts to recruit and retain foster families. Recommendation for Executive Action

GAO recommends that the Secretary of Health and Human Services seek  feedback from states on whether information on effective ways to work  with private providers to recruit and retain foster families would be useful  and if so, provide such information. HHS agreed with our recommendation and said it will explore  with states whether additional materials specific to private providers  would be useful. Appendix I: Objectives, Scope, and Methodology

	Overview

This report examines (1) how state child welfare agencies recruit foster  families, including those who provide therapeutic foster care services, (2)  challenges, if any, to recruiting and retaining families, and (3) the extent  to which the U.S. Department of Health and Human Services (HHS)  provides support to child welfare agencies in their efforts to recruit and  retain foster families. To obtain more in- depth information, we interviewed child welfare officials, private providers,  and foster parents in three selected states (California, Georgia, and  Indiana). We also reviewed relevant federal laws,  regulations, and HHS policies, as well as federal internal control  standards. The states were selected based on  factors such as recent changes in foster care and congregate care  caseloads, opioid abuse rates estimated by HHS in June 2016, variation  in child welfare administration systems (i.e., state- versus county- administered), and geographic location.
Why GAO Did This Study

Foster care caseloads have increased in recent years due, in part, to the national opioid epidemic. States have struggled to find foster families for children who can no longer live with their parents, including those who need TFC services. States may use private providers, such as non-profit and for-profit organizations, to help recruit and retain foster families. States may also use federal funds provided by HHS for these efforts. GAO was asked to review states' efforts to recruit and retain foster families.
This report examines: (1) how state child welfare agencies recruit foster families, including those who provide TFC services, (2) any challenges in recruiting and retaining foster families, and (3) the extent to which HHS provides support to child welfare agencies in these efforts. GAO reviewed relevant federal laws, regulations, and guidance; interviewed HHS officials; surveyed child welfare agencies in all states and the District of Columbia; held discussion groups with private providers and foster parents who provide TFC services; and conducted interviews with officials in California, Georgia, and Indiana, which were selected for factors such as changes in foster care caseloads, opioid abuse rates, and geographic location.

What GAO Found

States employ a range of strategies to recruit foster families and nearly all use private providers to recruit, particularly for therapeutic foster care (TFC) services, in which parents receive training and support to care for children who need a higher level of care. Recruitment strategies include searching for relatives, conducting outreach to the community, targeting certain populations, and obtaining referrals from current foster families. In response to GAO's national survey, 49 states reported using private providers to recruit foster families. In the three selected states where GAO conducted interviews, private providers were responsible for both recruiting and retaining foster families, such as helping families become licensed and providing them with support (see fig.).
States reported various challenges with recruiting and retaining foster families in response to GAO's survey. In recruiting families, over two-thirds of states reported challenges such as limited funding and staff, which can make prioritizing recruitment efforts difficult; extensive licensing processes; and difficulties finding families willing to care for certain children, such as those with high needs. In retaining families, 29 states reported concerns about inadequate support for foster families, which can include difficulties contacting child welfare agency caseworkers. In addition, 31 states reported limited access to services needed to care for children, such as child care.
The U.S. Department of Health and Human Services (HHS) provides a number of supports to help states recruit and retain foster families, including technical assistance with their recruitment programs, guidance and information, and funding. Most states GAO surveyed found HHS's supports moderately or very helpful. However, several private providers GAO interviewed in three selected states said they have not received guidance or information from child welfare agencies about recruiting and retaining foster families. In addition, 11 of the 14 providers said they were unaware of related HHS supports and all of them described concerns about communication with child welfare agencies. HHS officials said they encourage states to involve all relevant stakeholders in their efforts, though HHS has focused on supporting child welfare agencies. Consistent with internal control standards on communication, determining whether information on working with private providers would be useful to states could help HHS better support states' use of private providers in efforts to recruit and retain foster families.

What GAO Recommends

GAO recommends HHS seek feedback from states on whether information on effective ways to work with private providers to recruit and retain foster families would be useful and if so, provide such information. HHS agreed with GAO's recommendation.