G A O                     CHILD WELFARE
Accountability * Integrity * Reliability
Highlights of GAO-13-170, a report to
Congressional Committees

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.
View GAO-13-170. For more information,
contact Kay Brown at (202) 512-7215 or
brownke@gao.gov.

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, as seen in Figure I. Service gaps may harm child well-
being 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.
Figure I: Most Common Service Gaps Reported by 13 Selected Localities
Substance abuse assessmentitreatment
Assistance with material needs/housing
In-home services       --
Counselinglmental health services
Domestic violence services
Source: GAO analysis of information provided by child welfare officials in 13 selected localities.
United States Government Accountability Office