oversight

Foster Care: Effectiveness of Independent Living Services Unknown

Published by the Government Accountability Office on 1999-11-10.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                 United States General Accounting Office

GAO              Report to The Honorable Nancy L.
                 Johnson, U.S. House of Representatives



November 1999
                 FOSTER CARE
                 Effectiveness of
                 Independent Living
                 Services Unknown




GAO/HEHS-00-13
      United States
GAO   General Accounting Office
      Washington, D.C. 20548

      Health, Education, and
      Human Services Division

      B-283530

      November 5, 1999

      The Honorable Nancy L. Johnson
      Chairman, Subcommittee on Human Resources
      Committee on Ways and Means
      House of Representatives

      Dear Madam Chairman:

      Each year approximately 20,000 youths exit the foster care system with
      the expectation that they will be able to live self-sufficiently.1 After exiting
      the system, many of these youths face serious problems, including
      homelessness, lack of employment stability, incarceration, and early
      pregnancy. Recently, a congressional subcommittee raised concerns in
      hearings that the federal Independent Living Program (ILP), designed to
      help foster care youths make the transition to living independently, does
      not give youths leaving foster care the necessary life skills to complete
      basic education, find and maintain employment, or otherwise live
      self-sufficiently after leaving care. The Congress is currently considering
      legislation that would double program funds and expand services for
      youths in foster care and those who will leave foster care.

      All states provide independent living services to youths about to leave the
      foster care system. Because of your concerns that little is known about the
      level of services offered to these youths and whether the services match
      their needs, you asked us to (1) describe the extent of services provided
      under ILPs, and (2) discuss what is known about the effect of these
      services on youths’ ability to live on their own.2 In conducting this work,
      we reviewed relevant literature and 1998 annual ILP reports submitted by
      the states to the Department of Health and Human Services (HHS). We also
      interviewed state and federal officials and independent living experts and
      visited independent living programs in four locations—Contra Costa
      County, California; Baltimore City and County, Maryland; New York, New
      York; and the San Antonio region, Texas. In addition, to obtain national
      information on additional services offered by state ILPs, we surveyed all 50
      states and the District of Columbia. We conducted our work between
      January and September 1999 in accordance with generally accepted


      1
       When youths who have not been reunited with their families or adopted attain age 18, federal
      reimbursement is no longer made to states for the youths’ maintenance in foster care. However, some
      states allow youths to remain in care, at state expense, until age 21.
      2
      We testified on these issues in May 1999 and this report expands on that information. See Foster Care:
      Challenges in Helping Youths Live Independently (GAO/T-HEHS-99-121, May 13, 1999).



      Page 1                                        GAO/HEHS-00-13 Foster Care: Independent Living
                   B-283530




                   government auditing standards. (A more detailed discussion of our scope
                   and methodology appears in appendix I.)


                   States provide a wide range of services to better ensure that foster care
Results in Brief   youths are prepared to live on their own after they leave the foster care
                   system. Those services—funded by federal, state, local, and private dollars
                   totalling at least $131.5 million in 1998—include assisting youths in
                   attaining their educational goals, such as completing high school or
                   passing the General Educational Development (GED) test and attending
                   postsecondary schools; as well as assisting youths in finding and
                   maintaining employment.3 In addition, youths attend classes in daily living
                   skills, covering such topics as money management, hygiene,
                   housekeeping, and nutrition, and receive instruction in areas that help
                   youths interact successfully with adults, such as conflict management.
                   Other transitional services, such as supervised practice living
                   arrangements and after-care services, allow youths to try living on their
                   own prior to leaving the foster care system and provide temporary
                   assistance to ease the transition to independence. However, state and local
                   administrators told us that their ILPs cannot always provide all of the
                   assistance administrators and youths say is needed to help youths learn to
                   live on their own. For example, some programs do not have fully
                   developed links with employers to provide job leads, lack opportunities
                   for youths to practice skills in real-life settings, and fall short on the
                   number of supervised practice living arrangements needed for youths to
                   become more proficient at living self-sufficiently.

                   Even though the federal ILP was established in 1985, few national or local
                   studies have been completed to assess the effectiveness of independent
                   living services in helping youths through the transition to living on their
                   own after foster care.4 We identified only one national study that has been
                   completed to date, which found that services provided by ILPs have the
                   potential to improve outcomes for youths. In addition, although several
                   states indicated they have completed studies that measure general youth
                   outcomes, such as education and employment status, only a few attempted
                   to measure the helpfulness of ILP services in youths’ ability to attain
                   self-sufficiency. While HHS is tasked with overseeing implementation of ILP,
                   it has done little to determine program effectiveness and has no

                   3
                    Some states were unable to identify the amount of additional state, local, or private funds spent on
                   their ILPs.
                   4
                    Although ILP was established in 1985, funds for payments to the states were not appropriated until
                   1987.



                   Page 2                                          GAO/HEHS-00-13 Foster Care: Independent Living
             B-283530




             established method to review the states’ progress in helping youths in the
             transition from foster care. For example, HHS primarily relies on state
             annual program reports for effectiveness information and has no other
             monitoring efforts in place. However, the content and quality of the
             reports vary and they contain little information on program outcomes. HHS
             officials told us they recognize these deficiencies and the need to improve
             monitoring efforts. To begin the improvement process, HHS issued a
             contract in September of 1998 to analyze 10 years of annual state ILP
             reports to determine, among other things, which states are producing good
             ILP reports that could be models for other states and what measures HHS
             can take to improve state reporting and evaluation. We are making
             recommendations to HHS concerning the need to enhance HHS’ and states’
             accountability for preparing youths to live on their own.


             Adolescents in foster care, especially those who have been in care for a
Background   number of years, face numerous challenges in preparing to become
             self-sufficient adults once they leave the foster care system. Several
             programs help foster care youths in their transition to independent living,
             but only one—ILP—is specifically designed to serve this population.

             The transition from the foster care system to self-sufficiency can be
             difficult. Research has shown that many former foster care youths have
             serious educational deficiencies and rely on public assistance. For
             example, a 1991 study of foster care youths interviewed 2.5 to 4 years after
             they left care found that 46 percent had not finished high school.5
             Additionally, almost 40 percent were found to be a cost to the community
             through their dependence on such programs as public assistance and
             Medicaid. Similarly, the University of Wisconsin recently studied youths
             who had been out of care between 12 and 18 months, and found that
             37 percent had not finished high school and 32 percent were receiving
             public assistance.6 In addition, former foster care youths often find
             themselves lacking adequate housing. The Westat study reported that
             25 percent of the youths were homeless at least 1 night, and the University
             of Wisconsin study found that, after leaving care, 14 percent of the males
             and 10 percent of the females had been homeless at least once. Additional
             difficulties may further impede youths’ ability to become self-sufficient.
             The Westat study found that 51 percent of the youths were unemployed

             5
              Westat, Inc., A National Evaluation of Title IV-E Foster Care Independent Living Programs for Youth
             (Washington, D.C.: HHS, 1991).
             6
             Mark E. Courtney and Irving Piliavin, Foster Youth Transitions to Adulthood: Outcomes 12 to 18
             Months After Leaving Out-of-Home Care (Madison, Wisc.: University of Wisconsin, 1998).



             Page 3                                        GAO/HEHS-00-13 Foster Care: Independent Living
B-283530




and 42 percent had given birth or fathered a child. Likewise, the University
of Wisconsin found that 39 percent of the youths were unemployed, and
that 27 percent of the males and 10 percent of the females had been
incarcerated at least once.

ILP—the   primary program designed to help foster care youths become
self-sufficient—authorizes federal funding for states to establish and
implement services to assist youths aged 16 and over in making the
transition from foster care to independent living. Originally authorized in
1985 by P.L. 99-272 for a limited period, the program was reauthorized
indefinitely as part of the Omnibus Budget Reconciliation Act of 1993 (P.L.
103-66), which also increased federal funding to the current level of
$70 million per year. A portion of the federal funds—$45 million—is
distributed to states as an entitlement based on each state’s proportion of
all youths receiving federal foster care maintenance payments in fiscal
year 1984.7 States are also eligible to receive a proportional share of the
remaining $25 million in federal funds to match the funds they provide.

HHS  estimates that almost 77,000 youths aged 16 to 20 were in foster care
as of September 1998. While approximately 40 percent of the youths in this
age range will return to their biological families, almost 20,000 adolescents
per year leave the foster care system and are expected to live
self-sufficiently. Eligible ILP participants include youths aged 16 and over
for whom federal foster care payments are being made.8 At their option,
states may use ILP funds for foster care youths not receiving federal
assistance and former foster care youths who were in foster care after the
age of 16. Likewise, states may provide services to any of these youths
until the age of 21. Youth participation in ILP services is voluntary.

Other federal programs may also provide some assistance to this
population, but are not designed to specifically provide services to foster
care youths. For example, HHS’ Transitional Living Program for Homeless
Youth provides funds to communities for housing and independent living
services to homeless youths. A variety of other programs may also assist

7
 Under Title IV-E of the Social Security Act, federal matching funds are provided to states for foster
care maintenance costs. These funds cover a portion of the food, housing, and incidental expenses for
foster care children from families who would have been eligible for benefits under the former Aid to
Families With Dependent Children program using 1995 eligibility criteria. States are responsible for
any foster care costs they incur for children not eligible for federal support.
8
 States can receive federal foster care maintenance payments for eligible children while they are in
foster care family homes, private for-profit or nonprofit child care facilities, or public child care
institutions. Youths become ineligible for federal foster care maintenance payments at age 18 or, at a
state’s option, age 19 if a child in foster care is a full-time student in a secondary school and is
expected to complete the educational program prior to turning 19.



Page 4                                         GAO/HEHS-00-13 Foster Care: Independent Living
                         B-283530




                         youths. For example, Job Corps, under the auspices of the U.S.
                         Department of Labor, enrolls youths aged 16 to 24 who are economically
                         disadvantaged, in need of additional education or training, and living
                         under disorienting conditions such as a disruptive homelife. In addition,
                         other agencies, such as the Departments of Justice, Education, and
                         Housing and Urban Development, have education and employment
                         assistance programs targeted to disadvantaged and at-risk youths. Service
                         agencies in the states may also provide assistance to youths, including
                         educational, juvenile justice, mental health, public assistance, and
                         substance-abuse service agencies.

                         The federal government provides most of the funding for ILP. In addition,
                         HHS is responsible for assisting state child welfare systems by promoting
                         continuous improvement in the delivery of child welfare services. In this
                         regard, HHS central office staff are responsible for developing ILP-related
                         policies, procedures, and regulations, and for ensuring their
                         implementation by the states. HHS’ regional office staff serve as the local
                         ILP contacts for the states, review and approve state applications for ILP
                         funds, and review the annual state ILP reports. Regional staff also provide
                         technical assistance to the states and clarification on program
                         requirements. In addition, the University of Oklahoma’s National Child
                         Welfare Resource Center for Youth Development, under cooperative
                         agreement with HHS, is responsible for providing ILP training and technical
                         assistance to the states in coordination with the regional offices.

                         HHS issued instructions to states in December 1993 outlining allowable ILP
                         services including education and employment assistance, instruction in
                         daily living skills, and other support services to ease youths’ transition to
                         independent living. In addition, states must provide written transitional
                         independent living plans based on an assessment of each youth’s needs
                         and may establish outreach programs to attract individuals eligible to
                         participate in the program.


                         To better ensure that foster care youths are prepared to live on their own,
Multiple Services        state ILPs provide an array of services using a combination of federal, state,
Assist Youths in         local, and private funds. These services include assistance with completing
Achieving                education and finding employment; instruction in the basic skills needed
                         to live independently, such as money management, hygiene, housekeeping,
Independence, but        and nutrition; and transitional services, such as supervised practice living
ILPs Fall Short in Key   arrangements (see appendix II). However, state and local administrators
                         told us that their current ILPs fall short in key areas. For example, some
Areas

                         Page 5                              GAO/HEHS-00-13 Foster Care: Independent Living
                                         B-283530




                                         programs do not sufficiently seek out employment opportunities in the
                                         community and offer few opportunities for youths to participate in real-life
                                         practice opportunities or esteem-building experiences. Moreover, some
                                         programs could not provide enough housing or other transitional
                                         assistance to both youths still in care and those who have left care. To
                                         address these shortcomings, a few locations have added specialized stuff
                                         and programs, such as developing partnerships with local businesses for
                                         part-time youth employment.


ILP Services Supported by                To provide ILP services, states use federal annual ILP funds of $70 million,
Federal, State, and Other                $25 million in state matching funds, and additional dollars provided by a
Funds                                    variety of sources. For example, our survey showed that 35 states reported
                                         spending additional state, local, and private funding on their ILPs totaling at
                                         least $36.5 million (see table 1).9 Also, 20 states reported receiving in-kind
                                         ILP donations such as mentoring services, use of facilities for training,
                                         attorney services, drivers’ education training, college scholarships, books,
                                         school supplies, clothing, computers, gift certificates, and household
                                         supplies for youths.

Table 1: Categories of Non-Federal ILP
Funding                                                                         Range of funding among
                                         Type of funding                                reporting states              Total funding reported
                                         State (20 states)                           $75,000 to $11 million                         $22.8 million
                                         Local (7 states)                             $1,000 to $6.5 million                          $13 million
                                         Private (7 states)                             $1,500 to $295,000                           $0.7 million

                                         Because federal funds can only be used to serve youths aged 16 to 21,
                                         more than one-third of the states reported using some additional funds to
                                         provide services to some youths younger than 16. During federal fiscal
                                         year 1998, the states served a total of 2,169 youths under age 16. Our
                                         review of state annual ILP reports showed that approximately 42,680
                                         youths aged 16 or older—only about 60 percent of all eligible
                                         youths—volunteered to receive ILP services in 1998, and officials in the
                                         states we visited noted that attracting youths to participate in the program
                                         is a challenge.10




                                         9
                                          Thirty-five states reported spending additional dollars beyond the federal funds and state match, but
                                         not all of these states reported the amounts spent in each category.
                                         10
                                           Although not all states included participation figures in their annual reports, we determined that at
                                         least 42,680 youths in 40 states received some type of independent living service during 1998.



                                         Page 6                                          GAO/HEHS-00-13 Foster Care: Independent Living
                            B-283530




Education and               According to our review of annual state ILP reports, 41 states reported
Employment Assistance       assisting youths with preparing for, or completing, education or vocational
Offered, but Few Pathways   training.11 Of these 41 states, 26 offered assistance, such as tutoring or
                            remedial training, to help youths graduate from high school or receive a
From Foster Care            GED; 28 states helped youths prepare for vocational school, for instance
Developed                   through vocational testing or referral; and 33 states helped youths pursue
                            postsecondary education, such as through educational planning or
                            assessments, assistance in applying for financial aid or college admission,
                            or campus tours.12 Further, 21 states awarded some tuition aid or
                            scholarships for college or vocational schools, and 20 helped pay for other
                            educational expenses such as books, training materials, uniforms, college
                            entrance exam fees, or college application fees.

                            In total, 40 states reported providing employment services to youths. Of
                            these, 28 states assisted youths with job readiness, including instructing
                            them in how to write resumes, how to interview for and maintain a job,
                            and how to complete job applications; and 24 states helped youths with
                            job search. Moreover, 18 states helped with job placement. For example,
                            for several youths with negligible work skills, the District of Columbia
                            contracted for job placement services that included a job coach, on-the-job
                            assistance with work problems, transportation assistance, mentoring, and
                            periodic group sessions.

                            Although all four areas we visited provided assistance with education and
                            employment, we found that the ILPs did not provide services that fully
                            matched foster care youths to appropriate employment pathways. For
                            example, officials in three of the sites told us that vocational opportunities
                            for youths were limited for several reasons. State and local coordinators in
                            Texas indicated that few apprenticeship positions are available, while ILP
                            coordinators in Baltimore City and New York reported a lack of vocational
                            education programs that youths can afford and a lack of ILP funds to pay
                            for such programs. These officials also reported that culinary arts and
                            technology-related programs—two programs popular with foster care
                            youths—are relatively expensive. Of the four sites we visited, only Texas



                            11
                              We reviewed 1998 annual state ILP reports from 45 states plus the District of Columbia. However,
                            because no standard report format exists, states do not consistently report services offered during the
                            previous year. We counted only those states that specifically mentioned providing a particular service
                            either throughout, or in some portion of, the state in their 1998 report, although others may have
                            provided the service but not included this information as part of their program description. According
                            to an HHS ILP official, annual reports from Alaska, California, New York, South Carolina, and
                            Wyoming were not available at the time of our review.
                            12
                              Many of these states reported providing all the educational services mentioned.



                            Page 7                                         GAO/HEHS-00-13 Foster Care: Independent Living
                               B-283530




                               offers statewide tuition waivers for all state-supported vocational,
                               technical, and postsecondary schools.

                               Our field visits also revealed that connections between the ILP and
                               potential employers were not thoroughly developed. For example, ILP
                               coordinators in one location told us they did not have time to establish
                               relationships with very many employers and that employment
                               development efforts in their location are largely informal. State officials in
                               California and Maryland indicated that they believe more public-private
                               partnerships are needed to provide youths with employment
                               opportunities. In addition, New York City officials told us that they are just
                               beginning to devise ways to link with employers to enhance youths’ job
                               prospects. Several officials also pointed out that more staff need to be
                               assigned to this task if it is to be accomplished.

                               Some locations are attempting to address these training and employment
                               shortcomings. For instance, Maryland established a partnership between
                               the ILP, the United Parcel Service (UPS), the Living Classroom Foundation,
                               and the Annie E. Casey Foundation. This program provides employment
                               opportunities, according to UPS officials, to expose youths to a significant
                               and demanding first job that teaches them invaluable, transferable
                               workplace skills. UPS supervisors work closely with youths to identify
                               barriers and access other resources if needed (such as mentoring,
                               counseling, or job readiness programs), and strive to instill leadership
                               skills and develop the youths’ potential. For example, the youths attend
                               career and academic goal-setting sessions with a UPS School-to-Work
                               Specialist. Moreover, UPS supervisors maintain close contact with youths
                               after they have been hired to ensure their success on the job.
                               Transportation to the work site is provided and on-site college-level
                               classes are available, as well as opportunities to combine working for UPS
                               with working for other area employers such as banks, grocery stores, and
                               drug stores. UPS planned to hire 75 foster care youths during the first year
                               of the partnership.


States Provide Assistance      In our review of annual state ILP reports, we found that 46 states report
in Learning Daily Living       training youths in daily living skills such as money management, health
Skills, but Opportunities to   and safety, nutrition, housekeeping, parenting and sexual responsibility,
                               and interpersonal and other social skills. The four areas we visited also
Practice Skills Are Lacking    offer training in daily living skills. For example, in Contra Costa County,
                               California, youths attend a series of living skills workshops that cover,
                               among other topics, how to prepare a budget and how to open and use a



                               Page 8                             GAO/HEHS-00-13 Foster Care: Independent Living
B-283530




checking account. Likewise, life skills classes in the San Antonio, Texas,
area meet for 8 weeks and cover core areas, including personal and
interpersonal skills, health and safety, money management, and planning
for the future. In New York City, life skills classes provide instruction on
housekeeping, health care, interpersonal skills, food management,
transportation, and family planning, among others.

Although some daily living skills are taught in a classroom setting, officials
in the four states we visited stressed the importance of experiential
learning, and independent living experts concurred that youths benefit
from activities in which they can practice the skills learned. State and local
program officials acknowledged the importance of activities that allow
youths to perform—and perhaps initially fail at—daily tasks until they
become proficient. According to local officials and service providers,
many foster youths have learned to depend on the child welfare system for
their care and thus may not have been exposed to everyday experiences
other teens take for granted, such as cooking, grocery shopping, driving,
or taking excursions outside their communities. To address this, Texas
and California conduct a program called “Independent City”—a simulated
community in which young persons are assigned an income and must
apply for jobs, sign leases for apartments, arrange for utilities, open
checking accounts, and buy cars.

In addition to the need to gain practical living experience, officials in three
of the locations we visited reported that youths need to learn interpersonal
skills, such as conflict management, communication, and decision-making.
Officials report that youths who do not master these other skills may have
difficulty finding and maintaining employment. To learn these skills,
youths may participate in classroom-based training or in recreational
events. In New York City, for example, one service provider takes youths
to Broadway plays or restaurants to allow them to learn how to interact in
social situations, including how to behave and how to order from a menu.
After the activity, youths meet with the coordinator to discuss lessons
learned. Other opportunities for youths to develop social skills, such as
team-building and leadership, are provided by teen conferences, retreats,
and youth advisory boards. For instance, Maryland holds an annual
statewide teen conference where youths attend workshops on
self-empowerment, conflict resolution, and goal achievement. Texas offers
wilderness challenge and ropes courses to strengthen problem-solving and
team-building abilities. Moreover, according to our review of annual
reports, 22 states have youth advisory boards that work to improve
policies and services affecting foster youths. The Youth Advisory Board in



Page 9                              GAO/HEHS-00-13 Foster Care: Independent Living
B-283530




Massachusetts, for example, meets with the commissioner of the social
services department quarterly to express concerns and recommendations
regarding agency foster care services and policies.

Further, officials in the four states we visited emphasized that youths need
to be able to form and maintain relationships with others. Establishing a
connection to an adult is so important, according to Texas state officials,
that one goal of the state’s ILP is for every young adult to have a significant
adult in his or her life when he or she leaves foster care. To help youths
receive this type of social support, many states use mentoring programs.
According to a study of 29 child welfare programs’ mentoring services,
these services can take many forms: some link adult mentors to youths to
assist them in making the transition from foster care to adult living, while
other programs involve workplace mentoring where the employer
provides jobs, monitors the work experience, and offers career
development opportunities to young persons.13 Officials in all the locations
we visited viewed mentoring programs as one method to provide youths
with a vocational role model and opportunities to practice independent
living skills, as well as opportunities to form connections to adults who
serve as positive role models.

We found that opportunities to practice daily life tasks and to develop
self-esteem were limited in some of the locations we visited. Program
officials in two locations and foster care youths in three locations told us
that issues such as safety regulations for group homes inhibit or prevent
certain activities, such as practicing cooking. In addition, esteem-building
experiences are often limited to a small number of youths. For example,
local officials in Texas reported that opportunities for foster care youths
to participate in postsecondary school conferences or extended outdoor
activities were limited. In addition, programs offering adult mentors serve
a small number of youths. For example, a foster care service provider in
Texas—contracted by the state specifically to develop mentor
programs—reported difficulty finding mentors.




13
 Edmund V. Mech and others, “Mentors for Adolescents in Foster Care,” Child and Adolescent Social
Work Journal, Vol. 12, No. 4 (Aug. 1995).



Page 10                                      GAO/HEHS-00-13 Foster Care: Independent Living
                           B-283530




Housing and Other          Transitional living arrangements allow youths to live on their own and
Transitional Support       practice becoming proficient at managing their lives while still receiving
Services Provide Bridges   supervision and financial support. Our survey showed that more than
                           80 percent of the states provided transitional practice living arrangements
to Adulthood, but          to some youths while they are still in foster care to allow them an
Obstacles Impede           opportunity to experience independent living for a period of time. About
Self-Sufficiency           37 percent of the states offered housing to some youths after they left the
                           foster care system. In Baltimore County, Maryland, for example, the
                           Challengers Independent Living program seeks to provide youths with the
                           means to cope with independence once they leave foster care. In this
                           program, foster care youths can reside for 18 to 24 months in apartments
                           furnished and supervised by the service provider and receive a weekly
                           stipend to purchase clothing, food, and household supplies. They are also
                           responsible for cleaning the apartments and doing their own laundry. Each
                           youth’s foster care payment covers the cost of rent, utilities, and
                           administration of the program. Program staff also offer educational,
                           vocational, clinical, and home-life support, including additional
                           independent living skills training. Similar programs, such as the Real
                           Solutions Transitional Living Program in San Antonio, Texas, are available
                           to young adults who have left foster care. This privately funded program
                           provides youths with a group living arrangement for up to 3 years,
                           normally from ages 18 to 21, while they adjust to self-sufficiency.

                           Additional transitional support services provided by the states include
                           counseling, programs for youths with special needs and disabilities, and
                           after-care programs for youths who are no longer in the foster care
                           system.14 Officials in the states we visited said that many youths have
                           mental health issues that need to be addressed. Some states noted in their
                           annual ILP reports that individual or group counseling may help address
                           issues that act as barriers to independent living for the teen population,
                           such as drug abuse, or may increase the youths’ ability to utilize
                           independent living skills they were taught. Thirty-one states indicated in
                           their annual reports that they offer some type of counseling service, such
                           as individual, group, or peer counseling. In Illinois, for example, support
                           groups provide a forum for youths to express their feelings about being in
                           foster care, as well as to identify issues and fears about leaving it. Seven
                           states offered specialized programs for developmentally disabled youths
                           and four states offered services for those with emotional or behavioral
                           problems.



                           14
                            HHS data for 1998 identified 20 percent of foster youths between the ages of 16 and 20 as having a
                           disability.



                           Page 11                                        GAO/HEHS-00-13 Foster Care: Independent Living
B-283530




To assist youths who have exited foster care, our survey showed that, in
federal fiscal year 1998, 30 states provided formal services for a period of
time after foster care, serving a total of 7,830 youths between the ages of
11 and 24. The majority of these states reported providing a full range of
services, including education and employment assistance, training in daily
living skills, and individual and/or group counseling. In addition, 21 states
reported providing other services and assistance such as mentoring,
transportation assistance, medical coverage, and clothing. Our field visits
confirm that some states offer after-care services. For example, Florida
reports serving former foster care youths through tuition assistance,
counseling, opportunities to attend conferences and receive skills training
or to serve as mentors or co-trainers, referrals to other agencies for
assistance in finding a job or housing, transportation assistance, and
opportunities to use the resource library.

However, we noted some concerns about these services. For example, the
number of transitional living arrangements is limited. Our survey showed
that 38 states served 6,320 current foster youths and 12 states served 1,787
former foster youths.15 Officials in the four areas we visited confirmed that
the number of supervised transitional housing sites is very limited and that
they could not provide adequate housing for both youths in care and those
who have left the system. One transitional housing provider in Texas
indicated that the program has space for only 6 youths, while an additional
80 to 100 youths with no place to live upon exiting foster care could
benefit from this type of housing program. A transitional housing provider
in a second location explained that program staff carefully screen youths
for readiness to handle the responsibilities of managing their own place to
live and, because of limited capacity, accept only the most promising teens
into the program. In addition, some officials noted that their after-care
services are limited and that they believe youths could benefit from more
services than they can offer. For example, in Texas, after-care services are
available for only 6 months after the youth exits care. The services consist
mainly of referrals to other service agencies, visits to colleges, and a small
stipend for 4 months. After-care services in Baltimore County and New
York City are limited to referring the youths to other agencies that can
assist them.




15
 According to our survey, 43 states reported providing transitional housing to current foster care
youths and 19 states reported providing this service to former foster care youths in fiscal year 1998.
Only 38 and 12 states, respectively, provided the number of youths served.



Page 12                                         GAO/HEHS-00-13 Foster Care: Independent Living
                         B-283530




                         Given the significant challenges that youths face in moving from foster
Information on           care to adulthood, it is important to understand how effective the ILP is in
Program                  better ensuring outcomes for foster care youths. However, little
Effectiveness Is         information is available to help in understanding the outcomes these
                         programs achieve. HHS has not taken an active role in identifying whether
Limited                  state ILPs are providing services that increase youths’ chances of becoming
                         self-sufficient once they leave the foster care system or in sharing
                         information among the states.


Few National and Local   Few studies that address ILP effectiveness have been conducted on a
Studies on ILP           national or local level. Only one national study has been completed since
                         ILP was established in 1985. This study—conducted by Westat, Inc., with
Effectiveness
                         funding from HHS—found that services provided by ILPs have the potential
                         to improve outcomes for youths. The study found that skills training in
                         particular areas led to better outcomes (e.g., health training aided youths
                         in gaining access to health care), although no one skill area had a
                         consistent effect across all outcomes assessed. More comprehensive
                         effects were achieved when youths were taught a combination of skills.
                         Youths who received training in managing money, obtaining a credit card,
                         and buying a car, as well as help in how to find a job and gain access to
                         appropriate education opportunities, were more likely to keep a job for at
                         least a year.

                         Two other studies are currently under way; study results are due in fall
                         1999. The Child Welfare League of America recently developed a state
                         survey on independent living services to gather comprehensive
                         information on ILP topics such as the population served, the type of foster
                         care placement and permanency plan for these youths, fiscal information
                         on ILP funds, ILP policies, transitional living arrangements, and model
                         programs. In 1997, the Annie E. Casey Foundation awarded a grant to the
                         National Child Welfare Resource Center for Organizational Improvement
                         at the University of Southern Maine and the National Resource Center for
                         Youth Services at the University of Oklahoma to define the current
                         knowledge base regarding the transition of youths out of foster care and to
                         examine effective practices and policies which may improve opportunities
                         for youths to become fulfilled, productive adults.

                         In addition, 12 states told us they had conducted follow-up studies of
                         youths who had left foster care and 14 additional states reported they had
                         a follow-up study under way or were planning such a study. Eight states
                         provided a copy of completed studies; only three of these studies asked



                         Page 13                            GAO/HEHS-00-13 Foster Care: Independent Living
B-283530




former foster care youths about the effectiveness of independent living
services they received while in care. For example, an evaluation of the
Wayne County, Michigan, ILP attempted to contact former ILP participants
to obtain information on their current situations.16 However, none of the
former clients could be located and the study was changed to a survey of
youths currently participating in an ILP or those receiving after-care
services. Of the 61 youths surveyed, over 80 percent indicated that their
quality of life improved after they received independent living services.
Youths judged housing and health care services more effective than other
services, and judged employment services among the least effective. A
study of 26 youths in Nevada about 3 months after leaving foster care
showed that most of the respondents believed the ILP helped prepare them
to some extent for making the transition to living on their own, including
preparing them to find a place to live, prepare meals, budget money, and
locate community resources.17 However, 53 percent of the youths were not
satisfied with their independent living services. Finally, in a 1995 North
Carolina study comparing 44 ILP participants and 32 nonparticipants who
left foster care between 1992 and 1995, 65 to 73 percent of the participants
felt that ILP services were helpful to some extent in preparing them for
independent living, although no specific area of ILP assistance stood out.
Fifty-five percent of the ILP participants started living independently
immediately after leaving foster care, compared to only 12 percent of
nonparticipants. Similarly, 30 percent of the ILP participants were paying
all their housing expenses within 1 to 3 years after leaving foster care, as
compared to 19 percent of nonparticipants. According to the study, these
and other housing-related findings indicate a definite, though gradual,
movement toward independent living that is more pronounced for ILP
participants than for nonparticipants.

We identified three additional local studies that show positive effects of ILP
services and link participation in ILP with improved education, housing,
and other outcomes—from Baltimore County, Harris County (Houston,
Texas), and New York City. In the Baltimore County study, youths who
received ILP services were more likely to complete high school, have an
employment history, and be employed when they left foster care.18 In the
Harris County study, the author found that graduates of the Texas ILP


16
 Moore & Associates, Inc., Final Report: An Evaluation of the Wayne County Independent Living
Coalition, submitted to the Michigan Family Independence Agency (Sept. 1998).
17
 Hailu Abatena, “Independent Living Initiative Program: A Follow Up Survey Report of the Youth
Released from Foster Care in Nevada in 1996” (Henderson, Nev.: Nevada Research, Evaluation, and
Planning Consultants, undated).
18
 Maria Scannapieco and others, “Independent Living Programs: Do They Make A Difference?” Child
and Adolescent Social Work Journal, Vol. 12, No. 5 (Oct. 1995).


Page 14                                      GAO/HEHS-00-13 Foster Care: Independent Living
                           B-283530




                           achieved full-time employment earlier and were more likely to complete
                           high school or a GED at a younger age than youths who did not receive
                           independent living services.19 The New York City study of independent
                           living services provided by Green Chimneys Children’s Services showed
                           that 75 percent of the youths had completed high school or a GED,
                           72 percent had full-time employment when they left care, and 65 percent
                           had savings accounts.20


HHS Slow in Leading        A 1994 HHS Office of the Inspector General (OIG) report and a 1995 Harvard
Efforts to Determine ILP   University study both recommended HHS take a stronger role in managing
                           ILPs. However, HHS has been slow in leading efforts to determine if state
Effectiveness
                           ILPs improve the ability of youths leaving the foster care system to live on
                           their own.21 The OIG report made two broad recommendations: (1) that
                           HHS’ Administration for Children and Families (ACF) should restructure its
                           ILP application and program reporting procedures to more adequately
                           support state plans and to gain an accurate national picture of
                           independent living efforts, and (2) that ACF should focus its management
                           and program reporting efforts on sharing information among the states.
                           The OIG report noted that the lack of accurate national information on
                           independent living efforts weakens basic accountability and hinders
                           efforts to improve programs and to determine effective practices. In
                           addition, the Harvard study recommended that greater emphasis be placed
                           on sharing information, with HHS’ regional offices taking the lead in
                           exchanging information among these offices and the states for which they
                           are responsible. According to the study, only 3 of the 10 regional offices
                           provided technical assistance to states beyond policy interpretation.

                           Currently, HHS has few strategies in place to review the states’ progress in
                           helping youths in the transition from foster care. HHS primarily relies on
                           annual state ILP reports and summary statistics from these reports for
                           information about ILP effectiveness. According to HHS staff, no additional
                           monitoring strategies are in effect. There are two problems with relying on
                           the annual reports to determine ILP effectiveness. First, as the OIG report
                           noted and we confirmed during our review of annual state reports, states’
                           approaches to program reporting and the quality of their program reports


                           19
                            Jane T. Simmons, “PAL Evaluation Final Report,” unpublished report submitted to Harris County
                           (Texas) Children’s Protective Services (Mar. 6, 1990).
                           20
                            Gerald P. Mallon, “After Care, Then Where? Outcomes of an Independent Living Program,” Child
                           Welfare, Vol. 77 (Jan./Feb. 1998).
                           21
                            Office of Inspector General, “Independent Living Programs for Foster Care Youths: Strategies for
                           Improved ACF Management and Reporting,” HHS (#OEI-01-93-00090, Nov. 1994); and Kari Burrell and
                           Valeria Perez Ferreiro, Policy Analysis Exercise (Cambridge, Mass.: Harvard University, Apr. 12, 1995).


                           Page 15                                        GAO/HEHS-00-13 Foster Care: Independent Living
              B-283530




              vary greatly. According to the OIG report, many state reports do not
              adequately address the intensity of services or the range of efforts made
              for youths in various placement settings. Likewise, states use various
              definitions of terms, which the OIG reported can result in duplicate counts
              and inconsistent statistics. To illustrate, the term “to be served” can mean
              in one state that a youth has received an assessment, while in another
              state it means that the youth was enrolled in a formal life skills course.
              Second, states are required to report certain information to HHS on the
              status of ILP participants 90 days after program completion—such as
              whether the youths are employed, have completed high school or a GED, or
              are living independent of public assistance. However, states inconsistently
              report this information and question the value of the data because they
              believe that 90 days may be too soon to judge youths’ independence. For
              example, the OIG found that some states provide information on youths 90
              days after discharge from foster care, while other states look at youths’
              status 90 days after completing the discrete ILP. Our review of 1998 annual
              state reports reveals that few reports address the effectiveness of services
              and outcomes for youths, making these reports an ineffective means of
              consolidating information on program effectiveness across the nation. To
              illustrate the difficulty in obtaining this outcome information, our
              nationwide survey showed that while 29 states attempt to contact ILP
              youths in response to the 90-day requirement, only four states reported
              success in contacting more than half of the former foster care youths. The
              majority of the states could locate only some or a few.

              HHS officials told us that they recognize deficiencies in the annual state ILP
              reports, and that the agency needs to improve its monitoring of the
              program. However, because no other data currently exist with which to
              determine program effectiveness, HHS issued a contract in September 1998
              to conduct an analysis of 10 years of annual state ILP reports so it can
              begin to fill the data gaps. According to project staff, this analysis
              represents HHS’ first attempt since ILP began to summarize what states are
              doing with their ILP funds. Project objectives include identifying which
              states are producing ILP reports that could be used as models by other
              states, as well as what measures HHS can take to improve state reporting
              and evaluation.


              The Congress has identified adolescent foster youths as an important part
Conclusions   of the foster care population and raised questions about whether states are
              doing enough to prepare youths to live self-sufficiently. Unfortunately,
              serving the population of youths about to leave the foster care system is



              Page 16                             GAO/HEHS-00-13 Foster Care: Independent Living
                   B-283530




                   difficult. Research has shown that many pitfalls are encountered by these
                   youths once they are on their own. Information on the services foster care
                   youths need to help them become independent is critical to the success of
                   ILPs. However, states do not routinely receive information on what has
                   worked best in other states and have inconsistently applied HHS
                   regulations on following up with youths. HHS has not analyzed information
                   from state ILPs to develop a national perspective on what services are most
                   needed and which services are less important in preparing youths to live
                   on their own once foster care ends. We believe HHS should take steps to
                   build a system of reporting and monitoring tools that would provide
                   policymakers and program officials with the necessary information to
                   assess the effectiveness of ILPs.


                   To enhance HHS’ and the states’ accountability in preparing youths to live
Recommendations    on their own after leaving the foster care system, the Secretary of HHS
                   should develop a uniform set of data elements and a report format for
                   state reporting on ILP so that analysis of ILP information can be conducted
                   using consistent data and the results shared with the states; and concrete
                   measures of effectiveness for assessing state ILPs, such as the number of
                   youths with stable employment and housing at the time they leave foster
                   care and at specific intervals thereafter.


                   We requested comments on this report from HHS and state ILP officials in
Agency and Other   the four states we visited. HHS, New York, and Texas provided technical
Comments           comments, which we incorporated where appropriate. In addition, New
                   York’s comments mentioned the need for additional incentives to
                   encourage youths’ participation in the program. California and Maryland
                   did not comment.




                   Page 17                            GAO/HEHS-00-13 Foster Care: Independent Living
B-283530




We are sending copies of this report to the Honorable Donna E. Shalala,
Secretary of Health and Human Services; state ILP coordinators; state child
welfare agencies; and other interested parties. Copies will also be made
available to others on request. If you or your staff have any questions
about this report, please call me at (202) 512-7215. Other major
contributors to this report are listed in appendix III.

Sincerely yours,




Cynthia M. Fagnoni, Director
Education, Workforce, and Income Security Issues




Page 18                           GAO/HEHS-00-13 Foster Care: Independent Living
Page 19   GAO/HEHS-00-13 Foster Care: Independent Living
Contents



Letter                                                                                               1


Appendix I                                                                                          22

Scope and
Methodology
Appendix II                                                                                         24

Figures From Our
Review of Annual
State Reports
Appendix III                                                                                        32

GAO Contacts and
Staff
Acknowledgments
Related GAO Products                                                                                33


Table                  Table 1: Categories of Non-Federal ILP Funding                                6


Figures                Figure II.1: Specific Education Services Reported by States                  24
                         During 1998
                       Figure II.2: Specific Employment Services Reported by States                 26
                         During 1998
                       Figure II.3: Specific Daily Living Skills Training Reported by               28
                         States During 1998
                       Figure II.4: Specific Financial Assistance Provided by States                30
                         During 1998



                       Abbreviations

                       ACF        Administration for Children and Families
                       GED        General Educational Development
                       HHS        U.S. Department Health and Human Service
                       ILP        Independent Living Program
                       OIG        Office of the Inspector General
                       UPS        United Parcel Service


                       Page 20                           GAO/HEHS-00-13 Foster Care: Independent Living
Page 21   GAO/HEHS-00-13 Foster Care: Independent Living
Appendix I

Scope and Methodology


             To identify what is currently known about the services provided by
             Independent Living Programs (ILP) and the effect of these services on
             youths’ ability to live on their own, we reviewed the relevant literature on
             problems former foster care youths face in living independently, 1998
             annual ILP reports submitted by the states to the Department of Health and
             Human Services (HHS) (see appendix II)22, and studies showing the
             effectiveness of ILP services. We also interviewed experts on independent
             living services. We obtained the perspectives of representatives of the
             National Child Welfare Resource Center for Youth Development, the
             National Independent Living Association, the Child Welfare League of
             America, and the Casey Family Program. In addition, we interviewed
             officials of HHS’ Children’s Bureau and Family and Youth Services Bureau.

             We developed a state survey to obtain national information on additional
             services offered by state ILPs and on additional funds spent beyond the
             federal dollars and required state matching funds. In April 1999, we
             surveyed ILP coordinators in each of the 50 states and the District of
             Columbia. We received responses from all states and the District of
             Columbia, and from these responses we obtained general information on
             (1) additional state, local, and private funds spent on ILPs, (2) the number
             of youths younger than age 16 served who were served and the services
             provided to them, (3) the extent of after-care programs, (4) the states’
             ability to follow up with youths after leaving care, and (5) the extent of
             transitional housing services. We also obtained information on outcome
             studies conducted by the states. We did not verify the information
             obtained through the survey. However, we conducted telephone
             interviews with state respondents to clarify answers, as needed.

             To obtain information on the services offered by states to youths leaving
             care and the problems states face in meeting their needs, we visited
             independent living programs in four locations—Contra Costa County,
             California; Baltimore City and County, Maryland; New York City, New
             York; and the San Antonio region, Texas. We chose these four locations
             because our analysis of the literature and discussions with key
             independent living experts identified these localities as having ILPs that
             provide critical services to help youths become self-sufficient, such as
             postsecondary tuition waivers and well-developed employment links in the
             community. California and New York also have large populations of foster

             22
               We reviewed 45 annual state reports, plus the report from the District of Columbia. At the time of our
             review, reports were not available from Alaska, California, New York, South Carolina, and Wyoming.
             HHS subsequently received reports from Alaska, California, New York, and South Carolina, but these
             were received too late to be included in our analysis. Wyoming did not submit an annual report
             because the state did not use federal ILP funds in 1998.



             Page 22                                        GAO/HEHS-00-13 Foster Care: Independent Living
Appendix I
Scope and Methodology




care youths. In each state, we met with state ILP officials to obtain an
overview of how the program is implemented throughout the state. At the
local sites, we met with a variety of staff and clients, including ILP
coordinators, case workers, private service providers, and current and
former foster care youths. Where available, we met with youth advocacy
organizations.




Page 23                          GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II

Figures From Our Review of Annual State
Reports


Figure II.1: Specific Education Services Reported by States During 1998




                                           Note: Delaware and Missouri provided education services but did not specify the type of services
                                           in their 1998 annual reports.




                                           Page 24                                      GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II
Figures From Our Review of Annual State
Reports




a
 High school or General Educational Development (GED) services enable participants to seek a
high-school diploma or its equivalent. Tutoring is an example of such services.
b
 Vocational services enable youths to participate in appropriate vocational training and may
include vocational testing or referral.
c
 Postsecondary education services enable youths to prepare for or attend college or university.
These services may include educational planning, assistance obtaining financial aid or college
admission, or college testing preparation.


Source: State annual ILP reports for 1998.




Page 25                                       GAO/HEHS-00-13 Foster Care: Independent Living
                                          Appendix II
                                          Figures From Our Review of Annual State
                                          Reports




Figure II.2: Specific Employment Services Reported by States During 1998




                                          Note: Louisiana, Nebraska, and Vermont provided employment services, but did not specify
                                          which services.




                                          Page 26                                     GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II
Figures From Our Review of Annual State
Reports




a
 Job readiness services can include information on how to prepare for a job, such as how to
prepare a resume or complete job applications, or how to maintain employment.


Source: State annual ILP reports for 1998.




Page 27                                      GAO/HEHS-00-13 Foster Care: Independent Living
                                            Appendix II
                                            Figures From Our Review of Annual State
                                            Reports




Figure II.3: Specific Daily Living Skills Training Reported by States During 1998




                                            a
                                             Money management can include instruction in budgeting or opening a bank or credit card
                                            account.




                                            Page 28                                     GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II
Figures From Our Review of Annual State
Reports




b
 Health and safety can include information about substance abuse, hygiene, parenting, first aid,
and leisure.
c
 Food and nutrition can include information about how to shop for groceries or prepare and cook
food.
d
 Community resources can include information about access to resources such as medical care,
legal services, transportation, and recreation.
e
 Social skills can include activities to improve self-esteem, interpersonal relationships,
problem-solving, leadership, and sexual responsibility.
f
Montana reported providing daily living skills but did not identify specific training offered.


Source: State annual ILP reports for 1998.




Page 29                                         GAO/HEHS-00-13 Foster Care: Independent Living
                                           Appendix II
                                           Figures From Our Review of Annual State
                                           Reports




Figure II.4: Specific Financial Assistance Provided by States During 1998




                                           Page 30                                   GAO/HEHS-00-13 Foster Care: Independent Living
Appendix II
Figures From Our Review of Annual State
Reports




a
 Financial incentives or stipends can include incentives for completing training or units of training
in daily living skills.
b
These services include tuition waivers or scholarships.
c
 These services include books, training materials, uniforms, college exam fees, and college
application fees.
d
These expenses can include fares for buses, trains, or airplanes; or gas for youths’ automobiles.
e
 Start-up assistance includes items such as utility deposits or household items (e.g., furniture,
dishes, and linens).


Source: State annual ILP reports for 1998.




Page 31                                         GAO/HEHS-00-13 Foster Care: Independent Living
Appendix III

GAO Contacts and Staff Acknowledgments


                  David D. Bellis, Assistant Director, (202) 512-7278
GAO Contacts      Diana M. Pietrowiak, Evaluator-in-Charge, (202) 512-6239


                  Ellen Soltow, Suzanne Sterling, Jay Smale, and Joel Grossman also made
Staff             important contributions to this report.
Acknowledgments




                  Page 32                          GAO/HEHS-00-13 Foster Care: Independent Living
Related GAO Products


              Youth Mentoring Programs: Fiscal Year 1998 (GAO/HEHS-99-129R, May 28,
              1999).

              Foster Care: Challenges in Helping Youths Live Independently
              (GAO/T-HEHS-99-121, May 13, 1999).

              Foster Care: Increases in Adoption Rates (GAO/HEHS-99-114R, Apr. 20, 1999).

              Juvenile Courts: Reforms Aim to Better Serve Maltreated Children
              (GAO/HEHS-99-13, Jan. 11, 1999).

              Child Welfare: Early Experiences Implementing a Managed Care Approach
              (GAO/HEHS-99-8, Oct. 21, 1998).

              Foster Care: Agencies Face Challenges Securing Stable Homes for
              Children of Substance Abusers (GAO/HEHS-98-182, Sept. 30, 1998).

              Foster Care: Implementation of the Multiethnic Placement Act Poses
              Difficult Challenges (GAO/HEHS-98-204, Sept. 14, 1998).

              Child Protective Services: Complex Challenges Require New Strategies
              (GAO/HEHS-97-115, July 21, 1997).

              Foster Care: State Efforts to Improve the Permanency Planning Process
              Show Some Promise (GAO/HEHS-97-73, May 7, 1997).

              Child Welfare: Complex Needs Strain Capacity to Provide Services
              (GAO/HEHS-95-208, Sept. 26, 1995).




(116033)      Page 33                            GAO/HEHS-00-13 Foster Care: Independent Living
Ordering Information

The first copy of each GAO report and testimony is free.
Additional copies are $2 each. Orders should be sent to the
following address, accompanied by a check or money order
made out to the Superintendent of Documents, when
necessary. VISA and MasterCard credit cards are accepted, also.
Orders for 100 or more copies to be mailed to a single address
are discounted 25 percent.

Orders by mail:

U.S. General Accounting Office
P.O. Box 37050
Washington, DC 20013

or visit:

Room 1100
700 4th St. NW (corner of 4th and G Sts. NW)
U.S. General Accounting Office
Washington, DC

Orders may also be placed by calling (202) 512-6000
or by using fax number (202) 512-6061, or TDD (202) 512-2537.

Each day, GAO issues a list of newly available reports and
testimony. To receive facsimile copies of the daily list or any
list from the past 30 days, please call (202) 512-6000 using a
touchtone phone. A recorded menu will provide information on
how to obtain these lists.

For information on how to access GAO reports on the INTERNET,
send an e-mail message with "info" in the body to:

info@www.gao.gov

or visit GAO’s World Wide Web Home Page at:

http://www.gao.gov




PRINTED ON    RECYCLED PAPER
United States                       Bulk Rate
General Accounting Office      Postage & Fees Paid
Washington, D.C. 20548-0001           GAO
                                 Permit No. G100
Official Business
Penalty for Private Use $300

Address Correction Requested