oversight

Child Welfare: States' Progress in Implementing Family Preservation and Support Services

Published by the Government Accountability Office on 1997-02-18.

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

                 United States General Accounting Office

GAO              Report to the Chairman, Subcommittee
                 on Human Resources, Committee on
                 Ways and Means, House of
                 Representatives

February 1997
                 CHILD WELFARE
                 States’ Progress in
                 Implementing Family
                 Preservation and
                 Support Services




GAO/HEHS-97-34
      United States
GAO   General Accounting Office
      Washington, D.C. 20548

      Health, Education, and
      Human Services Division

      B-272396

      February 18, 1997

      The Honorable E. Clay Shaw, Jr.
      Chairman
      Subcommittee on Human Resources
      Committee on Ways and Means
      House of Representatives

      In the late 1980s, increases in illegal drug use, homelessness, and poverty
      contributed to dramatic increases in the rates of child abuse and neglect
      and the number of children in foster care. Intent on improving services for
      children and their families as well as reducing foster care costs, states
      began to reconsider their approach to child welfare. Rather than waiting
      until families reached the crisis stage, they began to focus more on early
      intervention and preventive services designed to strengthen and support
      families. By the early 1990s, however, the child welfare system was
      overwhelmed by the needs of an increasing number of at-risk families and
      children.1 States argued that additional federal funding was needed to
      supplement current state and federally funded programs. Therefore, to
      assist states in providing services designed to support families and help
      keep them together, the Congress enacted legislation as part of the
      Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) that authorized
      $930 million in federal funds to states over a 5-year period for family
      preservation and support (FPS) services. Family preservation services
      typically target families already in crisis whose children would otherwise
      be removed from home. Family support services are community-based
      activities intended to prevent the kinds of crises that family preservation
      services are aimed at alleviating. To receive federal funds for these
      services, each state had to submit a grant application in 1994 and a 5-year
      plan in 1995 that set quantifiable goals and methods for measuring
      outcomes.

      In response to your request concerning the status of states’ use of funds
      for FPS services, this report describes (1) the nature and extent of states’
      use of federal funds for new and expanded FPS services and (2) states’
      plans to assess the impact of these services on children and their families
      and impacts identified to date. This report builds on our prior work that
      assessed early federal and state implementation efforts.



      1
       See our prior reports, Child Welfare: Opportunities to Further Enhance Family Preservation and
      Support Activities (GAO/HEHS-95-112, June 15, 1995) and Child Welfare: Complex Needs Strain
      Capacity to Provide Services (GAO/HEHS-95-208, Sept. 26, 1995).



      Page 1                                              GAO/HEHS-97-34 Implementing FPS Services
                   B-272396




                   To collect information on states’ use of federal funds for and the impact of
                   FPS services, we conducted a nationwide survey of state child welfare
                   agencies; held in-depth interviews with officials in nine states and five
                   localities; interviewed Department of Health and Human Services (HHS)
                   officials in its headquarters office; and reviewed related federal and state
                   budget, summary, guidance, planning documents, and progress reports.
                   (See app. I for more details of our scope and methodology.)


                   All states reported to us that they are using federal funds to increase the
Results in Brief   availability of family preservation and family support services either by
                   creating new programs or expanding existing programs. Forty-four states
                   said that they introduced new programs. For example, some states
                   launched new programs in which counselors are available 24 hours a day
                   to work with families that have a history of child abuse. Forty-seven states
                   reported enhancing their existing programs or expanding them to serve
                   more clients. For example, adding a service like childcare could enhance a
                   family resource center that already provides an array of services, such as
                   parenting classes, afterschool activities, and family counseling.

                   As required by the law, our analysis shows that states appear to be
                   allocating a significant portion of their federal funds to both family
                   preservation and family support services. In the last 2 years, states
                   budgeted 56 percent of their service dollars to family support and
                   44 percent to family preservation. The somewhat greater emphasis on
                   family support services reflects priorities established through state and
                   community planning efforts. Moreover, many states already had family
                   preservation programs in place and decided to bolster family support
                   services.

                   To determine whether this infusion of federal funds improves services for
                   children and families, we identified a number of efforts that are underway
                   or planned to assess programs providing FPS services. States plan to track
                   the results of their federally funded services, for example, by measuring
                   the number of clients served and the extent to which their needs are met,
                   improvements in parent-child relationships, the degree that services are
                   coordinated, and indicators of community well-being such as child abuse
                   rates. Although not required to do so, at least 11 states are also planning
                   formal evaluations to determine whether the services actually improve
                   outcomes for families. Further, two federally sponsored evaluations are
                   underway to assess the effectiveness of family preservation and family
                   support services.



                   Page 2                                 GAO/HEHS-97-34 Implementing FPS Services
             B-272396




             Early results from 10 states indicate some successes, such as preventing
             child removal and continued maltreatment. While it is too early to
             determine the impact of these programs, federal and state officials report
             that the extensive community and interagency collaboration required by
             the law has resulted in improved identification of service needs, setting of
             priorities, and receipt of services by at-risk families otherwise overlooked.


             We previously reported that states originally funded most FPS services
Background   themselves or with nonfederal funds. As the demand for services
             increased and available resources became more constrained, states sought
             additional funding from federal sources, such as Title IV-B Child Welfare
             Services, Title XX Social Services Block Grant, and Title IV-A Emergency
             Assistance. However, funding levels were still insufficient to keep pace
             with service needs. By the early 1990s, over half the programs we surveyed
             reported that they were not able to serve all families who needed services
             primarily due to the lack of funds and staff.

             OBRA  1993 created the Family Preservation and Support Services program
             under Title IV-B, Subpart 2, of the Social Security Act. Administered by
             HHS’ Administration for Children and Families (ACF), OBRA 1993 authorized
             $930 million over a 5-year period. Through fiscal year 1997, Congress
             appropriated $623 million for grants to states to conduct planning
             activities and fund FPS services for the first time.2 The grants are based on
             each state’s percentage of children receiving Food Stamps, a federal food
             subsidy program for low-income households. State child welfare agencies
             are responsible for administering the FPS program in each of the 50 states
             and the District of Columbia.

             OBRA 1993 allowed states to use up to $1 million of their grant amount for
             planning purposes during the first year, with no required state match.
             Funds used for FPS services and other allowable activities, such as
             additional planning or evaluation, require a 25-percent state match. The
             law also requires states to spend a significant portion of service dollars for
             each type of service, which HHS has defined as at least 25 percent each for
             family preservation services and for family support services. Further, state
             administrative costs are limited to 10 percent.

             To receive FPS funds, states submitted grant applications to HHS by
             June 1994 and comprehensive plans a year later. These plans were based

             2
              An additional $52 million was set aside for court enhancement studies; FPS services grants to Indian
             tribes; and federal evaluation, research, training, and technical assistance. For fiscal year 1998, OBRA
             1993 authorized $255 million, which had not been appropriated at the time of our review.



             Page 3                                                GAO/HEHS-97-34 Implementing FPS Services
B-272396




on a needs assessment; developed with community groups; and
coordinated with health, education, and other agencies that serve children
and families. As required, the plans described goals that states expect to
achieve by 1999 and methods that they will use to measure their progress.
Federal guidance also encourages states to continue their collaborative
planning activities, improve service delivery, and leverage additional
funding from other sources for FPS services.

Family preservation programs generally serve families where child abuse
or neglect has occurred or where children have been identified as
representing a danger to themselves or others. These families risk having
their children temporarily or permanently placed outside the home in
foster care, juvenile detention, or mental health facilities. Most family
preservation programs provide specific services tailored to the family’s
needs to help ameliorate the underlying causes of dysfunction. These
services may include, for example, family counseling and training in
parenting skills. The intensity, duration, and packaging of services
differentiates these programs from the traditional delivery of child welfare
services, which also share the goal of placement prevention and family
reunification. Even among family preservation programs, however, service
delivery varies. In the widely used Homebuilders intensive crisis
intervention model, caseworkers typically carry small caseloads of two
families at a time and are available to families on a 24-hour basis for 4 to 6
weeks. In other program models, caseworkers may carry caseloads of up
to 20 families, with one or two personal contacts per week for a period of
7 or more months. (See app. II for a description of various family
preservation program models.)

Family support programs include a broad spectrum of community-based
activities that promote the safety and well-being of children and families.
In general, the purpose is to reach families before child abuse or neglect
occurs. Often provided in a community center or a school, family support
programs may include services outside the traditional scope of the child
welfare agency, such as health care, education, and employment. Some
family support programs offer a comprehensive array of services to an
entire community, including parenting classes, health clinics, and
counseling. Other programs are more narrow in scope and may focus only
on family literacy or provide information and referral services. Compared
to family preservation, eligible participants may be more broadly or
narrowly defined; for example, all families in a community or only teenage
mothers in a community. In practice, the distinction between family
preservation and family support services may be blurred.



Page 4                                  GAO/HEHS-97-34 Implementing FPS Services
                    B-272396




                    The federal FPS services legislation provides states with the flexibility to
States Are Using    meet the needs of children and families through family preservation and
Federal Funds for   community-based family support services. Exercising this flexibility, states
Both New and        have reported choosing to fund an array of services and, in many cases,
                    strategies for improving the ways in which services are delivered. Almost
Existing Services   all states appear to be introducing new family preservation and family
                    support services. Our analysis shows that states are allocating somewhat
                    more funds to family support services.


New and Expanded    Forty-four states reported that they used federal funds to create new
Services Vary       family preservation programs, family support programs, or both. For
                    example, Oregon has had one model of a family preservation
                    program—the Intensive Family Services Program—since 1980; however,
                    concerns about the high numbers of African-Americans in foster care in
                    one community prompted this state to initiate a new family preservation
                    program. This program is based on the Homebuilders service-delivery
                    model but refined to better meet the cultural needs of this population.3

                    Although almost all the states reported starting new programs, the size and
                    service levels of these programs vary across states and programs. Some
                    are quite small. For example, in a low-income neighborhood in Maryland, a
                    new family preservation component was added to a community-based
                    substance abuse treatment program. There, $40,000 pays for one
                    caseworker to provide family preservation services for as many as five
                    families at a time to prevent the need to remove children from their homes
                    while the parents are treated for substance abuse. Another new family
                    support program in this same community provides information and
                    coordinates communitywide activities to ensure families have knowledge
                    of and access to all available community resources. About $75,000 is being
                    spent for this program that plans to serve 200 persons by telephone or
                    in-person and make 600 contacts by mail a month.

                    By contrast, another community in Texas implemented a larger-scale
                    program spending $971,000 in federal funds over the last 2 years to create
                    a family resource center in each of three school districts. This new family
                    support program offers an array of services at each school-based center,
                    including parent education, counseling, adult education, childcare, some
                    health care, and family support workers for families in need of more


                    3
                     Compared with the Homebuilders model, Oregon’s state family preservation program relies less on
                    the provision of concrete and supportive services and more on family therapy; moreover, treatment is
                    less intensive.



                    Page 5                                              GAO/HEHS-97-34 Implementing FPS Services
                              B-272396




                              intensive services. As of August 1996, over 3,000 households containing
                              8,600 individuals had registered since the program’s inception.

                              In addition to introducing new programs, almost every state used federal
                              funds to fill gaps in existing FPS services. Forty-seven states reported
                              expanding existing family preservation services, family support services,
                              or both by making them available to more clients within existing service
                              areas, by adding more program sites, or enhancing programs by increasing
                              the intensity of existing services or adding new services as illustrated by
                              the following cases:

                          •   Texas expanded its intensive placement prevention program to additional
                              locations to reach new clients as well as more clients within existing
                              service areas. This family preservation program is designed to prevent the
                              need for placing abused and neglected children in foster care. The existing
                              18 service-delivery units are being expanded to 38 units and about 115 new
                              workers are being hired to serve an additional 520 families per year.
                          •   Arkansas expanded its Intensive Family Services program from 10 to 20
                              counties. This family preservation program was also enhanced by adding
                              emergency cash assistance for participating families. This new service will
                              enable families in crisis to address some of their immediate needs, such as
                              covering back rent to avoid becoming homeless.
                          •   One Maryland community enhanced a neighborhood recreation program
                              by adding new activities and increasing its hours of operation. Community
                              members voiced concern that the lack of recreational activities was a
                              factor in the adolescent crime rate. This family support program is
                              designed to give young people a safe place to congregate and recreate,
                              especially in the late afternoon and evening hours, to keep them off the
                              streets and away from the influence of illegal and drug-related activities.

                              The likelihood of states creating new or expanding existing programs
                              appeared unaffected by whether states had previously provided family
                              preservation or family support services, how long states have had service
                              dollars available, or whether service decisions were made at the state or
                              local level. Our analysis of state survey responses showed no clear
                              patterns regarding the circumstances that might result in states funding
                              certain types of services.


States Place Somewhat         As the law requires, most states are spending a significant portion of their
More Emphasis on Family       federal funds for family preservation services and family support services.
Support Services              Of the federal funds used for services in fiscal year 1996, states allocated



                              Page 6                                 GAO/HEHS-97-34 Implementing FPS Services
                                     B-272396




                                     an average of 56 percent to family support services and 44 percent to
                                     family preservation.4

                                     In 1996, over half the states allocated a majority of their service dollars for
                                     family support services, as shown in table 1. Four of these states are using
                                     all their service dollars for family support activities, which is allowable as
                                     long as the state justifies this distribution.

Table 1: Type of Service Receiving
Majority of Funding, by Number of    Type of service                                                                 Number of states
States, Fiscal Year 1996             Family support servicesa                                                                            29
                                     Family preservation services                                                                        11
                                     Equal funding for both services                                                                     11
                                     Total                                                                                               51
                                     a
                                      Four states—District of Columbia, Iowa, Massachusetts, and Tennessee—are using all their
                                     service dollars for family support services.

                                     Source: GAO analysis of HHS summary of state budget requests.



                                     While every state is initiating or expanding family support services, family
                                     preservation services, or both, slightly more states are using federal funds
                                     for family support services. Forty-one states reported introducing new
                                     family support programs, while 34 states initiated new family preservation
                                     programs. Forty-three states expanded existing family support services,
                                     compared to 38 states for family preservation.

                                     Several reasons may explain why states have placed somewhat more
                                     emphasis on family support services. According to federal and state
                                     officials, some states had already spent considerable state or other federal
                                     funds for family preservation services and decided—either at the onset or
                                     based on planning results—to place greater emphasis on family support
                                     services. Further, many states delegated to counties or communities the
                                     responsibility for conducting localized planning and making service
                                     decisions. Localities were apt to be more familiar with support services
                                     and to play a larger role in program decisions than the child welfare
                                     agencies familiar with family preservation.


Federally Funded Services            States have had 1 to 2 years to initiate or expand family preservation and
Were Implemented Within              family support services, depending on how they used their first year’s
Last 2 Years                         funds. All states spent at least a year doing collaborative community-based
                                     4
                                      Amounts for family preservation and support services are based on budget information that states
                                     submit to HHS each year. Data on actual expenditures are not readily available.



                                     Page 7                                              GAO/HEHS-97-34 Implementing FPS Services
                       B-272396




                       planning to develop their 5-year plans, in accordance with HHS guidance.
                       Nineteen states elected to implement services while simultaneously
                       conducting planning activities resulting in these states having had about 2
                       years to implement services. The majority of the states, however, began to
                       implement federally funded services a year later, after they had completed
                       their 5-year plans.5

                       For those states that have had a year to initiate or expand services, most
                       reported that implementation of family preservation and family support
                       services has been slower than they expected. In total, 25 states indicated
                       being behind schedule primarily due to the magnitude and complexity of
                       the implementation effort. Most of these states said that they experienced
                       delays in designing or developing FPS services. Moreover, the competitive
                       process to select communities or programs that would receive federal
                       funds also caused delays in several states. Officials had not anticipated the
                       time required to solicit and review proposals, respond to challenges, and
                       award contracts. Many states also reported that an extended period of
                       time was required to change their service-delivery system to facilitate
                       implementation, such as training staff on procedural changes and
                       collaborating with other service providers. In addition to these procedural
                       factors, many states attributed their receipt of federal funds later than
                       expected as a reason for being behind schedule.


Other Activities Are   While states appear to be using most of their federal FPS funds to initiate or
Designed to Improve    expand family preservation or family support services, many states are
Service Delivery       also undertaking a variety of activities to enable the service-delivery
                       system to serve vulnerable children and families more effectively and
                       efficiently. According to estimates provided by each state at the time of
                       our study, an average of 83 percent of federal funds had been spent on
                       direct services, such as the new and expanded family preservation and
                       family support services already described. The remaining federal dollars
                       were used for other allowable activities, including additional planning,
                       administration,6 and capacity-building such as training and technical
                       assistance.

                       Five states dedicated all their FPS funds to the provision of direct services,
                       while 46 states used a portion of their funds for other activities as well as


                       5
                        First-year funds were available to all states by Sept. 1994. The next year’s funds—triggered by states’
                       submittal of their 5-year plans—were available a year later.
                       6
                        According to federal guidance, administrative costs include costs for procurement, payroll
                       processing, management, data processing and computer services, and other indirect services.



                       Page 8                                                GAO/HEHS-97-34 Implementing FPS Services
                          B-272396




                          direct services. Thirty-eight of these states conducted activities designed
                          to enhance the capacity of state and local agencies to provide family
                          preservation and support services. These activities included staff training
                          in cultural awareness or procedural changes, technical assistance to
                          service providers, research or evaluation activities, and management
                          information system development and improvement. For example,
                          Arkansas held two conferences, which were attended by over 1,000
                          individuals, to educate the public on prevention issues, encourage
                          collaboration among providers, and provide technical assistance and
                          training to staff of community-based organizations. Several states
                          contracted with universities or private research firms to conduct outcome
                          evaluations. In Idaho, local panels were established to review closed child
                          protection cases to identify service gaps and improvements to the
                          service-delivery system responsible for investigating allegations of child
                          abuse and neglect.

                          In addition, 17 states reported that planning activities will continue beyond
                          1995. For example, Maryland is taking more time to allow its 19 local
                          management boards representing the state’s 24 counties to develop their
                          own community-based plans. At the time of our study, the state had
                          provided federal funds to 11 boards for localized planning. Eventually
                          every local management board in the state will have the opportunity to
                          develop its own plan.


                          Midway into this 5-year program, it is too early to identify what impact the
Results and Impact        federally funded family preservation and family support services have had
Will Be Monitored in      on the lives of vulnerable children and their families. Several efforts,
Various Ways              however, are underway to monitor results and assess impact. By law,
                          states must track results and report on their progress in achieving the
                          goals set in their 5-year plans. Some states will also conduct formal
                          evaluations to examine outcomes and processes. To determine the impact
                          of federally funded services, however, requires rigorous evaluation. Eleven
                          states plan to conduct such evaluations. In addition, federal efforts are
                          underway to assess the effectiveness of family preservation and family
                          support services.


States Will Use Various   States plan to track the results of federally funded services by using a
Measures and Methods to   variety of measures. At a minimum, all states report that they will track the
Track Results             number of children and families served and most will measure the extent
                          to which their needs are being met. Specifically, 45 states will look for



                          Page 9                                 GAO/HEHS-97-34 Implementing FPS Services
B-272396




evidence of changes in parent-child relationships, family functioning, or
participants’ satisfaction with services delivered. Many states will also
assess the well-being of children by using appropriate measures, such as
the number of infants discharged from community care who receive
follow-up care within 48 hours. More than half the states told us that they
expect to determine the program’s cost effectiveness, the efficacy of
certain services for particular client groups, or both. Finally, at least 45
states plan to monitor traditional indicators of child welfare, such as the
number of child abuse and neglect reports, and changes over time in one
or more aspects of the service-delivery system. For example, one state
plans to examine the extent to which consumers are participating in
service planning groups and services are provided in conjunction with
community and neighborhood organizations.

Having set goals and measurable objectives in their 5-year plans, states are
expected to annually report on outcomes and progress towards achieving
these goals. At the time of this report, HHS and its contractor responsible
for evaluating state implementation were reviewing states’ first progress
reports and expected to complete their initial analyses in December 1996.
In addition, some states will conduct formal evaluations that examine
processes and outcomes, in many cases in conjunction with schools of
social work at state universities. For example, Kentucky has contracted
with the University of Kentucky to develop an evaluation program to
assess the extent to which the state’s FPS services program reaches the
target population, monitor the frequency of service delivery and client
participation, tabulate the cost of implementing the program, and assess
the extent that program goals are achieved. In Arizona, the state’s
evaluation will track multiple child, family, and community outcome
measures over time and compare results to baseline indicators. Data
sources include family questionnaires, agency reports, and worker
assessments.

State plans for monitoring and evaluating FPS programs should yield useful
information on the size, nature, and outcomes of funded activities as well
as changes in the well-being of communities, families, and children.
Because these efforts will not necessarily confirm that the programs
caused improved outcomes, 11 states plan to conduct their own rigorous
evaluations—even though such evaluations are not required—that will
yield more conclusive results. For example, a research contractor will
conduct a 3-year randomized clinical trial of a home visitation program in
San Diego County, California, that is based on Hawaii’s Healthy Start




Page 10                                GAO/HEHS-97-34 Implementing FPS Services
                            B-272396




                            model.7 Researchers will randomly assign 500 families to one of two
                            groups—about half the families will receive program services and the
                            other families will not—and evaluate the effectiveness of the program
                            model as it is implemented in San Diego. Primary study objectives include
                            testing whether implementation of this model results in improved
                            outcomes and determining what cost-benefits are derived.


Federal Evaluations Are     Two federal evaluations are underway to rigorously assess the impact of
Designed to Assess Impact   FPS programs on children and families—one for family preservation and
                            the other for family support services. Each evaluation is comprised of
                            multiple studies of mature programs—initiated before the federal FPS
                            services law—that span a range of program models and methods for
                            targeting services. At the time that we prepared this report, the research
                            contractors were expected to begin data collection in the fall of 1996 and
                            issue interim reports a year later.

                            The family preservation evaluation is reviewing four programs that aim to
                            prevent out-of-home placement and one program that tries to reunite
                            foster children with their families.8 Two of these programs use the
                            Homebuilders crisis intervention model, while the other three use less
                            intensive service models. Each program evaluation is designed to assign
                            families to treatment and control groups. Families in the treatment group
                            receive services from the family preservation program. Families in the
                            control group receive services that they would have received if the
                            program was not available. Outcomes to be measured include changes in
                            foster care placement rates, recidivism, and duration in stay, as well as
                            family functioning and subsequent child abuse and neglect.

                            The family support evaluation consists of multiple studies of eight
                            different programs, including several comprehensive community family
                            support programs as well as those that focus on economic self-sufficiency,
                            family literacy, or preventing substance abuse.9 Five programs are being
                            evaluated using treatment and control groups. The remaining three
                            programs will compare families that receive program services with

                            7
                             The Healthy Start model uses home visitors to provide supportive services to families at risk of
                            becoming abusive. New mothers are screened and interviewed at the hospital and can voluntarily
                            receive family support services until their children are 5 years old.
                            8
                            The family preservations programs are in New York City, Philadelphia, the Louisville area of
                            Kentucky, the Memphis area of Tennessee, and selected counties in New Jersey.
                            9
                             The family support programs are in Albuquerque, New Mexico; San Jose, California; Cleveland, Ohio;
                            Denver, Colorado; Pensacola, Florida; New York City; several cities in Wisconsin; 11 counties in Iowa;
                            and 6 school districts in Kentucky.



                            Page 11                                              GAO/HEHS-97-34 Implementing FPS Services
                             B-272396




                             families in other programs or similar settings. For example, families that
                             participate in Florida’s Full Service Schools program will be compared
                             with families in comparable schools where the program is not offered.10
                             Outcomes to be measured include family functioning, child and family
                             well-being, instances of child abuse and neglect, and satisfaction with
                             services delivered.


Early Results Are Few, but   Although it is too early to identify service impacts on children and
Service-Delivery             families, 10 states reported that program results were available on
Approaches Have Been         federally funded FPS services. Most of these states collected data on the
                             number of children and families served, changes in child abuse and
Affected                     childhood mortality rates, as well as changes in their approaches to
                             delivering services. For example, Louisiana reported on the results of
                             federally funded projects after the first year of implementation. To
                             contribute to future planning efforts related to the configuration of family
                             preservation and family support services in Louisiana, the evaluation
                             described the services and population characteristics in three programs
                             and assessed the relationship between services and short-term outcomes.
                             In particular, the Intensive Home Based Services program, which is a
                             family preservation program, met its goal of preventing child removal and
                             continued maltreatment. A family support program, designed to prevent
                             child abuse and neglect, resulted in few reports of child maltreatment even
                             though a majority of cases had had one or two child abuse or neglect
                             reports before receiving program services. In another example for another
                             family support program operating at a child development center whose
                             primary service population is teenage parents and their children,
                             individual service needs were summarized based on participants’ and
                             workers’ completion of a new needs assessment form.

                             While not much is known yet about the impact of federally funded
                             services, the legislation appears to have affected the ways in which states
                             and localities develop and administer services for children and their
                             families. According to federal and state officials, the primary impact to
                             date has been to forge links between state agencies and the communities
                             they serve. The process of developing states’ 5-year plans resulted in
                             public agencies, organizations, service providers, and consumers working
                             together for the well-being of children and families. Many states departed
                             from their traditional method of administering child welfare services at the

                             10
                               The Full Service Schools model is a school-based family support program that integrates education,
                             medical, and human services for general and certain at-risk populations in predominantly low-income
                             communities. Primary objectives include helping children to be better prepared for school, reducing
                             teenage pregnancy rates, and reducing the need for mental health and substance abuse services.



                             Page 12                                             GAO/HEHS-97-34 Implementing FPS Services
                     B-272396




                     state level. In particular, 27 states reported distributing federal funds to
                     counties and other local entities, such as community groups and local
                     coalitions, to develop their own plans and make service decisions. Several
                     states took additional steps to better identify the service needs of children
                     and families. For example, Michigan is investing an additional $10 million
                     in state funds to supplement federal funds and enable each of its 83
                     counties to participate in the process of improving services to better meet
                     local needs. State officials credit this process with ensuring that at-risk
                     families now have greater access to needed services and contributing
                     significantly to the broader goal of positive system reform.


                     Before the enactment of OBRA 1993, FPS programs throughout the country
Conclusion           were unable to meet the demand for services to strengthen and support
                     families. Since then, states have begun to both initiate and expand
                     programs of family preservation and support services to achieve the
                     purpose of the FPS legislation. Early results indicate that these services are
                     being offered to families and children who might otherwise have fallen
                     through the cracks and that some programs supported with federal funds
                     have met their goals of strengthening families and reducing child abuse
                     and neglect. Information being gathered by states, universities, and
                     research firms should increase our understanding of the outcomes of
                     funded activities as well as changes over time in the well-being of
                     communities, families, and children. Moreover, the community-based
                     collaborative planning process undertaken seems to be having beneficial
                     effects on the service-delivery system. While there has been service
                     innovation and services have been expanded, it is still too early to tell
                     what will be the ultimate impact of these programs on children and
                     families.


                     In commenting on a draft of this report, HHS agreed with our findings that
Agency Comments      implementation has been slower than expected but has achieved several
and Our Evaluation   positive outcomes. In particular, HHS emphasized the availability of new
                     and expanded programs for both family preservation and support services,
                     the focus on family support as a balance to family preservation, and the
                     extension of services to families otherwise overlooked. Further, HHS noted
                     that the use of FPS funds has encouraged collaboration among programs
                     and levels of government and has attracted additional funds to meet
                     community needs.




                     Page 13                                 GAO/HEHS-97-34 Implementing FPS Services
B-272396




We are providing copies of this report to the Secretary of Health and
Human Services, state child welfare directors, and state FPS coordinators.
We will also make copies available to other interested parties upon
request. Should you or your staff have any questions or wish to discuss the
information provided, please call me at (202) 512-7125. Other GAO contacts
and staff acknowledgements are listed in appendix IV.

Sincerely yours,




Mark V. Nadel
Associate Director, Income Security Issues




Page 14                               GAO/HEHS-97-34 Implementing FPS Services
Page 15   GAO/HEHS-97-34 Implementing FPS Services
Contents



Letter                                                                                             1


Appendix I                                                                                        18
                       GAO Survey Instrument                                                      18
Scope and
Methodology
Appendix II                                                                                       20

GAO Survey of State
Child Welfare
Agencies
Appendix III                                                                                      38

Comments From the
Department of Health
and Human Services
Appendix IV                                                                                       40

GAO Contact and
Acknowledgments
Table                  Table 1: Type of Service Receiving Majority of Funding, by                  7
                         Number of States, Fiscal Year 1996




                       Abbreviations

                       ACF        Administration for Children and Families
                       ASPE       Office of the Assistant Secretary for Planning and Evaluation
                       FPS        family preservation and support
                       HHS        Department of Health and Human Services
                       OBRA       Omnibus Budget Reconciliation Act


                       Page 16                               GAO/HEHS-97-34 Implementing FPS Services
Page 17   GAO/HEHS-97-34 Implementing FPS Services
Appendix I

Scope and Methodology


             We had previously assessed federal and state efforts to implement the FPS
             provisions during the first 18 months after OBRA 1993 was enacted and
             highlighted areas in which those efforts could be enhanced.11 To update
             this information, we interviewed officials from HHS’ ACF, which is
             responsible for overseeing this program, and reviewed related federal
             guidelines. Recognizing that it might be too early to identify service
             impacts on children and families, we also reviewed several states’ 5-year
             plans and first annual progress reports to determine the availability of
             information related to our objectives and to document states’ plans for
             assessing impact.

             To obtain information about the status of federal evaluation efforts, we
             interviewed officials from HHS’ Office of the Assistant Secretary for
             Planning and Evaluation (ASPE) and ACF who are responsible for
             overseeing the three national evaluation contracts that will collectively
             assess state implementation and the effectiveness of FPS programs.


             We designed a survey instrument to obtain information about states’ use of
GAO Survey   federal funds for FPS services, plans for assessing impact, and impacts
Instrument   identified to date. We discussed development of the instrument with HHS
             headquarters staff and several state child welfare agency officials.

             We pretested the instrument by telephone with the Title IV-B agency’s FPS
             coordinator in two states—Indiana and New Jersey. We chose these states
             for our pretest because they had distributed their federal funds in different
             ways—one to counties to do their own planning and make service
             decisions and the other to programs directly based on state-level
             decisionmaking. We revised the instrument based on the results of the
             pretest.

             In late June and early July 1996, we sent a copy of the instrument to the
             appropriate official of the child welfare agency in each of the 50 states and
             the District of Columbia. We offered the officials the option of completing
             the instrument in writing and returning it to us within 2 weeks. We
             interviewed by telephone those officials who did not return a completed
             instrument.

             We did not verify the information obtained through the survey instrument.
             However, we conducted in-depth interviews in nine states to supplement
             information collected in the survey. In particular, we obtained additional

             11
               See GAO/HEHS-95-112, June 15, 1995.



             Page 18                                 GAO/HEHS-97-34 Implementing FPS Services
Appendix I
Scope and Methodology




information about (1) the programs that these states initiated or expanded
with federal funds, (2) how federal funds were distributed within the state,
and (3) plans for rigorous evaluation, if any. We conducted seven
interviews by telephone and two in person—one in Anne Arundel County,
Maryland, and one in Sacramento County, California. In each state, we
interviewed the same state-level individual(s) who responded to our
survey. In five of these states—California, Iowa, Maryland, Texas, and
Wisconsin—we also interviewed knowledgeable staff from a locality that
had received federal funds. We selected these nine states because of their
different size, location, and method for distributing federal funds.12

We conducted our work between May and September 1996, in accordance
with generally accepted government auditing standards.




12
 We conducted in-depth interviews in Arkansas, California, Iowa, Maryland, New Hampshire, North
Carolina, Oregon, Texas, and Wisconsin.



Page 19                                           GAO/HEHS-97-34 Implementing FPS Services
Appendix II

GAO Survey of State Child Welfare Agencies


               This appendix presents our survey of state child welfare agencies
               regarding their use of Title IV-B, Subpart 2, funds for services. Each
               question includes the summary statistics and the actual number of
               respondents that answered the question. In each case, we use the format
               that we believe best represents the data, including frequencies, means, and
               ranges.




               Page 20                               GAO/HEHS-97-34 Implementing FPS Services
     Appendix II
     GAO Survey of State Child Welfare Agencies




                                           U.S. General Accounting Office                                      6/25/96

              Interview of State Officials on OBRA 1993 and Family Preservation and Support Services

BACKGROUND INFORMATION (TO BE FILLED OUT BEFORE INTERVIEW AS MUCH AS POSSIBLE.)

A. State:     ________________ 51 Respondents

B. Interviewee Information

     NAME:             _______________________________________________

     ADDRESS:          _______________________________________________

                       _______________________________________________

                       _______________________________________________

                       _______________________________________________

     TITLE:            _______________________________________________


     PHONE #:          (________)________-____________ FAX #: (________)________-_______________

     DATE OF                                           TIME OF
     INTERVIEW:        __________/_________/__________ INTERVIEW:              _________________________
                          Mo.        Day         Yr.


Hello, Mr./Ms. ________________________________, my name is _______________________________________.
I am with the U.S. General Accounting Office (GAO), an agency of the Congress.

The Congress has asked us to study the nature and extent of new family preservation and support services since the
enactment of OBRA 1993, and how states are assessing the impact of these services on families, children and
communities. As part of the study, we are interviewing officials from all 50 states and the District of Columbia.

During the interview we will ask about the ways in which your state has used its Title IV-B Subpart 2 funds and
about recent family preservation and support initiatives in your state. We are also interested in how your state plans
to measure, or is measuring, the impact of family preservation and support services on families and children.

C.    This interview should take about 45 minutes. Do you have the time to talk with me now?

      1.    [ ]   Yes (IF "YES," GO TO E.),

      2.    [ ]   No

D.    When would be a good time to call you back?

E.    O.K., let’s begin.



                                                           1




     Page 21                                                          GAO/HEHS-97-34 Implementing FPS Services
       Appendix II
       GAO Survey of State Child Welfare Agencies




US E O F O B RA F UNDS

First we'd like to discuss how OBRA funds are being used in your state. Let me clarify that, when we say "OBRA
funds", we mean the federal family preservation and support funds provided by OBRA 1993--that is, Title IV-B
Subpart 2 funds. Also, our focus is on only those OBRA funds that your state received for services--that is, those
funds requiring a state match.

1.    On what date were OBRA funds first made available to your state to use for services? (ENTER DATE.)

      _________/__________/__________           Range-8/1/94 to 6/1/96
      Month Day       Year                      n =51



2.    Did your state allocate its OBRA funds to fam ily preservation and support programs directly, or did your
      state distribute funds to counties or other local governments for them to allocate to fam ily preservation an d
      support programs?        (CHECK ONE.) n =51

      1.   24 Family preservation and support programs directly        (GO TO QUESTION 7.)

      2.   22 Counties or other local governments

      3.    5   Both

3.    As of now, how many counties have received OBRA funds to use for fam ily preservation and support
      services ?  (ENTER NUMBER.) n =27

      1.                            Range=3-111
           No. of counties          Mean =27.6



4.    Did these counties do localized planning to decide what fam ily preservation and support services to fund?
      (CHECK ONE.) n =27

      1.   27 Yes

      2.    0   No


5.    Did your state retain any of its OBRA funds at the the state level before distributing funds to counties?
      (CHECK ONE.) n =27

      1.   24 Yes      =>    About what percentage was retained at the state level?    _______________________%
                                                                                       (ENTER PERCENTAGE.)
      2.    3   No                                                                     Range=2-77%
                                                                                       Mean =20.3%

6.    How many counties are there in your state? n =27

      1.                            Range=3-256
           No. of counties          Mean =65.4




                                                           2




       Page 22                                                           GAO/HEHS-97-34 Implementing FPS Services
     Appendix II
     GAO Survey of State Child Welfare Agencies




The next few questions ask about the use of OBRA funds that were available to your state for services. Again, we
mean those Title IV-B Subpart funds requiring a state match.

7.    Now I’d like to ask you about the use of OBRA funds in your state for activities that do not involve directly
      initiating or expanding family preservation or family support services. The question is, in your state...
      (CHECK ONE FOR EACH.)
     Have any OBRA funds been used to...                                                             Yes      No
                                                                                                     (1)      (2)

      1.   Pay for broad-based planning activities that were not covered by the FY 1994             17       34
           funds available for developing your state’s 5-year plan--that is, those first-year
           funds requiring no state match? n=51

      2.   Pay for efforts to increase your state’s capacity to provide family preservation         38       13
           and support services? Examples of this include training staff in cultural
           awareness or process changes; providing technical assistance to individuals,
           groups, and organizations that deliver family preservation and support services;
           conducting research or evaluation activities; and developing or improving
           management information systems. n=51

      3.   Fund the reporting of your state’s progress toward achieving the goals set out in        24       27
           the 5-year plan? n=51

      4.   Pay for family preservation and family support administrative costs? These               38       13
           include costs for procurement, payroll processing, management, data processing
           and computer services, as well as other indirect costs. n=51

      5.   Pay for or fund any other activity that does not involve directly initiating or          4        47
           expanding family preservation or family support services? (IF "YES," ASK
           RESPONDENT TO PLEASE SPECIFY.) n=51




      (IF ALL ITEMS IN QUESTION 7 ARE CHECKED "NO," GO TO QUESTION 9.)


8.    Of the OBRA funds your state has received for services so far, about what percentage has been used for the
      activities you just mentioned? And, about what percentage has been used to directly initiate or expand family
      preservation and support services?     (ENTER PERCENTAGE FOR EACH.) n=46

      1.   Range=1-84%            for activities that do not directly involve initiating or expanding services, as
           Mean=19%               mentioned in Question 7.

      2.   Range=16-99%           for directly initiating or expanding services.
           Mean=81%

           100%                   Total OBRA funds received for services




                                                           3




     Page 23                                                           GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




FAMILY PRESERVATION AND SUPPORT ACTIVITIES

Now we’d like to ask some questions about family preservation and support services that have been initiated or
expanded with OBRA funds. We will begin by asking a series of questions about family preservation services.

Family Preservation Services

9.    Before October 1, 1993, were any family preservation services provided in your state? (CHECK ONE.)
      n=51

      1.   50 Yes

      2.    1 No


10.   Since your state first received OBRA funds for services, have any of these funds been used to implement any
      family preservation services in your state?    (CHECK ONE.) n=51

      1.   45 Yes

      2.    6 No         (GO TO QUESTION 16 ON PAGE 7.)


The next few questions ask about the number of family preservation programs that have been funded with OBRA
dollars. Let me clarify that, when we say "program," we mean a type of program or model within which specific
services are provided. Examples of family preservation programs could include the Homebuilders crisis intervention
model, or a less intensive family reunification program. A particular program may be available at multiple sites, or
funds may be distributed to multiple service-providers to implement a particular program. (FOR A MORE
DETAILED DESCRIPTION OF DIFFERENT TYPES OF FAMILY PRESERVATION PROGRAMS OR MODELS,
SEE PAGE 16 AT THE BACK OF THIS SURVEY.)

11.   How many types of family preservation programs or models in your state have been funded with OBRA
      dollars? (ENTER NUMBER OR CHECK "DON’T KNOW".) n=45

      1.   _______________ n=36, Range=1-15, Mean=4.1
           No. of types of programs or models

      2.   9   Don’t know at state level




                                                         4




      Page 24                                                       GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




12.   We are interested in learning more about these family preservation services. First, we’d like to know if
      OBRA funds have been used to introduce brand new programs, or were OBRA funds used to expand or
      enhance existing programs. Second, we’d like to know how many programs were brand new, expanded, or
      enhanced. The first question is this: Anywhere in your state, have OBRA funds been used to ...      (CHECK
      ONE FOR EACH ITEM IN (A); IF "YES" IN (A), THEN CONTINUE TO (B).)


                                                                     (A)                             (B)
                                                                                             How many types of
                                                            Have OBRA funds                 family preservation
                                                             been used to...               programs or models are
                                                                                              in this category?
                                                                (CHECK ONE FOR              (ENTER NUMBER OR
                                                                    EACH)                  CHECK "DON’T KNOW")

                                                            Don’     No     Yes              No. of types of    Don’
                                                              t                            programs or models     t
                                                            know     (2)    (3)                    (1)          know
                                                             (1)                                                (2)
                                                                                  If yes
 1.    Introduce new family preservation programs           1        10    34      --->
       that were not used before? n=45
                                                                                  If yes
 2.    Expand existing family preservation programs         3        14    28      --->
       to new locations? n=45
                                                                                  If yes
 3.    Expand existing family preservation programs         3        12    30      --->
       to reach more clients within the same service
       areas? n=45
                                                                                  If yes
 4.    Enhance existing family preservation programs        2        11    32      --->
       by providing more of an existing service or
       introducing new services to the same number of
       clients within the same service areas? n=45
                                                                                  If yes
 5.    Do anything else regarding family preservation       3        39    3       --->
       services? (PLEASE SPECIFY.) n=45




13.   Since your state first received OBRA funds for services, have any clients been served, who would not have
      been served, without the provision of OBRA funding for these family preservation programs?       (CHECK
      ONE.) n=45

      1.   43 Yes

      2.   2 No




                                                        5




      Page 25                                                         GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




14.    Consider your state’s schedule for implementing OBRA-funded family preservation services. In general,
       would you say that the implementation of family preservation services in your state, as of now, is very much
       ahead of schedule, slightly ahead of schedule, on schedule, slightly behind schedule, or very much behind
       schedule?    (CHECK ONE.) n=45

       1.    0 Very much ahead of schedule           (GO TO QUESTION 16.)

       2.    4 Slightly ahead of schedule            (GO TO QUESTION 16.)

       3.   19 On schedule                           (GO TO QUESTION 16.)

       4.   16 Slightly behind schedule

       5.    6 Very much behind schedule



15.    Now, I’m going to mention some reasons why a state’s implementation of family preservation services might
       be behind schedule. Please indicate if any of these reasons apply to your state. (CHECK ONE FOR
       EACH.)


      Is implementation behind schedule because your state...                              Yes   No
                                                                                           (1)   (2)

      1.    Received its OBRA funds later than it expected to receive them? n=22           12    10

      2.    Decided to delay action on family preservation services until federal          5     17
            welfare reform was complete? n=22

      3.    Delayed action on family preservation services until receiving federal         9     13
            guidance related to the implementation of OBRA 1993? n=22

      4.    Experienced delays in developing or producing the 5-year plan? n=22            6     16

      5.    Experienced delays in designing or developing the "new" family                 14     8
            preservation services? n=22

      6.    Required an extended period of time to make changes to the existing            10    12
            service-delivery system before family preservation services could be
            implemented? These changes might include training staff on cultural
            awareness or process changes, collaborating with other related service
            providers, reorganizing departments, or changing service delivery processes.
            n=22

      7.    Experienced delays in any other pre-implementation activities? (IF "YES,"      14     8
            PLEASE SPECIFY.) n=22




                                                           6




      Page 26                                                         GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




Family Support Services

Now we’d like to ask a series of questions about family support services.

16.   Before October 1, 1993, were any family support services provided in your state? (CHECK ONE.) n=51

      1.   48 Yes

      2.    3 No


17.   Since your state first received OBRA funds for services, have any of these funds been used to implement any
      family support services in your state?   (CHECK ONE.) n=51

      1.   50 Yes

      2.    1 No          (GO TO QUESTION 23 ON PAGE 10.)


The next few questions ask about the number of family support programs that have been funded with OBRA
dollars. Let me clarify that, when we say "program," we mean a type of program or model within which specific
services are provided. Examples of some family support programs that have been replicated around the country
include: comprehensive/community family support programs like the Parents Services Project that originated in the
San Francisco Bay Area; child abuse and neglect prevention programs like Hawaii’s Healthy Start model; and school
readiness programs like HIPPY and Parents as Teachers (PAT). A particular program may be available at multiple
sites, or funds may be distributed to multiple service-providers to implement a particular program. (FOR A MORE
DETAILED DESCRIPTION OF DIFFERENT TYPES OF FAMILY SUPPORT PROGRAMS OR MODELS, SEE
PAGES 16 AND 17 AT THE BACK OF THIS SURVEY.)


18.   How many types of family support programs or models in your state have been funded with OBRA dollars?
      (ENTER NUMBER OR CHECK "DON’T KNOW".) n=50

      1.   _______________        n=37, Range=1-35, Mean=7.4
           No. of types of programs or models

      2.   13 Don’t know at state level




                                                         7




      Page 27                                                       GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




19.   We are interested in learning more about these family support services. First, we’d like to know if OBRA
      funds have been used to introduce brand new programs, or were OBRA funds used to expand or enhance
      existing programs. Second, we’d like to know how many programs were brand new, expanded, or enhanced.
      The first question is this: Anywhere in your state, have OBRA funds been used to ...     (CHECK ONE FOR
      EACH ITEM IN (A); IF "YES" IN (A), THEN CONTINUE TO (B).)


                                                                      (A)                            (B)
                                                                                             How many types of
                                                               Have OBRA funds                 family support
                                                                been used to...            programs or models are
                                                                                              in this category?
                                                                (CHECK ONE FOR              (ENTER NUMBER OR
                                                                    EACH)                  CHECK "DON’T KNOW")

                                                               Don’   No    Yes              No. of types of    Don’
                                                                 t                         programs or models     t
                                                               know   (2)   (3)                    (1)          know
                                                                (1)                                             (2)
                                                                                  If yes
 1.    Introduce new family support programs that              2      7     41     --->
       were not used before? n=50
                                                                                  If yes
 2.    Expand existing family support programs to new          2      16    32     --->
       locations? n=50
                                                                                  If yes
 3.    Expand existing family support programs to              1      14    35     --->
       reach more clients within the same service areas?
       n=50
                                                                                  If yes
 4.    Enhance existing family support programs by             2      17    31     --->
       providing more of an existing service or
       introducing new services to the same number of
       clients within the same service areas? n=50
                                                                                  If yes
 5.    Do anything else regarding family support               5      44    1      --->
       services? (PLEASE SPECIFY.) n=50




20.   Since your state first received OBRA funds for services, have any clients been served, who would not have
      been served, without the provision of OBRA funding for these family support programs?       (CHECK ONE.)
      n=50

      1.   49 Yes

      2.   1 No




                                                           8




      Page 28                                                          GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




21.    Consider your state’s schedule for implementing OBRA-funded family support services. In general, would
       you say that the implementation of family support services in your state, as of now, is very much ahead of
       schedule, slightly ahead of schedule, on schedule, slightly behind schedule, or very much behind schedule?
       (CHECK ONE.) n=50

       1.    1 Very much ahead of schedule           (GO TO QUESTION 23.)

       2.    4 Slightly ahead of schedule            (GO TO QUESTION 23.)

       3.   23 On schedule                           (GO TO QUESTION 23.)

       4.   17 Slightly behind schedule

       5.    5 Very much behind schedule

22.    Now, I’m going to mention some reasons why a state’s implementation of family support services might be
       behind schedule. Please indicate if any of these reasons apply to your state. (CHECK ONE FOR EACH.)


      Is implementation behind schedule because your state...                              Yes   No
                                                                                           (1)   (2)

      1.    Received its OBRA funds later than it expected to receive them? n=22           9     13

      2.    Decided to delay action on family support services until federal welfare       4     18
            reform was complete? n=22

      3.    Delayed action on family support services until receiving federal guidance     7     15
            related to the implementation of OBRA 1993? n=22

      4.    Experienced delays in developing or producing the 5-year plan? n=22            5     17

      5.    Experienced delays in designing or developing the "new" family support         15    7
            services? n=22

      6.    Required an extended period of time to make changes to the existing            13    9
            service-delivery system before family support services could be
            implemented? These changes might include training staff on cultural
            awareness or process changes, collaborating with other related service
            providers, reorganizing departments, or changing service delivery processes.
            n=22

      7.    Experienced delays in any other pre-implementation activities? (IF "YES,"      13    9
            PLEASE SPECIFY.) n=22




                                                           9




      Page 29                                                         GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




IMPACT OF FAMILY PRESERVATION AND FAMILY SUPPORT SERVICES

Now, I’d like to ask you about any results achieved by OBRA-funded family preservation and support services.
Again, when we say "OBRA funds", we mean Title IV-B Subpart 2 funds.

23.   We realize it may be too early to have done this, but has your state gathered any information on the results
      achieved so far by OBRA-funded...      (CHECK ONE FOR EACH.) n=51


                                                   Yes     No
                                                   (1)     (2)

       1. Family preservation services?            9      42

       2. Family support services?                 9      42

      (IF "NO" TO BOTH family preservation AND family support SERVICES, THEN GO TO QUESTION 28
      ON PAGE 13.)


24.   Now, I’m going to mention some measures that might be used to assess the impact of family preservation or
      family support services. First, we’d like to know if the measure was used. If so, we’d like to know if it was
      used to assess the impact of family presevation services, family support services, or both. The first question
      is this: For OBRA-funded family preservation or family support services, did anyone in your state
      measure...    (CHECK ONE FOR EACH ITEM IN (A); IF "YES" IN (A), THEN CONTINUE TO (B).)


                                                                            (A)                          (B)
                                                                        Did anyone             Was it used for family
                                                                        measure...               preservation (FP)
                                                                        (CHECK ONE            services, family support
                                                                         FOR EACH)             (FS) services, or both?
                                                                        No     Yes   If yes    (ENTER "FP", "FS", OR
                                                                                      --->
                                                                        (1)    (2)                   "BOTH")

 1.    The number of children, families, or clients served? n=10         0     10

 2.    The extent to which the needs of vulnerable or at-risk            5     5
       children and families were met? n=10

 3.    The number of foster care placements prevented or                 4     6
       number of family reunifications? n=10

 4.    Changes in the well-being of children, including each             6     4
       child’s development, school performance or readiness?
       n=10

 5.    Changes in parent-child relationships, family satisfaction,       5     5
       or family functioning? n=10

 6.    Changes in the community, such as in the number of                3     7
       child abuse/neglect reports, in poverty rates, in birth rates,
       or in childhood mortality rates? n=10



                                                            10




      Page 30                                                           GAO/HEHS-97-34 Implementing FPS Services
       Appendix II
       GAO Survey of State Child Welfare Agencies




                                                                          (A)                            (B)
                                                                      Did anyone               Was it used for family
                                                                      measure...                 preservation (FP)
                                                                      (CHECK ONE              services, family support
                                                                       FOR EACH)               (FS) services, or both?
                                                                       No     Yes    If yes    (ENTER "FP", "FS", OR
                                                                                      --->
                                                                       (1)    (2)                    "BOTH")

 7.     Changes to the service-delivery system, such as in             5       5
        caseloads or expenditures? n=10

 8.     Other changes to the service-delivery system, such as          2       8
        changes in the extent of collaboration, coordination, and
        inclusiveness? n=10

 9.     Still other changes to the service-delivery system, such as    6       4
        in staffing levels, staff training, number of cases per
        worker, or timeliness of services? n=10

 10.    Cost effectiveness?   n=22                                     8       2

 11.    Which types of services work best for certain groups of        7       3
        clients? n=22

 12.    Anything else? (IF "YES," PLEASE SPECIFY) n=10                 7       3




25.    We would like any information you might have on specific results of OBRA-funded family preservation or
       family support services in your state. Could you mail or fax to us any documentation? n=10

       1.   7   Yes => I will tell you where to mail or fax this information at the conclusion of this interview.

       2.   3   No




                                                           11




       Page 31                                                        GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




26.   I am going to now mention some ways in which the impact of OBRA-funded family preservation or family
      support services might be assessed. To your knowledge, in your state, ... (CHECK ONE FOR EACH.)
      Has anyone assessed the impact of OBRA-funded services by...                          Yes    No
                                                                                            (1)    (2)

      1.      Monitoring indicators? n=10                                                   9      1

      2.      Preparing periodic progress reports? n=10                                     8      2

      3.      Reviewing individual case records? n=10                                       2      8

      4.      Surveying clients? n=10                                                       5      5

      5.      Reviewing specific family preservation or family support programs?     n=10   4      6

      6.      Reviewing portions or all of your state’s child and family service-delivery   5      5
              system? n=10

      7.      Doing anything else? (IF "YES," PLEASE SPECIFY.) n=10                         2      8




27.   To your knowledge, has anyone in your state conducted a formal evaluation--that is, an evaluation that utilized
      an experimental design--to assess the effectiveness of OBRA-funded... (CHECK ONE FOR EACH.) n=10


                                                   Yes     No
                                                   (1)     (2)

           1. Family preservation services?        1       9

           2. Family support services?             0      10




                                                            12




      Page 32                                                           GAO/HEHS-97-34 Implementing FPS Services
       Appendix II
       GAO Survey of State Child Welfare Agencies




Plans to Assess Impact

We are interested in your state’s plans for assessing the impact of family preservation and family support services
on children, families, and communities.

28.    Now, I’m going to mention some measures that might be used to assess the impact of family preservation or
       family support services. First, we’d like to know if the measure will be used in your state. If so, we’d like
       to know if it will be used to assess the impact of family presevation services, family support services, or
       both. The first question is this: For OBRA-funded family preservation or family support services, does
       anyone in your state plan to measure...     (CHECK ONE FOR EACH ITEM IN (A); IF "YES" IN (A), THEN
       CONTINUE TO (B).)


                                                                             (A)                           (B)
                                                                         Will anyone               Will it be used for
                                                                         measure...             family preservation (FP)
                                                                         (CHECK ONE             services, family support
                                                                          FOR EACH)              (FS) services, or both?
                                                                         No     Yes    If yes    (ENTER "FP", "FS", OR
                                                                                        --->
                                                                         (1)    (2)                    "BOTH")

 1.     The number of children, families, or clients served? n=51        0      51

 2.     The extent to which the needs of vulnerable or at-risk            9     42
        children and families were met? n=51

 3.     The number of foster care placements prevented or                16     35
        number of family reunifications? n=51

 4.     Changes in the well-being of children, including each            14     37
        child’s development, school performance or readiness?
        n=51

 5.     Changes in parent-child relationships, family satisfaction,       6     45
        or family functioning? n=51

 6.     Changes in the community, such as in the number of                6     45
        child abuse/neglect reports, in poverty rates, in birth rates,
        or in childhood mortality rates? n=51

 7.     Changes to the service-delivery system, such as in               19     32
        caseloads or expenditures? n=51

 8.     Other changes to the service-delivery system, such as             4     47
        changes in the extent of collaboration, coordination, and
        inclusiveness? n=51

 9.     Still other changes to the service-delivery system, such as      21     30
        in staffing levels, staff training, number of cases per
        worker, or timeliness of services? n=51

 10.    Cost effectiveness?    n=51                                      19     32




                                                             13




       Page 33                                                           GAO/HEHS-97-34 Implementing FPS Services
       Appendix II
       GAO Survey of State Child Welfare Agencies




                                                                              (A)                            (B)
                                                                          Will anyone                Will it be used for
                                                                          measure...              family preservation (FP)
                                                                          (CHECK ONE              services, family support
                                                                           FOR EACH)               (FS) services, or both?
                                                                           No     Yes    If yes    (ENTER "FP", "FS", OR
                                                                                          --->
                                                                           (1)    (2)                    "BOTH")

 11.        Which types of services work best for certain groups of       16      35
            clients? n=51

 12.        Anything else? (IF "YES," PLEASE SPECIFY) n=51                42       9




(IF ALL ITEMS IN QUESTION 28 ARE CHECKED "NO," GO TO QUESTION 30.)


29.    We are interested in examples of specific measures that will be used to assess the impact of OBRA-funded
       family preseravtion or family support services. Does your state’s 5-year plan describe any of the measures
       that you just mentioned?    (CHECK ONE.) n=51

       1.      35 Yes =>      Please mail or fax us the relevant pages from your state plan. I will tell you where to
                              send this information at the conclusion of this interview.

       2.      16 No


30.    I am going to now mention some ways in which the impact of OBRA-funded family preservation or family
       support services might be assessed. To your knowledge, in your state, ... (CHECK ONE FOR EACH.)
       Will anyone assess the impact of OBRA-funded services by...                                Yes    No
                                                                                                  (1)    (2)

       1.       Monitoring indicators? n=51                                                       50      1

       2.       Preparing periodic progress reports? n=51                                         49      2

       3.       Reviewing individual case records? n=51                                           26      25

       4.       Surveying clients? n=51                                                           45      6

       5.       Reviewing specific family preservation or family support programs?      n=51      46      5

       6.       Reviewing portions or all of your state’s child and family service-delivery       39      12
                system? n=51

       7.       Doing anything else? (IF "YES," PLEASE SPECIFY.) n=51                             12      39




                                                              14




       Page 34                                                            GAO/HEHS-97-34 Implementing FPS Services
      Appendix II
      GAO Survey of State Child Welfare Agencies




31.   To your knowledge, will anyone in your state conduct a formal evaluation--that is, an evaluation that will
      utilize an experimental design--to assess the effectiveness of OBRA-funded... (CHECK ONE FOR EACH.)
      n=51


                                                  Yes     No
                                                  (1)     (2)

       1. Family preservation services?            8      43

       2. Family support services?                 8      43


REQUEST FOR OTHER DATA

32.   For background purposes, we are interested in other data that may be included in your state’s 5-year plan.
      Does your state’s plan include any data that portrays either graphically, in tables, or in narrative, any aspect of
      child welfare at or before the time the 5-year plan was developed? n=51

      1.   38 Yes => Please mail or fax us the relevant pages from your state plan.

      2.   13 No


33.   (IF "YES" TO QUESTIONS 25, 29, or 32.) You can mail or fax us (1) documentation related to results of
      family preservation/family support services in your state, (2) those sections of your state’s 5-year plan related
      to measures that will be used to assess the impacts of these services, or (3) those sections of the state plan
      related to child welfare data to:

      U.S. General Accounting Office
      Attn: Ms. Karen Lyons
      Federal Office Building
      2800 Cottage Way Room W-2326
      Sacramento, CA 95825

      The fax number is 916-974-1202

      If you have any questions, you can call me at 916-974-3341 (California time).


That concludes this interview. Thank you very much for your time and cooperation.




                                                           15




      Page 35                                                          GAO/HEHS-97-34 Implementing FPS Services
     Appendix II
     GAO Survey of State Child Welfare Agencies




                                                   DEFINITIONS


We define family preservation services and family support services as they appear in the Omnibus Budget
Reconciliation Act of 1993:

--    Family preservation services are typically designed to help families at risk or in crisis. Services may be
      designed to (1) prevent foster care placement, (2) reunify families, (3) place children in other permanent living
      arrangements, such as adoption or legal guardianship, (4) provide followup care to reunified families, (5)
      provide respite care for parents and other caregivers, and/or (6) improve parenting skills.

--    Family support services are primarily community-based preventive activities designed to promote the well-
      being of children and families. Services are designed to (1) increase the strength and stability of families, (2)
      increase parents’ confidence and competence in their parenting abilities, (3) afford children a stable and
      supportive family environment, and (4) otherwise enhance child development.

The terms, family preservation program and family support program, refer to the type of program or model
within which specific services are provided. A particular program may be available at multiple sites, or funds may
be distributed to multiple service-providers to implement a particular program.

      Family preservation programs are often distinguished by one of the following theoretical approaches or
      models:

      --   Crisis intervention technique forms the basis for the Behavioral Science Institute’s Homebuilders
           model. Key program characteristics include: contact with the family within 24 hours of the crisis;
           caseload sizes of one or two families per worker; service duration of 4 to 6 weeks; provision of both
           concrete services and counseling; staff availability to families on a 24-hour basis; and an average of 20
           hours of service per family per week.

      --   Family systems technique is a model typified by the FAMILIES program, originated in Iowa. Attention
           is focused on the way family members interact with one another and seeks to correct dysfunction by
           working on the family’s interaction with the community. Teams of workers carry a caseload of 10 to 12
           families; families are seen in their own homes for an average of four and one-half months; and both
           concrete and therapeutic services are provided.

      --   Therapeutic family treatment is a model that relies less on the provision of concrete and supportive
           services and more on family therapy. One of the first such programs was the Intensive Family Services
           Program which began in Oregon. Treatment is less intensive than the Homebuilders model and can be
           delivered in either an office or home setting. Workers carry a caseload of about 11 families and service
           duration is 90 days with weekly followup services provided for an average of 3 to 5 1/2 months.

      --   Some family preservation programs use slight variations of these existing models or hybrids of several
           models.

      Family support programs can be categorized by their type, which is closely aligned with their mission.
      Common program types are: (with nationally recognized programs and models in parentheses)

      --   Comprehensive/community family support programs offer a wide array of services and typically serve
           multiple populations, such as teen parents, juvenile offenders, and jobless adults. Programs tend to be
           community-based and open to the entire community. Program components may include some of the more
           narrowly focused family support programs listed below. (Parent Services Project)


                                                          16




     Page 36                                                           GAO/HEHS-97-34 Implementing FPS Services
Appendix II
GAO Survey of State Child Welfare Agencies




--   Child abuse and neglect prevention programs serve at-risk populations and focus on prevention of
     abuse and neglect by working to eliminate social isolation. Programs link families to one another and to
     services, including homevisiting, parenting education classes, peer support groups, and child-related
     services. (The Nurturing Program; Hawaii’s Healthy Start (replicated through Healthy Families America))

--   Economic self-sufficiency programs serve unemployed and/or underemployed parents by offering
     extensive job preparation, skills development workshops, training sessions, and job placement services.
     Most programs also provide comprehensive services for families, including referral to other community
     agencies, mental health services, and tax/legal assistance. (Comprehensive Child Development Program
     (federal program))

--   Family literacy programs focus on generating literacy competency in parents and children. Programs
     are often linked with community-based organizations, including libraries and family learning centers.
     (Parent and Child Education (PACE); Even Start (federal program); FAMILY MATH; National Center for
     Family Literacy; SERS Family Learning Centers)

--   Infant and child health and development programs serve families from prebirth until the child reaches
     the age of 3. Programs are often home-based and incorporate a strong emphasis on health and nutrition.
     Many programs are linked to healthcare facilities, including hospitals, clinics, and community health
     facilities. (Maternal Infant Health Outreach Worker (MIHOW) Project)

--   School readiness/achievement programs primarily aim at preparing children for school success. In
     addition to cognitive skills, many programs stress the development of children’s competencies in social,
     emotional, and physical domains. (Home Instruction Program for Preschool Youngsters (HIPPY); Parents
     as Teachers (PAT); Teachers Involve Parents in Schoolwork (TIPS))

--   Situation-specific programs are designed to meet the unique needs of families in specific situations,
     including homeless families, rural families, refugee families, military families, families with incarcerated
     members, and single-parent families. (Single Parent Resource Center)

--   Special needs programs primarily serve families whose children have special developmental needs or
     disabilities. Most programs focus on providing parents with information to enable them to cope with the
     additional stresses of nurturing special needs children. (Family, Infant, and Preschool Program (FIPP))

--   Substance abuse prevention programs are sometimes designed for all children and families and are
     preventive in orientation; in other cases, programs target children and youth known to be at-risk or live in
     substance abusing family situations. Programs aim at strengthening self-esteem and promoting healthy
     lifestyles. (Families and Schools Together (FAST))

--   Wellness programs serve families who are dealing with normal stresses of parenting. Programs offer a
     wide range of support to families in the area of parenting education. These programs tend to be co-
     located--at YWCAs, health councils, and religious service organizations--often functioning as a
     supplementary service for adults. (Child Rearing Program; Effective Parenting Information for Children
     (EPIC); The Mothers’ Center; Parents Place)




                                                    17




Page 37                                                          GAO/HEHS-97-34 Implementing FPS Services
Appendix III

Comments From the Department of Health
and Human Services




               Page 38     GAO/HEHS-97-34 Implementing FPS Services
Appendix III
Comments From the Department of Health
and Human Services




Page 39                                  GAO/HEHS-97-34 Implementing FPS Services
Appendix IV

GAO Contact and Acknowledgments


                  Karen E. Lyons, Evaluator-in-Charge, (916) 486-6442
GAO Contact
                  In addition to those named above, the following individuals made
Acknowledgments   important contributions to this report: Patricia L. Elston conducted both
                  the nationwide survey and in-depth interviews for a portion of the states
                  and coauthored the report; Deborah A. Moberly performed these same
                  tasks and conducted computerized analyses of the survey data; and
                  Joel I. Grossman assisted in developing, pretesting, and finalizing the
                  survey instrument.




(105826)          Page 40                               GAO/HEHS-97-34 Implementing FPS Services
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 6015
Gaithersburg, MD 20884-6015

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 (301) 258-4066, or TDD (301) 413-0006.

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