i United States General Accounting Office Report to the Select Committee on GAO’ 4 Children, Youth, and Families, House of Representatives September I990 CHILDREN’S ISSUES A Decade of GAO Reports and Recent Activities -.. GAO/HRD90-162 .. .* ii GAO United States General Accounting Office Washington, D.C. 20548 Human Resources Division I3-240552 September 21, 1990 The Honorable George Miller Chairman, Select Committee on Children, Youth, and Families House of Representatives The Honorable Thomas .J. Bliley, Jr. Ranking Minority Member Select Committee on Children, Youth, and Families House of Representatives This report responds to your May 8, 1990, request for a comprehensive report of GAO'S activities since 1980 on children’s issues. We have defined children’s issues to include a wide range of federal pro- grams and policy areas affecting children (from birth to age 18) and their families. Our work has addressed a broad spectrum of domestic issues that affect children, such as infant mortality, access to health care, poverty, homelessness, early childhood education and child care, and foster care. For this report, we have categorized the results of our work into the following issues: child day care, child welfare and social services, education, health, housing, income security, nutrition, youth employment and training, and other child and family issues. Table I categorizes, by issue, over 250 GAO reports, testimonies, ongoing assignments, and other activities on issues affecting children. The table further reflects an increase in GAO'S work on children’s issues: 58 reports were issued in the 18-month period from October 1, 1988, through March 31, 1990, compared with 119 reports issued in the g-year period of fiscal years 1980-88. In the 18-month period, our work most fre- quently addressed health and education issues. Page 1 GAO/HRIXlO-162 Children’s Issues: Reports and Activities 5240552 its issue date. At that time, we will send copies to interested parties and make copies available to others upon request. Should you have any questions concerning this report, please call me on (202) 275-1655. Other major contributors are listed in appendix VI. Linda G. Morra Director, Intergovernmental and Management Issues Page 3 GAO/HRBB&162 Children’s Issues: Reports and Activities Early Childhood Education: Information on Costs and 17 Services at High-Quality Centers (GAO/HRD- 89-130FS, July 21, 1989) Early Childhood Education: What Are the Costs of 18 High-Quality Programs? (GAO/HRD-90-43BR, Jan. 24,199O) Education Reform: Initial Effects in Four School 18 Districts (GAO/PEMD-89-28, Sept. 26, 1989) Effective Schools Programs: Their Extent and 19 Characteristics (GAO/HRD-89-132BR, Sept. 13, 1989) Special Education: Congressional Action Needed to 19 Improve Chapter 1 Handicapped Program (GAO/ HRD-89-54, May 23, 1989) Special Education: Estimates of Handicapped Indian 19 Preschoolers and Sufficiency of Services (GAO/ HRD-90-61BR, Mar. 5, 1990) Special Education: The Attorney Fees Provision of 20 Public Law 99-372 (GAO/HRD-90-22BR, Nov. 24,1989) Transition Series: Education Issues (GAO/OCG- 20 89-18TR, Nov. 1988) Vocational Education: Opportunity to Prepare for the 21 Future (GAO/HRD-89-55, May 10, 1989) Health 21 Health Care: Availability in the Texas-Mexico Border 21 Area (GAO/HRD-89-12, Oct. 26, 1988) Health Care: Children’s Medical Services Programs in 22 10 States (GAO/HRD-89-81, July 14, 1989) Health Care: Home Care Experiences of Families 22 With Chronically Ill Children (GAO/HRD-89-73, June 20,1989) Health Care: Nine States’ Experiences With Home 22 Care Waivers (GAO/HRD-89-95, July 14, 1989) Health Care Financing: Unreimbursed Charges of 23 Selected Children’s Hospitals (GAO/HRD-89-76, July 11, 1989) Human Embryo Laboratories: Standards Favored to 23 Ensure Quality (GAO/HRD-90-24, Dec. 19, 1989) Medicaid: States Expand Coverage for Pregnant 23 Women, Infants, and Children (GAO/HRD-89-90, Aug. 16,1989) Page 5 GAO/IIRD-SO-162 Children’s Issues: Reports and Activities contents Nutrition 30 Food Assistance: The National WIC Evaluation: 30 Reporting and Follow-Up Issues (GAO/RCED- 90-3, Dec. 14, 1989) Food Assistance Programs: Nutritional Adequacy of 30 Primary Food Programs on Four Indian Reservations (GAO/RCED-89-177, Sept. 29,1989) Food Stamp Program: A Demographic Analysis of 31 Participation and Nonparticipation (GAO/PEMD- 90-8, Jan. 19, 1990) Food Stamp Program: Administrative Hindrances to 31 Participation (GAO/RCED-89-4, Oct. 21, 1988) Food Stamp Program: Participants Temporarily 32 Terminated for Procedural Noncompliance (GAO/RCED-89-81, June 22,1989) Food Stamps: Reasons for Nonparticipation (GAO/ 32 PEMD-89-5BR, Dec. 8, 1988) School Lunch Program: Buy American Procedures at 32 Commodity Schools (GAO/RCED-89-218, Sept. 26, 1989) School Lunch Program: Buy American Procedures at 33 Schools With Cash or Credit in Lieu of Food (GAO/RCED-89-183, Aug. 9,1989) Transition Series: Agriculture Issues (GAO/OCG- 33 89-12TR, Nov. 1988) Youth Employment and Training 33 Job Training Partnership Act: Information on 33 Training, Placements, and Wages of Male and Female Participants (GAO/HRD-89-152FS, Sept. 12, 1989) Job Training Partnership Act: Youth Participant 33 Characteristics, Services, and Outcomes (GAO/ HRD-90-46BR, Jan. 24, 1990) Other Child and Family Issues 34 Legislative Branch: Parental Leave Practices and 34 Child Care Services (GAO/HRD-90-12, Nov. 14, 1989) Parental Leave: Revised Cost Estimate Reflecting the 34 Impact of Spousal Leave (GAO/HRD-89-68, Apr. 6,1989) United Nations: 1J.S.Participation in the Children’s 35 Fund (GAO/NSIAD-89-204, Sept. 27, 1989) Page 7 GAO/‘HRb90-162 Children’s Iesues: Reporta and Actltitlea Contents Appendix VI 57 Major Contributors to This Report Tables Table I: GAO Products and Activities on Children’s Issues 2 (Fiscal Year 1980-Mar. 1990) Table IV.l: Key GAO Contacts for Work on Children’s 50 Issues Figures Figure I. 1: GAO Reports on Children’s Issues 12 (Oct. 1988-Mar. 1990) Figure 11.1:GAO Testimony on Children’s Issues 36 (Oct. 1988-Mar. 1990) Figure III. 1: GAO Reports on Children’s Issues 39 (Fiscal Years 1980-88) Figure IV. 1: Ongoing GAO Assignments on Children’s 49 Issues (as of Mar. 3 1, 1990) Figure V.l: Published Articles and Papers by GAO Staff 54 on Children’s Issues (Oct. 1988-Mar. 1990) Page 9 GAO/HRD-90-162 Children’s Issues: Reports and Activities Page 11 GAO/HRDB@162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1983 Through March 1990 11 years, the federal government has increased its support for child care by about $2 billion in constant 1988 dollars. At the same time, however, support to low-income families declined as a proportion of the total fed- eral child care budget. This decline in the share of dollars spent for low- income families was mainly due to higher-income families expanding their use of the child care tax credit. No federal agency is responsible for coordinating all federal child care efforts, although there has been some child care coordination at the state level. While the supply of child care is difficult to measure because so much is privately provided and unregulated, information indicates that some types of child care, such as care for infants and toddlers, school-age children, and sick children, are in short supply. Child Care: Selected GAO developed from various data bases a selected bibliography on child Bibliography (GAO/HRD- care. This bibliography contains 386 citations, most accompanied by abstracts taken from the data bases. The cited literature includes 89-98FS, July 11, 1989) journal articles, books, research reports, studies, and conference papers published during the period 1978 to mid-1988. Marine Corps Child Care: In the spring of 1988, weekly fees for one child at the Marine Corps Recruit Depot, Parris Island, South Carolina, and the Marine Corps Air User Fee Increases at Station, Beaufort, South Carolina, child care centers ranged from $22 to Parris Island and Beaufort $24 and from $24 to $29, respectively, depending on the parent’s mili- Installations (GAO/HRD- tary rank. During 1988, both centers experienced significant pressures 89-74, Mar. 24, 1989) to increase user fees. These pressures resulted primarily from a combi- nation of factors, including: (1) directives from Marine Corps headquar- ters to cover more nonappropriated costs with user fees; (2) cuts in fiscal year 1988 morale, welfare, and recreation appropriations; and (3) increased manpower and operations expenses partly due to an overall Marine Corps initiative to improve the quality of child care. In 1988, both installations found it necessary to raise fees. The increased weekly child care fees at Parris Island ranged from $26 to $45 and in Beaufort from $36 to $40. Military Child Care: The demand for child care services has exceeded the supply at most mil- Extensive, Diverse, and itary bases. Military child care is provided on installations primarily through child development centers and family day care homes. Care in a Growing (GAO/HRD-89-3, center is given by trained caregivers on a fee-for-service basis. Care in Mar. 8, 1989) family day care homes is given in government housing, usually by a trained military spouse, at a rate agreed upon by the caregiver and the Page 13 GAO/HRIWO-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Tbmugh March 1990 Foster Care: Incomplete In response to reports of widespread abuses of the foster care system, the Adoption Assistance and Child Welfare Act of 1980 revised several Implementation of the child welfare programs. Evidence suggests, however, that the revised Reforms and Unknown requirements have not been completely carried out. Although 94 percent Effectiveness (GAO/ of the states had met ACYF’S minimum requirements for the case review PEMD-89-17, Aug. 14, system by 1987, ACYF compliance reviews revealed problems in com- 1989) pleting case reviews within the required time periods. In the absence of a national evaluation or comprehensive information system, GAO could not determine if the reforms carried out have reduced the number of unnecessary and inappropriate placements of children into foster care. Although procedural protections have generally been instituted, present conditions suggest a continuing need for incentives to fully implement these reforms and, perhaps, additional efforts by ACYF and the states to strengthen them. Foster Care: Preliminary During the 197Os, widespread abuses of the foster care system were Report on Reform Effects reported. In light of these reports, the Adoption Assistance and Child Welfare Act of 1980 amended several child welfare programs under the (GAO/PEMD-8923BR, Social Security Act. In particular, the act made funds available for the June 1,1989) federal Foster Care program and large funding increases for the Child Welfare Services grant, contingent on the states’ implementation of cer- tain procedural protections for children in foster care. This briefing report presents, primarily in tabular form, the preliminary results of GAO’S review. Final results were reported in GAO/PEMD-89-17. Foster Parents: Recruiting Foster care professionals report that recruiting and retaining foster par- and Preservice Training ents are becoming increasingly difficult. Preservice training, which is provided before social services agencies approve parents and place Practices Need Evaluation foster children with them, is seen by foster care professionals as a con- (GAO/HRD-89-86, Aug. 3, tinuation of recruiting that can help prepare foster parents for the chal- 1989) lenges of caring for foster children. Reliable data on state recruitment and retention of foster parents, however, are not generally available. Few formal evaluations of states’ foster parent recruiting and preservice training strategies have been done. As a result, HHS should comprehen- sively evaluate the effectiveness of various foster parent recruiting strategies. Page 15 GAO/HRD90-162 Children’s Issues: Reports and Activities -- Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1990 -- did not adequately monitor and administer the grant agreements, as pre- scribed by federal regulation and Office of Management and Budget (OMB) circulars. DOD Overseas Schools: DOD spent about $755 million in 1988 to run 271 overseas schools Additional Assurances of attended by over 150,000 students, who are dependents of military and DOD civilian personnel stationed abroad. GAO found that while DOD Educational Quality schools are accredited and their students tend to score well on standard- Needed (GAO/HRD-90-13, ized tests, DOD school management and parents should have additional Mar. 15, 1990) assurances that the schools are providing students with a high-quality education. Scores provide but one measure of education quality and should be supplemented with other indicators-like promotion rates and measures of the variety of course offerings. DOD also needs better procedures for documenting that the schools have quality teachers and that students meet graduation standards. School advisory committees have been established to give parents and teachers a forum for express- ing their views on school operations; however, these committees seldom exercise their specific authority to advise school principals on budgets and course curricula. DODhas implemented widely used drug and alcohol abuse programs in its schools and has generally corrected facilities’ shortcomings, such as inadequate space and leaky roofs, that were iden- tified by its accrediting organization. Early Childhood Preliminary results of a GAO survey of 265 high-quality early childhood Education: Information on education programs showed that, on average, they spent $4,070 per child in fiscal year 1988; after adjusting for in-kind donations, the cost Costs and Services at High- per child was $4,660. The average child-to-teacher ratio for 4-year-old Quality Centers (GAO/ children was about 9 to 1; at many of these centers, the ratios for HRD-89-130FS, July 21, infants and toddlers were closer to 4 to 1. More than three-fourths of 1989) center expenses were for salaries and benefits and rent or mortgage. Other costs were for additional operating expenses-such as educa- tional materials and equipment, food, office supplies, repairs and main- tenances, insurance, and utilities-and supplementary services, such as health screening and parent education. Final results were reported in GAO/FIRD-90.43BR. Page 17 GAO/HIUW@162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on children, October 1988 Through March 1990 Effective Schools This briefing report discusses (1) the number of school districts with Programs: Their Extent effective schools programs, (2) common program characteristics and practices, (3) how school districts evaluate the effect of their programs and Characteristics on students’ academic achievement, and (4) federal requirements for (GAO/HRD-89-132BR, evaluating these programs. Sept. 13,1989) Special Education: In 1965, the Congress established the Title I (now Chapter 1) Handi- capped Program. Primarily, the program was to help states finance the Congressional Action education of handicapped children, most of whom were severely handi- Needed to Improve capped, in state-operated or supported institutions. In 1975, the Con- Chapter 1 Handicapped gress enacted a much larger program through the Education of the Program (GAO/HRD-89-54, Handicapped Act (EHA). This act required that states assure an adequate May 23,1989) education for all handicapped children and provided additional federal financial assistance. Handicapped children covered by Chapter 1 are generally educated separately from nonhandicapped children. Although the services these handicapped children receive are similar in nature to those provided under EHA, they often are more frequent or more inten- sive, reflecting their more serious handicapping conditions. Chapter 1 is administratively similar to EHA, and the procedural safeguards guaran- teed to EHA program participants are also provided to Chapter 1 pro- gram students. However, a number of problems in Chapter 1 administration may indicate a need for legislative changes. For example, four states that count children with handicaps generally not considered to be severe have received nearly half of all program funds. The Con- gress should restructure the Chapter 1 program to eliminate funding imbalances and to better assure that all states focus on severely handi- capped children. Also, the Congress should enact legislation to merge the Chapter 1 and EHA programs. If the programs are merged, the Congress should consider a separate funding set aside for states to use to serve only severely handicapped children. Special Education: GAO is required by Public Law loo-297 to review the Bureau of Indian Estimates of Handicapped Affairs’s (BIA) programs for educating handicapped Indian preschoolers. This briefing report discusses GAO’S estimates of (1) the number of hand- Indian Preschoolers and icapped Indian preschoolers on the 63 reservations with schools admin- Sufficiency of Services istered by BIA and (2) the sufficiency of services they receive. GAO (GAO/HRD-90-61BR, estimates that while nearly 3,000 handicapped Indian preschoolers aged Mar. 5, 1990) 3 and 4 live on the 63 reservations with BIA schools, only 838 of these children were receiving special education services in school year 1988- 89. At least 24 percent of 791 handicapped children with Individual Page 19 GAO/HBD-90162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Childreq October 1986 Through March 1990 financial management systems to address accounting and internal con- trol weaknesses. Vocational Education: Providing quality vocational education to underserved groups in all areas of each state and encouraging modernization and improvement of Opportunity to Prepare for vocational education programs are two major objectives of the Carl D. the Future (GAO/HRD- Perkins Vocational Education Act. In the six states and 20 localities GAO 89-55, May 10,1989) visited, vocational education programs and services consistent with the Perkins Act were provided. But vocational education students in eco- nomically depressed areas may be less likely to receive Perkins funding for improved or modernized program activities than students outside such areas. All six states visited allocated more than half of their basic state grants to economically depressed areas, as the act requires. But some states designated relatively wealthy areas as “economically depressed” and gave them greater per capita funding than some poorer communities. Further, the disadvantaged population allocation formula includes students who are academically disadvantaged but not poor. Thus, some relatively wealthy school districts can receive more money per low-income student than districts with high concentrations of low- income students. Should the Congress want to target additional Perkins Act funds to poor communities, it could amend the act to (1) require states to allocate at least as much Perkins funding for each vocational student in economically depressed areas as in other areas of the state, (2) remove “academically disadvantaged” students who are not poor from the fund allocation formula for the disadvantaged, and (3) require that any Perkins funds redistributions for the disadvantaged and handi- capped populations be made in approximately the same proportions between poorer and wealthier areas as the original allocations. Health Health Care: Availability -Concern haa been expressed about the health problems and availability in the Texas-Mexico of health care in the Texas-Mexico border area counties. Some of the findings were that the general birth rate was higher, the death rate was Border Area (GAO/HRD- lower, and the communicable disease rate was relatively higher than 89-12, Oct. 26, 1988) elsewhere in the United States. A majority of the border counties have physician shortages; areas with populations of under 9,000 do not have hospital or clinic facilities and emergency care equipment. Four catego- ries of federal, state. and local health-related programs could benefit Page 21 GAO/IIRDSO-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1990 of 32 home and community-based waivers. Children were eligible for services under 24 of them and represented about 10 percent of the indi- viduals served under these arrangements. Officials in eight of the nine states told us they were satisfied with the results achieved with their waivers; that is, they were able to provide less costly home and community-based care. On the other hand, most states reported difficul- ties with their initial attempts to obtain waivers. Some officials believed that the initial waiver application and approval process was a long, stretched out, and uncertain process. Health Care Financing: Unreimbursed charges at the 13 children’s hospitals that GAO visited Unreimbursed Charges of averaged about 20 percent of their total charges for patient care during fiscal year 1986, the latest year for which they had complete data at the Selected Children’s time. Such charges are attributable to charity care, bad debts, and Hospitals (GAO/HRD- allowances and discounts available under contractual arrangements 89-76, July 11, 1989) with certain public and private payers. The contractual arrangements accounted for 59 percent of the unreimbursed charges, followed by charity care and bad debts. Hospitals attempted to mitigate the impact of unreimbursed charges by (1) considering them in setting patient charges and (2) generating income from other sources. Human Embryo The successful application of advanced reproductive technologies has Laboratories: Standards raised the hopes of many infertile couples. Because human embryo labo- ratories play an important role in the treatment of such patients, GAO Favored to Ensure Quality surveyed laboratory personnel qualifications, quality control measures, (GAO/HRD-90-24, and techniques. GAO found that these factors varied, and most of the Dec. 19, 1989) technology practitioners responding to GAO'S survey generally agreed that some oversight of human embryo laboratories would improve the quality of care people receive. Most respondents favored more uniform personnel qualifications and quality control requirements. Many repro- ductive technology program directors, however, opposed mandating standardized techniques, noting that similar results may be obtained when different methods, materials, and techniques are used. Medicaid: States Expand In recent years, most states have expanded Medicaid eligibility for preg- Coverage for Pregnant nant women, infants, and young children. Eighty-six percent of states have raised their income limits for Medicaid eligibility for pregnant Women, Infants, and women and infants. In addition to raising income levels, 36 states have Children (GAO/HRD- adopted at least two other options-dropping assets tests (guaranteeing 89-90, Aug. 16, 1989) continuous eligibility) and offering temporary (presumptive) eligibility Page 23 GAO/~99-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Thruugh March 1990 Youth Camps: Nationwide No federal legislation currently exists to regulate youth camp safety and health. Instead, states develop and implement their own youth camp and State Data on Safety health and safety standards. Nationally, and in five of the six states GAC) and Health Lacking visited, little information was available on accidents, illnesses, and fatal- (GAO/HRD-89-140, ities that occur at youth camps. Youth camp safety and health stan- Sept. 20, 1989) dards in the 50 states vary widely, and GAO found no source of nationwide data on the states’ enforcement activities whether conducted by the state centrally or delegated to local jurisdictions. Housing Children and Youths: On a given night, about 68,000 children and youths aged 16 or younger About 68,000 Homeless may be members of families that are literally homeless. Of these chil- dren and youths, about 25,500 are likely to be in urban shelters and and 186,000 in Shared hotels; about 21,800 are likely to be in suburban and rural areas; about Housing at Any Given 4,000 are housed by churches; about 9,000 may be sleeping in aban- Time (GAO/PEMD-89- 14, doned buildings, cars! or public places; and about 7,700 may be in June 15,1989) various other settings. In addition to those who are literally homeless, nearly 186,000 children and youths may be precariously housed, spending the night in doubled-up circumstances. Homelessness: Homeless This report analyzes the characteristics of youths who were served by and Runaway Youth shelters funded under the Runaway and Homeless Youth Act. GAO found that while there have been reports of a growing population of homeless Receiving Services at youths, little information is available on the size or characteristics of Federally Funded Shelters either the total homeless youth population or the subgroup seeking (GAO/HRD-90-45, assistance from runaway and homeless shelters. As the result of its Dec. 19, 1989) analysis, however, GAOmade the following observations: . Homeless youths seem to be a diverse group of people facing many problems. . The shelter network may not be able to meet some needs of homeless and runaway youths. l Many youths may not be receiving needed services after they leave the shelters. . Many homeless youths who do not return to their families after leaving a shelter move on to unstable living arrangements. l Very few of the homeless youths appear to leave shelters for indepen- dent living programs. Page 26 GAO/IIRD40-162 Children’s Issues: Reports and Activities Appendix I AnAmotawdBibliographyof GAOReports on Children, October 1988 Through March 1990 Housing Conference: For many years, the federal government has played an important role in ensuring and providing an adequate and affordable supply of decent, National Housing Policy safe, and sanitary housing for many citizens. Since 1980, however, fed- Issues (GAO/RCED-89-l -74, eral funding for housing programs has been reduced substantially for Aug. 1989) some programs and others have been targeted for further reduction or even elimination. The Congress and the administration have again begun to emphasize the need for immediate attention to programs that would provide an adequate and affordable supply of housing, including housing for the homeless. This staff study presents the proceedings of a September 1988 conference sponsored by GAO to help it plan its future work on the problems of availability and affordability of housing for low-income households, homeless individuals and families, and first- time home buyers. In view of the recently disclosed problems of mis- management at HUD, GAO also plans to undertake studies of internal con- trols in various HUD programs. Rental Housing: Housing EILJD is currently operating two similar rental assistance subsidy pro- grams-certificates and vouchers-whose identical goals are to provide Vouchers Cost More Than low-income families with decent, safe, and affordable rental housing. Certificates but Offer The administration has proposed that the certificate program be Added Benefits replaced with the voucher program, claiming that vouchers are less (GAO/RCED-89-20, costly and are more efficient. The latest data available, however, indi- Feb. 16, 1989) cate that voucher costs are likely to be higher than certificate costs. Using data from HIJD'S first-year report on the housing voucher program, GAO calculated that with HUD'S 1989 budget request, about 9,500 fewer families can be assisted with vouchers than with certificates. GAO believes that operating one rental assistance program is advantageous; it would provide consistent benefits to program recipients and a unified approach to delivering housing assistance. The merits and drawbacks of features presently distinguishing vouchers from certificates need to be evaluated. Transition Series: Housing GAO found that the new administration, which came into office January 1989, will need to: (1) encourage continued private investment in low- and Urban Development income housing, focusing on individual markets to determine the amount Issues (GALO/OCG-89- of federal incentives needed; (2) consider the cost effectiveness of pre- 22TR, NovI. 1988) serving public, low-income housing; (3) continually monitor tax policies; (4) discontinue the separate housing voucher and certificate programs to assist low-income families, and consolidate the best features of both programs into one program aimed at providing equitable, cost-effective Page 27 GAO/IIRD-96.162 Children’s Issues: Reports and Activities Appendix 1 An Annotated Bibliography of GAO Reports on Children, October 1968 Through March 1996 Interstate Child Support: OCSEand state caseload and collection data are of questionable reliability and provide limited information about interstate child support. OCSE Case Data Limitations, data cannot be used to determine the relative size of states’ interstate Enforcement Problems, versus total caseloads because CASE collects different types of informa- Views on Improvements tion on interstate and total cases. Some of the barriers states identified Needed (GAO/HRD-89-25, that affect collections are insufficient staff, lack of automation, dif- Jan. 27, 1989) fering policies and procedures among states, and lack of communica- tion/cooperation between states. Some ongoing improvements at the state level include: (1) strengthening state legislation, policies, and pro- cedures; (2) increasing attention and priority to interstate cases; (3) improving absent parent location services; and (4) increasing staffing and training. Some suggested actions at the federal level should include: standardizing laws, procedures, and forms that bear on interstate cases; establishing child support office performance standards for handling interstate cases; and establishing an interstate computer network with uniform processing requirements for each state. Transition Series: Health Among other things, GAO reported that HHS needs to provide strong lead- and Human Services Issues ership to establish performance standards, encourage states to use proven collection techniques, and promote automated child support (GAO/OCG-89-lOTR, enforcement systems. Nov. 1988) --. Welfare Reform: This briefing report focuses on Alabama’s proposed welfare reform Alabama’s Demonstration demonstration project called Avenues to Self-Sufficiency through Employment and Training Services. Specifically, the report (1) analyzes Project (GAO/HRD-89- the procedures used to process the demonstration project proposal, 129BR, Aug. 17,1989) including whether the project complied with current law, and (2) pro- vides information about the project’s characteristics, such as benefits and changes associated with the project, the project’s effects on future beneficiaries, and Alabama’s early cost and savings estimates if the pro- gram is implemented in three counties and statewide. Page 29 GAO/HRD99-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1990 determine the nutritional adequacy of program benefits for specific indi- viduals. Four major diet-related health conditions exist on the four res- ervations: obesity, diabetes, heart disease, and hypertension. Although proper nutrition may not cure these conditions, it can reduce their com- plications or help prevent their occurrence. These programs do not spe- cifically address the special dietary needs of Indian recipients; however, GAO believes that ensuring that recipients receive and apply adequate nutrition education can help meet these needs. Food Stamp Program: A Why do some households that are eligible for food stamps not receive Demographic Analysis of them? GAO found that in 1987, over 56 percent of eligible households did not participate in the Food Stamp Program. Households receiving other Participation and welfare benefits were more likely to participate in the Food Stamp Pro- Nonparticipation (GAO/ gram. On the other hand, households receiving social security, those PEMD-90-8, Jan. 19, 1990) headed by the elderly, and those headed by both white and nonwhite single men were less likely to receive food stamps. The main reasons given for not participating in the program were (1) lack of interest in the benefits, (2) a lack of program information, and (3) problems with the program or lack of access to it. Given that outreach efforts may be resumed under the Hunger Prevention Act, GAO believes states should be encouraged to target those groups that would most benefit from the program. - Food Stamp Program: States have adopted a number of procedures to assure eligibility for Administrative Hindrances Food Stamp Program benefits and ensure that needy persons receive the appropriate amount of assistance in the most economical and efficient to Participation (GAO/ way possible. However, under certain circumstances, procedures RCED-89-4, Oct. 21, 1988) adopted by states (California, Illinois, Maryland, Oklahoma, and Texas) GAO visited have prevented or delayed eligible households from applying for food stamps and participating in the program. For example, GAO found that two offices conducted normal business only 4 days each week, which limited access to food stamp services, all local offices in one state and one local office in each of two other states did not consider applicants for expedited benefits or provide expedited benefits on time, and three local offices in one state did not always help applicants obtain the documents they needed to complete their applications. Page 31 GAO/IIRBSO-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1996 School Lunch Program: School districts receiving federal funds are required, whenever possible, to purchase only food products that are produced in the United States. Buy American Procedures GAO found that the Food and Nutrition Service and two of the three at Schools With Cash or states visited have implemented the Buy American provisions, but had Credit in Lieu of Food done only limited monitoring to determine compliance. Officials at three (GAO/RCED-89-183, of the four school districts GAO visited were aware of the Buy American Aug. 9, 1989) requirement and had instructed suppliers to deliver domestic products only. Officials in two of the districts periodically inspected product labels to ensure that the Buy American requirement was being met. Monitoring by the Food and Nutrition Service was limited. Transition Series: As part of the transition series of reports, GAO found that, among other Agriculture Issues (GAO/ things, USDA needs to improve the effectiveness and accuracy of the food stamp sanction system and resolve unpaid sanctions owed to the federal OCG-89-1ZTR, Nov. 1988) government. Youth Employment and Training Job Training Partnership This fact sheet discusses the occupations in which male and female par- Act: Information on ticipants in the Job Training Partnership Act program were trained and subsequently placed. It provides (1) a summary of the skill level of occu- Training, Placements, and pations for which men and women were trained and placed; (2) a com- Wages of Male and Female parison of the number and percentage of men and women trained in Participants (GAO/HRD- specific occupations, categorized as higher, moderate, and lower skill 89-152FS, Sept. 12, 1989) level positions; and (3) a similar comparison for those placed in specific occupations. Job Training Partnership The Job Training Partnership Act offers training to economically disad- Act: Youth Participant vantaged youth, many of whom lack basic work skills and remain unem- ployed despite economic expansion and a shortage of qualified workers. Characteristics, Services, This briefing report provides information on the characteristics of and Outcomes (GAO/HRD- youths (aged 14 to 21) enrolled under Title IIA of the act, the services 90-46BR, Jan. 24, 1990) they received, and the outcomes they attained. Page 33 GAO/HRD96-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1990 United Nations: U.S. GAOfound that officials and representatives of other major donor coun- Participation in the tries believe that United Nations Children’s Fund (UNICEF)programs are managed in a generally effective manner. They do, however, have cer- Children’s Fund tain concerns about UNICEFpolicies and programs. GAOobserved condi- (GAO/NSIAD-89-204, tions at some UNICEF-assistedproject sites that suggested increased Sept. 27, 1989) monitoring and oversight might be helpful. United Nations audits of UNICEF’S1985 and 1986 financial statements were critical of several accounting and financial management practices. UNICEFmanagement has responded affirmatively to the auditor’s recommendations. While the United States remains a major contributor to and participant in UNICEF, it is no longer the predominant donor, and its level of influence may be declining. Page 36 GAO/HRD9O-162 Children’s Issues: Reports and Activities Appendix11 GAO Testimony on Children’s Issues, October 1988 Through March 1990 GAO'S Study of Overseas Department of Defense Dependents’ Schools, by William J. Gainer, Human Resources Division, before the Subcommittee on Military Personnel and Compensation, House Committee on Armed Services (GAO/T-HKD-89-1 , Oct. 5, 1988). Impacts of Education Reform, by Eleanor Chelimsky, Program Evalua- tion and Methodology Division, before the Subcommittee on Elementary, Secondary and Vocational Education, House Committee on Education and Labor (GAO/T-PEMD-XW, Mar. 7, 1989). Implementation of the Carl D. Perkins Vocational Education Act, by William J. Gainer, Human Resources Division, before the House Com- mittee on Education and Labor (GAO/T-HKD-89-08, Mar. 7, 1989). Observations on Ohio’s Implementation of the Drug-Free Schools and Communities Act, by .John H. Luke, Detroit Regional Office, before the Senate Committee on Governmental Affairs (GAO/T-HRD-90-18, Feb. 13, 1990). Vocational Education: Opportunity to Prepare for the Future, by William J. Gainer, Human Resources Division, before the Subcommittee on Education, Arts, and Humanities, Senate Committee on Labor and Human Resources ((;.~o/T~rrr~D-89-Dr, .June 22, 1989). _________- Meeting the Needs of Children in a Home-Based Setting, by J. William Health Gadsby, Human Resources Division, before the Senate Committee on Finance (GAO/T-HRD-89-30, June 20, 1989). Nationwide and State Data on Youth Camp Safety and Health Not Col- lected, by Linda G. Morra, Human Resources Division, before the Sub- committee on Health and Safety, House Committee on Education and Labor (GAO/T-HRD-8%'27, Sept. 20, 1989). Adequacy of Nutrition Programs on Indian Reservations, by Flora H. Nutrition Milans, Resources, Community, and Economic Development Division, before the Senate Committee on Agriculture, Nutrition and Forestry and the Senate Select Committee on Indian Affairs (GAO/T-RCED-90-30, Feb. 20, 1990). Page37 GAO/HRD-90162 Children’s Issues: Reports and Activities Appendix III - GAO Reports on Children, FiscallYears 1980-88 GAO issued 119 reports on issues affecting children and their families from fiscal years 1980 through 1988. Figure III.1 shows the distribution of these reports among nine different issues. From 1980 through 1984, GAO issued more reports on child welfare and social services issues than any other issue. From 1985 through 1988, however, the emphasis shifted to income security and nutrition issues. Figure 111.1:GAO Reports on Children’s Issues (Fiscal Years 1980-88) 30 Number of Rqwxls 25 r Child Care: Availability for Civilian Dependents at Selected Installa- Child Day Care tions (GAOIHRD-88-115, Sept. 15, 1988) WD Child Care: Employer Assistance for Private Sector and Federal Employees (GAO/GGD-86-38, Feb. 11, 1986) Military Child Care Programs: Progress Made, More Needed (GAO/ FED-82-30, June 1, 1982) Page 39 GAO/HRD96-162 Children’s Issues: Reports and Activities Appaulix III GAO Reports on Children, Fixal Years 1980.66 Health and Human Services: Documentation of Funding Decisions for Child Abuse and Neglect Grants Inadequate (GAO/HRD-87-69, May 22, 1987) Implementation of Public Law 94-142 As It Relates to Handicapped Delinquents in the District of Columbia (GAO/GGD86-4, Oct. 17, 1985) Improved Federal Efforts Needed to Change Juvenile Detention Prac- tices (GAO/GGD%23, Mar. 22, 1983) Increased Federal Efforts Needed to Better Identify, Treat, and Prevent Child Abuse and Neglect (GAO/HRD-80-66, Apr. 29, 1980) Inter-title Transfers-A Way for States to Increase Federal Funding for Social Services (GAO/HRD-81.116, July 10, 1981) Juvenile Justice: Grant to the National Partnership to Prevent Drug and Alcohol Abuse (GAO/GGD-88-5BR, Apr. 6, 1988) Legislative Changes Are Needed to Handle Certain Cases Under the Fed- eral Youth Corrections Act (GAO/GGD-83-40, Mar. 9, 1983) Missing Children: Missing Children Data Collected by the National Crime Information Center (GAO,XKXWS~IFS, Jan. 28, 1986) Propriety of Non-Federal Cash Matching Requirements for Juvenile Jus- tice Grants (GAO/GGD-X4-28, Dec. 9, 1983) Residential Care: Patterns of Child Placement in Three States (GAO/ PEMD-85-02,June 28, 1985 ) Review of Certain Aspects of Group Home Care for Children in Cali- fornia (GAO/HRD-85-62, ,July 19, 1985) Sexual Exploitation of Children-A Problem of Unknown Magnitude (GAOIHRD-82-64, Apr. 20, 1982) States Are Funding Juvenile Justice Projects That Conform to Legisla- tive Objectives (GAO/GGI)-x0-40, Mar. 7, 1980) States Use Several Strategies to Cope with Funding Reductions Under Social Services Block Grant (GAO/HAD-84.68, Aug. 9, 1984) Page 41 GAO/HRD-90.162 Children’s Issues: Reports and Activities Appendix III GAO Reports on Children, Fiscal Years 1980-98 Greater Use of Exemplary Education Programs Could Improve Educa- tion for Disadvantaged Children (GAOIHRD-81~65, Sept. 15, 1981) Impact Aid: San Antonio Military School Districts Can Adjust to Reduced Federal Assistance (GAO/HRD-88.63BR, May 19, 1988) School Dropouts: Survey of Local Programs (GAOIHRD-87-108, July 20, 1987) School Dropouts: The Extent and Nature of the Problem (GAO/HRD-86- 106BR, June 23, 1986) Should the Bureau of Indian Affairs Continue to Provide Educational Services to Indian Children? (GAO/CED-80-72, Apr. 23, 1980) Special Education: Financing Health and Educational Services for Handi- capped Children (GAO/HRD-X6-GZBR, July 31, 1986) Unanswered Questions on Educating Handicapped Children in Local Public Schools (GAO/HRDm81-43, Feb. 5, 1981) Better Management and More Resources Needed to Strengthen Federal Health Efforts to Improve Pregnancy Outcome (GAO~HRD-80-24, Jan. 21, 1980) Block Grants: Federal Set-Asides for Substance Abuse and Mental Health Services (GAO!HRD-88-17, Oct. 14, 1987) DOD Health Care: Pediatric and Other Emergency Room Care (GAO/ ~~~-88-113, Sept. 28, 1988) Early Observations on States’ Plans to Provide Children’s Mental Health Services Under the ADAMH Block Grant (GAO/HRD-85-84, July 10, 1985) Immunization: Safety and Use of Polio Vaccines (GAO/HRD-87.83BR, May 11,1987) Maternal and Child Health Block Grant: Program Changes Emerging Under State Administration (GAO/HRD+W35, May 7, 1984) Medicaid: Interstate Variations in Benefits and Expenditures (GAO/ HRD-87.67BR, May 4, 1987) Page 43 GAO/HRB99-162 Children’s Issues: Reports and Activities Appmdix III GAO Reports on Children, Fiscal Years 1980-38 Child Support: Need to Improve Efforts to Identify Fathers and Obtain Support Orders (GAOiHRD-87-37, Apr. 30, 1987) Child Support: States’ Implementation of the 1984 Child Support Enforcement Amendments (GAO/HRD-86-4OBR, Dec. 24, 1985) Child Support: States’ Progress in Implementing the 1984 Amendments (GAO/HRD-87.11,OCt. 3, 1986) Federal Personnel: Garnishments of Wages for Commercial and Domestic Debts (GAOjGGD-88-49FS, Feb. 17, 1988) Tax Policy: Evaluation of IRS’ Refund Offset Study (GAO/GGD-88-117, Sept. 1, 1988) I~J.S.Child Support: Needed Efforts Underway to Increase Collections for Absent Parents (GAO,%RD-85-5, Oct. 30, 1984) Welfare: Expert Panels’ Insights on Major Reform Proposals (GAO/ HRD-88-59, Feb. 3, 1988) Welfare: Income and Relative Poverty Status of AFDC Families (GAO/ HRD-88-9, NOV. 4, 1987) Welfare: Relationships and Incomes in Households with AFDC Recipi- ents and Others (GAOjHRD-88-78, May 11, 1988) Welfare Eligibility: Programs Treat Indian Tribal Trust Fund Payments Inconsistently (GAO/HI(I)-88-38, May 20, 1988) Welfare Reform: Projected Effects of Requiring AFDC for Unemployed Parents Nationwide ((;AO@IRD-8&88BR, May 23, 1988) Welfare Simplification: States’ Views on Coordinating Services for Low- Income Families (GAO ~1~1~-87-110~s, July 29, 1987) Welfare Simplification: Thirty-Two States’ Views on Coordinating Ser- vices for Low-Income Families (GAO/HRD-87.GFS, Oct. 30, 1986) Welfare and Taxes: Extending Benefits and Taxes to Puerto Rico, Virgin Islands, Guam, and American Samoa (GAO/HRD87-60, Sept. 15. 1987) Page 45 GAO/HRD90-162 Children’s Issues: Reports and Activities GAO Reporta on Children, Fkd Years 19SO-96 Participation in the National School Lunch Program (GAO/RCED-84-132, Mar. 30, 1984) School Lunch Program: Evaluation of Alternatives to Commodity Dona- tions (GAOIRCED-~~-~ 13, June 11, 1987) School Meal Programs: Options for Improving the Verification of Stu- dent Eligibility (GAO/RCED-~~-~ZZBR, Mar. 17, 1986) Supplemental Food Program: Savings From Food Purchases Could Increase WE Participation (GAO/RCED-88-183BR, July 25, 1988) Supplemental Food Program: Using Cost Saving Methods Could Increase Participation (GAOIRCED-~~-%BR,~C~. 9, 1987) Surplus Commodities: Temporary Emergency Food Assistance Pro- gram’s Operations and Continuance (GAOIRCED88-11, Oct. 19, 1987) WIC Evaluations Provide Some Favorable But No Conclusive Evidence on the Effects Expected for the Special Supplemental Program for Women, Infants, and Children (GAO/PEMD84-4, Jan. 30,1984) CETA Demonstration Provides Lessons on Implementing Youth Pro- Youth Employment grams (GAO/HRD-~~-~,I%X. 8,198O) and Training Job Corps: Its Costs, Employment Outcomes, and Service to the Public (GAO/HRD86-121BR, July 30, 1986) Job Training Partnership Act: Data Collection Efforts and Needs (GAO/ HRD-86-69BR, Mar. 31, 1986) Job Training Partnership Act: Initial Implementation of Program for Disadvantaged Youth and Adults (GAOIHRD-~~-~, Mar. 4, 1985) Job Training Partnership Act: Summer Youth Programs Increase EmphasisonEducation (GAO/HRD87-lOlBR,June 30, 1987) Labor Market Problems of Teenagers Result Largely From Doing Poorly in School (GAOIPAD82-06, Mar. 29, 1982) Summer Youth Jobs Program: Congressional Action Has Increased Emphasis on Remedial Education (GAO/HRD88-118, Sept. 30, 1988) page47 GAO/HRDg0162Children'sIssues:ReportsandActi~ties Appendix IV Ongoing GAO Assignments on Children’s Issues, as of March 31,199O As of March 31, 1990, GAO had 44 assignments in process on issues affecting children. Figure IV.1 shows the distribution of these assign- ments among nine different issues. Figure IV.l: Ongoing GAO Assignments on Children’s Issues (as of Mar 31, 1990) 14 Number of Aesignmmts 12 10 a 6 4 2 Table IV. 1 provides contact points for ongoing GAO assignments. Page 49 GAO/HRD-9@162 Children’s Issues: Reports and Activities Appendix N Ongoing GAO Assignments on Children’s Issues, aa of March 31,199O Civil Rights Enforcement in Schools Education Current and Proposed Methods Used to Allocate Chapter 1 Funds Infor- mation on Drug-Free Schools Program Innovative Urban Schools Programs Learning-Disabled Students in the Education of the Handicapped Act Program Supplemental Education Services Provided to Immigrant Children IJnder the Emergency Immigrant Education Act of 1984 The Need for Financial Assistance for School Construction as Autho- rized by Public Law 8 l-8 15 Federal Efforts to Prevent Infection in Out-of-School Health AIDS: Adolescents HIV AIDS: School-Based Efforts to Prevent Adolescent HIV Infection Analysis of the Cost of Health, Social, and Related Services for Infants of Substance-Abusing Women Characteristics of the Uninsured in Michigan and Other Selected States Characteristics of the Ininsured in Selected States Home Visiting as a Means to Improve Maternal and Child Health and Well-Being Drug Abuse Among School Drop-Outs and Pregnant Teens + Drug Abuse Prevention/Education Projects for Preteens: Effectiveness and Promising Practices + Effects of Expanded Eligibility for Medicaid-Financed Prenatal Care on Participation + State Responses to Federal Efforts to Expand Medicaid Program Coverage Page 61 GAO/HRD90162 Children’s Issues: Reports and Activities Appendix N Ongoing GAO Assignments on Children’s Issues, aa of March 31,199O Child Labor Violations and Workplace Fatalities and Injuries Suffered Youth Employment by Minors in the U.S. and Training Child Labor Violations and Sweatshops in the U.S. Youth Employment Policies: A Review of Policies and Practices of the U.S. and Several Competitor Nations Page 63 GAO/HRD90162 Children’s Issues: Reports and Activities Appendix V Other Publications and Papers by GAO Staff on ChiIdren’s Issues, October 1988 Through March 1990 Frederick Mulhauser, Education PEMD, l presented a paper on GAO'S evaluations of education programs, before a symposium on evaluation for education policy and practice, sponsored by the University of Warwick, in Coventry, England, September 22-24, 1989. l authored “Reviewing Bilingual Education for Congress,” in the March 1990 issue of The Annals of the American Academy of Political and Social Science. Jeffrey Mayer, PEMD, . authored “Evaluation of Maternal and Child Health Community Nursing Services: Application of Two Quasi-Experimental Designs,” Health Action Papers, fall 1988. l co-authored: “Pregnant Women Eligible for Medicaid Expansion of Maternity Ser- vices: Implications for Outreach,” Evaluation and The Health Profes- sions, December 1989. “A Randomized Evaluation of Smoking Cessation Interventions for Preg- nant Women at a WIG Clinic,” The American Journal of Public Health, January 1990. “The Dissemination of Therapeutic Foster Care,” in R.P. Hawkins and J. Breiling (Editors) Therapeutic Foster Care: Critical Issues, Washington, D.C.: Child Welfare League of America, 1989. l presented papers on: Application of an evaluation framework to expanded maternity services at the Annual Meeting of the American Evaluation Association, San Francisco, October 1989. Community-based approaches to maternal and infant health at the Second Biennial Conference on Community Research and Action, East Lansing, Michigan, June 1989. Page 56 GAO/HRMO46Z Chhken’s Issues: Reports and Activities Appeqdix VI Major Contributors to This Report IHuman Resources David D. Bellis, Project Manager Division, Janice S. Raynor, Evaluator Washington, D.C. (llt%362) Page 57 GAO/IiRD-9@162 Children’s Issues: Reports and Activities a Appendix V Other Publleations and Papers by GAO Staff on Children’s Issues, October 1988 Through March 1990 Sheila Smythe, HRD, authored “Safeguarding Our Children’s Health,” The GAO Journal, fall 1988. Mark Rom, Income Security PEMD, authored “The Family Support Act of 1988: Federalism, Developmental Policy, and Welfare Reform,” Publius, summer 1989, and co-authored “Federalism, Welfare Reform, and Residential Choice,” American Political Science Review, fall 1989. Joanne Frankel and Tom Medvetz, HRD, and Harriet Ganson, Boston Youth Employment Regional Office, presented a paper, “Using the CPS to Evaluate the Job and Training Training Partnership Act,” at the annual meeting of the American Eval- uation Association, New Orleans, Louisiana, November 1988. Kalman Rupp, HKD, co-authored “Participation in JTPA,” published in Evaluation Forum, February 1989. Carlotta Young, HKD, presented a paper, ‘Sweatshops Threaten the Health of Workers Throughout the U.S. in Multiple Industries,” at the 117th Annual Meeting of the American Public Health Association in Chi- cago, Illinois, October 25, 1989. Stephanie Shipman, PEMD, authored “General Criteria for Evaluating Other Child and Social Programs,” describing GAO'S framework for evaluating and com- Family Issues paring children’s programs, Evaluation Practice, spring 1989. Page 56 GAO/IIRE-90162 Children’s Issues: Reports and Activities Other Publications and Papers by GAO Staff on Children’s Issues,October 1988 Through March 1990 In addition to the issued reports and testimonies given, GAO staff inde- pendently published 10 articles in professional journals and presented 7 papers to professional meetings on child-related topics from October 1988 through March 1990.’ Figure V.l shows the distribution of these articles and papers among nine different issues. Figure V.l: Published Articles and Papers by GAO Staff on Children’s Issues (Ott 1988-Mar 1990) 10 Number of Publications s William Laurie, Detroit Regional Office, presented a paper, “Child Care: Child Day Care Diversity in Infancy,” at the Ohio Academy of Science 98th Annual Meeting, in Cleveland, Ohio, April 12, 1989. Lisa Cassady, GGD, presented a paper, “The Family Response to Conflict Child Welfare and Scale: Development of a Measure of Marital Conflict and Children’s Social Services Exposure and Reactions,” at the fall meeting of the Capitol Area Social Psychological Association, Bethesda, Maryland, October 21, 1989. ‘These articles and papers do not necessarily reflect the vmvs and opinions of GAO. Page 54 GAO/HRD9O-162 Children’s Issues: Reports and Activities Appendix IV Ongoing GAO Assl@ments on Children’s Issues, 8s of March 31,1996 The Crack Epidemic Effectiveness of Supportive Housing Demonstration Program Housing HUD'S Use of Surplus and Underutilized Federal Property for the Homeless America’s Underclass: Size, Causes, and Cures Income Security Characteristics of Low-Income Single-Parent Families Credit Bureau Reporting to Encourage Child Support Payments Interstate Child Support Enforcement: Interstate Access to Absent Parent Information Can Be Improved Job Opportunities and Basic Skills (JOBS) Training Program of the Family Support Act of 1988 Measuring Effects of the AFDC Unemployed Parent Program + Methods for Assessing the Full Costs and Benefits of Innovative Child Support Enforcement Programs + Trends in the Size and Composition of the Poverty Population + An Analysis of Alternative Methods for Defining a Household Within Nutrition the Food Stamp Program Food and Nutrition Problems on Indian Reservations Implementation of the New Temporary Emergency Food Assistance Pro- gram Provisions of the Hunger Prevention Act of 1988 States’ Experiences in Containing Infant Formula Costs in the WIG Program Verification of Washington Family Independence Program Payments Page 52 GAO/HRIN6-162 Children’s Issues: Reports and Activities Appendix lv Table IV.l: Key GAO Contacts for Work on Children’s Issues Issues Contact Chrld Welfare and Socral Services (Juvenile Lowell Dodge, Drrector, Administratron of Justice Issues) Justice Issues, GGD, (202) 275-8389 Child Welfare and Socral Servrces, Income Joseph Delfico, Drrector, Income Secunty Security Issues, HRD, (202) 275-6193 Educatron; Youth Employment and Training Franklrn Frazier, Director, Education and Employment Issues, HRD, (202) 275-1793 -___ Health Janet Shikles, Director, Health Financrng and Polrcy Issues, HRD, (202) 275-5451 Mark Nadel, Assocrate Director, Natronal and Publrc Health Issues, HRD. (202) 275-6195 Housing John Ols, Drrector, Housing and Communrty -~ _~__. Development Issues, RCED, (202) 275-5525 Nutntion John Harman, Drrector, Food and Agriculture Issues. RCED, (202) 275-5138 --~ Other Child and Family Issues Linda Morra, Director, Intergovernmental and Management Issues, HRD. (202) 275-1655 For assignments followed by a ‘I+“, contact Carl E. Wisler, Director, Planning and Reporting, Program Evaluation and Methodology Division, (202) 275-1854. Analysis of Juvenile Detention Child Welfare and Social Services Child Abuse Prevention Challenge Grant Program Foster Care Children’s Duration in Care and Rate of Reentry Foster Care Reform Implementation, Length of Stay, and Recidivism Out-of-State Placement of Children in Group Residential Care Respite Care for Families With Children at Risk of Abuse Selected Aspects of the Department of Health and Human Services’ Office of Human Development Services’ Management of Foster Care and Child Welfare Services Unintentional Firearms Injuries + Page 60 GAO/HRB3@162 Children’s Issues: Reports and Activities Appendix III GAO Reports on ChlIdren, FiscnI Years 1986.88 The Job Training Partnership Act: An Analysis of Support Cost Limits and Participant Characteristics (GAOIHRD-86-16, Nov. 6, 1985) Youth Job Training: Problems Measuring Attainment of Employment Competencies (GAO/HRD-87-33, Feb. 11, 1987) Children’s Programs: A Comparative Evaluation Framework and Five Other Child and Illustrations (GAO/PEMD&-ZBBR, Aug. 31, 1988) Family Issues Needs-Based Programs: Eligibility and Benefit Factors (GAO/HRD-86- 107x3, July 9,1986) Parental Leave: Estimated Cost of Revised Parental and Medical Leave Act (GAO/HRD-88-103, May 26, 1988) Parental Leave: Estimated Cost of Revised Parental and Medical Leave Act Proposal (GAO/HRD-88-132, Sept. 27, 1988) Parental Leave: Estimated Costs of H.R. 925, the Family and Medical Leave Act of 1987 (GAO/HRD-88-34, Nov. 10, 1987) Page 48 GAO/IIRD-96-162 Children’s Issues: Reports and Activities Appendix IIl GAO Reports on Children, Fiscal Years 198088 Work and Welfare: Analysis of AFDC Employment Programs in Four States (GAO/HRD-88-33FS, Jan. 5, 1988) Work and Welfare: Current AFDC Work Programs and Implications for Federal Policy (GAOIHRD-87.34, Jan. 29, 1987) Benefit Overpayments: Recoveries Could Be Increased in the Food Nutrition Stamp and AFDC Programs (GAO/RCED-86-17, Mar. 14, 1986) Child Care Food Program: Better Management Will Yield Better Nutri- tion and Fiscal Integrity (GAO/CED-80-91, June 6, 1980) Food Stamp Program: Evaluation of Improper Denial or Termination Error Rates (GAO/RCED-88.12, Oct. 22, 1987) Food Stamp Program: Participation by AFDC Households (GAO/RCEE+88- 85~R, Feb. 11,1988) Food Stamp Program: Refinements Needed to Improve Accuracy of Quality Control Error Rates (GAO/RCED-86-195, Sept. 19, 1986) Food Stamp Program: Reporting of Application Activities Could Be Improved (GAO/RCED-88.156, July 14, 1988) Food Stamp Program: Restoration of Improperly Denied or Terminated Benefits (GAOIRCED-87-51, Oct. 30, 1986) Food Stamp Program: Results of the Simplified Application Demonstra- tion Project (GAO/RCED-87.102, June 11, 1987) Food Stamp Program: Trends in Program Applications, Participation, and Denials (GAO/RCED-87.80BR, Apr. 2, 1987) Food Stamps: Examination of Program Data and Analysis of Nonpartici- pation (GAO/PEMD-88-21, July 5, 1988) Need to Foster Optimal Use of Resources in the Special Supplemental Food Program for Women, Infants, and Children (GAO/RCED-86-106, Sept. 27,1985) Overview and Perspectives On TheFoodStamp Program(GAO/RCED-85- 109, Apr. 17,1985) Page 46 GAO/HRtWO-162 Children’s Issues: Reports and Activities Appendix III GAO Reports on Children, Fiscal Years 1986-66 Prenatal Care: Medicaid Recipients and Uninsured Women Obtain Insuf- ficient &T(GAO/HRD87-137, sept.30, 1987) Teenage Pregnancy: 500,000 Births a Year but Few Tested Programs (GAO/PEMD&lGBR, July 21,1986) The Sudden Infant Death Syndrome Program Helps Families but Needs Improvement (GAO,'HRI)-81.25, Feb. 6, 1981) Changes in Rent Burdens and Housing Conditions of Lower Income Housing Households (GAO/KCE~)-~~-~I~~, Apr. 23, 1985) Federal Rental Housing Production Incentives: Effect on Rents and Investor Returns (GA~!KCED-85-1 14, May 10, 1985) Federally Supported Centers Provide Needed Services for Runaways and Homeless Youth (GAO/IPE-83-7, Sept. 26, 1983) Homelessness: A Complex Problem and the Federal Response (GAO/ HRD-85-40, Apr. 9, 1985 ) Homelessness: Implementation of Food and Shelter Programs Under the McKinney Act (GAO~RCED-88-63, Dec. 8, 1987) Housing Allowances: An Assessment of Program Participation and Effects (GAOIPEMD-86-8, Feb. 10, 1986) HUD Not Fulfilling Responsibility to Eliminate Lead-Baaed Paint Hazard in Federal Housing (GAO/CED-81-31, Dec. 16, 1980) Public Housing Vacancies and the Related Impact of HUD'S Proposal to Reduce Operating Subsidies (GAO/RCED85-93, Mar. 29, 1985) Rural Rental Housing: Cost Information on FMHA’s Section 515 Program and Other Housing Options (GAOIRCED87.SG, Aug. 18, 1987) Child and Family Welfare: Selected HHS Discretionary Funding in Fiscal Income Security Year 1985 (GAO/HRI)-8fi-87FS, Apr. 10, 1986) Child Support Collection Efforts for Non-AFDC Families (GAO/HRD~~-3, Oct. 30, 1984) page44 GAO/HRD-!?I3162 Children’s Issues: Reports and Activities - Appendix Ill GAO Reports on Children, Piscal Years 1966.66 The Office of Juvenile Justice and Delinquency Prevention’s Special Emphasis Program Has Not Realized Its Full Potential (GAO/GGD8242, Apr. 16,1982) The Proposed Missing Children and Serial Murder Tracking Program Is Not Eligible for Juvenile Justice and Delinquency Prevention Act Special Emphasis Funds (GAOIGGD-847, Nov. 16,1983) Bilingual Education: A New Look at the Research Evidence Education PEMD-~~-~~BR,Mar. 10, 1987) (GAO/ Bilingual Education: Information on Limited English Proficient Students (GAO/HRD87-85BR, Apr. 30, 1987) Bureau of Indian Affairs Plans to Consolidate Off-Reservation Indian Boarding Schools (GAOjRCED83-204, Sept. 12, 1983) Compensatory Education: Chapter l’s Comparability of Services Provi- sion (GAO/HRD87-102, Aug. 27, 1987) Compensatory Education: Chapter 1 Participants Generally Meet Selec- tion Criteria (GAO/HRD-87-26, Jan. 30, 1987) Compensatory Education: Chapter 1 Services Provided to Private Secta- rian School Students (GAO/HRD-87-128BR, Sept. 21, 1987) Deaf Education: Costs and Student Characteristics at Federally Assisted Schools (GA~/HRD~~-~~BR, Feb. 14, 1986) Deaf Education: The National Mission of Gallaudet’s Elementary and Secondary Schools (GAO/HRDS~-133, Sept. 30, 1987) Disparities Still Exist in Who Gets Special Education (GAO/IPE-81-1, Sept. 30,198l) DODSchools: Funding and Operating Alternatives for Education of Dependents (GAO/HRD-87-16, Dec. 10, 1986) Education Block Grant Alters State Role and Provides Greater Local Dis- cretion (GAO/HRD~~-18,Nov. 19, 1984) Page 42 GAO/HlD9lX162 Children’s Issues: Reports and Activities Appendix III GAO Reports on Children, Fiscal Years 198088 Child Welfare and Care (GAO/HRD-81-73, Apr. 20, 1981) Social Services Appointments to and Operations of the National Advisory Committee for Juvenile Justice and Delinquency Prevention (GAO/GGD-84-8, Nov. 30, 1983) Better Federal Program Administration Can Contribute to Improving State Foster Care Program (GAO/HRD84-2, Aug. 10, 1984) Better Monitoring and Recordkeeping Systems Needed to Accurately Account for Juvenile Justice Practices (GAO/GGD-84-85, July 9, 1984) Circumstances That Resulted in New York Receiving About Half of the Federal Foster Care Reimbursement to States in Fiscal Year 1978 (GAO/ ~~~-81-156, Sept. 24, 1981) Competitive and Noncompetitive Grant Awards Made by the Office of .Juvenile Justice and Delinquency Prevention (GAO/GGD-85-6, Oct. 26, 1984) Drug Suppression/Habitual Offender Program Awards Were Proper (GAO~GGD-84-44, Apr. 3. 1984) Federal and State Actions Needed to Overcome Problems in Adminis- tering the Title XX Program (GAOIHRD-81-8, Oct. 29, 1980) Follow-up Review to Report on Increased Federal Efforts Needed to Better Identify, Treat, and Prevent Child Abuse and Neglect (GAO/ HRDW153,Sept. 18, 1981) Foster Care: Use of Funds for Youths Placed in the Rite of Passage Pro- gram(GAO/HRD87-23RK, Dec. 9, 1986) Guyana Tragedy Points to a Need for Better Care and Protection of Guardianship Children (GAO/HRD-81-7, Dec. 30, 1980) Head Start: An Effective Program but the Fund Distribution Formula Needs Revision and Management Controls Need Improvement (GAO/ HRD-81-83, July 23, 1981) Page 40 GAO/HRB96-162 Children’s Issues: Reports and Activities Appendixll GAOTestimonyonChildren's Issues, October1988ThroughMarch1990 GAO'S Review of USDA'S National WIG Evaluation Report and Follow-up Issues, bv Keith 0. Fultz. Resources, Communitv. and Economic Devel- opment Division, before the House Select Committee on Hunger, the Senate Committee on Agriculture, Nutrition, and Forestry, and the Sub- committee on Nutrition and Investigations, Senate Committee on Agri- culture, Nutrition, and Forestry (GAO/T-RCED-90-21, Jan. 24, 1990). Use of Surplus Dairy Products in the National School Lunch Program, by William E. Gahr, Resources, Community, and Economic Development Division, before the Subcommittee on Nutrition and Investigations, Senate Committee on Agriculture, Nutrition, and Forestry (GAO/T- RCEDW49, June 14, 1989). Child Labor Violations and Sweatshops in the US., by Franklin Frazier, Youth Employment Human Resources Division, before the Subcommittee on Employment and Training and Housing, House Committee on Government Operations (GAO/T- HRD-90-18, Mar. 16, 1999). Job Training Partnership Act: Comments on H.R. 2039, The JTPA Amendments of 1989, by William J. Gainer, Human Resources Division, before the House Committee on Education and Labor (GAO/T-HRD-89-32, June 29,1989). Senate Bill 543: The Job Training Partnership Act Youth Employment Amendments of 1989, by William J. Gainer, Human Resources Division, before the Subcommittee on Employment and Productivity, Senate Com- mittee on Labor and Human Resources (GAO/T-HRD-89-18, May 11, 1989). Cost Estimate of the Family and Medical Leave Act of 1989 (H.R. Other Child and GAO'S 770) by William J. Gainer, Human Resources Division, before the Sub- Family Issues committee on Labor-Management Relations, House Committee on Educa- tion and Labor (GAO/T-HRD-89-4, Feb. 7, 1989) GAO'S Cost Estimate of the Family and Medical Leave Act Proposal, by William J. Gainer, Human Resources Division, before the Subcommittee on Children, Families, Drugs, and Alcoholism, Senate Committee on Labor and Human Resources (GAO/T-HRD-89-3, Feb. 2, 1989). Page38 GAO/HRD90-162Children.s 1ssues:ReportsmdActivities Annendix II GAO Testimony on Children’s Issues, October 1988 Through March 1990 From October 1988 through March 1990, GAO testified 17 times before congressional committees on issues affecting children. Figure II. 1 shows the distribution of testimony among nine different child-related issues. Figure 11.1:GAO Testimony on Children’s Issues (Ott 1988.Mar. 1990) 10 Number of Testlmonlsc Respite Care: Insights on Federal, State, and Private Sector Involvement, Child Welfare and by Franklin Frazier, Human Resources Division, before the Subcom- Social Services mittee on Select Education, House Committee on Education and Labor (GAO/T-HRD-89-12, Apr. 6, 1989). Education Information: Production and Quality Deserve Increased Education Attention, by Lois-ellin Datta, Program Evaluation and Methodology Division, before the Subcommittee on Government Information and Reg- ulation, Senate Committee on Government Affairs (GAO/T-PEMD-90-7, Nov. 1, 1989). Page 36 GAO/HRD-90162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Repoti on ChiIdren, October 19.96 Through March 1396 Other Child and Family Issues Legislative Branch: This report provides information on parental leave policies and child care services in the legislative branch. Eighty-one Senators’ offices Parental Leave Practices responded to GAO’S questionnaire. The 16 standing committees of the and Child Care Services Senate, the Office of the Secretary of the Senate, and the Senate Ser- (GAO/HRD-90-12, geant at Arms also responded to GAO’S telephone survey. Most of the 81 Nov. 14, 1989) Senators’ offices, the 16 Senate committees, and Senate offices had maternity and parental leave policies, although they varied greatly. Both the Senate and the House of Representatives run child care centers with a combined enrollment of about 115 children. Among the legislative branch agencies, only GAO and the Government Printing Office plan to open child care centers.’ Lack of management support, along with funding and space problems, tends to impede the opening of child care centers. Parental Leave: Revised GAO was asked to estimate the cost of adding a provision allowing 10 Cost Estimate Reflecting weeks of unpaid leave to care for a seriously ill spouse to the proposed Family and Medical Leave Act of 1989 (H.R. 770). The act would permit the Impact of Spousal an employee to take up to 10 weeks of unpaid leave over a Z-year period Leave (GAO/HRD-89-68, upon the birth or adoption or placement for foster care of child, or the Apr. 6, 1989) serious health condition of a child or parent, and up to 15 weeks every year for personal illness. Upon returning to work, the employee is guar- anteed the same or equivalent job. The proposed legislation would require employers to continue health benefits for workers while on unpaid leave on the same basis as if the employee were still working, but does not require the continuation of other employee benefits. The pro- posed provision would provide the same job protection and health bene- fits. The estimated cost of H.R. 770 to employers who have 50 or more workers would be $188 million annually. If the legislation is expanded the cost increases by $142 million to about $330 million annually. When firms employing between 35 and 49 people are included, the cost of H.R. 770 is estimated to be $212 million annually, which increases to $368 million annually when the provision to care of seriously ill spouses is included. ‘GAO’s on-site child day care center qxned in June 1990. Page 34 GAO/HRIN@162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1938 Through March 1990 Food Stamp Program: The Food Stamp Program is designed to provide low-income household members additional food purchasing power to help them acquire an ade- Participants Temporarily quate low-cost diet. However, eligible participants can be temporarily Terminated for Procedural terminated from the program if they do not comply with procedural Noncompliance requirements. GAO, on the basis of its sample, estimated that about 49 (GAOIRCED-89-81, percent of the households in Georgia and about 68 percent of the house- June 22,1989) holds in Wisconsin experienced breaks in service. Participant-caused breaks resulting in benefit losses were caused by participants not (1) submitting timely monthly reports, (2) providing requested verification documents, (3) notifying their local office regarding the nonreceipt of stamps, (4) meeting work requirements, and (5) filing timely or complete new applications for recertification. Food Stamps: Reasons for Based on an analysis of nationally representative data, GAO found that, Nonparticipation in 1979 and 1986, slightly more than one-half of the households eligible for food stamps did not participate in the program because they did not (GAO/PEMD-89-5BR, think they were eligible. Approximately one-third of those who thought Dec. 8, 1988) they were ineligible also thought their assets or income were too high for the Food Stamp Program. About two-thirds of the eligible nonpartici- pants who thought they were eligible for benefits did not try to get food stamps. The reasons this group gave for not participating in the pro- gram were they (1) did not need the benefits and (2) were concerned about the likely administrative “hassles.” School Lunch Program: The over 15,000 school districts participating in USDA’S National School Buy American Procedures Lunch Program are required, whenever possible, to use federal funds to purchase food products that are produced only in the United States. at Commodity Schools Generally, GAO found that the Food and Nutrition Service and two of the (GAO/RCED-89-2 18, four states that it visited had implemented the Buy American require- Sept. 26,1989) ment, but monitoring of compliance has been limited. The Service and the states have not done any monitoring, although some of the school districts have inspected delivered food items. Neither the Service nor the states GAO visited monitor commodity school district purchases to ensure that the Buy American requirement is met. Although waivers from the Buy American requirement are permitted, neither the Service nor the states had received waiver requests from any of the districts. Page 32 GAO/HRD-W-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports onChildren,October1988Through Man-h 1990 Nutrition Food Assistance: The At an annual cost of about $1.93 billion, the Special Supplemental Food Program for Women, Infants, and Children (WE) provides nutritional National WIC Evaluation: supplements and education to needy pregnant women, breast-feeding Reporting and Follow-Up mothers, and children up to age 5. In 1986, the U.S. Department of Agri- Issues (GAO/RCED-90-3, culture (USDA) published a study entitled The National WIGEvaluation, Dec. 14, 1989) which discussed the effects of the program on participants’ nutrition and health. Almost immediately questions surfaced about how the study was reviewed and reported. USDA said it deleted the original chapter and executive summaries and replaced them with a compendium of results because the data did not justify the research team’s favorable conclu- sions about WIG.GAO found, however, that USDA'S compendium of results (1) contained errors and misleading statements about some of the data and (2) deleted the study team’s overall conclusions about WIG'S effect on participants. In contrast, the original executive summary used appro- priate methodology, was accurately presented, and reported the study’s main conclusions: that WIG improves the diet of pregnant women and children, adds to maternal weight gain, increases the use of prenatal care, and reduces preterm deliveries. In 1984, arguing that the response rate would be too low, I:SDA withdrew a proposal to assess WIG'S effect on the physical and mental development of children born to mothers who had participated in the evaluation. Since the response rate prob- ably would have been higher than USDA reported, GAO believes USDA acted prematurely in canceling this follow-up study. USDA is now deciding whether to pursue a study of WIG'S effect on a different group of children. Food Assistance Programs: GAO looked at whether food assistance programs met the nutritional Nutritional Adequacy of needs of Indians living on four reservations: Fort Berthold in North Dakota; Pine Ridge in South Dakota; White Earth in Minnesota; and Primary Food Programs on Navajo in Arizona, New Mexico, and Utah. GAO found that several food Four Indian Reservations assistance programs serve the four Indian reservations, the two largest (GAO/RCED-89-177, being USDA'S Food Stamp Program and Food Distribution Program on Sept. 29,1989) Indian Reservations. These two programs are designed to provide recipi- ents with benefits consistent with national dietary guidelines. However, because many factors affect the nutritional value of the food people consume, such as the quantity of food eaten, food preparation methods, and the variable nutritional needs of individuals, GAO was unable to Page30 GAO/HRD-90162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1088 Tbrou8h March 1990 support to those with housing needs; and (5) implement long-term solu- tions that take into account the diversity of the homeless population and the array of contributory causes. Welfare Hotels: Uses, GAO examined the use of “welfare hotels” as primary housing for needy families. Welfare hotels are regarded as commercially owned, one-story Costs, and Alternatives or multistory hotels or motels providing shelter to a clientele composed (GAO/HRD-89-26BR, exclusively or primarily of homeless families receiving some type of Jan. 31,1989) public assistance. Basic services provided to hotel residents usually include a room with a private bath, linen changes, room cleaning, and general facility maintenance. However, services can vary; in some instances families have difficulty receiving even basic hotel service. Ilotel costs vary widely, from an average of $65 to $100 per night in New York City. Average daily rates paid in other localities include: $49 in Washington, D.C.; $50 in the state of New Jersey; $75 to $89 in West- chester County, New York; and $35 and below in other localities. Alter- natives, such as congregate family shelters and transitional apartments, can be more expensive than hotels. Various government and private sector initiatives are underway to address the need for low-income housing. Income Security Child Support: State The IIIIS Office of Child Support Enforcement (OCSE) administers the pro- Progress in Developing gram to strengthen state and local efforts to find absent parents, estab- lish paternity, obtain child support orders, and collect support Automated Enforcement payments. The Congress recognized that the use of automation could Systems (GAO/HRD-89- result in more efficient, cost-effective child support enforcement; thus, it IOFS, Feb. 10,1989) authorized enhanced federal funding for planning, developing, and installing comprehensive, statewide automated systems. GAO inter- viewed officials in all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands to find out states’ progress in the develop- ment of automated systems for these programs. Of the 54 state systems, ‘as of May 1988, CKXEhad certified 2 as fully operating. The rest of the states’ systems were as follows: 14 were mostly operating, 15 were in the developing or installing phase, and 21 were in the preplanning or planning phase. The other two states had no plans to establish compre- hensive systems. Page 28 GAO/IIRLW@162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Tlwough March 1990 Because troubled youths and those who are younger than age 16 may not be suitable for independent living programs, more information is needed on alternative programs. - Homelessness: HUD’s and The McKinney Act authorized additional funding for three existing pro- grams-the Federal Emergency Management Agency’s (FEMA) Food and FEMA’s Progress in Shelter Program, the Department of Housing and Urban Development’s Implementing the (HUD) Emergency Shelter Grants Program, and its Supportive Housing McKinney Act Demonstration Program. The act also established two new HUD pro- (GAO/RCED-89-50, grams-Supplemental Assistance for Facilities to Assist the Homeless May 11,1989) and the Single Room Occupancy Program. HUD and FEMA program funds enable many organizations to provide an increased amount of shelter, meals, and other services that may not otherwise be provided and that are often crucial to keeping facilities operational. The impact of the FEMA program, however, was lessened because it provided little or no funds during the crucial winter months of 1987-88. FEMA had disbursed $97 million of its $124 million McKinney Act funds by May 31, 1988; however, only $8.3 million was disbursed by January 31, 1988, and $31.5 million by February 28. Actions were taken to alleviate this situa- tion during the winter of 1988-89. The impact of the HIJD program has been limited because these are long-term programs and grantees have made few disbursements. As of May 31, 1988, HUD had disbursed only 5 percent of the $253 million provided for its programs. FEMA and HIJD disbursements reached 100 percent and 24 percent, respectively, by February 17,1989. Homelessness: McKinney GAO is required to report annually on the status of programs authorized Act Programs and Funding under the McKinney Act. The act, which seeks to establish a comprehen- sive program to help homeless people, now funds 18 programs that pro- for Fiscal Year 1989 vide direct services for the homeless. This report outlines the act’s (GAO/RCED-90-52, legislative history, describes each McKinney Act program, and details Feb. 16, 1990) moneys provided under each program, by state, for fiscal year 1989. Of the $1.1 billion that the Congress appropriated for McKinney Act pro- grams during fiscal years 1987-89, the largest portion-around $365 million-went to FEMA'S Emergency Food and Shelter Program, which gives emergency food and shelter to needy people. Page 26 GAO/HRIHJO-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1998 Through March 1990 - to pregnant women. GAO also observed, however, that while a lack of money is the most important obstacle to obtaining care, other barriers- such as the overall inadequacy of the prenatal care system, administra- tive and institutional obstacles presented by the health care system, and personal and cultural factors-must also be eliminated if access to care for pregnant women, infants, and children is to be further improved. - Pediatric AIDS: Health and Acquired immunodeficiency syndrome (AIDS) is rapidly becoming a major health threat to children. It is now the ninth leading cause of Social Service Needs of death among children I- to 4-years old; within the next 3 to 4 years it Infants and Children could be among the top five leading causes of childhood death. Most (GAO/HRD-89-96, children infected with the human immunodeficiency virus (HIV) are from May 5,1989) low-income and disadvantaged families who have limited access to ade- quate health care services. As a result, these children and their families rely on public health and social services systems. In some communities, these systems are already overburdened. Consequently, these children are at risk of long and costly hospital stays that tend to reduce the overall quality of life compared to a home environment. In the communi- ties that were reviewed, foster care, home health care, and support ser- vices have been developed or expanded to help reduce the time HIV- infected children spend in the hospital and the resultant health care costs. All communities reported, however, inadequate current capacity to meet the demand for such services as day care, group homes that provide intermediate-level care, respite care, mental health counseling, and transportation. Some federal support is available to fund these services. Teenage Smoking: Higher The 1970s saw a decline in the teenage smoking participation rate, Excise Tax Should which appears to have been largely caused by anti-smoking campaigns and related public health measures. By the 1980s the decline appar- Significantly Reduce the ently had stalled. To trigger a further decline, health experts and others Number of Smokers have called for increases in the cigarette excise tax. Raising the federal (GAO/HRD-89-119, excise tax on cigarettes will reduce teenage smoking to the extent that June 30,1989) they will respond to higher cigarette prices. Page24 GAO/HRD4K%162 Children’s Jssues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1990 various segments of this population, depending on whether program eli- gibility requirements are met. Health Care: Children’s GAO reviewed how 10 states (Arizona, California, Florida, Georgia, Maine, Maryland, Minnesota, Mississippi, Ohio, and Texas) use federal Medical Services Programs Maternal and Child Health (MCH) Services block grant funds to support in 10 States (GAO/HRD- their children’s medical services (CMS) programs. All 10 states allocated 89-81, July 14, 1989) federal MCH funds to their CMSprograms, but 8 states did not designate, or earmark, MCH funds for specific CMS activities. Arizona designated federal funds almost exclusively for CMS personnel and administrative costs, and Ohio, for CMS administration and medical case management. Most CMS programs (1) provided many medical services, such as physi- cian office visits, medications, medical equipment and supplies, and therapies; (2) provided some support services, such as case manage- ment, counseling, and transportation; and (3) covered a wide range of medical conditions. Health Care: Home Care From 10 to 15 percent of all U.S. children have a chronic health condi- Experiences of Families tion, health researchers estimate, and about 1 million of these have a severe form of the condition. In general terms, a chronic illness is a con- With Chronically Ill dition that lasts for a substantial period of time and has continuing and Children (GAO/HRD- often debilitating effects. While some changes in service delivery and 89-73, June 20, 1989) financing have supported the home care concept, families still reported difficulties in obtaining needed services. Parents say three factors com- monly accounted for their difficulties--lack of (1) financing because of health insurance coverage limitations, (2) information on services avail- able, and (3) a focal point to contact when help was needed with home care. Among possible improvements are (1) consolidating information on existing services and making it available to all organizations serving chronically ill children, (2) providing this information to parents during the hospital discharge planning process, and (3) referring parents who need help in the home-care setting to organizations providing case man- agement services. Health Care: Nine States’ Medicaid normally does not pay for long-term medical care provided Experiences With Home outside of institutions. GAO visited nine states (California, Florida, Georgia, Maine, Maryland, Minnesota, Mississippi, Ohio, and Texas) to Care Waivers (GAO/HRD- get information on states’ experiences in applying for, renewing, and 89-95, July 14, 1989) administering Medicaid waivers to permit payment for home care pro- vided to chronically ill children. These nine states administered a total Page 22 GAO/HRMlO-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1999 Through March 1990 Education Programs were receiving fewer services than their program prescribed. BIA officials attributed the insufficient services to a shortage of qualified personnel and inadequate funding. GAO recommends that each BIA field office annually identify and locate every preschooler thought to be handicapped and in need of special education services. Special Education: The Under the Handicapped Children’s Protection Act of 1986, courts are Attorney Fees Provision of authorized to award reasonable attorney fees to parents who prevail in cases brought against state and local education agencies, regarding the Public Law 99-372 education of their handicapped children. GAO did a national study of the (GAO/HRD-90-22BR, impact of the law’s attorney fees provision. Increases in the number of Nov. 24, 1989) administrative hearings between fiscal years 1984 and 1988 and the small number of civil action decisions during this same period suggest a trend toward informal resolution of disputes between parents and school districts. Educational placement issues were the most frequent type of complaint considered in both administrative hearings and in civil action cases. Overall, parents prevailed in 43 percent of the administra- tive decisions prepared by administrative hearing officers and in 43 per- cent of the civil action cases during the 5-year period. Parents who were represented by attorneys in administrative hearings accounted for almost 60 percent of the cases in which parents prevailed. Since the act’s passage, parents have increased their use of attorneys in adminis- trative hearings; however, GAO could not conclude that the increase resulted from the act. Attorney fees awarded under the act, while not large, have more than doubled from fiscal years 1987 to 1988-from about $157,000 to $387,000. However, about three-fourths of the state agencies had no statewide information on the amount of attorney fees awarded. GAO believes the financial data it obtained significantly under- state state and local education agencies’ actual annual expenditures for attorney fees awarded to parents. Transition Series: This report is one of a series of 26 special reports issued in November Education Issues (G.AO/ 1988 during the executive branch’s transition to a new administration. Among other things, GAO noted that the Department of Education could OCG-89-18TR, Nov. 1988) . enhance its role in elementary and secondary education programs by (1) providing better guidance for federal program implementation and (2) collecting and analyzing education related data from states and l strengthen departmental management by (1) developing an operational management system with realistic program priorities and (2) improving Page 20 GAO/HRB99-162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1990 Early Childhood To assist the Congress in its consideration of legislation that would fund education programs for children too young for kindergarten (mainly 4- Education: What Are the year-olds), GAO looked at the costs of high-quality early childhood edu- Costs of High-Quality cation programs. In this briefing report, GAO (1) estimated the average Programs? (GAO/HRD- annual cost per child, (2) compared the average annual salaries of early 90-43BR, Jan. 24, 1990) childhood education teachers with those of public elementary school teachers, and (3) determined the extent to which the costs of a typical early childhood education center change when factors like the teacher- to-student ratio change. Education Reform: Initial GAO examined student data from four large school districts in four states Effects in Four School where comprehensive state-level reforms have been in effect long enough for a class of students to experience at least 3 years of high Districts (GAO/PEMD- school under the new requirements. These reforms have included such 89-28, Sept. 26, 1989) changes as more academic course requirements for graduation and a passing score on an exit test. With respect to the performance of educa- tionally disadvantaged students, GAO found that education reform was neither a disaster nor a boon in the four districts examined. While disad- vantaged students appear to have improved performance in some cases, these improvements were modest. The effects of reform on dropout rates were mixed. Only two districts had sound data to identify drop- outs. In one, the rate increased modestly; in the other, it decreased mod- estly. Increased enrollment in academic courses after reform was associated with a slight decline in vocational enrollment for disadvan- taged students. This raised two possible concerns: (1) the decline occurred entirely among the type of vocational education courses that prepare students for the labor market rather than among consumer or homemaking courses and (2) disadvantaged postreform students were somewhat less likely than disadvantaged prereform students to have scheduled five or more vocational courses over 3 years of high school. These findings suggest that at-risk students may be receiving less occu- pational training than do their prereform counterparts. Concerns were also raised about the effect of education reforms on the availability of some vocational education courses and on the number of vocational edu- cational teachers employed. Page 18 GAO/HlUHW162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1989 Through March 1990 Head Start: Information on HHS'S Head Start program annually provides more than $1.2 billion in child development services to about 450,000 children, aged 3 to 5 years. Sponsoring Organizations Participating children attend Head Start centers in their communities, and Center Facilities where they receive nutrition, medical, social, mental health, and educa- (GAO/HRD-89-123FS, tional services. This fact sheet provides information on public and pri- July 12, 1989) vate organizations that operate local Head Start programs and the kinds of facilities these programs use. Education Compensatory Education: For more than 2 decades, public school teachers in the Chapter 1 pro- Aguilar v. Felton gram, the federal program of compensatory education for the disadvan- taged, provided remedial services to sectarian (religious) private school Decision’s Continuing students on private school premises. However, in its Aguilar v. Felton Impact on Chapter 1 decision, the Supreme Court ruled that this practice was unconstitu- Program (GAO/HRD-89- tional. In this report, GAO identifies (1) how much school districts had 131BR, Sept. 27,1989) spent or planned to spend for new methods of providing remedial ser- vices and (2) how states plan to distribute to school districts federal funds authorized to help pay for these methods. GAO also determined (1) the changes in sectarian private school participation since the ruling and (2) the satisfaction of public and private school officials with the new methods and the resulting quality of instructional services in selected school districts. Desegregation Activities: From 1978 through 1987, the Cleveland School District received $385.9 Administration of million in federal funds for desegregation activities. No federal funds were provided specifically for desegregation activities after June 1987. Education Grant Funds at GAO found that federal funds were appropriately spent on desegregation the Cleveland School activities; however, the school district did not comply with all the speci- District (GAO/HRD-89-83, fications of a 1978 court-ordered desegregation plan and subsequent Aug. 29,1989) federal grant agreements. The school district (1) requested and received excessive advances of federal grant funds; (2) accrued interest on these advances, but did not report or remit this income to the Department of Education; (3) without required Education approval, obligated and spent first-year grant funds in the second year; and (4) did not comply with some federal procurement requirements. The deficiencies GAO found in the school district went undetected because Education officials Page16 GAO/JJRB9@162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliogaphy of GAO Reports on Children, October 1966 Through March 1990 families needing care. The military provides most of its child care at child development centers, which are designed to (1) offer care at a lower cost than private sector care and at more convenient locations and (2) provide services that may not be available in the private sector. As of February 9, 1988, child development centers and family day care homes had the combined capacity to care for about 62,000 children at the same time, an 82-percent increase over the end of fiscal year 1984. In spite of the growth, centers cannot currently meet demand. Of the installations GAO surveyed, 185 maintained waiting lists of interested parents. These lists contained the names of about 24,700 children. Child Welfare and Social Services Adoption: Assistance The conference report on the National Defense Authorization Act for Provided by Selected Fiscal Years 1988 and 1989 directed GAO to obtain information on the assistance private employers give employees who are adopting children. Employers to Adopting The conference report indicated that this information was needed to Parents (GAO/HRD-90- evaluate the Department of Defense (DOD) test adoption expense reim- 47FS, Dec. 19,1989) bursement program. This fact sheet presents information on selected employers’ financial assistance for comparison with DOD’S test program and information on leave available from the selected employers to adopting parents. Foster Care: Delayed In reviewing foster care reforms required for states’ receipt of addi- Follow-Up of tional funds under the Child Welfare Services grants program, GAO found that the Department of Health and Human Services’(HHs) Admin- Noncomplying States May istration for Children, Youth, and Families (ACYF) has been diligent Reduce Incentive for about recouping Child Welfare Services incentive funds once a state has Reform (GAO/PEMD-89- been determined to be ineligible for such funds. ACYF, however, has been 16, Sept. 13, 1989) slow to review the performance of some states that have failed compli- ance reviews in previous years, resulting in payments of about $24.7 million since 1984 to six states that may not have been eligible for those funds. To ensure that incentive funds are expended in compliance with the law, ACYF should promptly rereview those six states that failed a review between 1983 and 1985. ACYF should also do periodic reviews promptly in the future. Page 14 GAO/HRD9@162 Children’s Issues: Reports and Activities Appendix I An Annotated Bibliography of GAO Reports on Children, October 1988 Through March 1990 From October 1988 through March 1990, GAO issued 58 reports on chil- dren and their families. Figure I.1 shows the distribution of these reports among nine different issues. Figure 1.1: GAO Reports on Children’s Issues (013 1988.Mar. 1990) 14 Number of Reporfs 12 10 - 6 Child Day Care Child Care: Government This briefing report identifies child care funding, describes coordination Funding Sources, of child care programs and services, and summarizes current informa- tion on the availability of child care. It also includes information on how Coordination, and Service programs affect low-income families seeking child care. GAO estimated Availability (GAO/HRD- that in fiscal year 1988, federal funding for child care would exceed 90-26BR, Oct. 13, 1989) $6.6 billion. These services were provided through 46 programs, although almost 90 percent of the funding was for four major pro- grams-the Child and Dependent Care Tax Credit, the Social Services Block Grant, Head Start, and the Child Care Food Program. In the past Page 12 GAO/HRDW-162 Children’s Issues: Reports and Activities c4lntents Abbreviations ACYF Administration for Children, Youth and Families AIDS acquired immunodeficiency syndrome 13IA Bureau of Indian Affairs CMS children’s medical services DOD Department of Defense EHA Education of the Handicapped Act FEMA Federal Emergency Management Agency GAO General Accounting Office HHS Department of Health and Human Services HIV human immunodeficiency virus HUD Department of Housing and Urban Development MCH maternal and child health OCSE Office of Child Support Enforcement OMB Office of Management and Budget USDA U.S. Department of Agriculture UNICEF United Nations Children’s Fund (formerly United Nations International Children’s Emergency Fund) WIG Special Supplemental Food Program for Women, Infants, and Children Page 10 GAO/HBD-96-162 Children’s Issues: Reports and Activities contents Appendix II 36 GAO Testimony on Child Welfare and Social Services Education 36 36 Children’s Issues, Health 37 October 1988 Through Nutrition 37 Youth Employment and Training 38 March 1990 - Other Child and Family Issues 38 Appendix III 39 GAO Reports on Child Day Care Child Welfare and Social Services 39 40 Children, Fiscal Years Education 42 1980-88 Health 43 Housing 44 Income Security 44 Nutrition 46 Youth Employment and Training 47 Other Child and Family Issues 48 Appendix IV 49 Ongoing GAO Child Welfare and Social Services Education 50 51 Assignments on Health 51 Children’s Issues, as of Housing 52 March 31, 1990 Income Security 52 Nutrition 52 Youth Employment and Training 53 Appendix V 54 Other Publications and childDaycare 54 Child Welfare and Social Services 54 Papers by GAO Staff Education 55 on Children’s Issues, Health 55 October 1988 Through income Security Youth Employment and Training 56 56 March 1990 Other Child and Family Issues 56 Page 8 GAO/HRD-90-162 Children’s Issues: Reports and Activities Pediatric AIDS: Health and Social Service Needs of 24 Infants and Children (GAO/HRD-89-96, May 5,1989) Teenage Smoking: Higher Excise Tax Should 24 Significantly Reduce the Number of Smokers (GAO/HRD-89-119, June 30,1989) Youth Camps: Nationwide and State Data on Safety 25 and Health Lacking (GAO/HRD-89-140, Sept. 20, 1989) Housing 25 Children and Youths: About 68,000 Homeless and 25 186,000 in Shared Housing at Any Given Time (GAO/PEMD-89-14, June 15,1989) Homelessness: Homeless and Runaway Youth 25 Receiving Services at Federally Funded Shelters (GAO/HRD-90-45, Dec. 19,1989) Homelessness: HUD’s and FEMA’s Progress in 26 Implementing the McKinney Act (GAO/RCED- 89-50, May 11,1989) Homelessness: McKinney Act Programs and Funding 26 for Fiscal Year 1989 (GAO/RCED-90-52, Feb. 16,199O) Housing Conference: National Housing Policy Issues 27 (GAO/RCED-89-174, Aug. 1989) Rental Housing: Housing Vouchers Cost More Than 27 Certificates but Offer Added Benefits (GAO/ RCED-89-20, Feb. 16, 1989) Transition Series: Housing and Urban Development 27 Issues (GAO/OCG-89-22TR, Nov. 1988) Welfare Hotels: Uses, Costs, and Alternatives (GAO/ 28 HRD-89-26BR, Jan. 31, 1989) Income Security 28 Child Support: State Progress in Developing 28 Automated Enforcement Systems (GAO/HRD-89- lOFS, Feb. 10,1989) Interstate Child Support: Case Data Limitations, 29 Enforcement Problems, Views on Improvements Needed (GAO/HRD-89-25, Jan. 27,1989) Transition Series: Health and Human Services Issues 29 (GAO/OCG-89-lOTR, Nov. 1988) Welfare Reform: Alabama’s Demonstration Project 29 (GAO/HRD-89-129BR, Aug. 17,1989) Page6 GAO/‘HRD9O-162 Children’s lssuee: Reporta and ActMties Contents - Letter 1 Appendix I 12 An-Annotated Child Day Care Child Care: Government Funding Sources, 12 12 Bibliography of GAO Coordination, and Service Availability (GAO/ Reports on Children, HRD-90-26BR, Oct. 13, 1989) Child Care: Selected Bibliography (GAO/HRD- 13 October 1988 Through 89-98FS. July 11, 1989) March 1990 Marine Corps Child Care: User Fee Increases at 13 Parris Island and Beaufort Installations (GAO/ HRD-89-74, Mar. 24, 1989) Military Child Care: Extensive, Diverse, and Growing 13 (GAO/IIRD-89-3, Mar. 8, 1989) Child Welfare and Social Services 14 Adoption: Assistance Provided by Selected 14 Employers to Adopting Parents (GAO/HRD- 90-47FS. Dec. 19, 1989) Foster Care: Delayed Follow-Up of Noncomplying 14 States May Reduce Incentive for Reform (GAO/ PEMD-89-16, Sept. 13, 1989) Foster Care: Incomplete Implementation of the 15 Reforms and LJnknown Effectiveness (GAO/ PEMD-89-17, Aug. 14, 1989) Foster Care: Preliminary Report on Reform Effects 15 (GAO/PEMD-89-23BR, June 1,1989) Foster Parents: Recruiting and Preservice Training 15 Practices Need Evaluation (GAO/HRD-89-86, Aug. 3, 1989) Head Start: Information on Sponsoring Organizations 16 and Center Facilities (GAO/HRD-89-123FS, July 12. 1989) Education 16 Compensatory Education: Aguilar v. Felton 16 Decision’s Continuing Impact on Chapter 1 Program (GAO/HRD-89-131BR, Sept. 27, 1989) Desegregation Activities: Administration of 16 Education Grant Funds at the Cleveland School District (GAO/HRD-89-83, Aug. 29, 1989) DOD Overseas Schools: Additional Assurances of 17 Educational Quality Needed (GAO/HRD-90-13, Mar. 15. 1990) Page 4 GAO/HRD9@162 Children’s Isawe: Reports and Activities B-240552 Table I: GAO Products and Activities on Children’s Issues (Fiscal Year 1980-Mar 1990) Type of activity Reports Reporls Testimonies Ongoing jobs Other issued issued (as of activities= Issue (FYs 1980-88) (10/88- 03/90) (IO/S&O?;; 03/31/90) (10/W 03/90) Total Child day care 3 4 0 0 1 a Child welfare and social serwes 28 6 1 8 1 44 Education 18 12 6 7 2 45 Health 10 10 2 11 7 40 Housing 9 8 0 2 0 19 Income secuntv 18 4 0 8 2 32 Nutrition 19 9 3 5 0 36 Youth employment and training 9 2 3 3 3 20 Other child and family issues 5 3 2 0 1 11 Total 119 58 17 44 17 255 ‘Includes other external publIshed articles and papers delivered by GAO staff Most GAO reports and activities included in this report focus primarily on children. However, some focus on federal programs serving children more indirectly, such as food stamps or housing assistance. We have not included all GAO reports on such federal programs. Instead, we have included only those that deal primarily with improving access to or the quality or effectiveness of services for children, The results of our work are organized in five appendixes as follows: . An annotated bibliography of reports on federal programs and policy areas affecting children and their families, from October 1988 through March 1990. (See app. I.) l Testimony of GAO officials before congressional committees on federal programs and policy areas relating to children and their families, for the same period. (See app. II.) . All relevant GAO reports issued from fiscal years 1980 through 1988. (See app. III.) . Ongoing assignments relating to children and families, as of March 31, 1990. (See app. IV’.) . Published articles and papers independently prepared by GAO staff on child-related issues, from October 1988 through March 1990. (See app. V.) As agreed with your office, unless you publicly announce its contents earlier, we plan no further distribution of this report until 10 days from Page 2
Children's Issues: A Decade of GAO Reports and Recent Activities
Published by the Government Accountability Office on 1990-09-21.
Below is a raw (and likely hideous) rendition of the original report. (PDF)