Child Welfare:

Better Data and Evaluations Could Improve Processes and Programs for Adopting Children with Special Needs

GAO-05-292: Published: Jun 13, 2005. Publicly Released: Jul 13, 2005.

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On September 30, 2002, the most recent date for which Department of Health and Human Services (HHS) data were available, about 126,000 foster children were waiting to be adopted. Estimates suggest that a significant portion of these children had one or more special needs, such as a medical condition or membership in a minority group, that may discourage or delay their adoption. Federal support in the form of adoption subsidies and incentive payments to states is available to promote special needs adoption. This report (1) identifies the major challenges to placing and keeping special needs children in adoptive homes, (2) examines what states and HHS have done to facilitate special needs adoptions, and (3) assesses how well the Adoption Assistance Program and the Adoption Incentives Program have worked to facilitate special needs adoptions, and determines if changes might be needed.

According to state child welfare officials, limited resources, court processes, and delays in completing interstate placements challenged the adoption of children with special needs by hindering recruitment of adoptive families and delaying the adoption process. In particular, adoptive parents in many states received lower subsidies and fewer services than foster parents. In addition, child welfare officials, court staff, and judges said that the adoption process can take months to complete because hearings to terminate parents' rights are hard to schedule and may involve appeals. Further, officials said that interstate placements are often hampered by delays in completing home studies of prospective families, although no data exist to assess the timeliness of such placements. States and HHS have developed and implemented strategies and programs to promote special needs adoptions, but few evaluations measure their effectiveness. Four of the 5 states we visited sponsored post adoption resource centers. However, only 9 of 49 states responding to a relevant question in our survey indicated that they had evaluated the effectiveness of their services. At the federal level, HHS supported and promoted local innovation, provided technical assistance, and disseminated information, but the agency has done little to assess the effectiveness of the programs it has funded. When HHS has taken steps to have states assess funded projects, the agency has not ensured sufficient rigor to assess effectiveness. The Adoption Assistance and Adoption Incentives Programs have provided support for special needs adoptions, but data are lacking to determine if changes are needed to better facilitate adoption. The former uses an income eligibility threshold that is more restrictive than other cash assistance programs' standards of need and may not include all who might otherwise qualify. Since 1998, the Adoption Incentives Program has provided financial awards to almost all states for increasing adoptions, but does not provide a specific inducement for interstate placements. Data to track and credit states for collaborating on interstate placements are not available.

Status Legend:

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To better understand delays associated with interstate placements, the Secretary of HHS should assist states in collecting and reporting data related to the interstate placement processes, especially the time needed to complete home studies and the sending and receiving state for each child placed across state lines. Such assistance could include modifying HHS's central data system, the Adoption and Foster Care Analysis and Reporting System, in conjunction with the agency's ongoing efforts to update and revise this system. HHS should analyze the data to assess the extent to which home studies cause delays or impede interstate adoptions and to identify which states are facilitating timely interstate placements. If supported by its findings, HHS should consider proposing legislation to amend existing law so that both sending and receiving states could claim an interstate adoption for purposes of determining award eligibility.

    Agency Affected: Department of Health and Human Services

    Status: Closed - Implemented

    Comments: This recommendation has been addressed with the July 2006 enactment of the Safe and Timely Interstate Placement of Foster Children Act of 2006 (P.L. 109-239), to which our report greatly contributed. To accelerate inter-jurisdictional placements and improve the protection of adoptive and foster children across state lines, the law requires that a state receiving a request to place a child for adoption or foster care complete a home study within 60 days. The state making the request must then respond within 14 days of receiving the home study. In addition, the law authorizes funding for an incentive program of $1,500 for every home study completed within 30 days and requires that state plans for child welfare services include reference to state efforts to facilitate orderly and timely in-state and interstate placements.

    Recommendation: To improve HHS's ability to assess the effectiveness of its funded projects, the Secretary of HHS should develop guidance to ensure that rigorous design elements are incorporated into projects and related evaluations. Such guidance could consider the nature and structure of the projects and include measures to control costs.

    Agency Affected: Department of Health and Human Services

    Status: Closed - Not Implemented

    Comments: According to HHS, it has already taken steps to strengthen evaluation requirements and provided technical assistance and therefore, views this recommendation as unnecessary. However, the agency acknowledged that some demonstration projects have sometimes yielded results of limited utility because of problems adhering to negotiated evaluation protocols. HHS will continue to improve the quality of information generated by funded projects and work with states to identify rigorous, administratively feasible evaluation strategies. In fiscal years 2006, 2007 and 2009 the Administration for Children and Families (ACF) officials reported no additional action.

    Recommendation: To assess the extent to which the Social Security Act's Title IV-E adoption assistance eligibility criteria exclude some economically disadvantaged children with special needs, the Secretary of HHS should (1) gather data on the economic circumstances of special needs children who do not currently qualify for IV-E and (2) develop a model to estimate the federal cost of expanding eligibility.

    Agency Affected: Department of Health and Human Services

    Status: Closed - Not Implemented

    Comments: This recommendation is being considered as part of the Adoption and Foster Care Analysis and Reporting System (AFCARS) review. In fiscal year 2007 and 2009, the Administration for Children and Families (ACF) officials reported that they did not take any additional action on this recommendation.

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