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entitled 'Healthy Marriage and Responsible Fatherhood Initiative: 
Further Progress Is Needed in Developing a Risk-Based Monitoring 
Approach to Help HHS Improve Program Oversight' which was released on 
October 27, 2008. 

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Report to the Chairman, Subcommittee on Income Security and Family 
Support, Committee on Ways and Means, House of Representatives: 

United States Government Accountability Office: 

GAO: 

September 2008: 

Healthy Marriage And Responsible Fatherhood Initiative: 

Further Progress Is Needed in Developing a Risk-Based Monitoring 
Approach to Help HHS Improve Program Oversight: 

GAO-08-1002: 

GAO Highlights: 

Highlights of GAO-08-1002, a report to the Chairman, Subcommittee on 
Income Security and Family Support, Committee on Ways and Means, House 
of Representatives. 

Why GAO Did This Study: 

Strengthening marriages and relationships in low-income families has 
emerged as a national strategy for enhancing the well-being of 
children. The Deficit Reduction Act of 2005 (DRA) appropriated $150 
million in discretionary grants each year from 2006 through 2010 to 
implement the Healthy Marriage and Responsible Fatherhood Initiative. 
To provide insight into how these programs are being implemented and 
monitored, GAO is reporting on (1) how the Department of Health and 
Human Services (HHS) awarded grants and the types of organizations that 
received funding; (2) what activities and services grantees are 
providing, including those for domestic violence victims; (3) how HHS 
monitors and assesses program implementation and use of funds; and (4) 
how program impact is measured. GAO surveyed grantees, interviewed HHS 
staff, reviewed HHS records and policy, and visited several programs. 

What GAO Found: 

Operating under a deadline that allowed HHS 7 months to award grants, 
HHS shortened its existing process to award Healthy Marriage and 
Responsible Fatherhood grants to public and private organizations. 
During this process, HHS did not fully examine grantees’ programs as 
described in their applications, including the activities they planned 
to offer, and this created challenges and setbacks for grantees later 
as they implemented their programs. For example, some grantees told us 
that they were informed that certain activities were not permitted 
months into program implementation even though HHS had approved these 
same activities described in their grant applications. 

The Healthy Marriage and Responsible Fatherhood programs provide 
similar activities, but their focus and target populations differ. 
Healthy Marriage programs are more likely to provide marriage and 
relationship activities, while Responsible Fatherhood programs are more 
likely to provide parenting skills. Additionally, both programs serve 
low-income and minority groups, but Healthy Marriage grantees are more 
likely to target teenaged youth, and Responsible Fatherhood grantees 
are more likely to target incarcerated parents. Both programs’ grantees 
reported that they refer domestic violence victims to specialists in 
their communities. 

HHS uses methods that include site visits and progress reports to 
monitor grantees, but it lacks mechanisms to identify and target 
grantees that are not in compliance with grant requirements or are not 
meeting performance goals, and it also lacks clear and consistent 
guidance for performing site monitoring visits. Moreover, HHS’s ability 
to readily identify which grantees are not in compliance or not meeting 
goals is hindered because it currently lacks uniform performance 
indicators and a computerized management information system that would 
enable HHS to more efficiently track key information on individual 
grantees. HHS told us that it is in the process of developing a 
management information system and has submitted uniform performance 
indicators for review. 

HHS has established a rigorous research agenda to gauge the long-term 
impact of healthy marriage and responsible fatherhood activities on 
diverse, low-income populations. HHS is sponsoring three multiyear 
impact evaluations of the Healthy Marriage program and one of the 
Responsible Fatherhood program. 

Figure: Domestic Violence Materials Distributed by Various Grantees: 

This figure is a picture of a selection of domestic violence materials 
distributed by various grantees. 

[See PDF for image] 

Source: GAO photo. 

[End of figure] 

What GAO Recommends: 

GAO recommends that HHS employ a risk-based approach to monitoring 
grantees and conducting grantee site visits, using its planned 
management information system and information from both progress 
reports and performance indicators to help identify those grantees at 
risk of not meeting performance goals or not in compliance with grant 
requirements. HHS also should create clear, consistent guidance and 
policy for monitoring Healthy Marriage and Responsible Fatherhood 
grantees. HHS is in the process of developing a risk-based approach to 
monitoring, but disagreed that they lacked clear, consistent monitoring 
guidance. GAO believes that its recommendations remain valid. 

To view the full product, including the scope and methodology, click on 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-1002]. For more 
information, contact Kay Brown at (202) 512-7215 or brownke@gao.gov. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

HHS Awarded Grants to a Range of Public and Private Organizations, but 
the Awards Process Contributed to Challenges for Some Grantees: 

Programs Offer a Range of Similar Activities, but Their Focus and 
Target Populations Differ: 

HHS Has a Program Monitoring System, but Lacks Mechanisms to Identify 
and Target Grantees Not in Compliance with Grant Requirements or Not 
Meeting Performance Goals: 

HHS Has Long-term Research Underway Intended to Assess Program Impact: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Objective, Scope, and Methodology: 

Appendix II: Grantee Selection Criteria: 

Appendix III: States and Territories with Grantees That Provide Direct 
Services to Participants as of February 2008: 

Appendix IV: Curricula Being Used by Healthy Marriage and Responsible 
Fatherhood Grantees and Frequency of Use: 

Appendix V: Comments from the Department of Health and Human Services: 

Appendix VI: GAO Contact and Staff Acknowledgments: 

Table: 

Table 1: Allowable Activities as Described in DRA: 

Figures: 

Figure 1: Breakdown of DRA Funds for the Healthy Marriage and 
Responsible Fatherhood Initiative, Fiscal Year 2007: 

Figure 2: Activities Provided by Healthy Marriage and Responsible 
Fatherhood Grantees: 

Figure 3: Examples of Curricula Used by Healthy Marriage and 
Responsible Fatherhood Grantees: 

Figure 4: Domestic Violence Materials Distributed by Various Grantees: 

Figure 5: Grantee Target Populations: 

Figure 6: Examples of Recruitment Materials Used by Healthy Marriage 
and Responsible Fatherhood Grantees: 

Figure 7: Methods of Notifying Participants of Voluntary Participation 
in Programs: 

Figure 8: HHS Healthy Marriage and Responsible Fatherhood Impact 
Research Studies: 

Abbreviations: 

BSF: Building Strong Families: 

DRA: Deficit Reduction Act of 2005: 

GED: General Educational Development: 

HHS: Department of Health and Human Services: 

Initiative: Healthy Marriage and Responsible Fatherhood Initiative: 

MSF-IP: Marriage and Family Strengthening Grants for Incarcerated and 
Re- entering Fathers and Their Partners: 

SHM: Supporting Healthy Marriage: 

TANF: Temporary Assistance for Needy Families: 

United States Government Accountability Office: 

Washington, DC 20548: 

September 26, 2008: 

The Honorable Jim McDermott: 
Chairman: 
Subcommittee on Income Security and Family Support: 
Committee on Ways and Means: 
House of Representatives: 

Dear Mr. Chairman: 

Strengthening marriages and relationships in low-income families has 
emerged as a national strategy for enhancing the well-being of 
children. With the passage of the Deficit Reduction Act of 2005 (DRA), 
Congress appropriated $150 million in discretionary grants each year 
from 2006 through 2010 to implement the Healthy Marriage and 
Responsible Fatherhood Initiative (Initiative). The Initiative 
represents an unprecedented financial commitment by the federal 
government to support marriage and fatherhood programs. The focus of 
the Healthy Marriage program is to encourage the formation and 
maintenance of two-parent households through healthy marriage promotion 
activities, while the focus of the Responsible Fatherhood program is to 
strengthen the role of the father in a child's life. The Initiative 
supports two goals under Temporary Assistance for Needy Families 
(TANF), the federally funded block grant that funds programs designed 
to help needy families achieve self-sufficiency. The goals are to 
prevent and reduce the incidence of out-of-wedlock pregnancies and to 
encourage the formation and maintenance of two-parent families. To 
implement the Initiative, the Department of Health and Human Services 
(HHS) competitively awarded grants to various organizations to support 
a broad range of activities to promote healthy marriage and responsible 
fatherhood. To address domestic violence concerns, DRA required all 
grantees to consult with a domestic violence expert and to include 
information on how they will address domestic violence issues in their 
grant applications to HHS. It also required that participation by 
individuals in the program be voluntary. 

To gain insight into how these programs are being implemented, you 
asked that we determine (1) how HHS awarded grants and the types of 
organizations that received funding; (2) what activities and services 
grantees are providing, including those for domestic violence victims; 
(3) how HHS monitors and assesses program implementation and use of 
funds, and (4) how program impact is measured. 

To respond to these questions, we conducted a web-based survey of all 
122 Healthy Marriage and 94 Responsible Fatherhood grantees that 
provide direct services to program participants, asking them to provide 
information about various aspects of their programs including the 
characteristics of their organization, services they offered, curricula 
used, and their process and procedures for identifying domestic 
violence.[Footnote 1] Of the 216 grantees to whom we sent our survey, 
211 responded for a response rate of 98 percent. Throughout this report 
survey results are based on the number of grantees responding to a 
particular question. Additionally, to obtain more in-depth information 
about services marriage and fatherhood grantees are providing, we 
visited 14 grantees in Washington, Oklahoma, New Mexico, Indiana, 
Oregon, and the District of Columbia. On 2 of these visits, we 
accompanied HHS staff responsible for monitoring grantees. We selected 
grantees to achieve variation in geographic location, type of grant 
awarded, award amount, services, organization type, and the programs' 
target populations. In addition, we conducted telephone interviews with 
organizations that were awarded grants to provide technical assistance 
to grantees, and help organizations develop fatherhood programs. 
Moreover, to understand the criteria HHS used to award grants and the 
manner in which HHS monitors and assesses program implementation, we 
randomly selected 40 Healthy Marriage and Responsible Fatherhood 
grantee case files to review.[Footnote 2] In this review, we examined 
several documents, including applications, semiannual progress and 
financial reports, grantee selection panel score sheets, and 
correspondences between grantees and agency officials. To determine how 
program impact is measured, we interviewed organizations that have 
received contracts to conduct impact evaluations of Healthy Marriage 
and Responsible Fatherhood interventions and assessed their 
methodological approach to measuring impact. We also interviewed HHS 
officials about the uniform, program-wide performance indicators under 
development and surveyed grantees about how they measure program 
performance. We conducted this performance audit from July 2007 to 
September 2008, in accordance with generally accepted government 
auditing standards. Those standards require that we plan and perform 
the audit to obtain sufficient and appropriate evidence to provide a 
reasonable basis for our findings and conclusions based on our audit 
objectives. We believe that the evidence obtained provides a reasonable 
basis for our findings and conclusions based on our audit objectives. 
For additional information on our scope and methodology, see appendix 
I. 

Results in Brief: 

Operating under a deadline that allowed HHS 7 months to award grants, 
HHS shortened its process to award grants to public and private 
organizations on time. Under DRA, which was passed in February 2006, 
HHS had to award the grants by the end of September 2006. Within that 
time frame, HHS had to write and publicize the grant announcements, 
develop criteria for selecting grantees, and convene panels to review 
and score the more than 1,650 applications for funding it received. 
After the applications were reviewed and scored, HHS awarded grants to 
a diverse set of grantees--216 public, private, and nonprofit 
organizations that provided direct services to participants--based on a 
range of criteria, including the grantees' approach to recruiting and 
retaining participants and strategy to address issues of domestic 
violence. However, HHS did not fully examine grantees' programs as 
proposed in grantee applications, including the activities they planned 
to offer, and this contributed to challenges for some grantees when 
implementing their programs. For example, during our site visits, 5 out 
of 14 grantees told us that even though they had received approval from 
HHS to implement their program as outlined in their grant applications, 
HHS informed them after they had begun serving participants that 
certain activities were not permitted under the grant legislation. 

Healthy Marriage and Responsible Fatherhood programs offer a range of 
similar activities, but their focus and target populations differ. Both 
Healthy Marriage and Responsible Fatherhood programs offer activities 
and services related to marriage and relationship skills, parenting, 
and economic stability, but according to our survey, Healthy Marriage 
programs are more likely to provide marriage and relationship services, 
whereas Responsible Fatherhood programs are more likely to focus on 
parenting skills. For example, 94 percent of Healthy Marriage grantees 
reported that they provide activities related to marriage and 
relationships, compared to 55 percent of Responsible Fatherhood 
grantees. On the other hand, 92 percent of Responsible Fatherhood 
grantees report that they provide activities related to parenting 
compared to 47 percent of Healthy Marriage programs. Additionally, 
grantees from both programs reported that they refer domestic violence 
victims to specialists in their communities. By making referrals to 
domestic violence specialists in their communities, both Healthy 
Marriage and Responsible Fatherhood programs attempt to ensure that 
victims of domestic abuse receive services. Almost all grantees in both 
programs said they include domestic violence awareness as part of their 
programs and, according to our survey, have protocols in place for 
detecting and responding to signs of domestic violence. For example, 
grantees from both programs told us they have specific classroom 
sessions devoted to helping couples identify the signs of unsafe and 
unhealthy relationships. The services offered by the two grant programs 
are targeted to a range of groups, however, Healthy Marriage programs 
were more likely to target high school and teenaged youths, and 
Responsible Fatherhood programs were more likely to target incarcerated 
fathers. According to our survey, grantees inform individuals that 
their participation in the programs is voluntary through a range of 
methods, including verbal and written notification. 

HHS uses multiple methods to monitor grantees' programs; however it 
lacks mechanisms to identify and target grantees that are not in 
compliance with grant requirements or are not meeting performance 
goals. To monitor Healthy Marriage and Responsible Fatherhood grantees, 
HHS uses a combination of site visits, phone calls, e-mails, and 
progress reports, but these tools are not used strategically to help 
identify problems grantees are experiencing. Our review of grantee case 
files found documentation of grantees that were not meeting performance 
targets, such as participant recruitment goals, or not in compliance 
with grant requirements, such as providing only those services allowed 
under the grant. However, HHS did not always give priority to these 
grantees for site visits or other monitoring activities, which was 
further confirmed during our interviews with grantees. Instead, HHS 
told us that the decision of which grantees to visit and in what order 
was left to the discretion of individual HHS staff, and monitoring site 
visits were scheduled based on staff preferences. When HHS conducted a 
site visit, we found that HHS staff lacked specific and clear guidance 
on how to conduct visits, and therefore the length and types of issues 
reviewed and documentation examined varied depending on who conducted 
the visit. For example, on some monitoring site visits, HHS staff 
observed grantees providing services and in other instances, staff did 
not. Finally, although HHS maintains paper files for each of the 
grantees, the breadth and detail of these files vary considerably. HHS 
told us that they plan to implement a computerized management 
information system in fall 2008 which would enable it to more 
efficiently track key information on individual grantees and combine 
grantee communications and performance data. According to HHS, the 
first phase of the web-based management information system has been 
completed. HHS also told us that it currently is in the process of 
developing uniform performance indicators that will eventually be part 
of its planned management information system. These performance 
indicators have been developed and are currently under review by the 
Office of Management and Budget. 

HHS has established a rigorous research agenda to gauge the long-term 
impact of healthy marriage and responsible fatherhood activities on 
diverse, low-income populations. HHS is sponsoring three multiyear 
impact evaluations of the Healthy Marriage program and one of the 
Responsible Fatherhood program. These evaluations will assess the 
effectiveness of marriage and fatherhood programs on low-income 
populations who traditionally have not been the focus of such studies. 
Using a research design that compares study participants that received 
marriage and fatherhood services to similar participants that did not, 
the researchers will be able to compare the groups and measure any 
differences resulting from their participation in the programs. One 
study is assessing the impact of healthy marriage promotion activities 
on low-income, unmarried couples around the time of the birth of a 
child using data collected at three stages of participants' lives. This 
study will examine a range of outcomes, including whether marriage 
services improved marital relationships, changed couples' attitudes 
toward marriage, reduced marital instability, and improved child well- 
being. Studies such as these often are difficult and take time to 
complete, but are considered the best method for assessing program 
impact. Results from these studies will not be available until after 
fiscal year 2010, when the current appropriation for the Healthy 
Marriage and Responsible Fatherhood Initiative expires, but HHS 
officials note that the results may help inform future policy 
decisions. 

To provide better program oversight, we are recommending that the 
Secretary of HHS employ a risk-based approach to monitoring grantees 
and conducting grantee site visits, using its planned management 
information system and information from progress reports and 
performance indicators to help identify those grantees at risk of not 
meeting performance goals or not in compliance with grant requirements. 
HHS also should create clear, consistent guidance and policy for 
monitoring Healthy Marriage and Responsible Fatherhood grantees. 

Background: 

Welfare reform in 1996 made sweeping changes to the national welfare 
policy, including a new emphasis on marriage as an area of societal and 
governmental concern. With the passage of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996, which established the 
Temporary Assistance for Needy Families (TANF) program, Congress wrote 
into law that marriage is the foundation of a successful society and 
promotes the interests of children. Congress was, in part, prompted to 
address this issue because of what it deemed a "crisis in our Nation" 
in the rate of pregnancies and births to unmarried women. In the 
legislation, Congress cited the negative consequences to children that 
result from these pregnancies and births, including greater risk for 
child abuse and neglect, higher rates of poverty, and lower educational 
aspirations. 

TANF was reauthorized under the Deficit Reduction Act of 2005 (DRA), 
and signed into law in February 2006. DRA appropriated $150 million a 
year for 5 years in discretionary grants for the Healthy Marriage and 
Responsible Fatherhood Initiative (Initiative).[Footnote 3] While the 
Initiative was established as part of TANF, the nation's welfare 
program, it does not impose income limits for program participants. 
However, HHS designated a few priority groups for funding under the 
Initiative, including incarcerated fathers and low-income, unwed, 
expectant or new parents. In structuring the Initiative, HHS created 
two distinct grant programs--one relating to Healthy Marriage and one 
to Responsible Fatherhood--but with common aims. The Healthy Marriage 
program is aimed at encouraging the formation and maintenance of two- 
parent households to improve child well-being through healthy marriage 
promotion, and the Responsible Fatherhood program is designed to 
strengthen the role of the father as a means of promoting child well- 
being, specifically within the context of marriage. HHS has stressed 
that the overarching Initiative is not designed to encourage couples to 
stay in unhealthy marriages. 

In the legislation, Congress prescribed the "allowable" activities for 
the Initiative (see table 1). Given the broadness of these allowable 
activities, HHS developed examples of services grantees could provide, 
such as providing after-school programs for high school students and 
marriage education courses that incorporate information on financial 
literacy. Although providing services to victims of domestic violence 
is not an allowable activity (see table 1), organizations were required 
by DRA to describe in their grant application how their programs or 
activities would "address" issues of domestic violence, and commit in 
their application to consult with experts in domestic violence in 
developing their programs and activities. The DRA also required that 
organizations describe in their application what they would do to 
ensure and how they would inform individuals that participation in 
programs is voluntary. 

Table 1: Allowable Activities as Described in DRA: 

Allowable activities; 
Healthy Marriage: * Public advertising campaigns on the value of 
marriage and the skills needed to increase marital stability and 
health; 
* Education in high schools on the value of marriage, relationship 
skills, and budgeting; 
* Marriage education, marriage skills, and relationship skills 
programs, that may include parenting skills, financial management, and 
job and career advancement, for nonmarried, pregnant women and 
nonmarried, expectant fathers; 
* Premarital education and marriage skills training for engaged couples 
and for couples or individuals interested in marriage; 
* Marriage enhancement and marriage skills training programs for 
married couples; 
* Divorce reduction programs that teach relationship skills; 
* Marriage mentoring programs that use married couples as role models 
and mentors in at-risk communities; 
* Programs to reduce the disincentives to marriage in means-tested aid 
programs, if offered in conjunction with any activity described above; 
Responsible Fatherhood: * Activities to promote marriage or sustain 
marriage through activities such as:  
- counseling, mentoring, and disseminating of information about the 
benefits of marriage and dual-parent involvement for children; 
- relationship skills education; 
- disseminating of information on the causes of domestic violence and 
child abuse; 
and: 
- skills-based marriage education and financial planning; 
* Activities to promote responsible parenting through activities such 
as: 
- counseling, mentoring, and mediation, and dissemination of 
information about good parenting practices; 
and: 
- skills-based parenting education, encouragement of child support 
payments, and other methods; 
* Activities to foster economic stability by helping fathers improve 
their economic status; 
* Activities to promote responsible fatherhood such as the development, 
promotion, and distribution of a media campaign to encourage the 
appropriate involvement of parents in the life of their child that are 
conducted through a contract with a nationally recognized, nonprofit, 
fatherhood promotion organization. 

Source: Deficit Reduction Act of 2005, Pub. L. No. 109-171. 

[End of table] 

In fiscal year 2007 most of the funding, approximately $113 million, 
was used to support Healthy Marriage and Responsible Fatherhood 
demonstration grants, while the remaining funds were used for research, 
technical assistance, administrative costs, and other TANF-related 
activities (see fig. 1). 

Figure 1: Breakdown of DRA Funds for the Healthy Marriage and 
Responsible Fatherhood Initiative, Fiscal Year 2007: 

This figure is a pie graph showing a breakdown of DRA funds for the 
healthy marriage and responsible fatherhood initiative, during fiscal 
year 2007. 

Healthy Marriage Grants: 50%; 
Responsible Fatherhood grants: 25%; 
Marriage and Fatherhood Research: 12%; 
Technical Assistance to Grantees: 7%; 
Other: 4%; 
Administrative Overhead: 2%. 

[See PDF for image] 

Source: Analysis of budget information provided by HHS. 

Note: "Other" includes 1 percent for Tribal TANF child welfare 
expenditures and the remainder for TANF-related activities. 

[End of figure] 

As part of the agency's overall research agenda, HHS has sponsored 
several impact evaluations of its programs. These evaluations are 
considered to be the best method of determining the extent to which the 
program, rather than other factors, is causing specific participant 
outcomes. Impact evaluations, which are awarded through a competitive 
bid process to experienced research firms, often are complex, multiyear 
studies that can be difficult and costly to undertake and require 
particular attention to both study planning and execution. Moreover, 
maintaining proper incentives to obtain and sustain the participation 
of populations that do not have financial and familial stability can be 
challenging. In previous work, we found that HHS has established a 
rigorous research agenda that regularly evaluates how well its programs 
are working.[Footnote 4] In particular, HHS has a diverse research 
agenda focused on TANF that includes research on strategies to help low-
income individuals gain self-sufficiency.[Footnote 5] 

HHS Awarded Grants to a Range of Public and Private Organizations, but 
the Awards Process Contributed to Challenges for Some Grantees: 

HHS awarded grants to a range of public and private organizations, but 
its awards process later contributed to challenges for these grantees. 
HHS shortened its awards process to meet a deadline specified in 
legislation that allowed 7 months to award grants. HHS awarded grants 
to a diverse set of grantees that provided direct services to program 
participants in 47 states, the District of Columbia, and American 
Samoa. However, as part of its awards process, HHS did not fully 
examine grantees' programs as described in grantee applications, 
including the activities they planned to offer, contributing to 
challenges for some grantees as they were implementing their programs. 

HHS Shortened Its Existing Awards Process to Meet DRA Deadline for 
Awarding Grants: 

HHS shortened its process to award grants by the end of the fiscal year 
(September 30). Under DRA, which became law in February 2006, HHS had 
to award grants in 7 months. Within this time frame, HHS had to perform 
several tasks related to the awards process. Specifically, HHS staff 
said they developed the grant announcements and the criteria for 
selecting grantees under tight time constraints and limited the amount 
of time organizations could apply for grants to fewer than the 60 days 
recommended in HHS's policy manual. HHS officials, who told us they had 
not expected that more than 1,650 organizations would apply for 
funding, hired The Dixon Group, a management consulting firm, to 
receive applications, locate grant application reviewers, and assist 
with reviewer training.[Footnote 6] At the same time The Dixon Group 
was receiving applications, they also were selecting peer reviewers. 
Approximately 600 peer reviewers served on 40 to 50 review panels for 4 
weeks during July and August. While the grant announcements stated that 
grant application reviewers should be experts, HHS allowed peer review 
of the applications and The Dixon Group and HHS characterized graduate 
students, professors, and practitioners as peer reviewers. Further, 
because individuals who were experts in the field of marriage and 
fatherhood applied for the grants, it limited the pool of available 
expert reviewers. We reviewed several of the resumes of the peer 
reviewers and found that while most had experience as federal 
reviewers, their professional and volunteer experiences were not always 
directly relevant to marriage and fatherhood services. For example, one 
peer reviewer had experience in nursing and another listed experience 
as a social studies teacher. 

To determine which organizations would receive funding, HHS developed 
guidance that outlined a five-part criteria for most grants, with each 
criterion worth a specific amount of points. Reviewers scored 
organizations' applications using the guidance provided by HHS and by 
judging how well the applicant responded to each criterion. For 
example, a major criterion was the applicant's "approach," worth 40 
points. For this criterion, applicants were asked to describe their 
approach to recruiting and retaining participants, their proposed 
activities, and time frames for accomplishing specific milestones. 
Applicants also were required to demonstrate that their proposed 
activities were consistent with the needs of their target population 
and that the rationale for the approach was based on the demonstrated 
effectiveness of similar activities. Finally, under their approach 
section, applicants also had to describe how they planned to address 
issues of domestic violence and ensure voluntary participation. For the 
"organizational profile" criterion, worth 20 points, organizations had 
to provide information that demonstrated their qualifications to serve 
participants, including organizational charts, financial statements, 
resumes, letters of support, and the qualifications of partnering 
organizations. As part of other criteria, applicants were asked to 
provide a budget and budget justification, and information on how they 
proposed to measure the outcomes of their programs. Applicants could 
receive up to 5 bonus points if they demonstrated prior experience in 
developing, implementing, or managing skills-based marriage or 
fatherhood education programs. See appendix II for a table of the 
criteria used for each type of grant. 

The peer reviewers used these criteria to score applicants, and HHS 
ranked the applications based on the scores. With some exceptions, 
applications that received the highest scores were awarded grants. HHS 
made exceptions to ensure, among other things, that grants were 
geographically distributed and reflected a diversity of target 
populations and communities served. 

In September 2006, HHS began notifying grantees of their awards, but 
experienced a setback when they had to reconvene review panels to 
rescore 31 applications. When scoring some applications, some reviewers 
incorrectly gave applicants zero points for the "approach" section. 
According to the grant announcements, if applicants failed to discuss 
how they would inform individuals that program participation was 
voluntary, as well as discuss specific issues relating to domestic 
violence issues, they would receive no points for the "approach" 
criterion. HHS discovered that reviewers had incorrectly interpreted 
whether applicants satisfied this portion of the "approach" criterion, 
and after clarifying the criteria, required that they rereview the 
applications.[Footnote 7] 

HHS Awarded Grants to a Diverse Set of Grantees: 

HHS awarded grants to a diverse set of grantees that included 216 
different organizations--122 were Healthy Marriage and 94 were 
Responsible Fatherhood demonstration grants that provided direct 
services to program participants in 47 states, the District of 
Columbia, and American Samoa (see app. III). In responding to our 
survey, grantees selected multiple categories to describe their 
organizational type. The majority--89 percent of the grantees-- 
classified themselves as nonprofits. However, faith-based, for-profit, 
and private organizations also received funding. Awards for Healthy 
Marriage demonstration grants ranged from $225,000 to $2.4 million, and 
awards for Responsible Fatherhood demonstration grants were for smaller 
amounts, ranging from $188,000 to $1 million. 

Over two-thirds of our survey respondents indicated that their 
organization had prior experience related to healthy marriage or 
responsible fatherhood activities. This experience included providing 
workshops for couples and singles, parenting classes, and relationship 
workshops for high school students. Some of these organizations also 
provided a broader array of other services to the community, such as 
mental health services and counseling services, and substance abuse 
treatment. Also, at least a dozen of the grantees had provided 
abstinence services and some Healthy Marriage grantees were previous 
recipients of grants from HHS for related purposes, including healthy 
marriage curriculum development and fostering healthy marriage within 
underserved communities. 

HHS's Grant Awards Process Contributed to Challenges Grantees Had 
Implementing Programs: 

HHS's grant awards process contributed to challenges grantees later 
faced implementing their programs. HHS was able to announce grant 
awards by September 30; however HHS did not fully examine grantees' 
programs as described in grantee applications. Specifically, we found 
during 5 of our 14 site visits that grantees, whose program activities 
had initially been approved by HHS, were later told that those same 
activities were not allowed under the conditions of their award. For 
example, during a site visit, one grantee reported that it proposed 
providing services to unmarried couples in its application and was 
doing so until HHS informed them that these services were not allowed 
under the conditions of their award. Another grantee told us that it 
was providing General Educational Development (GED) education as part 
of its Healthy Marriage program, but was later notified that the 
activity was not allowed. These grantees were well into program 
implementation when they were told to discontinue certain activities. 
One grantee we visited said it engaged in activities that were not 
allowable under the grant for a full year before being informed by HHS 
that the activities were not permissible. The grantee told us that it 
would have benefited from more timely review and feedback from HHS. In 
another case, HHS told a grantee that it would have to extend the 
length of its workshops for participants from 60 minutes to 90 minutes 
to 8 hours, even though the grant application noted that short, 
workshops would be provided.[Footnote 8] To implement this change, the 
grantee said it would likely incur additional expenses, such as paying 
facilitators for extra time and spending more for rental space. 

HHS told us that it received more applications than expected and this 
was the first time it awarded these grants. HHS also said it had 
learned from this experience. 

Programs Offer a Range of Similar Activities, but Their Focus and 
Target Populations Differ: 

While the range of activities offered and populations served by Healthy 
Marriage and Responsible Fatherhood programs' grantees are similar, 
their focus and target populations differ. Both programs offer a range 
of similar activities, but a greater percentage of marriage programs 
provided activities related to marriage and relationship skills and a 
larger percentage of fatherhood programs provided parenting skills. 
Grantees for both programs reported that they refer domestic violence 
victims to specialists when appropriate. Additionally, while both 
programs target such groups as minority and low-income populations, 
Healthy Marriage grantees are more likely to target high school or 
teenaged youths, and Responsible Fatherhood grantees are more likely to 
target incarcerated parents. 

Both Programs Offer a Range of Similar Activities and Refer Domestic 
Violence Victims to Specialists When Appropriate, but They Differ in 
Which Activities They Offer Most Frequently: 

Both programs offer a range of similar activities, and grantees from 
both programs said they refer victims of domestic violence to 
specialists in their communities when appropriate (see fig. 2). 
However, according to our survey, while both programs offer many 
similar activities, Healthy Marriage programs focus more on those 
related to marriage and relationship services, whereas Responsible 
Fatherhood programs are more likely to focus on providing services 
teaching parenting skills. Specifically, 94 percent of Healthy Marriage 
grantees, compared to 55 percent of Responsible Fatherhood grantees, 
reported offering marriage and relationship activities. During our 
visits to several Healthy Marriage grantees, we often observed 
activities related to marriage and relationships. For example, we 
observed a Healthy Marriage workshop where couples took quizzes to 
determine how well they knew one another and then participated in a 
discussion about commitment, chemistry, and compatibility. Conversely, 
92 percent of Responsible Fatherhood grantees, compared to 47 percent 
of Healthy Marriage grantees, reported in our survey that they provide 
services related to teaching parenting skills. For example, a 
Responsible Fatherhood grantee program we visited included in its 
curriculum parenting skills training, such as lessons on a child's 
developmental needs and how to communicate with children of different 
ages. In addition, Responsible Fatherhood grantees were more likely 
than Healthy Marriage grantees to report that they focused on providing 
programs with specific services to help participants achieve economic 
stability, including assistance with finding a job. Healthy Marriage 
grantees also reported that they focus on economic stability 
activities, but to a lesser extent than Responsible Fatherhood 
programs. According to HHS, Healthy Marriage grantees can provide these 
services only within the context of allowed activities (see table 1). 
For example, Healthy Marriage grantees might discuss financial issues 
as part of marriage and relationship skills. Depending on the 
conditions of the award, grantees might provide more than one of the 
services or activities listed in figure 2. 

Figure 2: Activities Provided by Healthy Marriage and Responsible 
Fatherhood Grantees: 

This figure is a combination bar showing activities provided by healthy 
marriage and responsible fatherhood grantees. The X axis represents 
allowable activities, and the Y axis represents percentage. 
			
Allowable activities: Economic stability; 
Healthy marriage: 37; 
Responsible fatherhood: 58. 

Allowable activities: Divorce reduction; 
Healthy marriage: 37; 
Responsible fatherhood: 13. 

Allowable activities: Marriage & Relationship Education for High 
Schools Students; 
Healthy marriage: 45; 
Responsible fatherhood: 18. 

Allowable activities: Education on the Benefits of Marriage; 
Healthy marriage: 16; 
Responsible fatherhood: 8. 

Allowable activities: Marriage & Relationship Skills; 
Healthy marriage: 94; 
Responsible fatherhood: 55. 

Allowable activities: Marriage enhancement for|married couples; 
Healthy marriage: 69; 
Responsible fatherhood: 27. 

Allowable activities: Marital Mentoring; 
Healthy marriage: 42; 
Responsible fatherhood: 11. 

Allowable activities: Pre-marital education; 
Healthy marriage: 70; 
Responsible fatherhood: 24. 

Allowable activities: Promoting Responsible Parenting; 
Healthy marriage: 47; 
Responsible fatherhood: 92. 

Allowable activities: Public Advertising Campaigns; 
Healthy marriage: 59; 
Responsible fatherhood: 25. 

[See PDF for image] 

Source: GAO analysis of Healthy Marriage and Responsible Fatherhood 
grantees' responses to survey. 

[End of figure] 

Both Healthy Marriage and Responsible Fatherhood grantee programs offer 
services for varying lengths of time and in various settings. Some 
programs have one intensive session in a lecture setting, while others 
offer classroom settings that are more interactive and may be offered 
for 1 or 2 hours 1 night a week for up to 17 weeks. One grantee program 
we visited offered marriage workshops to participants at weekend 
retreats with paid lodging, and two Responsible Fatherhood programs we 
visited included optional home visits by staff. In addition, some 
grantees run advertisements or sponsor advertising campaigns that 
discuss the importance of healthy marriage and responsible fatherhood. 
For example, one advertising campaign designed a billboard that read "a 
diamond isn't the only thing that should last forever." 

According to our survey, the majority of grantees--98 percent--deliver 
their services through classroom instruction using a curriculum (see 
fig. 3). Many survey respondents said they developed and used their own 
curriculum (41 percent of Healthy Marriage and 47 percent of 
Responsible Fatherhood respondents). For example, one grantee we 
visited said it developed its own Spanish-language curriculum because 
the few existing Spanish-language curricula for Responsible Fatherhood 
programs did not meet the specific needs of the Latino population the 
grantee served. Other grantees adapt commercially available curricula 
to meet the needs of participants. The most-commonly-used, commercially 
available curriculum was the Prevention and Relationship Enhancement 
Program. This curriculum focuses on identifying strengths and 
weaknesses of a marriage, improving communication skills, and 
increasing the connection between the partners. Technical assistance 
providers make information about curricula available to grantees on 
their Web site. A list of curricula used by multiple grantees is in 
appendix IV. 

Figure 3: Examples of Curricula Used by Healthy Marriage and 
Responsible Fatherhood Grantees: 

This figure is a picture of different examples of curricula used by 
health marriage and responsible fatherhood grantees. 

[See PDF for image] 

Source: GAO photo. 

[End of figure] 

Most grantees--about 93 percent--reported in our survey that they 
include information on domestic violence in their programs. For 
example, several grantees modified their curriculum to include a 
discussion of domestic violence with participants. One survey 
respondent noted that it leads a discussion on domestic violence issues 
that helps participants self-identify and understand domestic violence. 
During our site visits, some Healthy Marriage grantees told us that 
they focus on the characteristics of a healthy relationship. In 
addition to discussing topics related to relationship health and 
domestic violence awareness, grantees also distribute informational 
materials about domestic violence (see fig. 4). For example, during a 
site visit to a Healthy Marriage grantee, we observed classroom 
instructors distributing pamphlets on recognizing signs of domestic 
violence. Handouts include state Directories of Domestic Violence 
Support Services; handbooks for domestic violence victims, and victims' 
rights; and pamphlets on topics ranging from "recipes for safety" to 
the characteristics of an abusive relationship. 

Figure 4: Domestic Violence Materials Distributed by Various Grantees: 

This figure is a picture is domestic violence materials distributed by 
various grantees. 

[See PDF for image] 

Source: GAO photo. 

[End of figure] 

Additionally, most grantees reported in our survey that they have 
protocols for how staff should handle instances where program 
participants may be victims of domestic violence, and many grantees 
train their staff on identifying signs of domestic violence, as well as 
on teaching program participants the signs of unhealthy relationships. 
Moreover, most grantees reported that they consult with domestic 
violence organizations and refer potential domestic violence victims to 
them. For example, one grantee we visited told us that it consulted 
with two different domestic violence organizations when designing its 
Responsible Fatherhood program. The domestic violence organizations 
helped the grantee develop part of a workshop related to domestic 
violence and also presented information to program participants. During 
our site visits, grantees also told us they refer program participants 
to domestic violence specialists when appropriate. For example, one of 
the grantees we visited said that when it encountered a potential 
domestic violence situation, it held a joint meeting with a caseworker, 
domestic violence expert, and a family services coordinator. 
Collectively they determined the appropriate referral for the person. 
The DRA does not include domestic violence services as an allowed 
activity, but does require that programs have in place mechanisms for 
addressing domestic violence. 

Programs Focus Services on Different Target Populations: 

Healthy Marriage and Responsible Fatherhood grantee programs focus on 
providing services to different populations, but they both target low- 
income and minority populations. According to our survey, 58 percent of 
Healthy Marriage and 52 percent of Responsible Fatherhood grantees 
target low-income individuals, and 39 percent of Healthy Marriage and 
36 percent of Responsible Fatherhood grantees target minorities (see 
fig. 5). Healthy Marriage grantee programs target high school or 
teenaged youths at higher rates than Responsible Fatherhood grantee 
programs, in part, because education in high schools is one of the 
Healthy Marriage program's allowed activities. On the other hand, 
Responsible Fatherhood programs target incarcerated parents, typically 
fathers, because HHS designated a portion of the program's funding for 
this population. Both grantee programs allow men and women to 
participate in their programs--even though the Responsible Fatherhood 
programs were created specifically to target men, they are both open to 
men and women. An administrative complaint was filed by a legal 
advocacy organization centering on whether women have equal access to 
the program and subsequently HHS reminded grantees that the Responsible 
Fatherhood programs are open to eligible men and women.[Footnote 9] 

Figure 5: Grantee Target Populations: 

This figure is a combination bar graph showing grantee target 
populations. The X axis represents the target population, and the Y 
axis represents the percentage of grantees who target. One bar 
represents health marriage, and the other responsible fatherhood. 
			
Target population: High school students/youths; 
Healthy marriage: 43; 
Responsible fatherhood: 8. 

Target population: Singles; 
Healthy marriage: 13; 
Responsible fatherhood: 4. 

Target population: Unmarried couples; 
Healthy marriage: 44; 
Responsible fatherhood: 17. 

Target population: Co-habitating unmarried couples; 
Healthy marriage: 11; 
Responsible fatherhood: 13. 

Target population: Married couples; 
Healthy marriage: 30; 
Responsible fatherhood: 14. 

Target population: Parents; 
Healthy marriage: 42; 
Responsible fatherhood: 84. 

Target population: Low income; 
Healthy marriage: 58; 
Responsible fatherhood: 52. 

Target population: Incarcerated persons; 
Healthy marriage: 9; 
Responsible fatherhood: 31. 

Target population: Minorities; 
Healthy marriage: 39.22; 
Responsible fatherhood: 36. 

Target population: Other; 
Healthy marriage: 6; 
Responsible fatherhood: 30. 

[See PDF for image] 

Source: GAO analysis of Health Marriage and Responsible Fatherhood 
grantees' responses to survey. 

[End of figure] 

Grantees use a variety of methods to attract participants to the 
program. According to our survey, grantees rely heavily on word of 
mouth, but they also attract participants through educational handouts 
and brochures, referrals, and advertisements such as promotion 
campaigns (see fig. 6). For example, one grantee we visited, which 
targets Latinos, indicated that while it advertises through a variety 
of methods including community-based advertising, radio, and door-to- 
door recruiting, it had difficulty attracting participants. Some 
grantees told us they devised numerous incentives to better retain 
participants. For example, one grantee we visited told us it provides 
food and child care at each session, transportation subsidies, and Wal- 
Mart and Babies R Us gift cards once participants completed the 
program. 

Figure 6: Examples of Recruitment Materials Used by Healthy Marriage 
and Responsible Fatherhood Grantees: 

This figure is a picture of examples of recruitment materials used by 
healthy marriage and responsible fatherhood grantees. 

[See PDF for image] 

Source: GAO photo. 

[End of figure] 

Participation in the Healthy Marriage and Responsible Fatherhood 
programs must be voluntary as required by DRA, and according to our 
survey, grantees used a variety of methods to inform participants that 
participation was voluntary. Specifically, 95 percent of survey 
respondents indicated they provide verbal notification that 
participation is voluntary, while 89 percent indicated that they 
provide written notification (see fig. 7). 

Figure 7: Methods of Notifying Participants of Voluntary Participation 
in Programs: 

This figure is a combination bar graph showing methods of notifying 
participants of voluntary participation in programs. The X axis 
represents the delivery method, and the Y axis represents percentage of 
survey responses. One bar represents healthy marriage, and the other 
represents responsible fatherhood. 

Delivery method: Verbal notification; 
Healthy Marriage: 95; 
Responsible Fatherhood: 94. 

Delivery method: Written notification; 
Healthy Marriage: 84; 
Responsible Fatherhood: 95. 

Delivery method: Sign in sheet; 
Healthy Marriage: 70; 
Responsible Fatherhood: 64. 

Delivery method: Waiver form; 
Healthy Marriage: 53; 
Responsible Fatherhood: 57. 

Delivery method: Web site; 
Healthy Marriage: 47; 
Responsible Fatherhood: 37. 

Delivery method: Posted notification; 
Healthy Marriage: 33; 
Responsible Fatherhood: 37. 

Delivery method: Other; 
Healthy Marriage: 49; 
Responsible Fatherhood: 46. 

[See PDF for image] 

Source: GAO analysis of Healthy Marriage and Responsible Fatherhood 
grantees' responses to survey. 

[End of figure] 

HHS Has a Program Monitoring System, but Lacks Mechanisms to Identify 
and Target Grantees Not in Compliance with Grant Requirements or Not 
Meeting Performance Goals: 

HHS has a program monitoring system, but it lacks the mechanisms to 
identify and target grantees not in compliance with grant requirements 
or not meeting performance goals. HHS uses multiple tools to monitor 
grantee programs, such as site visits and reviews of reports submitted 
by grantees. However, HHS lacks specific guidance for conducting 
monitoring site visits. Moreover, HHS's ability to target grantees in 
need of assistance is hindered by the lack of an effective Management 
Information System. 

HHS Uses Multiple Tools to Monitor Grantees: 

To monitor Healthy Marriage and Responsible Fatherhood grantee 
performance, HHS uses multiple tools including a combination of phone 
calls, e-mails, grantee progress reports, and site visits. HHS also 
reviews grantee Single Audit Act reports.[Footnote 10] HHS is 
responsible for monitoring the 216 Healthy Marriage and Responsible 
Fatherhood grantees and according to our survey; almost all grantees 
reported some contact from HHS staff.[Footnote 11] According to the 
grantees we visited, HHS staff contact them at least once a month. 
Grantees said that HHS staff typically contact them to notify them of 
opportunities for technical assistance, address errors or issues that 
arise during review of required programmatic and financial progress 
reports, and to notify them of upcoming events. In addition, some 
grantees also initiate communication with HHS to ask questions 
regarding policy, to request approval for certain activities, or to 
request budget modifications. 

Semiannually, HHS requires grantees to submit both programmatic and 
financial progress reports, which, among other things, provide HHS with 
updates on grantees' progress toward meeting performance goals that 
grantees established for themselves in their applications, as well as 
provide information on grantees' compliance with domestic violence and 
other HHS policies. For example, some grantees report to HHS on the 
number of participants they expect to serve. Some grantees also may 
report on the types of activities and participant satisfaction with 
programs or services as well as changes in participant behavior before 
and after programs. They also may report on any problems they may be 
experiencing, including recruiting challenges. Because grantees can set 
their own program goals and establish their own measures for these 
goals, there is considerable variation among the information being 
collected. Financial progress reports contain information, such as 
financial statements, that allow HHS to track the use of grant funds. 
HHS also monitors grantees' use of funds by tracking grantees' draw 
down of funds. Specifically, HHS also is able to compare financial 
progress reports submitted by grantees with reports from the HHS 
electronic grant payment management system to monitor grantees' 
withdrawal of funds. For example, if HHS observes that a grantee has 
not withdrawn funds according to its schedule, they will contact the 
grantee to determine the reason the grantee has not been withdrawing 
funds. For grantees that received federal funds in excess of $500,000, 
HHS monitors and reviews audit reports in accordance with the Single 
Audit Act. According to HHS, its review of grantee Single Audit Act 
reports covers compliance with audit standards, completeness, 
timeliness, and other audit considerations. 

As part of HHS's on-site monitoring, at least one HHS staff member will 
interview grantee staff, review program documents, and in some 
instances observe programs in operation. For example, when we 
accompanied HHS during two grantee site visits in March of this year, 
HHS and one of the grantees discussed challenges the grantee was 
experiencing with recruiting participants. HHS discovered that the 
grantee, whose target population included a rural district, was 
struggling to meet its goal for the number of participants it initially 
believed it would serve. The HHS official referred the grantee for 
technical assistance in order to help it improve participant 
recruitment and retention. HHS officials told us that monitoring site 
visits was a priority for them and their goal was to visit all grantees 
within the first 3 years of the award period. As of August 2008, HHS 
told us that approximately 84 percent of grantees had received a site 
visit from HHS since September of 2006, when the programs were first 
funded. Our survey results confirmed that HHS had visited most of the 
grantees in the first 2 years.[Footnote 12] 

HHS Lacks Guidance for Conducting Site Visits and Other Monitoring 
Activities: 

HHS staff lack specific guidance for conducting site visits and other 
monitoring activities, according to our interviews with HHS staff, 
visits and interviews with grantees, and file reviews. As a result, the 
length and types of issues reviewed and documentation examined by HHS 
during site visits varied depending on who conducted the visit. HHS 
officials told us that staff responsible for monitoring are to use the 
legislation, grant announcements, and site visit protocol as guidance 
to monitor grantee performance. Although legislation and grant 
announcements provide some general guidance, they do not specifically 
define what is permitted under each allowed activity. For example, the 
grant announcement lists marriage education as an allowed activity for 
some grantees, but does not specifically describe what marriage 
education activities are permitted under the grant. We also found the 
site visit protocol provided by HHS was limited to a checklist of 
topics for HHS to cover during grantee site visits. The checklist did 
not detail the process, the criteria for conducting monitoring site 
visits, or the key items to be examined, leaving each monitoring staff 
member the discretion to determine what information to gather and how 
best to gather it. Moreover, we found other inconsistencies in how HHS 
conducts monitoring visits. For example, during some monitoring site 
visits, HHS staff observed grantees providing services while in other 
instances they did not. According to HHS officials, HHS staff are 
required only to observe services if the timing of the visit coincides 
with services, but they are not required to schedule monitoring site 
visits to coincide with sessions. Because some HHS officials do not 
observe grantees providing services, they cannot confirm that the 
services are in fact being provided or that the funding is being spent 
as intended. 

The lack of sufficient guidance from HHS may have led HHS staff to 
inconsistently apply HHS policy among some grantees. For example, 
through our interviews and file review, we found that some monitoring 
staff members allowed several Healthy Marriage and Responsible 
Fatherhood grantees to use incentives to retain program participants, 
while others were told they were not permitted to use similar 
incentives. From our review of grantee files, we found instances where 
HHS staff worked with grantees to adjust or lower the goals they 
developed for themselves to meet second-year targets. Other grantees 
who did not meet their year-1 performance goals were not permitted to 
adjust their performance targets. In another example, HHS officials 
told us that abstinence education was not allowable under the Healthy 
Marriage program, but we observed during our site visits and review of 
grantee data several Healthy Marriage grantees operating programs that 
focused on abstinence education. 

HHS's Ability to Target Grantees Not in Compliance with Grant 
Requirements or Not Meeting Performance Goals Is Hindered by the Lack 
of an Effective Management Information System: 

The lack of an effective management information system that captures 
key information on individual grantees hinders HHS's ability to 
appropriately identify which grantees are not in compliance with grant 
requirements or are not meeting performance goals. Although it 
maintains paper files on each grantee, the breadth and detail in these 
files vary considerably. For example, some HHS staff keep very detailed 
logs on grantees, while others maintain minimal records. Moreover, the 
information in these files is not always used to target grantees in 
need of assistance or to identify how grantees are using their funds. 
For example, one grantee used grant funds to provide marriage education 
services not allowed under its grant to participants. Although 
information such as how grantees are using their funds should be 
contained in the files, the grantee in this instance was notified 
months after initiating services that the program was not allowed, 
causing the grantee to use alternative sources of funding to provide 
services. Moreover, through our case studies, we found instances where 
grantees did not receive timely feedback on progress reports, documents 
that are part of the files HHS maintains on individual grantees. These 
files provide an early alert to problems grantees may be experiencing 
and could potentially identify grantees at risk of not meeting 
performance goals. Despite HHS having this information, some grantees 
told us that they did not receive timely feedback from HHS, causing 
them setbacks in implementing program activities. 

Without an effective management information system, HHS has not been 
able to take a strategic approach to conducting grantee site visits and 
other monitoring activities. Although HHS told us that grantees 
experiencing challenges should receive priority for site visits, our 
review of a random sample of grantee files showed that several grantees 
were having difficulty recruiting participants, yet HHS did not always 
give them priority for on-site review. Moreover, during our site 
visits, some grantees told us they were experiencing difficulty meeting 
participation goals or recruiting the number of participants they 
indicated to HHS they would serve through their program. These grantees 
also were not targeted specifically for on-site monitoring. 
Specifically, the decision of which grantees to visit and in what order 
was left to the discretion of HHS staff, according to HHS officials. 
Because grantees that were experiencing challenges did not always 
receive priority for monitoring site visits and these site visits were 
scheduled based on HHS staff scheduling preferences, we found that 
monitoring was not always based on grantee risk or need. 

HHS told us it is in the process of developing a database that will 
help it standardize and combine grantee communications and performance 
information. According to HHS, the first phase of the web-based 
management information system has been completed. The system is 
designed to replace the paper files and, according to HHS, will 
considerably reduce or eliminate inconsistencies in HHS's 
recordkeeping. The management information system will capture 
performance indicators developed by the grantee and submitted 
semiannually in grantee programmatic progress reports, such as 
grantees' progress toward meeting participant recruitment goals and 
changes in participant behavior. The new system should allow HHS to 
better manage and search for grantee information, upload grantee 
communications, and track data from grantee programmatic progress 
reports. It is not clear, however, when HHS will be able to include 
uniform performance indicators that it plans to collect from individual 
grantees. HHS officials told us that performance indicators have been 
developed, but are pending implementation while they are currently 
under review by the Office of Management and Budget. HHS said it 
anticipates having grantees begin collecting data in autumn or early 
winter of 2008, the start of the third year of funding for the 5-year 
initiative. According to HHS, the uniform performance indicators will 
eventually be part of its planned management information system. 

HHS Has Long-term Research Underway Intended to Assess Program Impact: 

HHS has four multiyear studies of marriage and fatherhood programs 
underway that are intended to assess the impact of the programs on 
various populations and understudied groups, the final results of which 
are expected between 2011 and 2013. Funded partially by the DRA, HHS 
awarded contracts to three organizations--RTI International; 
Mathematical Policy Research; and MDRC--that competitively bid to 
conduct the evaluations, which run over several years and across 
several marriage or fatherhood programs.[Footnote 13] Two of the impact 
studies will exclusively follow grantees funded under the Healthy 
Marriage and Responsible Fatherhood Initiative, while the other two 
studies will follow a mix of grantees and healthy marriage programs not 
funded under the Initiative. In all cases, the programs being studied 
primarily offer participants skills-based marriage or fatherhood 
education. The primary focus of HHS's research is to determine the 
impact, if any, marriage and fatherhood programs have on couples, 
families, and fathers as a result of participation in the programs. 
Impact evaluations are the strongest method for assessing the efficacy 
of a program because they allow for a comparison between similar groups 
that differ only with respect to whether they received a service or 
"treatment." However, they often are difficult and expensive to conduct 
because they take years to complete and it often is difficult to retain 
enough participants to produce meaningful results. Prior research has 
focused on the impact of marriage services on middle-income families 
and couples. A review of the literature, sponsored by HHS, on the 
overall impact of marriage and relationship programs found that, on 
average, middle-income couples receiving services showed increased 
relationship satisfaction and improved communication skills. HHS's 
research agenda represents the first major federal effort to study the 
impact of healthy marriage and responsible fatherhood programs on low- 
income populations and is part of a wider body of research being 
developed by HHS.[Footnote 14] 

Two of the three healthy marriage studies--the Building Strong Families 
(BSF) and the Supporting Healthy Marriage (SHM) evaluations--focus on 
low-income couples who are expecting or have recently had a child. The 
BSF is following 5,103 low-income unmarried couples across seven 
marriage programs around the time of the birth of a child using data 
collected at three stages of participants' lives. The SHM study is 
examining the effects of healthy marriage programs on 6,860 married 
couples across eight marriage programs. The third healthy marriage 
study--the Community Healthy Marriage Initiative--expands its focus 
beyond specific target populations to entire communities: the 
initiative is comparing couples in three different geographic 
communities with federally funded healthy marriage programs-- 
Milwaukee, Wisconsin; Dallas, Texas; and St. Louis, Missouri--with 
three demographically similar communities--Cleveland, Ohio; Ft. Worth, 
Texas; and Kansas City, Missouri--where there are no federally funded 
healthy marriage programs. The study, which involves 4,200 
participants, will explore whether the presence of intensive healthy 
marriage programs promotes changes in attitudes and behavior toward 
marriage in the communities being studied. In addition to the three 
healthy marriage evaluations, HHS also is funding an impact evaluation 
of Responsible Fatherhood programs. The National Evaluation of the 
Responsible Fatherhood, Marriage and Family Strengthening Grants for 
Incarcerated and Re-entering Fathers and Their Partners (MFS-IP) began 
in 2006, when the first year of Responsible Fatherhood funds became 
available, and is currently enrolling participants. The MFS-IP, much 
like the three marriage studies, will explore changes in couple quality 
and changes in attitudes toward marriage. In addition, the MFS-IP will 
assess changes in outcomes for employment and economic stability, in 
line with the parameters of activities allowed under the legislation 
for Responsible Fatherhood grantees (see fig. 8). 

Figure 8: HHS Healthy Marriage and Responsible Fatherhood Impact 
Research Studies: 

This figure is a diagram showing HHS healthy marriage and responsible 
fatherhood impact research studies. 

[See PDF for image] 

Source: Data provided by HHS. 

[A] The official title of this Impact Study is "The National Evaluation 
of the Responsible Fatherhood, Marriage and Family Strengthening Grants 
for Incarcerated and Re-entering Fathers and Their Partners." 

[End of figure] 

For all four studies, evaluators will collect outcome data for the 
couples participating in programs at various stages of the study and 
then compare the results against groups of couples who did not 
participate in the programs. Because the two groups are, by nature of 
the study design, similar in every major respect, any differences 
between the two groups can be attributed to the program. The evaluators 
for the four studies differed on the methods they used to create these 
two groups. Two of the four studies, the BSF and the SHM, randomly 
assign couples to either a group that receives services (the 
experimental group) or group that does not (the control group). The 
other two studies are quasi-experimental. This type of study uses 
methods other than random assignment to create a comparison group, such 
as selecting a set of individuals who have similar characteristics to 
the group receiving the program services under study. 

To compare these groups in the four studies over time, the evaluators 
are conducting surveys and interviews, generally 1 year and 3 years 
after participating in a program, in order to gauge couples' and 
families' outcomes. The surveys ask questions about how couples are 
communicating after participating in a program; whether they are using 
the skills they learned in the program; and how they would rate, 
overall, the quality of their relationship since participating in the 
program. The evaluators also will administer the same surveys to the 
couples not participating in Healthy Marriage or Responsible Fatherhood 
programs in order to make comparisons between the two groups. For 
example, the BSF study will examine a range of outcomes, including 
whether marriage services improved marital relationships, reduced 
marital instability, and improved child well-being. 

In general, we found the evaluations to be well-designed and rigorous, 
however, there are inherent difficulties presented by the Community 
Healthy Marriage Initiative, which assesses the impact of healthy 
marriage programs on entire geographic areas. Specifically, it may be 
difficult to find and study true comparison communities. One positive 
feature of the study is the collection of baseline data for each of the 
participating communities; however, it is difficult to determine if the 
contractors have captured and controlled for the important variables 
needed to match the communities. In addition, it will be difficult to 
determine if changes in the community stem from Healthy Marriage 
program services or some other factors. 

Conclusions: 

Marriage and fatherhood programs have emerged as a national strategy 
for improving the well-being of children. The federal government has 
committed $150 million annually for 5 years for these programs and 
provided for an evaluation the Healthy Marriage and Responsible 
Fatherhood Initiative to determine how well the Initiative is working 
for low-income populations. While HHS has made an effort to visit 
nearly all of the programs in their first 2 years of operations, absent 
mechanisms for detecting grantee compliance and performance issues, 
some grantees did not receive monitoring and technical assistance soon 
enough and had to make modifications to their program well into 
implementation. Moreover, effective monitoring was hampered by a lack 
of an effective management information system that captures key 
information, including uniform performance indicators for grantees, and 
the lack of consistent and clear monitoring guidance. Without an 
effective monitoring system or clear and consistent monitoring 
guidance, grantees may continue to be at risk of noncompliance with HHS 
policy or of not meeting performance requirements. 

Recommendations for Executive Action: 

In order to improve monitoring and oversight of Healthy Marriage and 
Responsible Fatherhood grantees, we are recommending that the Secretary 
of HHS: 

* employ a risk-based approach to monitoring grantees and conducting 
grantee site visits, using its planned management information system 
and information from both progress reports and uniform performance 
indicators to help identify those grantees at risk of not meeting 
performance goals or not in compliance with grant requirements; and: 

* create clear, consistent guidance and policy for monitoring Healthy 
Marriage and Responsible Fatherhood grantees. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to HHS for its comments; these 
appear in appendix V. In its comments, HHS concurred with our 
recommendation that it employ a risk-based approach to monitoring using 
its planned management information system and performance indicators to 
help identify grantees for monitoring, saying these tools would further 
enhance oversight and monitoring efforts currently underway. In its 
comments, HHS states that it has already developed and implemented this 
portion of the recommendation, including developing a customized 
approach to prioritizing site visits and technical assistance. However, 
HHS caveats that only the first phase of its web-based management 
information system has been completed and that performance indicators 
that would help them identify those grantees at risk, are still 
awaiting approval by OMB. A fully implemented management information 
system with performance indicators in place will further enhance HHS's 
ability to monitor grantees based on risk. 

HHS disagreed with the portion of our recommendation that HHS lacks 
specific guidance for conducting monitoring site visits. In its 
comments, HHS stated that it developed a clear, comprehensive, and 
thorough protocol and trained project officers on the critical and 
essential items that must be covered during grantee site visits. As we 
stated in our report, this protocol was limited to a checklist of 
topics to be covered during the site visit and did not describe the 
process to be followed or criteria to be used to monitor grantees. 
Moreover, the lack of clarity in this protocol may have contributed to 
the inconsistencies in how site visits were administered by HHS staff, 
as noted in our report. 

HHS also stated in its response that fiscal oversight or monitoring a 
grantee's fiscal compliance can be used as an alternative mechanism to 
confirm whether grantees are providing services or spending funds as 
the grant intended. While we agree that monitoring grantee's fiscal 
compliance is essential, HHS's comments do not change our view that 
observing activities is critical to confirming that grantees are 
actually providing services as intended by the grant. 

Finally, HHS commented on our finding that some grantees were operating 
programs focused on abstinence education. HHS stated that it is 
impermissible to use Deficit Reduction Act (DRA) funding for abstinence 
education, however, grantees may use funding from other sources to 
provide abstinence education through programs separate from the Healthy 
Marriage and Fatherhood programs. We visited one such program whose 
staff told us that they used DRA funding to support their abstinence 
education program and that abstinence education was not provided as a 
single lesson, but was the focus of the entire curriculum. 

HHS also provided technical changes to a draft of the report, which we 
incorporated into the report as appropriate. 

As agreed with your office, unless you publicly announce its contents 
earlier, we plan no further distribution of this report until 30 days 
after its issue date. At that time, we will send copies of this report 
to the Honorable Michael O. Leavitt, Secretary of Health and Human 
Services, relevant congressional committees, and other interested 
parties. In addition, the report will be available at no charge on 
GAO's Web site at [hyperlink, http://www.gao.gov]. Please contact me on 
(202) 512- 7215 if you or your staff have any questions about this 
report. Contact points for our offices of Congressional Relations and 
Public Affairs may be found on the last page of this report. Key 
contributors to this report are listed in appendix VI. 

Sincerely yours, 

Signed by: 

Kay E. Brown: 

Director, Education, Workforce, and Income Security Issues: 

[End of section] 

Appendix I: Objective, Scope, and Methodology: 

To gain insight into how Healthy Marriage and Responsible Fatherhood 
programs are being implemented, we were asked to report on (1) how the 
Department of Health and Human Services (HHS) awarded grants and the 
types of organizations that received funding; (2) the activities and 
services grantees are providing, including those for domestic violence 
victims; (3) the manner in which HHS monitors and assesses program 
implementation and use of funds; and (4) how program impact is 
measured. 

To address the objectives, we conducted a Web-based survey of 122 
Healthy Marriage and 94 Responsible Fatherhood grantees asking them to 
provide information about various aspects of their programs. We 
received a response rate of 98 percent. We also visited 14 grantees in 
Washington, Oklahoma, New Mexico, Indiana, Oregon, and the District of 
Columbia. In addition, we conducted telephone interviews with 
organizations that provide technical assistance to grantees and help 
other organizations develop fatherhood programs. To further understand 
the criteria HHS used to award grants and the manner in which HHS 
monitors and assesses program implementation, we reviewed 50 grantee 
case files, 40 randomly and 10 deliberately selected, examining 
documents such as applications, semiannual progress and financial 
reports, grantee selection panel score sheets, and correspondences 
between the grantees and agency officials. To determine how program 
impact is measured, we interviewed organizations that received 
contracts to conduct impact evaluations of Healthy Marriage and 
Responsible Fatherhood interventions and assessed their methodological 
approach to measuring impact. 

Survey of Marriage and Fatherhood Programs: 

To address all of our objectives, we conducted a Web-based survey of 
all 216 demonstration grantees that provided direct services to 
participants, 122 Healthy Marriage and 94 Responsible Fatherhood 
grantees.[Footnote 15] We asked grantees about various aspects of their 
programs, including the characteristics of their organization, services 
they offered, experience providing similar services, curricula used, 
their process and procedures for identifying domestic violence, staff 
training; and any evaluations the grantees were conducting on their 
own. In order to identify respondents for our survey, we obtained lists 
of grantees and contact information from HHS's Administration for 
Children and Families and their Office of Grants Management. We 
compared the two lists to compile the most accurate list of grant 
recipients and contact information. In some cases, we contacted the 
organization directly to determine the appropriate contact person and 
obtain updated information. Of the 216 grantees contacted, 211 provided 
information, for a response rate of 98 percent. The survey data was 
collected from February 2008 to April 2008. 

Because this was not a sample survey, it has no sampling errors. 
However, the practical difficulties of conducting any survey may 
introduce errors, commonly referred to as nonsampling errors. For 
example, difficulties in interpreting a particular question, sources of 
information available to respondents, or entering data into a database 
or analyzing them can introduce unwanted variability into the survey 
results. We took steps in developing the questionnaire, collecting the 
data, and analyzing them to minimize such nonsampling error. For 
example, prior to launching our survey, we worked with social science 
survey specialists to develop the questionnaire and minimize error. We 
tested the content and format of the questionnaire with multiple 
grantees prior to administering the survey to address issues such as 
differences in question interpretation, and differences in data 
tracking. We conducted 10 survey pretests. As a result of our pretests, 
we changed survey questions as appropriate and tested those changes 
with grantees that participated in our original pretests. Further, the 
final pretests were performed using the Web-based survey tool, which 
checked for accuracy and usability. To ensure grantees responded to the 
survey, we sent e-mail reminders and conducted follow-up telephone 
calls with nonrespondents. Since this was a Web-based survey, 
respondents entered their answers directly into the electronic 
questionnaire, eliminating the need to key data into a database, 
minimizing error. We used content coding, computer edits, and 
independent analysts to assess the reliability of the information 
collected. 

Site Visits to 14 Grantees: 

To gather information to respond to all of these questions, we visited 
14 grantees--9 Healthy Marriage grantees and 5 Responsible Fatherhood 
grantees--in Washington, Oklahoma, New Mexico, Indiana, Oregon, and the 
District of Columbia. We selected grantees to achieve variation in 
geographic location, type of grant awarded, award amount, services, 
organization type, program curriculum, and the programs' target 
populations. During each site visit we asked the grantees about the 
grant application process and their programs, including accessibility 
of funds, services provided, guidance and communication with HHS, and 
challenges the grantees experienced. During seven of these site visits, 
we observed the implementation of marriage and fatherhood services. 
Further, we also observed HHS staff in the process of conducting two 
grantee site visits. In analyzing our site visit interviews we arrayed 
and analyzed narrative responses thematically. The site visits were 
conducted from December 2007 through April 2008. 

File Review: 

Further, to learn about the criteria used to award grants and HHS's 
monitoring activities, we conducted a review of 50 grantee case files 
out of the total 229 grants awarded in September 2006. We conducted a 
simple random sample of 40 Healthy Marriage and Responsible Fatherhood 
grantee case files--28 Healthy Marriage grantees and 12 Responsible 
Fatherhood grantees. We also deliberately selected and reviewed an 
additional 10 grantee case files; the team deliberately reviewed case 
files for 1 technical assistance grantee, 6 grantees that assist other 
organizations with developing fatherhood programs, and 3 grantees we 
visited. During the case file review, we examined documents contained 
in the grantee's case file including, the grantee's original and 
continuation application, semiannual progress and financial reports, 
grantee selection panel score summary sheets, correspondences between 
the grantee and agency officials, and site visit reports. We reviewed 
the documents to assess HHS's compliance with its grants policy manual 
and to understand how HHS monitors use of funds. We also reviewed 
Single Audit Reports for the selected sample of grantees. To facilitate 
the case file review, we developed a data collection instrument to 
record specific information for each case file reviewed. We used 
content coding to analyze the qualitative information from our data 
collection instrument. We conducted our review on-site at HHS's 
Administration for Children and Families. 

Review of Internal HHS Documents and Interviews with HHS Officials: 

We also reviewed the HHS grant selection criteria included in the grant 
announcements and HHS's internal guidance on grant selection processes 
which we compared to the selection of Healthy Marriage and Responsible 
Fatherhood grant recipients. In addition to these reviews, we 
interviewed HHS and the contractor responsible for hiring reviewers and 
organizing the review panels. 

To determine how HHS measures program impact, we collected survey 
instruments, design papers, and program guidelines for each of the four 
impact evaluations underway in order to assess their methodological 
soundness. In addition, we interviewed HHS staff responsible for 
overseeing the contractors responsible for the impact evaluations. To 
gauge how HHS is monitoring the progress of grantees, we interviewed 
HHS staff regarding its process for monitoring grantees, including 
guidance used and staff training provided to determine how HHS monitors 
and assesses program implementation and use of funds. 

Interviews with Experts: 

To identify critical components that should be included in services 
provided by grantees, we interviewed multiple experts in the areas of 
marriage, fatherhood, and domestic violence. We also interviewed 
grantees and contractors that were not direct providers of healthy 
marriage and responsible fatherhood services but received funding under 
the Healthy Marriage and Responsible Fatherhood Initiative to provide 
technical assistance to demonstration grantees, conduct research, and 
help other organizations develop fatherhood programs. 

We conducted this performance audit from July 2007 to September 2008, 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe that 
the evidence obtained provides a reasonable basis for our findings and 
conclusions based on our audit objectives. 

[End of section] 

Appendix II: Grantee Selection Criteria: 

Criteria: Approach; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): 40; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): 40; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): 35; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): 40; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): 40; 
Score values: Healthy Marriage Resource Center (1 grant awarded): 45. 

Criteria: Staff and position data; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): [Empty]; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): [Empty]; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): [Empty]; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): [Empty]; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): 20; 
Score values: Healthy Marriage Resource Center (1 grant awarded): 15. 

Criteria: Results and benefits expected; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): [Empty]; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): [Empty]; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): [Empty]; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): [Empty]; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): 15; 
Score values: Healthy Marriage Resource Center (1 grant awarded): . 

Criteria: Objectives and need for assistance; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): 10; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): 10; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): 15; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): 10; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): 15; 
Score values: Healthy Marriage Resource Center (1 grant awarded): . 

Criteria: Budget and budget justification; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): 15; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): 15; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): 15; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): 15; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): 10; 
Score values: Healthy Marriage Resource Center (1 grant awarded): 20. 

Criteria: Organizational profile; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): 20; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): 20; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): 20; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): 20; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): [Empty]; 
Score values: Healthy Marriage Resource Center (1 grant awarded): 20. 

Criteria: Evaluation; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): 15; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): 15; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): 15; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): 15; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): [Empty]; 
Score values: Healthy Marriage Resource Center (1 grant awarded): 
[Empty]. 

Criteria: Experience (bonus points); 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): 5; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): 5; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): [Empty]; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): 5; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): [Empty]; 
Score values: Healthy Marriage Resource Center (1 grant awarded): 
[Empty]. 

Criteria: Total score possible; 
Score values: Healthy Marriage Demonstration Grants (122 grants 
awarded): 105; 
Score values: Promoting Responsible Fatherhood Grants (94 grants 
awarded): 105; 
Score values: National Fatherhood Capacity-Building Grants (1 grant 
awarded): 100; 
Score values: Promoting Responsible Fatherhood Community Access (5 
grants awarded): 105; 
Score values: Healthy Marriage/ Responsible Fatherhood Research 
Initiative (3 grants awarded): 100; 
Score values: Healthy Marriage Resource Center (1 grant awarded): 100. 

Source: Healthy Marriage and Responsible Fatherhood grant 
announcements. 

[End of table] 

[End of section] 

Appendix III: States and Territories with Grantees That Provide Direct 
Services to Participants as of February 2008: 

State or territory: Alabama; 
Number of Healthy Marriage grantees: 2; 
Number of Responsible Fatherhood grantees: 0; 
Total: 2. 

State or territory: Alaska; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: American Samoa; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 0; 
Total: 1. 

State or territory: Arizona; 
Number of Healthy Marriage grantees: 3; 
Number of Responsible Fatherhood grantees: 1; 
Total: 4. 

State or territory: Arkansas; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 1; 
Total: 2. 

State or territory: California; 
Number of Healthy Marriage grantees: 10; 
Number of Responsible Fatherhood grantees: 9; 
Total: 19. 

State or territory: Colorado; 
Number of Healthy Marriage grantees: 6; 
Number of Responsible Fatherhood grantees: 3; 
Total: 9. 

State or territory: Connecticut; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 2; 
Total: 2. 

State or territory: Delaware; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: District of Columbia; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 3; 
Total: 3. 

State or territory: Florida; 
Number of Healthy Marriage grantees: 10; 
Number of Responsible Fatherhood grantees: 3; 
Total: 13. 

State or territory: Georgia; 
Number of Healthy Marriage grantees: 4; 
Number of Responsible Fatherhood grantees: 3; 
Total: 7. 

State or territory: Hawaii; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: Idaho; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: Illinois; 
Number of Healthy Marriage grantees: 3; 
Number of Responsible Fatherhood grantees: 2; 
Total: 5. 

State or territory: Indiana; 
Number of Healthy Marriage grantees: 5; 
Number of Responsible Fatherhood grantees: 2; 
Total: 7. 

State or territory: Iowa; 
Number of Healthy Marriage grantees: 2; 
Number of Responsible Fatherhood grantees: 1; 
Total: 3. 

State or territory: Kansas; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 0; 
Total: 1. 

State or territory: Kentucky; 
Number of Healthy Marriage grantees: 3; 
Number of Responsible Fatherhood grantees: 1; 
Total: 4. 

State or territory: Louisiana; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 2; 
Total: 2. 

State or territory: Maine; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 1; 
Total: 2. 

State or territory: Maryland; 
Number of Healthy Marriage grantees: 3; 
Number of Responsible Fatherhood grantees: 4; 
Total: 7. 

State or territory: Massachusetts; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 0; 
Total: 1. 

State or territory: Michigan; 
Number of Healthy Marriage grantees: 3; 
Number of Responsible Fatherhood grantees: 6; 
Total: 9. 

State or territory: Minnesota; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 4; 
Total: 4. 

State or territory: Mississippi; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 0; 
Total: 1. 

State or territory: Missouri; 
Number of Healthy Marriage grantees: 5; 
Number of Responsible Fatherhood grantees: 1; 
Total: 6. 

State or territory: Montana; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 2; 
Total: 2. 

State or territory: Nebraska; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 0; 
Total: 0. 

State or territory: Nevada; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 0; 
Total: 0. 

State or territory: New Hampshire; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: New Jersey; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: New Mexico; 
Number of Healthy Marriage grantees: 5; 
Number of Responsible Fatherhood grantees: 1; 
Total: 6. 

State or territory: New York; 
Number of Healthy Marriage grantees: 4; 
Number of Responsible Fatherhood grantees: 7; 
Total: 11. 

State or territory: North Carolina; 
Number of Healthy Marriage grantees: 3; 
Number of Responsible Fatherhood grantees: 1; 
Total: 4. 

State or territory: North Dakota; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 0; 
Total: 0. 

State or territory: Ohio; 
Number of Healthy Marriage grantees: 7; 
Number of Responsible Fatherhood grantees: 3; 
Total: 10. 

State or territory: Oklahoma; 
Number of Healthy Marriage grantees: 2; 
Number of Responsible Fatherhood grantees: 1; 
Total: 3. 

State or territory: Oregon; 
Number of Healthy Marriage grantees: 2; 
Number of Responsible Fatherhood grantees: 1; 
Total: 3. 

State or territory: Pennsylvania; 
Number of Healthy Marriage grantees: 6; 
Number of Responsible Fatherhood grantees: 5; 
Total: 11. 

State or territory: Rhode Island; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: South Carolina; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: South Dakota; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 2; 
Total: 2. 

State or territory: Tennessee; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 2; 
Total: 3. 

State or territory: Texas; 
Number of Healthy Marriage grantees: 15; 
Number of Responsible Fatherhood grantees: 6; 
Total: 21. 

State or territory: Utah; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 0; 
Total: 1. 

State or territory: Vermont; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: Virginia; 
Number of Healthy Marriage grantees: 3; 
Number of Responsible Fatherhood grantees: 2; 
Total: 5. 

State or territory: Washington; 
Number of Healthy Marriage grantees: 2; 
Number of Responsible Fatherhood grantees: 1; 
Total: 3. 

State or territory: West Virginia; 
Number of Healthy Marriage grantees: 0; 
Number of Responsible Fatherhood grantees: 1; 
Total: 1. 

State or territory: Wisconsin; 
Number of Healthy Marriage grantees: 5; 
Number of Responsible Fatherhood grantees: 1; 
Total: 6. 

State or territory: Wyoming; 
Number of Healthy Marriage grantees: 1; 
Number of Responsible Fatherhood grantees: 0; 
Total: 1. 

State or territory: Total; 
Number of Healthy Marriage grantees: 122; 
Number of Responsible Fatherhood grantees: 94; 
Total: 216. 

Source: GAO analysis of HHS-provided data. 

Note: These data represent Healthy Marriage and Responsible Fatherhood 
demonstration grantees only. 

[End of table] 

[End of section] 

Appendix IV: Curricula Being Used by Healthy Marriage and Responsible 
Fatherhood Grantees and Frequency of Use: 

Name of curriculum: ORG Designed[A]; 
Number of Healthy Marriage grantees using curriculum: 44; 
Number of Responsible Fatherhood grantees using curriculum: 37. 

Name of curriculum: Prevention and Relationship Enhancement Program 
(PREP)[A]; 
Number of Healthy Marriage grantees using curriculum: 41; 
Number of Responsible Fatherhood grantees using curriculum: 12. 

Name of curriculum: PREPARE/ENRICH[A]; 
Number of Healthy Marriage grantees using curriculum: 28; 
Number of Responsible Fatherhood grantees using curriculum: 6. 

Name of curriculum: 24/7[A]; 
Number of Healthy Marriage grantees using curriculum: 2; 
Number of Responsible Fatherhood grantees using curriculum: 21. 

Name of curriculum: Practical Application of Intimate Relationship 
Skill (PAIRS)a; 
Number of Healthy Marriage grantees using curriculum: 19; 
Number of Responsible Fatherhood grantees using curriculum: 3. 

Name of curriculum: Premarital Interpersonal Choices & Knowledge 
(PICK)/ a.k.a. How to Avoid Marrying a Jerk or Jerkette[A]; 
Number of Healthy Marriage grantees using curriculum: 18; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Focus and Re-focus[A]; 
Number of Healthy Marriage grantees using curriculum: 11; 
Number of Responsible Fatherhood grantees using curriculum: 2. 

Name of curriculum: Nurturing Fathers; 
Number of Healthy Marriage grantees using curriculum: 0; 
Number of Responsible Fatherhood grantees using curriculum: 11. 

Name of curriculum: Connections; 
Number of Healthy Marriage grantees using curriculum: 10; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: Love's Cradle; 
Number of Healthy Marriage grantees using curriculum: 8; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: WAIT[A]; 
Number of Healthy Marriage grantees using curriculum: 8; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: LoveU2; 
Number of Healthy Marriage grantees using curriculum: 6; 
Number of Responsible Fatherhood grantees using curriculum: 2. 

Name of curriculum: Family Wellness; 
Number of Healthy Marriage grantees using curriculum: 7; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Fragile Families[A]; 
Number of Healthy Marriage grantees using curriculum: 3; 
Number of Responsible Fatherhood grantees using curriculum: 5. 

Name of curriculum: Mastering the Magic of Love; 
Number of Healthy Marriage grantees using curriculum: 5; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Inside Out Dads; 
Number of Healthy Marriage grantees using curriculum: 0; 
Number of Responsible Fatherhood grantees using curriculum: 5. 

Name of curriculum: Loving Couples Loving Children; 
Number of Healthy Marriage grantees using curriculum: 5; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: STEP[A]; 
Number of Healthy Marriage grantees using curriculum: 3; 
Number of Responsible Fatherhood grantees using curriculum: 2. 

Name of curriculum: Ten Great Dates; 
Number of Healthy Marriage grantees using curriculum: 3; 
Number of Responsible Fatherhood grantees using curriculum: 2. 

Name of curriculum: Responsible Fatherhood; 
Number of Healthy Marriage grantees using curriculum: 0; 
Number of Responsible Fatherhood grantees using curriculum: 4. 

Name of curriculum: Active Relationships; 
Number of Healthy Marriage grantees using curriculum: 3; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Basic Training for Couples; 
Number of Healthy Marriage grantees using curriculum: 3; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: Fatherhood Development; 
Number of Healthy Marriage grantees using curriculum: 0; 
Number of Responsible Fatherhood grantees using curriculum: 3. 

Name of curriculum: Quenching the Fathers Thirst; 
Number of Healthy Marriage grantees using curriculum: 0; 
Number of Responsible Fatherhood grantees using curriculum: 3. 

Name of curriculum: Smart Steps for Stepfamilies; 
Number of Healthy Marriage grantees using curriculum: 3; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: Eight Habits of Successful Marriages; 
Number of Healthy Marriage grantees using curriculum: 2; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Relationship Enhancement; 
Number of Healthy Marriage grantees using curriculum: 2; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Bringing Baby Home; 
Number of Healthy Marriage grantees using curriculum: 2; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: Choosing the Best; 
Number of Healthy Marriage grantees using curriculum: 2; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: Power of Two; 
Number of Healthy Marriage grantees using curriculum: 2; 
Number of Responsible Fatherhood grantees using curriculum: 0. 

Name of curriculum: Preparing for Successful Fathering; 
Number of Healthy Marriage grantees using curriculum: 0; 
Number of Responsible Fatherhood grantees using curriculum: 2. 

Name of curriculum: Effective Black Parenting; 
Number of Healthy Marriage grantees using curriculum: 0; 
Number of Responsible Fatherhood grantees using curriculum: 2. 

Name of curriculum: Building Blocks for Successful Relationships and 
Parenting; 
Number of Healthy Marriage grantees using curriculum: 1; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Financial Literacy; 
Number of Healthy Marriage grantees using curriculum: 1; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: LINKS; 
Number of Healthy Marriage grantees using curriculum: 1; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Name of curriculum: Married and Loving It; 
Number of Healthy Marriage grantees using curriculum: 1; 
Number of Responsible Fatherhood grantees using curriculum: 1. 

Source: GAO analysis of Healthy Marriage and Responsible Fatherhood 
grantees' responses to survey. 

Note: These data are from our survey question regarding curricula and 
include data from the options listed and those provided in the optional 
write-in box. In addition to these curricula listed, 59 grantees 
provided the name of a curriculum that only 1 grantee reported using. 

[A] Denotes curricula listed in survey question. Others provided in 
written responses by grantees. 

[End of table] 

[End of section] 

Appendix V: Comments from the Department of Health and Human Services: 

Department Of Health & Human Services: 
Office Of The Secretary: 

Assistant Secretary for Legislation: 

Washington, DC 20201: 

September 17, 2008: 

Kay E. Brown: 
Director: 
Education, Workforce, and Income Security: 

Government Accountability Office: 
441 G Street NW: 
Washington, DC 20548: 

Dear Ms. Brown: 

Enclosed are the Department's comments on the U.S. Government 
Accountability Office's (GAO) draft report entitled: "Healthy Marriage 
and Responsible Fatherhood Initiative: Risk- Based Monitoring Would 
Help Improve Program Oversight" (GAO-08-1002). 

The Department appreciates the opportunity to review and comment on 
this report before its publication. 

Sincerely, 

Jennifer R. Luong: 

for: 

Vincent J. Ventimiglia, Jr.: 
Assistant Secretary for Legislation: 

Attachment: 

Department Of Health & Human Services: 
Administration For Children And Families: 
Office of the Assistant Secretary, Suite 600: 
370 L'Enfant Promenade, S.W.: 
Washington, D.C. 20447: 

September 16, 2008: 

To: Vincent J. Ventimiglia, Jr.: 
Assistant Secretary for Legislation: 

From: Daniel C. Schneider:  
Acting Assistant Secretary for Children and Families 

Subject: Government Accountability Office (GAO) Draft Report Titled, 
"Healthy Marriage and Responsible Fatherhood Initiative: Risk-Based 
Monitoring Would Help HHS Improve Program Oversight" (GAO-08-1002)
Attached are comments of the Administration for Children and Families 
on the above-referenced GAO draft report. 

Should you have questions or need additional information, please 
contact Robin McDonald, Director, Division of State Territory TANF 
Management, at (202) 401-5587. 

Attachment: 

Comments Of The Administration For Children And Families On The 
Government Accountability Office's Draft Report Titled, "Healthy 
Marriage And Responsible Fatherhood Initiative: Risk- Based Monitoring 
Would Help HHS Improve Program Oversight" (GAO-08-1002):  

The Administration for Children and Families (ACF) appreciates the 
opportunity to comment on the Government Accountability Office's draft 
report. ACF is responding to GAO's recommendations as well as other 
critical items mentioned in the report. 

GAO Recommendations: 

In order to improve monitoring and oversight of Healthy Marriage and 
Responsible Fatherhood grantees, we are recommending that the Secretary 
of HHS: 

* Employ a risk-based approach to monitoring grantees and conducting 
grantee site visits, using its planned management information system 
and information from both progress reports and uniform performance 
indicators to help identify those grantees at risk of not meeting 
performance goals or not in compliance with grant requirements, and

* Create clear, consistent guidance and policy for monitoring Healthy 
Marriage and Responsible Fatherhood grantees. 

ACF General Comments: 

To the extent that ACF's Office of Family Assistance has been proactive 
in implementing the GAO recommendations prior to the report's findings, 
ACF requests that these measures be incorporated in the overview 
section of the report. 

ACF Comments on heading, "What GAO Found": 

* First paragraph, first sentence, "HHS adapted its existing process in 
order to award Healthy Marriage and Responsible Fatherhood grants." – 
The present language suggests that there was irregularity in the 
process. Consistent with departmental protocol, HHS followed its 
existing process; however, the prescribed timeframe was limited due to 
the delay in signing the legislation in February 2006. 

* Third paragraph – Please see "Pages 4-5, last paragraph, last 
sentence –" on page 2 hereof for OFA's full comment. 

ACF Comments on Full Report: 

Page 1, paragraph 1, fifth and sixth sentences – While it is 
appropriate to state that the HM/RF initiative supports two goals under 
the Temporary Assistance for Needy Families (TANF) program, it should 
be made clear that these are discretionary grant programs and are not 
funded under the TANF block grant. 

Page 2, second paragraph, first sentence and footnote 1 – It should be 
noted that the Responsible Fatherhood Community Access grants provide 
technical assistance, etc., to sub-awardees that provide direct 
services. This means that there are several other organizations 
providing direct services to grantees. ACF requests that footnote 1 
included a statement to that effect. ACF also requests that the last 
sentence of footnote 1 be changed to read, "Since making the initial 
awards, 5 organizations have relinquished their grants, 6 were slated 
for non-continuation of future funding, and 1 new grant was awarded." 

Page 4, second paragraph – Performance data was not available until 
April 2007, shortly before the period of this study. During that time, 
ACF/OFA developed site-monitoring protocols and other tools and trained 
FPOs to use them in preparation for their visits. Copies of the site 
visit protocols were provided to GAO. 

Before FPOs had the benefit of the semi-annual reports, ACF/OFA 
launched a vigorous plan to conduct 50 percent of grantee site 
monitoring visits by the end of the first budget year. In accordance 
with the program announcements, the grantee programs had a 90-day start 
up period, followed by program implementation. By the programs' mid-
budget year, the grantees had been operating, i.e., providing direct 
services, for approximately 3 months. 

Following the first semi-annual report, and subsequently the second, 
ACF/OFA developed and implemented a more targeted, customized approach 
to prioritizing site visits and technical assistance to enhance its 
preliminary strategy of FPO oversight from the program's inception. An 
initial performance assessment by the FPOs revealed that 30 grantees 
were in need of high- intensity technical assistance. Each of those 
grantees was placed on a Corrective Action Plan (CAP) with specific, 
time-limited tasks to rectify program deficiencies. Technical 
assistance teams were directed to provide customized, on-site and 
follow-up TA to ensure grantee progress. These proactive corrective 
measures resulted in most grantees (23) achieving or exceeding the 75 
percent performance improvement targets, while 6 grantees were slated 
for non-continuation of future funding and 1 grantee decided to 
relinquish because of their inability to demonstrate adequate progress.

Pages 4-5, last paragraph, last sentence – Development of the first 
phase of the web-based management information system (MIS) has been 
completed and FPOs have been trained on its usage—well in advance of 
the intended fall 2008 target deadline. This system is designed to 
replace the paper files that GAO describes and will considerably reduce 
or eliminate the inconsistencies described. Throughout its report, GAO 
frequently cites as a deficiency HHS/ACF's lack of uniform performance 
indicators. GAO was made aware during its interview with Federal staff 
that such indicators require clearance from the Office of Management 
and Budget (OMB), which can take at least 120 days for completion. ACF 
is pleased to report these indicators have been submitted to OMB for 
review. ACF anticipates final approval by the end of calendar year 
2008. 

Page 5, second paragraph (recommendations re: monitoring grantees 
utilizing the MIS system) – As ACF has indicated in its prior comments, 
ACF/OFA has undertaken implementation of a grant monitoring strategy 
that prioritizes and provides targeted and customized technical 
assistance to struggling grantees. 

Page 5, second paragraph, last sentence – Suggest changing to read, 
"Results from these studies will not be available until after the 
current appropriation for the Healthy Marriage and Responsible 
Fatherhood Initiative expires after Fiscal Year 2010." 

Page 6, second paragraph – See "Page 1, paragraph 1, fifth and sixth 
sentences –" on page 1 hereof for needed clarification of HM/RF's 
relationship with TANF. 

Page 6, footnote 2 – Change to: "The DRA restricted HHS to awarding no 
more than $50 million each year for Responsible Fatherhood activities 
and $2 million each year for coordination between Tribal TANF and child 
welfare services." 

Page 9, graph – ACF requests that GAO revise the reference to tribal 
child welfare expenditures to reflect that these expenditures are 
specifically authorized by the Deficit Reduction Act (DRA). These 
expenses make up 1 percent of the total, and it may be helpful to 
separate this out from "Other" so that this category is only 3 percent 
instead of 4 percent. 

Page 9, Note (below graph) – The last statement about 2007 money in 
2006 contracts is for TANF-related activities (rapid response technical 
assistance), so ACF does not believe the last statement is necessary as 
it is covered in the first part of the sentence. As stated immediately 
above, an additional 1 percent of this "Other" category is tribal TANF 
child welfare services as specified in the DRA. ACF believes this 
should either be labeled as a separate slice of the pie or listed first 
in the note, as it is one of the activities explicitly allowed under 
DRA. 

Page 10, first paragraph – See first bullet on page 1 hereof. 

Page 10, second paragraph – The length of time that program 
announcements were posted was reduced to accommodate the shortened time 
period between the signed legislation (February 2006) and award 
deadline (September 30, 2006). Had this accommodation not occurred, the 
grants would not have been awarded in a timely manner and HHS would 
have risked loss of the first year's appropriation. 

GAO lists "students" among the list of reviewer characterizations. 
However, GAO does not clarify that "student" reviewers in this category 
were at the graduate or professional level. No one under the age of 21 
was permitted to serve as a peer reviewer. 

Page 12, footnote 6 – OFA recommends revising the note to reflect that 
one grantee was funded after the re-review, not several. 

Additionally, the eight-hour curriculum mentioned on this page was a 
requirement described in the program announcement. ACF recommends that 
GAO include in footnote 7 a statement that reflects that all applicants 
had advance knowledge of this requirement and are responsible for 
assuring their compliance. 

Page 19, bottom paragraph, last sentence – Suggest changing to read, 
"An administrative complaint was filed with HHS's Office for Civil 
Rights by a legal advocacy organization centering on whether women have 
equal access to the program, and in April 2007, HHS reminded grantees 
that the Responsible Fatherhood programs are open to all eligible men 
and women, i.e., fathers or mothers." 

Page 22, last paragraph – OFA disagrees that HHS lacks specific 
guidance to conduct monitoring site visits. To the contrary, OFA 
developed a clear, comprehensive, and thorough protocol and trained 
FPOs on the critical and essential items that must be covered during 
the site visits. Copies of the site visit protocols were provided to 
GAO. As previously stated, ACF/OFA's proactive, comprehensive 
performance assessment and corrective action resulted in most grantees 
(23) achieving or exceeding specified performance improvement targets. 
Further, because of their inability to demonstrate adequate progress, 6 
grantees were slated for non-continuation of their funding for 
subsequent years and 1 grantee decided to relinquish its grant. 

Page 23, footnote 9 – Given the technical assistance conferences, 
Webinars, phone calls, emails, correspondence, site visits and 
teleconferences, ACF considers it unlikely that there were two grantees 
that never received contact with Federal staff. 

Page 25, top paragraph – GAO suggests that FPOs are unable to confirm 
whether services are, in fact, being provided is directly related to 
whether or not HHS can confirm whether funding is being spent as 
intended. This is incorrect. Observing a class is only one of several 
ways that HHS provides grant fiscal and programmatic oversight. ACF's 
Office of Grants Management, as the fiscal agent for these 
discretionary programs, has established reporting systems and protocols 
for managing grantee's fiscal compliance. It is common for 
discretionary grant programs that lack the funding resources to conduct 
site visits. 

Page 25, middle paragraph – Finally, GAO has not made a clear 
distinction between what activities may be permissible under a 
different funding stream from what is impermissible under DRA funding. 
For example, there are several abstinence education organizations that 
receive funding from the Community Based Abstinence Education (CBAE) 
program—a separate discretionary grant program within ACF's Family and 
Youth Services Bureau. These organizations are also receiving DRA funds 
to conduct healthy marriage education. While the DRA-funded program may 
not provide abstinence education, the organization itself, which 
receives funds from both DRA and CBAE, may in fact do both abstinence 
education and marriage education in separate programs. 

Another factor that GAO would need to consider is that in Allowable 
Activity #2, which targets high school students on the benefits of 
marriage, healthy relationships, etc., may include a session that 
refers to abstinence without running afoul of compliance with the DRA. 
For example, a marriage grantee may conduct a 12-week marriage 
education program, which includes a session on "Making Wise Choices in 
Relationships." Including abstinence as one choice to consider does not 
violate the DRA's prohibition. 

Page 25, last paragraph, continuing to page 26 – Comments regarding the 
MIS system and the uniform performance measures have been previously 
addressed. On August 25, 2008, the notice of HHS/ACF's proposal of 
uniform performance indicators was posted in the Federal Register. This 
is the initial phase of OMB's clearance and approval process, which can 
take a minimum of 120 days to complete. 

Page 30 – While ACF disagrees with GAO's characterization of the 
absence of mechanisms to detect and forestall grantee non-compliance, 
ACF concurs that these tools would further enhance the diligent 
oversight and monitoring currently underway. OFA, the program office 
that administers the HM/RF programs, has already developed and 
implemented the two recommendations listed in the report and will 
continue to refine procedures, oversight, provision of technical 
assistance, and compliance for the duration of the program. 

[End of section] 

Appendix VI: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Kay E. Brown, (202) 512-7215 or brownke@gao.gov: 

Acknowledgments: 

Sherri Doughty (Assistant Director) and Ramona L. Burton (Analyst-in- 
Charge) managed all aspects of the assignment. Michelle Bracy, Melissa 
Jaynes, and Chhandasi Pandya made significant contributions to this 
report, in all aspects of the work. In addition, Cathy Hurley, Kevin 
Jackson, Stuart Kaufman, and Luann Moy provided technical support in 
design and methodology, survey research, and statistical analysis; 
Daniel Schwimer provided legal support; and Jessica Orr assisted in the 
message and report development. 

[End of section] 

Footnotes: 

[1] In 2006, HHS awarded a total of 229 grants, of which 216 were 
Healthy Marriage and Responsible Fatherhood demonstration grants that 
provided direct services to participants. We surveyed all of these 
grantees. We did not survey the remaining grantees: those that either 
provided research or technical assistance, assisted organizations with 
developing fatherhood programs, or relinquished their grants. Moreover, 
we did not survey organizations that received money from grant 
recipients to provide direct services, subawardees. Since making the 
initial awards, 4 organizations have relinquished their grants, 1 
organization had its grant terminated, and 1 new grant was awarded. 
There are 6 organizations currently pending non-continuation of award 
funds. 

[2] We purposively selected 10 additional case files to review. They 
were selected based on the types of assistance provided or were part of 
our site visits. 

[3] The DRA restricted HHS to awarding no more than $50 million each 
year for Responsible Fatherhood activities and $2 million each year for 
coordination between Tribal TANF and child welfare services. 

[4] GAO, Program Evaluation: An Evaluation Culture and Collaborative 
Partnerships Help Build Agency Capacity, GAO-03-454 (Washington, D.C.: 
May 2, 2003). 

[5] GAO, Welfare Reform: More Information Needed to Assess Promising 
Strategies to Increase Parents' Incomes, GAO-06-108 (Washington, D.C.: 
Dec. 2, 2005). 

[6] According to HHS, they amended an existing Dixon Group contract to 
include additional services relating to the Healthy Marriage and 
Responsible Fatherhood Initiative. 

[7] At least one organization received a grant after having its 
application rescored. 

[8] Grant announcements noted that participants of marriage education 
services must receive a minimum of 8 hours of instruction delivered 
over time, or the number of instructional hours and days commensurate 
with the established guidelines required by the author of the 
curriculum used. 

[9] Eligible men include fathers, expectant fathers, and father figures 
and eligible women include mothers. 

[10] All nonfederal entities that expend $500,000 or more of federal 
awards in a year are required to obtain an annual audit in accordance 
with the Single Audit Act of 1996 and Office of Management and Budget 
Circular A-133, "Audits of States, Local Governments and Non-Profit 
Organizations." A single audit combines an annual financial statement 
audit with additional audit coverage of federal funds. HHS receives an 
audit reporting package for grantees that expend more than $500,000 or 
more in federal awards from the Federal Audit Clearinghouse 
administered by the Department of Commerce. 

[11] All but 2 of 207 grantee respondents indicated they had contact 
with HHS monitoring staff. 

[12] When we surveyed grantees in February 2008, about 60 percent 
reported receiving a site visit from HHS. 

[13] Research is partially funded with DRA and other HHS funding. 

[14] The wider body of HHS's research agenda includes four studies 
running alongside the impact evaluations that will evaluate how the 
marriage and fatherhood programs being studied for the impact 
evaluation are being implemented. HHS also has awarded three grants 
under the DRA to study Responsible Fatherhood curricula. 

[15] While 229 grants were awarded, we only surveyed the 216 
demonstration grantees that provided direct services to participants. 

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