Child Welfare: HHS Should Facilitate Information Sharing Between States to Help Prevent and Address Maltreatment in Residential Facilities

What GAO Found

Several state agencies—including those responsible for child welfare, facility licensing, and education—work with federally funded residential facilities for youth to help prevent and address incidents of maltreatment, according to officials in four selected states. Maltreatment could include either abuse or neglect, and could result in injuries or even death. State agencies try to prevent the maltreatment of youth by requiring background screenings of facility staff, training staff, and increasing interagency coordination, among other things. When maltreatment occurs, states may respond in various ways, such as prohibiting a facility from taking in new residents or revoking its license.

Differing interpretations of what constitutes maltreatment may result in facilities over- or under-reporting incidents, thereby complicating states' data collection efforts, according to state officials and other stakeholders. In response, selected states have taken steps to make it easier for residential facility staff to determine what types of incidents they should report, such as by providing facilities with technical assistance on states' legal reporting requirements.

Stakeholders and discussion group participants suggested additional steps that states could take to identify and address maltreatment in residential facilities, including improved facility staff and state investigator training, improved oversight, and increased provider accountability (see figure). Officials from the Departments of Health and Human Services (HHS) and Education emphasized that states are primarily responsible for oversight of residential facilities and efforts to prevent maltreatment; however, the agencies told us that they support states' efforts by providing technical assistance and guidance. Nonetheless, some officials in the four selected states reported having minimal contact with or receiving little to no information from federal agencies, including HHS's Administration for Children and Families (ACF), the federal agency responsible for administering federal programs that provide for the safety of youth. HHS's strategic plan highlights the importance of disseminating strategies to prevent child maltreatment. By facilitating information sharing among states about promising data collection practices, training, oversight, and strategies for holding facilities accountable through stronger enforcement mechanisms, HHS could help states prevent and minimize further trauma for youth in these facilities and potentially save lives.

Why GAO Did This Study

News media have reported several incidents of youth being maltreated by staff employed at residential facilities. Some of these youth were in the child welfare system and some had special needs. States oversee these facilities, and often contract with private providers to operate them. Little information is publicly available about incidents of maltreatment in federally funded residential facilities for youth. GAO was asked to review this issue.

This report examines (1) how selected states help prevent and address maltreatment in federally funded residential facilities, (2) the challenges selected states face in reporting and collecting maltreatment data, and (3) the additional steps suggested by stakeholders to address maltreatment and how relevant federal agencies are supporting state efforts. GAO interviewed state officials in four states—Arkansas, California, Massachusetts, and the Washington, D.C.—that were selected using federal data on high and low percentages of youth in residential facilities and recommendations from subject matter experts, among other factors; conducted discussion groups with residential facilities administrators and former residents of facilities; and reviewed relevant federal and state laws, regulations, and agency documents.