In another situation, the caseworker will have to determine whether the child care training provided by a private family service agency to a teenage mother enables her to care for her two children who currently are in foster care.

In another situation, the caseworker may have to arrange for an emergency caretaker to stay with some children in their own home instead of being placed in an institution while their mother is in a hospital receiving emergency medical care.

Although title XX provides discretion to States to define services to accomplish the goals of the title XX program, there are certain limitations. Title XX funds may not be used:

(1) for the purchase or improvement of land, or the purchase, construction, or permanent improvement (other than minor remodeling) of any building or other facility;

(2) for the provision of cash payments for costs of subsistence or for the provision of room and board (other than costs of subsistence during rehabilitation, room and board provided for a short term as an integral but subordinate part of a social service, or temporary emergency shelter provided as a protective service);

(3) for payment of the wages of any individual as a social service (other than payment of the wages of welfare recipients employed in the provision of child day care services);

(4) for the provision of medical care (other than family planning services, rehabilitation services, or initial detoxification of an alcoholic or drug dependent individual) unless it is an integral but subordinate part of a social service;

(5) for social services (except services to an alcoholic or drug dependent individual or rehabilitation services) provided in and by employees of any hospital, skilled nursing facility, intermediate care facility, or prison, to any individual living in such institution;

(6) for the provision of any educational service which the State makes generally available to its residents without cost and without regard to their income;

(7) for any child day care services unless such services meet applicable standards of State and local law; or

(8) for the provision of cash payments as a service (except as otherwise provided in (2) above).

The Secretary of the Department of Health and Human Services may grant a State's request to waive the prohibition against the use of title XX funds for medical services or against the purchase or improvement of land or buildings where it is found that extraordinary circumstances justify such uses.

TABLE 4. PERCENTAGE DISTRIBUTION OF TITLE XX DOLLARS SPENT ON EACH SERVICE AND PERCENTAGE FOR EACH CASH SERVICE SPENT BY RECIPIENT CATEGORY-OCTOBER 1978 TO SEPTEMBER 1979

Section 13. Child Welfare, Foster Care and Adoption Assistance Program-Title IV, Parts B and E

Although child protective services in America date back to the 19th century, the first protective services were provided by voluntary, private organizations. The passage of the 1935 Social Security Act was an impetus for greater State involvement in public child protective services. During the following two decades, 35 States enacted statutes assigning responsibility for the protection and care of neglected children to State agencies. The development of public protective services also was accelerated by the 1962 amendments to the Social Security Act which required that each State extend child welfare services to all political jurisdictions within the State, and which made aid to families with dependent children (AFDC) foster care funds and services available to abused and neglected children from families who were receiving, or were potentially eligible for AFDC. The 1974 amendments to the Social Security Act, which established the title XX social services program, required that each State provide child protective services on a statewide basis.

There are an estimated 500,000 children in the United States who are in foster care homes or institutions. About 20 percent of this total, or 102,000 children, received support under the aid to families with dependent children program.

The Federal share of support for AFDC-foster care children was $208 million in fiscal year 1978 and $327 million in fiscal year 1981. In most States the Federal matching rate for foster care maintenance payments is the same as the medicaid matching rate for the State. The average Federal share for all States is about 54 percent.

Family foster care accounts for approximately 55 percent of Federal expenditures (75 percent of placements); foster care group homes and other institutions account for 45 percent of Federal expenditures (but only 25 percent of placements). In December 1980, average costs per child in foster family homes and institutions combined was $378. Analysed by type of placements, these costs averaged $261 in foster homes, and $1,161 in child care institutions.

In hearings on child welfare services program and foster care program in 1977 and in 1979, the Subcommittee on Public Assistance and Unemployment Compensation received extensive testimony on the need to improve the quality of services available to families and children. The testimony made clear that there was a need not only for improved Federal funding, but also for new requirements to assure that State programs include alternatives to foster care, and protections for children who, nonetheless, must be placed in foster care.

(196)

TABLE 1.-AID TO FAMILIES WITH DEPENDENT CHILDREN, FOSTER CARE SEGMENT: RECIPIENTS OF CASH PAYMENTS AND AMOUNT OF PAYMENTS, BY STATE, DECEMBER 1980 (INCLUDING NONMEDICAL VENDOR PAYMENTS)

TABLE 1.-AID TO FAMILIES WITH DEPENDENT CHILDREN, FOSTER CARE SEGMENT: RECIPIENTS OF CASH PAYMENTS AND AMOUNT OF PAYMENTS, BY STATE, DECEMBER 1980 (INCLUDING NONMEDICAL VENDOR PAYMENTS)-Continued

IMPLEMENTATION OF CHILD WELFARE AND FOSTER CARE REFORMS

The Adoption Assistance and Child Welfare Act of 1980, Public Law 96-272, enacted on June 17, 1980, authorizes a modified foster care program and a new adoption assistance program under a new part E of title IV of the Social Security Act. In the new part E and in the modifications made in the title IV-B child welfare services program, a comprehensive set of services, procedures, and safeguards are described which all States are to implement within the next several years. Increases in Federal funds for title IV-B child welfare services are structured with the intent of both providing States with some additional resources to assist them in implementing the described services, procedures, and safeguards and in providing States financial incentives to implement them as quickly as possible.