Children Affected by Trauma: Selected States Report Various Approaches and Challenges to Supporting Children

Trauma is a widespread, harmful, and costly public health problem, and its effects are especially detrimental to children. Any frightening, dangerous, or violent event that threatens a child or their loved ones can potentially be traumatic. While not every child who experiences trauma will suffer lasting effects, trauma significantly increases the risk of mental health problems, difficulties with social relationships and behavior, physical illness, and poor school performance. GAO was asked to review selected states' efforts to support children affected by trauma.

This report describes (1) the assistance that HHS and Education provide to help state and local agencies support children affected by trauma; (2) how child welfare and education agencies in selected states support these children; and (3) the challenges these agencies have faced in selected states in supporting these children.

GAO interviewed state and local officials in six states that were selected based on recommendations from subject-matter experts and federal officials, among other factors; administered a questionnaire to 16 state agencies in the selected states; interviewed federal officials from HHS and Education; and reviewed relevant federal, state, and local agency documents, such as reports and guidance. Although our findings cannot be generalized to all states, they provide insight into government support for children affected by trauma.

GAO is not making recommendations in this report.

The Department of Health and Human Services (HHS) and the Department of Education (Education) provide grants, disseminate information, and fund training and technical assistance to help state and local agencies support children affected by trauma. HHS's Administration for Children and Families and Substance Abuse and Mental Health Services Administration (SAMHSA) have awarded discretionary grants specifically to address childhood trauma. In addition, state and local officials reported making use of other discretionary grants from HHS and Education—as well as formula funds meant for broad purposes like mental health, substance abuse, child welfare, and education—to support their work with children affected by trauma. In terms of non-financial support, state and local officials in six selected states all referred to the National Child Traumatic Stress Network, which is funded by SAMHSA, as an important resource for information, training, and technical assistance. Both HHS and Education have also made other guidance and informational resources available to states.

Officials in child welfare and education agencies in the six selected states reported using a range of approaches to help children affected by trauma, including training staff, screening children, and providing services and support systems. To train child welfare workers, educators, and birth and foster parents to understand trauma and its effects on children, agencies in the six selected states used various approaches, such as learning communities, which include in-person learning and coaching, and online courses. Several state child welfare agencies also used learning communities to train clinicians in trauma-focused therapies. In addition, child welfare and education agencies in five states used screening tools to identify children exposed to and exhibiting symptoms of trauma. Children identified as experiencing trauma are referred for a trauma-informed mental health assessment. Also, to help children affected by trauma, child welfare and education agencies in five of the six states provide support and services. For example, in one state, caseworkers provide specialized services, including weekly visits, to children and families.

Officials in the six selected states reported facing various challenges in their efforts to support children affected by trauma, and they emphasized the importance of engaged leadership in establishing and sustaining support for these children. In three states, officials said that a lack of such leadership hindered their efforts, and they described cases that included delayed, incomplete, or unsuccessful implementation of initiatives. Officials in all six states also talked about limitations on their agency's capacity to support children affected by trauma, including:

high rates of staff turnover, especially in child welfare;

limited staff time to dedicate to trauma initiatives;

lack of clinicians trained in trauma-focused therapies; and

insufficient funding to support trauma initiatives.

Officials in some states reported strategies they have used to help address these challenges, including providing additional support to employees and coordinating with partner agencies to jointly leverage resources, expertise, and data.

Trauma is a widespread, harmful, and costly public health problem, and  its effects are particularly detrimental to children, according to the U.S.  Department of Health and Human Services (HHS). Children can be  exposed to various types of trauma. Any frightening, dangerous, or violent  event that threatens the life or safety of a child or their loved ones can  potentially be traumatic. For example, in fiscal year 2017, HHS reported  that there were approximately 674,000 victims of child maltreatment,  including neglect and physical and sexual abuse. In addition, in 2016,  students ages 12 through 18 experienced an estimated 749,400  victimizations (theft and nonfatal violent victimization) at school and  601,300 victimizations away from school. While not every child who  experiences trauma will suffer lasting effects, studies have shown that for  many there are serious short- and long-term consequences. As GAO has  previously reported, trauma significantly increases the risk of mental  health problems, difficulties with social relationships and behavior,  physical illness, and poor school performance.

You asked us to review how selected states identify and treat children  and families who have experienced or are at risk of experiencing trauma.  This report examines:  1.  the assistance HHS and the U.S. Department of Education  (Education) provide to help state and local agencies support children  affected by trauma;  2.  how child welfare and education agencies in selected states are  supporting children affected by trauma; and  3.  the challenges child welfare and education agencies in selected  states have faced in supporting children affected by trauma.

To address these objectives, we conducted in-person and telephone  interviews with state and local officials in six states, and administered a  questionnaire to 16 state agencies. The states we selected were  Colorado, Massachusetts, North Carolina, Ohio, Washington, and  Wisconsin. These states were selected based on four criteria: (1)  recommendations from subject-matter experts and federal agency  officials; (2) reviews of state child welfare and education agency websites  to locate statewide initiatives to support children affected by trauma; (3)  variation in state child welfare system administrative frameworks (two  state-administered, three county-administered, and one hybrid partially  administered by the state and partially administered by counties); and (4)  geographic diversity. We spoke with state child welfare officials in all six  states and with state education and Medicaid   officials in four states. Also, in each state we selected two localities and  interviewed local officials from the respective child welfare and education  agencies, where practicable. These localities were selected based on  recommendations from state officials and geographic diversity (one urban  and one rural). In addition, we interviewed officials from other selected  state and local agencies and organizations, such as departments of  health, interagency trauma groups, universities, and hospitals, as  appropriate. We also reviewed relevant state and local child welfare and  education agency documents, such as annual reports and policy  guidance.

We supplemented and confirmed the information obtained during  interviews with state officials through a questionnaire sent to 16 state  agencies across the six states from August to October 2018. We pre- tested the questionnaire with three state agencies in Washington and  updated the questions based on feedback from those agencies. All 16  agencies completed the questionnaire.

To obtain additional information about the assistance federal agencies  provide to help child welfare and education agencies in selected states in  their efforts to support children affected by trauma, we interviewed  officials from HHS’s Administration for Children and Families (ACF),  Substance Abuse and Mental Health Services Administration (SAMHSA)  and the Centers for Medicare and Medicaid Services (CMS). We also  interviewed officials from Education, including officials with the Office of  Elementary and Secondary Education. We reviewed relevant agency  documents, such as guidance provided to states, issue briefs, and budget  documents. Our findings cannot be generalized to states or localities  outside our selection sample.

We conducted this performance audit from January 2018 to April 2019 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.

Trauma or adverse childhood experiences may include physical and  sexual abuse, neglect, bullying, community-based violence, extreme  poverty, the loss of a parent or primary caretaker, or natural disasters,  among other things. These experiences may overwhelm a child’s natural  ability to cope and can cause stress reactions in children, including  feelings of intense fear, terror, and helplessness. When children are  exposed to chronic stressful events, their neurodevelopment can be  disrupted. As a result, a child’s cognitive functioning or ability to cope with  negative or disruptive emotions may be impaired, causing long-term harm  to their physical, social, and emotional well-being. These adverse  effects may include changes in a child’s emotional responses; ability to  think, learn, and concentrate; impulse control; self-image; attachments to  caregivers; and relationships with others. Traumatic experiences have  been linked to a wide range of health-related conditions, including  addiction, depression and anxiety, and risk-taking behavior, and may also  increase the likelihood of chronic ill health conditions, such as obesity,  diabetes, heart disease, cancer, and even early death. Not all children will  experience all of these effects. Children’s responses to traumatic events  are unique and affected by many factors, including their age at the time of  the event, the frequency and perceived severity of trauma, and the child’s  innate sensitivity, as well as protective factors such as the presence of  positive relationships with healthy caregivers, physical health, and natural  coping skills.

While all children can be affected by trauma, trauma is common among  children who enter the child welfare system. Many of these children  have been abused or neglected, and involvement in the child welfare  system, primarily through placements into a foster care home, may cause  additional trauma due to the separation from family; changes in school  placement, neighborhood, and community; as well as fear and uncertainty  about the future. Child welfare experts generally believe that child welfare  systems that use trauma-informed approaches are better able to  address children’s safety, permanency, and well-being needs. Although  trauma-informed frameworks may vary, they generally include  interventions as well as a change in culture; thus if an agency or  organization is taking a trauma-informed approach, it is incorporating  knowledge of trauma and its effects into its policies, procedures, and  practices. A trauma-informed child welfare system may offer services to  help identify and mitigate the effects of trauma, including screening and  assessing children for trauma, and providing or referring children to  services. These approaches may produce improved outcomes for  children in the child welfare system, including fewer children requiring  crisis services, such as residential treatment, and fewer foster home  placements, placement disruptions, and reentries into foster care. Other  trauma-informed approaches may result in reduced lengths of stay in  foster care and improved child functioning and increased well-being.

In addition to child welfare agencies, school staff and members of the  school community can play a key part in recognizing and responding to  children who have experienced trauma. In a 2017 report on child well- being, GAO reported that an expert noted that health and human service  agencies are not the only entities needed to address child well-being and  suggested that community stakeholders work together to determine what  resources are needed for the children in their community. A trauma- informed school, characterized by an understanding and a commitment of  teachers and staff to an awareness of how trauma affects students, is an  example of a coordinated approach to trauma. Trauma-informed teachers  and staff are aware of trauma’s impact on students’ behavior, their  relationships, their ability or inability to self-regulate behavior, and how it  contributes to their classroom behavior. Specific elements of a trauma- informed school may include addressing and treating traumatic stress,  developing partnerships with students and families, evaluating and  revising school discipline policies and practices, and creating a trauma- informed learning environment.

Federal agencies, academic institutions, and community-based treatment  centers have generated evidence-based trauma treatments that clinicians  and therapists can use when working with children and their families.  See table 1 for examples of treatments.

Recent studies have also found that trauma-informed approaches that are  infused into the practices and work of child welfare and school staff can  help children, their families, and others. While these studies are limited in  terms of the number of participants, they indicate the positive effects of  including trauma-informed approaches into the work of child welfare staff  and educators. For example, one study that used child welfare  administrative data for about 1,500 children from Kansas found that  implementing a trauma-informed approach was associated with improved  child well-being and placement stability for children in foster care.  Another study of two public child welfare agencies that involved 52  children, as well as child welfare staff, mental health providers, and foster  parents and kinship caregivers, suggests, among other things, that fewer  children exited foster homes for negative reasons, such as running away  or moving to a group home, when families were trained in a trauma- informed approach. In addition, a study of 126 female youths residing in  two treatment centers in Massachusetts suggests that the youth at the  center receiving the trauma-informed approach experienced a reduction  in post-traumatic stress disorder symptoms compared with the youth in  the residential center that did not offer this approach. A study of five  schools that adopted a trauma-sensitive approach also reported positive  outcomes. For example, the study found a decrease in disciplinary  actions, and staff at one school reported that the school felt safer and  calmer. School staff also reported improved relations among colleagues  and with students, as well as better relations between students and  increased parent engagement.

HHS and Education Provide Grants, Disseminate Information, and Fund Training and Technical Assistance to Help State and Local Agencies Support Children Affected by Trauma

HHS and Education Provide Multiple Sources of Funding That State and Local Agencies Can Use to Support Children Affected by Trauma

HHS’s ACF and SAMHSA have awarded discretionary grants to states  specifically to address childhood trauma. From 2011 to 2013, ACF  awarded 20 state and local agencies and other organizations  discretionary grants to address childhood trauma, according to ACF  officials, totaling about $58 million. Each grantee, including two state  child welfare agencies and a county agency as well as two universities in  five of the six states we selected to review, received up to 5 years of  funding. The grants were used to screen and refer children to treatment,  implement or expand trauma-focused, evidence-based treatments, and  bridge the gap between child welfare and mental health. According to  HHS officials, funding for the last of these grants will end in September  2019.

SAMHSA also awards discretionary grants specifically to address  childhood trauma to state and local agencies, universities, and other  organizations through an initiative to transform mental health care for  children and adolescents affected by trauma. The National Child  Traumatic Stress Network (NCTSN), a collaborative network of experts  created through the National Child Traumatic Stress Initiative (NCTSI),  conducts research on trauma treatment approaches and provides  services to children affected by trauma. In fiscal year 2017, SAMHSA  received over $48 million for the NCTSN, and it awarded four new grants  and supported 82 5-year grant continuations through NCTSI. Officials that  we spoke with from one state child welfare agency, three universities, and  two nonprofits in four of the selected states received grants through this  initiative. Several of these entities used these funds to train clinicians and  educate other child serving professionals about trauma and mental health  conditions.

In addition to grants that were specifically meant to address childhood  trauma, the selected states used other HHS discretionary grants to  support children affected by trauma. For example, officials from five state  education agencies in the selected states told us that they received  SAMHSA’s Project Advancing Wellness and Resilience Education  (Project AWARE) grant. Wisconsin officials also said they received  Education’s School Climate Transformation Grant, which was used to  create the state’s trauma-sensitive schools initiative. Washington officials  credited SAMHSA’s Mental Health Transformation Grant with driving the  state’s initial trauma-informed work, including its guide about trauma in  schools.

State agency officials also reported using formula funds, meant for broad  purposes like mental health, substance abuse, child welfare, and  education, to support their work with children affected by trauma. Officials  from five agencies in the selected states reported using formula funding  from Title IV-E of the Social Security Act to help children affected by  trauma. According to Colorado officials, the state’s Title IV-E waiver has  allowed child welfare workers to screen, assess, and provide  interventions that are trauma-informed. Also, North Carolina officials told  us that Title IV-E, combined with other funding sources, has helped pay  for trauma-informed learning communities to help counties build trauma- informed programming. Two states reported using the Substance Abuse  and Mental Health Block Grants. (See table 2 for additional grants  states reported using to support children affected by trauma.)

In addition to federal funding, officials in the six selected states reported  receiving state funding to support children affected by trauma. For  example, officials in North Carolina told us that, in 2013, the North  Carolina General Assembly appropriated $1.8 million in annually recurring  funds to train clinicians in evidence-based trauma treatments. Also, in  Massachusetts, state funding may be used to create and support trauma- sensitive initiatives in schools, among other things. In addition to state  funding, officials in three of the selected states reported using nonprofit  funding to support their efforts.

HHS and Education Share Information and Fund Training and Technical Assistance to Help State and Local Agencies Support Children Affected by Trauma

HHS offers information and funds training and technical assistance to  help state and local agencies support children affected by trauma. For  example, state and local child welfare officials in each of the six selected  states cited the National Child Traumatic Stress Network (NCTSN) as an  important resource for information, training, or technical assistance.  State and local officials in four of the selected states told us that they use  the NCTSN’s Child Welfare Trauma Training Toolkit curriculum to train  their staff. The curriculum, designed to be completed in about 13 hours,  covers topics such as the essential elements of a trauma-informed child  welfare system, the impact of trauma on the brain and body, and the  identification of trauma-related needs of children and families. Also, two  state child welfare agencies told us that they use the Resource Parent  Curriculum to train foster parents and others about trauma, and another  used the Think Trauma curriculum to prepare trainers of group home and  residential center staff; both curricula are provided through the NCTSN.  In addition, the NCTSN makes other resources available to state and  local communities on its website. For example, NCTSN offers fact sheets  about various assessments and treatments, including those mentioned in  table 1, as well as two evidence-based treatments for use in school  settings.

In addition to information and training provided through the NCTSN, in  2012, HHS’s ACF issued guidance to encourage state child welfare  directors to focus on improving behavioral and social-emotional outcomes  for children who have experienced abuse or neglect. In 2013, SAMHSA,  in collaboration with ACF and CMS, issued joint guidance to encourage  the integrated use of trauma-focused screening, functional assessments,  and evidence-based practices in child-serving settings. Also, in 2014,  SAMHSA, in an effort to help service sectors, such as child welfare,  education, and juvenile justice, become more trauma-informed, released  Concept of Trauma and Guidance for a Trauma-Informed Approach. This  document included a framework of key assumptions and principles of a  trauma-informed approach. SAMHSA intended that the trauma framework  be relevant to its federal partners and their state and local system  counterparts and to practitioners, researchers, and trauma survivors,  families, and communities. (See table 3.)

In addition to the information and training and technical assistance  referenced above, HHS and Education fund technical assistance centers  and make other resources available to states, including:

SAMHSA’s National Center for Trauma-Informed Care and  Alternatives to Seclusion and Restraint offers technical assistance to  various publicly-funded systems and organizations on issues relating  to trauma education, among other things.

Education’s Readiness and Emergency Management for Schools  Technical Assistance Center helps local education agencies before,  during, and after emergency situations. Among its various activities,  this technical assistance center offers information and technical  assistance to local education agencies and others on Psychological  First Aid for Schools, which is an intervention model to assist  students, staff, and families in the immediate aftermath of an  emergency.

Education’s National Center on Safe Supportive Learning  Environments as well as its Positive Behavioral Interventions and  Supports Technical Assistance Center offer an array of materials  about trauma and approaches to supporting children affected by it.

ACF, through its Child Welfare Information Gateway website, provides  information on building trauma-informed systems, assessing and  treating trauma, and addressing secondary trauma in caseworkers. It  also offers trauma resources for caseworkers, caregivers, and  families, as well as information about trauma training. In some  instances, the website directs users to SAMHSA or the NCTSN’s  website.

Selected States Use Various Approaches to Support Children Affected by Trauma

Officials we spoke with in the six selected states told us they used a  variety of approaches to help staff understand trauma and its effects on  children, identify children affected by trauma, and provide support to  them. These approaches range from training child welfare workers,  educators, and clinicians to screening children for symptoms caused by  traumatic experiences. They also include developing support systems,  including providing services, to children and their families who need more  help. While we did not evaluate the effectiveness of the selected state  and county initiatives, many of them incorporate key trauma principles  and activities cited in the SAMHSA framework above. For additional  information on examples of approaches taken in each selected state and  in selected counties, see appendixes I and II.

State and local child welfare and education agency officials in the six  selected states use various approaches to train staff and birth and foster  parents about trauma and its effects on children and families. Child  welfare officials in two states, Wisconsin and North Carolina, told us that  they use learning communities to train staff, and in some instances, foster  parents. For example, North Carolina’s child welfare agency used a  learning community approach—which included face-to-face training, as  well as coaching and practice, over an extended period—to work with  child welfare staff in 32 of the state’s 100 counties, according to a state  official. In a 2016 agency report, state officials reported that the 9- to 12- month learning community process was designed to allow staff the time  required to become steeped in trauma knowledge, to learn how to spread  that knowledge into skills and practices, and to develop a sustainable  program. Conversely, state and local education and child welfare officials  in three states told us that they use online learning or university  coursework to train staff. For example, Wisconsin education agency  officials told us that they developed a three-tiered training, including  online modules for educators and school staff. The modules are designed  for self-study and, among other things, include guidance on making  policies and procedures more trauma-sensitive, as well as information  about the characteristics of safe, supportive learning environments. Also,  Massachusetts state child welfare officials told us that they partnered with  three universities to provide trauma-focused courses to child welfare  workers, and local school officials told us that a university offers a  graduate certificate in trauma and learning to area educators. corroborated, when possible, the information we received during our state and county  interviews with relevant state documents. We provided officials the opportunity to review  the content for accuracy and provide revisions or corrections. a 10-hour, self-paced webinar. According to Wisconsin’s child welfare  website, clinicians who complete the training are eligible for certification  as TF-CBT therapists and can be listed on a national website of certified  clinicians. Similarly, North Carolina’s state child welfare agency, in  partnership with a nonprofit organization, trains clinicians in four trauma- focused, evidence-based therapies, including TF-CBT and Parent-Child  Interaction Therapy. Similar to the Wisconsin effort, over the course of a  year, clinicians learn about these therapies and practice them with  children and families.

While training staff and parents is important to broaden understanding of  trauma and its impact on affected children, identifying these children is  also key to helping them receive needed support, including trauma- focused treatment. State and local child welfare and education officials in  five of the six selected states told us that they screen certain children to  determine whether they have experienced trauma, are exhibiting  symptoms of trauma, or need to be referred for a trauma-informed mental  health assessment. For example, North Carolina and Washington child  welfare officials told us they screen children for trauma when they enter  the child welfare system. North Carolina counties that participated in the  state’s training efforts, described above, use two screening tools: one for  children under age 6 and the other for those ages 6 through 21. The  social worker, with input from the caregiver, completes the screening tool  for children under age 6. Older children are asked questions about their  exposure to trauma, including physical abuse, domestic violence, sexual  abuse, and other traumatic events. According to the North Carolina child  welfare agency, the trauma screen has a number of benefits for child  welfare practice, including informing placement decisions for the youth,  prioritizing children who might need to receive treatment quickly, and  providing the mental health professional with a better understanding of a  child’s issues. Child welfare officials in Washington also reported  integrating trauma screening into the state’s child screening program,  using a 2012 ACF trauma grant. Children and youth are screened within  30 days of placement in foster care if officials expect them to remain in  care 30 days or more. With these grant funds, officials reported that  Washington’s child welfare agency added a tool to screen for children’s  trauma symptoms and developed a protocol that rescreens these children  every 6 months. In addition, education agency officials from three states  told us that schools have developed processes to identify students who  may have experienced trauma. For example, one Wisconsin school  district official told us that any staff member, family member, or student  can refer a student for screening. This official explained that the school  district formed school-based teams to review information, such as data on  suspensions and class disruptions, to identify at-risk students. In addition  to the screening process, the school district developed school-based and  community mental health service partnerships at 23 schools where  therapists provide mental health services, according to this official.

State and local child welfare and education agency officials in five of six  selected states told us they have developed support systems, which can  include providing services, to try to help children affected by trauma. For  example, Colorado and Ohio child welfare agencies have spearheaded  efforts to provide services and support to children who may have  experienced trauma. The Colorado child welfare agency, as part of its  system of care, uses an evidence- and team-based planning model,  referred to as high-fidelity wraparound services, to manage care for  children with or at risk of serious emotional disturbance and who are  involved in multiple systems, such as the child welfare and juvenile justice  systems. As part of these wraparound services, county child welfare  staff and local service providers and professionals work with the family to  create a plan for them and their children. A coordinator sets up meetings,  oversees the plan, and makes sure all team members participate in  achieving the plan’s goals. In addition to the coordinator, a family  advocate provides peer support, via weekly visits, to parents and  caregivers of youth receiving wraparound services. In addition, depending  on the needs of the child, wraparound services may include participating  in a support group or meeting with a therapist or grief counselor, among  other things. In Ohio, child welfare officials in two counties told us about a  partnership that provides services to children and their families who have  experienced trauma because of parents’ substance use disorder. As  part of the program, children and parents are screened for trauma and  may get referred for treatment and services. Families receive wraparound  services that are provided by a caseworker and family peer mentor; the  family peer mentor has personal experiences with addiction and is in  recovery.

In addition, state education agency officials in four selected states told us  that they had at least one statewide effort administered by the state  education agency to help support all children, including those affected by  trauma. Colorado, Washington, and Wisconsin encourage schools to  implement tiered systems of behavioral support, according to state  officials. Tiered systems of support generally consist of three tiers of  support: (1) universal supports that apply to all children; (2) specialized  supports for smaller groups of children; and (3) supports for individual  children who need intensive interventions. To implement the first tier,  school staff support students in various ways, such as interacting with  students and setting up a dedicated space in a classroom for students to  regulate their behavior. The second tier may include convening small  groups to help children with similar behavioral issues learn how to  regulate their emotions, and the last tier may include intensive support for  students who need more help, such as developing and implementing  wraparound services plans. School district officials that we spoke with in  Massachusetts told us that although they do not use tiered systems of  behavioral support, they help children affected by trauma by employing  practices to create safe classroom environments for all students, such as  developing and building upon relationships and engaging students in  structured conversations.

Child Welfare and Education Agencies in Selected States Identified Leadership and Capacity Limitations as Challenges to Supporting Children Affected by Trauma

Officials in Selected States Reported That Leadership Is Important for Supporting Children Affected by Trauma

Officials in all six selected states spoke of the importance of having  engaged leadership in establishing and sustaining support for children  affected by trauma. They cited a wide range of leaders, including state  government officials; managers and supervisors; and those in partner  agencies, such as schools or nonprofits, who supported these states’  trauma efforts. In some cases, these leaders helped establish new  trauma initiatives. For example, Wisconsin’s former First Lady launched  the work of a statewide, interagency trauma initiative. Additionally, Ohio  county child welfare officials spoke about the value of obtaining  management support for their plan to become a trauma-informed  organization. In other cases, leaders were seen as important to sustaining  trauma initiatives and ensuring their impact. In Massachusetts, university  officials said that, to ensure the continued availability of evidence-based  therapies, they train not only clinicians, but also the individuals who  supervise them. Also, a county public health official in Washington, whose  agency is implementing trauma initiatives in schools, told us that their  efforts tend to be unsuccessful unless they first engage school leadership  and align their health initiatives with the schools’ existing efforts.

Federal officials and reports have also cited leadership as an important  factor in the implementation of trauma initiatives, with some maintaining  that leadership is necessary to support children affected by trauma because of the need to change an organization’s culture. In 2013,  NCTSN reported on takeaways from a learning collaborative in which  nine teams led by child welfare agencies developed, implemented, and  tested trauma-informed child welfare practices. Based on the  experiences of the teams, the NCTSN report stated that strong and  consistent leadership is necessary to implement trauma-informed practice  because it requires a shift in organizational culture. SAMHSA’s 2014  guidance for a trauma-informed approach similarly suggests that  organizations consider the importance of leadership to initiate a systems- wide change. In addition, HHS officials, who worked with states on a  series of trauma-related grants awarded between 2011 and 2013, also  told us that leadership commitment was important for their grantees in  building organizational and worker resiliency, acting upon data and  evaluation, and sustaining initiatives. These documents and statements  echo previous GAO work on organizational transformation; for example,  in 2003 we reported on key practices found at the center of successful  transformation efforts, noting that leadership must set the direction, pace,  and tone and provide a clear, consistent rationale that brings everyone  together behind a single mission.

In addition to discussing the important role that leadership plays in  establishing and sustaining support for children affected by trauma,  officials in three states highlighted instances in which a lack of leadership  hindered their efforts to support these children. The cases they described  included delayed, incomplete, or unsuccessful implementation of trauma  initiatives.

Delayed implementation. Officials in one school district said they  had developed policies around multi-tiered system of supports in 2009  but did not receive support from political leaders or funding for the  initiative until 2016. They told us that this hindered the initiative’s  implementation.

Incomplete implementation. State education officials in that same  state said that a lack of leadership hindered their ability to track school  districts’ implementation of the state’s trauma initiatives. These  officials said that a lack of requirements for districts to scale up  trauma work was a barrier to collecting data on local activities. In  another state, there was a county child welfare initiative to implement  universal trauma screening which was conducted in partnership with a  local university. The university reported that less than half of children  with open cases were screened during the project period, which  university officials attributed to some supervisors not supporting the  screening initiative.

Unsuccessful implementation. According to officials in a third state,  turnover among high-level leaders contributed to difficulties integrating  trauma-informed practices at the state’s child welfare agency, and the  agency was not successful at implementing a trauma screening  process.

Child Welfare and Education Officials in Selected States Also Reported Capacity Limitations and Other Challenges to Supporting Children Affected by Trauma

Officials in all six selected states talked about limitations on their agency’s  or organization’s capacity to support children affected by trauma.  Limitations included high rates of staff turnover, limited staff time to focus  on trauma, insufficient numbers of clinicians trained in trauma-focused,  evidence-based therapies, and insufficient funding for trauma initiatives.  Some agencies and organizations had taken actions to address these  challenges.

Secondary Traumatic Stress  According to the National Child Traumatic  Stress Network (NCTSN), Secondary  Traumatic Stress (STS) is the emotional  duress experienced when hearing about  another person’s traumatic experiences.  Professionals working with children affected  by trauma, such as child welfare workers, are  commonly at risk of developing STS. STS can  compromise these professionals’ ability to do  their jobs and may drive them to leave their  job or their professional field.  NCTSN notes that several factors can  increase the risk for developing STS,  including heavy caseloads of children affected  by trauma, social or organizational isolation,  and feeling unprepared for the job due to lack  of training. NCTSN suggests taking a multi- dimensional approach to STS, which includes  both prevention and intervention. This could  include strategies such as establishing self- care groups, helping workers maintain work- life balance, and training organizational  leaders on STS. education agencies. Child welfare officials in all six states talked about  high rates of staff turnover, while education officials did so in two states  (Colorado and Wisconsin). Staff turnover resulted in difficulties  maintaining staff trained in trauma-informed approaches and sustaining  institutional trauma knowledge and trauma-related activities, according to  officials. Colorado university officials partnering with a county child  welfare agency said that staff turnover forced them to invest additional  time in training replacement staff and made it more difficult for child  welfare officials to conduct regular follow-ups. Similarly, one education  official in another part of Colorado said that high turnover at many  agencies, including education and child welfare, hindered the county’s  efforts to maintain institutional knowledge about trauma-informed  practices and sustain the services these agencies were providing to  children affected by trauma. Some state and local officials in three states  attributed high rates of staff turnover to fatigue and secondary traumatic  stress, which is the emotional duress that staff may experience when they  hear about children’s traumatic experiences (see sidebar). Some  agencies said that they sought to address staff turnover by supporting  employees through training on secondary traumatic stress; at least one  agency in each of the six states offered such training. Officials from Ohio  and Wisconsin told us that another way they were addressing the issue  was by participating in an HHS-funded project to improve child welfare  workforce outcomes.

Many agencies also said they faced limitations on the time that staff could  dedicate to trauma initiatives. This issue was more commonly raised by  education agencies than by child welfare agencies. Education agency  officials reported this limitation in three of four states that had education  initiatives, whereas child welfare officials reported it in two of the six  selected states. Some of these officials explained that lack of staff time to  focus on trauma may have limited the implementation of their trauma  initiatives. State education officials in Washington and local education  officials in Massachusetts told us that they have the expertise to provide  trauma training to schools and community groups, but time limitations  restrict their ability to do so. A Colorado county child welfare official told  us that some caseworkers see trauma screening as an additional burden  due to their already large workload, and a child welfare official in another  Colorado county told us that many caseworkers forget to do trauma  screening because they are busy. At least one agency we interviewed in  each of the six states has or had a staff position dedicated to trauma  work, which could help address this limitation.

Officials in all six selected states said that there were not enough  clinicians trained in trauma-focused, evidence-based therapies to serve  children affected by trauma. GAO has previously reported on difficulties  finding specialty care for children. For example, in 2017 we found that  limited access to mental health services was a challenge for several  selected states due to a variety of factors, including insufficient numbers  of providers in certain specialties, such as child psychiatrists. Some  officials indicated that a shortage of clinicians trained in trauma-focused,  evidence-based therapies can limit the ability of child welfare agencies to  address trauma. For example, state child welfare officials in  Massachusetts specifically noted that identifying children affected by  trauma is not helpful if there are not enough clinicians trained in these  therapies to treat them. County child welfare officials in Massachusetts  and local healthcare partners in Ohio said that providers sometimes rely  on interns to address the shortage of clinicians, but Massachusetts  officials viewed this as problematic because interns have short tenures  that prevent them from establishing relationships with the children.  Officials in five of the six selected states told us about initiatives to  address the shortage by training clinicians in trauma-focused, evidence- based therapies, and university officials in Massachusetts described an  initiative to make trained clinicians more accessible. (See text box.)

LINK-KID: A centralized trauma treatment referral service  The Child Trauma Training Center at the University of Massachusetts  Medical School trains clinicians and operates a centralized referral  service called LINK-KID. The goal of LINK-KID is to facilitate  connections between children in need of trauma-focused, evidence- based therapies and clinicians who have been trained to provide such  therapies. LINK-KID maintains an active database of trained clinicians  throughout the state of Massachusetts.

University officials told us that anyone in Massachusetts with concerns  about a child, including family, teachers, clinicians, and child welfare  workers, may call the service. LINK-KID collects information about the  child and family, works with them to decide which treatment is most  appropriate, and ensures the child is referred for that treatment.

University officials said that using LINK-KID is easier for families and  child welfare workers, who otherwise might have to call multiple service  providers to determine who offers the needed treatment and accepts  their insurance. These officials also said they have seen a reduction in  the time children must wait for treatment when using LINK-KID. They  said that prior to LINK-KID, they saw many children waiting 6 months to  a year to receive treatment after having been identified as having  experienced trauma, whereas wait times are generally between 25 and  40 business days with LINK-KID.

Finally, some agencies said they had difficulties getting or maintaining  sufficient funding to support trauma initiatives. Officials in Washington,  including, among others, state and local education officials and a local  public health partner, reported this issue. In addition, local officials in four  other states noted limited funding to support trauma initiatives. School  district officials in Washington indicated that a lack of funding limited their  implementation support for one major trauma initiative to approximately  one-quarter of their schools. These schools were chosen based on need,  as demonstrated by measures such as discipline and absenteeism rates.  County child welfare officials in Ohio said they had to stop one of their  trauma initiatives 3 years ago because the state funding supporting the  initiative ran out. Those Ohio officials said they have relied on  relationships and collaboration to address the issue of scarce funding. For  example, they said that county organizations, including local government  agencies, private healthcare providers, and nonprofits, share data  extensively and pool funding to support various initiatives. One initiative  they pointed to is a local interagency council which provides services to  children affected by trauma.

Child welfare and other officials in the six selected states, including  officials with nonprofit partners, a state department of health, and a state  interagency collaborative, also raised at least one other challenge.  Challenges included sharing data while remaining in compliance with  state and federal privacy laws; sharing data across incompatible systems;  limitations on services billable to Medicaid; and Medicaid reimbursement  rates. Some agencies had taken actions to address or avoid data sharing  challenges. In the states where child welfare officials identified Medicaid- related challenges, state Medicaid officials offered a different perspective  on perceived Medicaid challenges and cited alternative ways to support  children affected by trauma.

Officials in all six states talked about sharing data with other agencies for  various purposes; however, privacy laws and regulations were sometimes  cited by these officials as a barrier to sharing data about children affected  by trauma. For example, officials in two Massachusetts school districts  told us they are notified by police or child welfare workers when a child  has been involved in an incident with those agencies. One official  described the goal of this effort as making staff aware of incidents and  events that may affect children’s learning and behavior and ensuring that  children feel supported. However, child welfare officials in four of the six  selected states and other officials in two states said that it was difficult to  share data while remaining in compliance with state and federal privacy  and confidentiality laws and regulations, though the reasons they cited for  these difficulties varied. State child welfare officials in Massachusetts  told us that the state has strict privacy laws in addition to federal laws  such as the Health Insurance Portability and Accountability Act of 1996.  These officials said that data sharing is possible but generally requires a  specific memorandum of understanding because of privacy laws. In  contrast, a state child welfare official in North Carolina said they had  difficulties with counties not understanding what data they are allowed to  share. That official told us that the state tries to mitigate this challenge by  helping counties understand what they can share and encouraging them  to share screening information with mental health and medical providers.  Additionally, a North Carolina university has published state-specific  guidance on sharing education, mental health, and other records.

Systems incompatibility and technology issues were also sometimes seen  as barriers to sharing data about children affected by trauma. Child  welfare officials in three of the six selected states, and state health  officials in a fourth state, said that incompatibility among various systems  made data sharing very difficult or impossible. For example, county  officials in Wisconsin said that the state’s child welfare and juvenile justice  offices use one data reporting system while the state’s mental and  behavioral health offices use another, and these two statewide data  systems are unable to communicate. While state child welfare officials in  Colorado also reported systems incompatibility issues, county child  welfare officials in that state talked about efforts to make data systems  more accessible to relevant partners. Officials in one county said that they  have a database which is accessible by all members of the county’s multi- agency partnership, including child welfare, school districts, public health,  and others. Those officials also said they use a universal release-of- information which includes all partner agencies, enabling them to share  data at multi-agency meetings.

Additionally, child welfare officials in Colorado, Ohio, and Massachusetts  said that certain services for children affected by trauma or certain service  providers were not billable to Medicaid, although Medicaid officials in  these states offered a different perspective and cited alternative ways to  support these children. Depending on the state, child welfare officials  said they could not bill wraparound services, trauma assessments,  transportation, or non-traditional therapies, such as animal therapy or  community and relationship building. County child welfare officials in  Ohio also mentioned restrictions on providers; they said that potential  peer support specialists with a criminal background and interns could not  bill Medicaid. However, Medicaid officials in these states generally said  that such services were billable to Medicaid, and Ohio Medicaid officials  said that interns and those with a criminal background could bill Medicaid,  under certain circumstances. For example, they said that while certain  severe criminal offenses, such as homicide, could exclude someone from  providing services, those with lesser offenses could become eligible after  a waiting period. Colorado and Ohio Medicaid officials we spoke with  offered some alternative ways to use Medicaid to support children  affected by trauma in cases where services could not be billed to  Medicaid. For example, a Colorado Medicaid official and a child welfare  official both said that Medicaid does not pay providers for travel time or  mileage and that this can be a problem in rural areas; however, the state  Medicaid official said that telehealth is available to address this issue and  that reimbursement rates for services in rural areas can be higher to  reflect the additional cost of travel.

Finally, child welfare and Medicaid officials in Colorado and North  Carolina also had different perspectives regarding Medicaid  reimbursement rates. Child welfare and other officials in these states said  that certain services for children affected by trauma, such as trauma  assessments and trauma-focused, evidence-based therapies, are  expensive, and that Medicaid reimbursement rates are too low to  incentivize providers to offer these services. However, Colorado and  North Carolina Medicaid officials explained that most children in Medicaid  in their states receive mental health care through managed care, where  the state pays a set rate per child to managed care organizations (MCOs)  to provide or arrange for any mental health services a child may need,  including trauma-related care. MCOs, in turn, reimburse providers for the  services they deliver, and MCOs set the rates they pay providers for  those services rather than the state. Medicaid officials in Colorado and  North Carolina noted that MCOs have flexibility to negotiate rates with  providers and may choose to reimburse at a higher rate. North Carolina  Medicaid officials said that some MCOs in their state were reimbursing  providers at a higher rate for comprehensive, trauma-informed mental  health assessments, and a Colorado Medicaid official also noted that  MCOs in their state may vary reimbursement rates based on provider  availability, offering higher rates in areas where there are shortages.

We provided a draft of this report to HHS and Education for review and  comment. HHS did not provide written comments. Education provided  technical comments, which were incorporated into the report as  appropriate.

As agreed with your offices, unless you publicly announce the contents of  this report earlier, we plan no further distribution until 30 days from the  report date. At that time, we will send copies of this report to the  Secretaries of HHS and Education, congressional committees, and other  interested parties. In addition, this report will be available at no charge on  the GAO website at https://www.gao.gov  If you or your staff have any questions about this report, please contact  me at (202) 512-7215 or larink@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. GAO staff who made key contributions to this report are  listed in appendix IV.

Appendix II: Selected County Information

Appendix III: GAO Contact and Staff Acknowledgments

In addition to the contact named above, Elizabeth Morrison (Assistant  Director), Ramona L. Burton (Analyst-In-Charge), Isabella Guyott, and  Robin Marion made significant contributions to this report. Also  contributing to this report were Luqman Abdullah, Susan Aschoff, Sarah  Cornetto, Kelsey Kreider, Hannah S. Locke, Jean McSween, Mimi  Nguyen, Stacy Ouellette, Michelle Rosenberg, Almeta Spencer, Daren K.  Sweeney, Shelia L. Thorpe, and Carolyn Yocom.

Trauma is a widespread, harmful, and costly public health problem, and is especially detrimental to children. Any frightening, dangerous, or violent event that threatens a child or their loved ones may be traumatic. While not every child suffers lasting effects, trauma significantly increases the risk of mental health and other problems.

Among other things, we interviewed and surveyed officials in 6 states on the challenges agencies face in helping these children. Officials stressed the importance of engaged leadership, citing efforts that struggled without it. They also reported other challenges, including shortages of trained personnel.


Whistleblowers: Office of Special Counsel Should Require Information on the Probationary Status of Whistleblowers

Federal employee whistleblowers—individuals who report allegations of wrongdoing—potentially help to safeguard the government from fraud, waste, and abuse. OSC was created to help protect whistleblowers. Probationary employees—generally those with less than 1 or 2 years of federal service—can be especially vulnerable to reprisal because they have fewer protections from adverse personnel actions, including termination.

A 2017 law included a provision for GAO to examine retaliation against whistleblowers in their probationary period. This report examines (1) the extent to which probationary employees filed whistleblower disclosures or reprisal complaints, (2) termination rates of complainants, and (3) OSC procedures related to probationary employees.

GAO used complaint data and workforce data to identify the probationary status of employees who filed claims with OSC from fiscal year 2014 to 2018 (the most recent full years of available data); estimated the number of instances where claimants were terminated; and reviewed OSC procedures.

GAO found that existing data are not sufficient to determine if the rates of filing whistleblower disclosures, retaliation complaints, or both vary by probationary status. The average annual number of probationary and permanent federal employees from fiscal years 2014 to 2018 was approximately 1.9 million employees. Over this time frame, an average of approximately 2,800 employees—about 0.15 percent—filed complaints each year. Existing data were not sufficient to determine probationary status of employees for over 18 percent of each year's complaints. Therefore, it is not possible to determine whether probationary employees file at lower, comparable, or higher rates than their prevalence in the overall employee population. Specifically, probationary employees represented about 13.5 percent, on average, of the federal workforce, and GAO estimates that they filed from 6.6 percent to 18.2 percent of complaints.

GAO estimates suggest that both permanent and probationary employees who filed complaints were consistently terminated at higher rates than federal employees government-wide. For example, in fiscal year 2018, the termination rate for probationary employees government-wide was 1.1 percent, while the lowest estimated rate of termination among probationary employees who filed a complaint was 10.1 percent. For permanent employees, the overall termination rate was 0.3 percent, while the lowest estimated rate for filers was 2.9 percent.

GAO estimates also suggest that probationary employees who filed complaints were terminated at higher rates than permanent employees who did the same. For example, in fiscal year 2018:

The lowest estimated termination rate for probationary employees who filed whistleblower disclosures (10.1 percent) exceeded the maximum estimated rate for permanent employees who did the same (5.2 percent).

The lowest estimated termination rate for probationary employees who filed retaliation complaints (17.4 percent) exceeded the maximum estimated rate for permanent employees who did the same (9.9 percent).

The lowest estimated termination rate for probationary employees who filed both types (14.1 percent) exceeded the maximum estimated rate for permanent employees who did the same (13.2 percent).

The Office of Special Counsel's (OSC) complaint form allows but does not require complainants to identify whether they are probationary or permanent employees when filing a whistleblower disclosure or retaliation complaint. OSC officials said they try to limit mandatory data fields to the information that is necessary for processing a case, and that they have no plans to do any analysis of employees in their probationary period who file claims. However, the higher rates of termination GAO found for filers generally, and probationary employees specifically, suggests that there could be a risk of unequal treatment. Without first identifying probationary employees who file whistleblower claims, OSC would lack complete data should it decide at some point to analyze the effect of probationary status on filers. Collecting and maintaining such data on every claimant would provide OSC or other entities the ability to analyze termination rates or other issues related to a whistleblower's probationary status.

GAO recommends that OSC require claimants to identify their status as permanent or probationary employees. OSC disagreed with GAO's recommendation. GAO continues to believe the recommendation is valid, as discussed in the report.

Federal employee whistleblowers—individuals who report allegations of  wrongdoing such as a violation of law, abuse of authority, or gross  mismanagement—potentially help to safeguard the government from  fraud, waste, and abuse. Their willingness to come forward may also help  improve government operations. However, whistleblowers risk reprisals  from their agencies for their disclosures, including possible demotion,  reassignment, or termination. Federal laws are in place to help protect  federal employees from workplace retaliation for whistleblowing. The Civil  Service Reform Act of 1978 provided the first protections for  whistleblower disclosures and created the Office of Special Counsel  (OSC) to help protect federal whistleblowers.

More recently, the Dr. Chris Kirkpatrick Whistleblower Protection Act of  2017 provided additional protections, applicable to most federal  employees who experience retaliation for disclosing waste, fraud, or  abuse in the federal government. The act is named in honor of Dr. Chris  Kirkpatrick, a whistleblower who questioned excessive prescription  practices at the Department of Veterans Affairs Medical Center in Tomah,  Wisconsin. Dr. Kirkpatrick took his own life after being terminated from  that medical center. The act included a provision for us to examine  retaliation against whistleblowers who are in the probationary period of  their employment with the federal government. Probationary employees— generally those with less than 1 or 2 years of federal service—can be  especially vulnerable to reprisal because they have fewer protections  from adverse personnel actions.

This report (1) analyzes the extent to which employees who filed  whistleblower disclosures and retaliation complaints were in a  probationary status, (2) analyzes the extent to which these filings were  associated with differences in termination rates, and (3) examines OSC  procedures related to probationary employees.

To address these objectives, we interviewed relevant OSC officials  concerning OSC procedures and responsibilities for collecting and  maintaining whistleblower data and also reviewed OSC whistleblower  disclosure and retaliation complaint processes and forms used to collect  whistleblower data. We also used data from the Office of Special  Counsel’s OSC 2000 database and data from the Office of Personnel  Management’s (OPM) Enterprise Human Resources Integration (EHRI)  database to create a matching key to identify the probationary status of  employees who filed certain complaints with OSC. The matching key is  based on variables such as first name, last name, and agency.

The key allowed us to match 82 percent of the OSC complainant records  from fiscal year 2014 through 2018 (the most recent full fiscal year  available at the time of our analysis). We refer to that group as matched  employees. We refer to the 18 percent group we could not match as  unmatched employees. Because it is not possible to determine the  probationary status for unmatched complaints, the rates of filing among  matched complaints may not precisely reflect the overall rates for all  probationary employees. To account for this uncertainty, we estimated  minimum and maximum rates of filing for permanent and probationary  employees. Further, we calculated the number of instances in which  matched employees who filed either a whistleblower disclosure or a  retaliation complaint were terminated from federal employment. As we did  with filing rates, we also estimated minimum and maximum termination  rates to account for the uncertainty introduced by unmatched complaints.  While other indicators, such as transfers could represent a potential  retaliatory action, we focus on terminations because this is the most serious adverse action for which probationary employees have little  protection and because OSC officials indicated that cases with  terminations are prioritized.

Importantly, we did not determine (1) whether the disclosures and  complaints filed had merit, (2) whether the termination actions were  justified, or (3) whether the termination actions were before or after the  filing of the whistleblower disclosure or retaliation complaint. Further, we  did not assess OSC’s review of the filed disclosures and complaints.  Because our estimates do not consider these factors, they do not  represent proof of a causal relationship between filing and terminations,  but rather one indicator of potential risk. For a more detailed description  of our methodology see appendix I.

We assessed the reliability of the OSC 2000 data by reviewing relevant  documentation, interviewing knowledgeable OSC officials, and  electronically testing the data to identify obvious errors or outliers. We  assessed the reliability of the EHRI data by reviewing our past analyses  that used EHRI data, coordinating with OPM officials knowledgeable  about the data, and conducting electronic testing of EHRI to assess the  accuracy and completeness of the data used in our analyses. We  determined that OSC’s data were sufficiently reliable to present the  number of complaints filed by type. With regard to probationary status,  the data were not available in OSC 2000. As a result, probationary status  and termination rates were drawn from EHRI, which we found to be  sufficiently reliable for this purpose.

We conducted this performance audit from January 2019 to May 2020 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.

OSC is an independent federal investigative and prosecutorial agency. Its  primary mission is to safeguard the merit system in federal employment  by protecting employees and applicants for federal employment from  prohibited personnel practices, especially reprisal for whistleblowing.  OSC reviews disclosures of wrongdoing within the federal government  from current federal employees, former employees, and applicants for  federal employment. These individuals, known as whistleblowers, make  disclosures of alleged wrongdoing to OSC that the employee reasonably  believes evidences either (1) a violation of law, rule, or regulation; (2)  gross mismanagement; (3) gross waste of funds; (4) abuse of authority;  (5) a substantial and specific danger to public health or safety; or (6)  censorship related to research, analysis, or technical information. If a  whistleblower believes his or her agency took, threatened to take, or did  not take a personnel action because of a protected disclosure, the  whistleblower may file a retaliation complaint with OSC. An employee  may file a retaliation complaint with OSC even if the protected disclosure  was made to another body such as an Inspector General’s office rather  than OSC.

Various statutory provisions have established protections for federal  employee whistleblowers over the years. The Civil Service Reform Act of  1978 provided the first statutory whistleblower protections for disclosures  of violations of laws, mismanagement, or gross waste of funds for federal  employees, former employees, and applicants for employment. The  1978 act established both the Merit Systems Protection Board (MSPB)  and OSC and placed OSC within MSPB. Under the act, OSC was  authorized to review allegations of wrongdoing within federal agencies, to  investigate and obtain corrective action over allegations of prohibited  personnel practices, including whistleblower retaliation, and to initiate  disciplinary actions against employees who commit prohibited personnel  practices, among other things.

Later, to strengthen protections for those who claim whistleblower  retaliation, Congress passed the Whistleblower Protection Act of 1989.  The 1989 act separated OSC from MSPB, making OSC an independent  agency. The act also created the individual right of action, allowing  whistleblowers to bring their appeals to MSPB after exhausting remedies  at OSC. In 2012, the Whistleblower Protection Enhancement Act clarified  the scope of protected whistleblowing under the Whistleblower Protection  Act and mandated broader outreach to inform federal employees of their  whistleblower rights, among other things. Further, the Dr. Chris  Kirkpatrick Whistleblower Protection Act of 2017, among other items,  enhanced disciplinary penalties for supervisors who retaliate against  whistleblowers.

Federal employees in the civil service are required to serve a period of  probation when they begin serving initial appointments. These periods are  typically for 1 to 2 years, and they allow an agency to evaluate the  employee before the appointment becomes final. Our prior work notes  that the probationary period provides a way for agencies to dismiss poorly  performing employees or those engaging in misconduct before the  process to do so becomes more complex and lengthy. In particular, we  concluded that the probationary period could be more effectively used by  agencies, which in turn could help agencies deal with poor performers  more effectively. According to MSPB, the probationary period, if used  fully, is one of the most helpful assessment tools available for supervisors  to determine an individual’s potential to fulfill the requirements of the  specific position.

During the probationary period, the employee is still technically  considered an applicant for employment. As such, probationary  employees do not have the same protections against adverse personnel  actions as other employees. Prior to firing a probationary employee for  poor job performance or misconduct, an agency does not need to afford  the same procedural protections required before removing a non- probationary employee. Therefore, it is reasonable to expect that  probationary employees will be terminated at higher rates than permanent  employees. Probationary employees also lack the same rights to appeal  adverse actions, such as demotions or removals, to the MSPB that other  federal employees have.

However, probationary employees do have some legal protections. For  example, probationary employees may file a complaint with OSC if they  believe a personnel action such as reassignment, demotion, or removal  was retaliation for whistleblowing. If OSC determines there are  reasonable grounds to believe that retaliation has occurred, it may seek  corrective action, including filing a petition with the MSPB. Additionally, a  probationary employee who has filed a complaint with OSC may  subsequently file an individual right of action with MSPB.

Probationary employees also may appeal to MSPB if they believe they  have been fired for partisan political reasons or because of discrimination  based on their marital status. Probationary employees also have the  right to file a complaint of discrimination with their agencies and  subsequently file an appeal of a final agency decision with the Equal  Employment Opportunity Commission or a civil action in federal district  court if they believe that they have been discriminated against based on  their race, color, religion, sex, national origin, age, disability, or genetic  information.

Existing Data are Insufficient to Determine if the Rate of Filing Whistleblower Disclosures or Retaliation Complaints Varies by Probationary Status

The average annual total of probationary and permanent federal  employees from fiscal years 2014 through 2018 was approximately 1.9  million. During the same time period, 14,043 federal employees filed  whistleblower disclosures, whistleblower retaliation complaints, or both.  That is, an average of roughly 2,800 employees—about 0.15 percent of  the federal workforce—filed complaints each year.

For whistleblower disclosure complaints, whistleblower retaliation  complaints, or both over this 5-year period, we estimate that probationary  employees filed between 6.6 percent and 18.2 percent of complaints,  while permanent employees filed between 76.8 percent and 93.4 percent  of complaints. Because existing data are insufficient to determine  probationary status of employees for more than 18 percent of each year’s  complaints, it is not possible to determine whether probationary  employees file at lower, comparable, or higher rates than their prevalence  (about 13.5 percent, on average, across this time period) in the overall  employee population. Figure 1 shows how many employees we could  determine through matching were in probationary and permanent status  when they filed whistleblower disclosure or retaliation complaints, along  with the numbers of unmatched complaints for fiscal year 2018. The  pattern is similar for the other years we examined; estimates for each  year are available in appendix II.

Estimates Suggest Probationary Employees Who Filed Complaints Were Consistently Terminated at Higher Rates than Permanent Employees Who Filed, and at Higher Rates than Employees Government-wide

Overall, probationary employees—whether or not they have filed a  complaint with OSC—are terminated at a higher rate than permanent  employees, which is consistent with expectations that determining the  suitability of employees for the particular position is a major purpose of  the probationary period. In fiscal year 2018, 1.1 percent of probationary  employees were terminated, regardless of whether they filed a  whistleblower disclosure or retaliation complaint. In the same year, 0.3  percent of permanent employees were terminated, regardless of filing  status. These percentages were consistent across the years we studied.  As discussed below, estimated termination rates for permanent and  probationary employees who filed either or both types of complaints we  examined consistently exceeded these government-wide rates.  Specifically, among permanent employees who filed, estimated  termination rates could be anywhere from 1.7 to 17.1 percentage points  higher than the 0.4 percent average for all permanent employees over  this period. Among probationary employees who filed, estimated  termination rates could be from 5.3 to 72.6 percentage points higher than  the 1.3% average for these employees government-wide.

Whistleblower disclosures. Estimated termination rates among  employees who filed whistleblower disclosures from fiscal years 2014 to  2018 were higher than termination rates among all federal employees.  This applies to both probationary and permanent employees. Specifically,  estimated termination rates for probationary employees who filed were  higher than estimated termination rates for permanent employees who  filed. For example, as shown in table 1, in fiscal year 2018:

The lowest estimated rate (minimum) of termination among  probationary employees who filed whistleblower disclosures was 10.1  percent, compared to the overall 1.1 percent termination rate for all  probationary employees.

The lowest estimated rate (minimum) of termination among  permanent employees who filed whistleblower disclosures was 2.9  percent, compared to the overall 0.3 percent termination rate for all  permanent employees.

Taking unmatched complaints into account, we estimated that the  termination rate for probationary employees who filed whistleblower  disclosures could be any percentage from 10.1 to 46.9 percent.

Taking unmatched complaints into account, we estimated that the  termination rate for permanent employees who filed whistleblower  disclosures could be any percentage from 2.9 to 5.2 percent.

The minimum estimated termination rate for probationary employees  (10.1 percent) who filed whistleblower disclosures exceeds the  maximum estimated rate for permanent employees who filed  whistleblower disclosures (5.2 percent).

Whistleblower retaliation complaints. We found that the lowest  possible rates (minimums) of termination for employees who filed  whistleblower retaliation complaints were higher than termination rates  among all federal employees, both for probationary and permanent  employees. Specifically, estimated termination rates for probationary  employees who filed were higher than estimated termination rates for  permanent employees who filed. For example, as shown in table 2, in  fiscal year 2018:

The lowest estimated rate (minimum) of termination for probationary  employees who filed retaliation complaints was 17.4 percent,  compared to the overall 1.1 percent termination rate for all  probationary employees.

The lowest estimated rate (minimum) of termination for permanent  employees who filed retaliation complaints was 5.5 percent, compared  to the overall 0.3 percent termination rate for all permanent  employees.

Taking unmatched complaints into account, we estimated that the  termination rate for probationary employees who filed whistleblower  retaliation complaints could be any percentage from 17.4 to 69.4  percent.

Taking unmatched complaints into account, we estimated that the  termination rate for permanent employees who filed retaliation  complaints could be any percentage from 5.5 to 9.9 percent.

The minimum estimated termination rate for probationary employees  who filed retaliation complaints (17.4 percent) exceeds the maximum  estimated rate for permanent employees who filed retaliation  complaints (9.9 percent).

Both whistleblower disclosures and retaliation complaints. For the  category of employees who filed both whistleblower disclosures and  retaliation complaints, termination rates were higher than termination  rates among all federal employees, both for probationary and permanent  employees. Specifically, estimated termination rates for probationary  employees who filed were higher than estimated termination rates for  permanent employees who filed. For example, as shown in table 3, in  fiscal year 2018:

The lowest estimated rate (minimum) of terminations among  probationary employees who filed both whistleblower disclosures and  retaliation complaints was 14.1 percent, compared to the overall 1.1  percent termination rate for all probationary employees.

The lowest estimated rate (minimum) of terminations among  permanent employees who filed both types of complaints was 7.8  percent, compared to the overall  0.3 percent termination rate for all  permanent employees.

Taking unmatched complaints into account, we estimated that the  termination rate for probationary employees who filed both types of  complaints could be any percentage from 14.1 to 56.3 percent.

Taking unmatched complaints into account, we estimated that the  termination rate for permanent employees who filed both types of  complaints could be any percentage from 7.8 to 13.2 percent.

The minimum estimated termination rate for probationary employees  who filed both a whistleblower disclosure and a retaliation complaint  (14.1 percent) exceeds the maximum estimated rate for permanent  employees who, filed both types of complaints (13.2 percent).

As previously discussed, probationary employees being terminated at a  higher rate than permanent employees is consistent with expectations,  given that determining the suitability of employees for the particular  position is a major purpose of the probationary period. However, the  higher rate of termination for filers generally, and the higher estimated  rates for probationary employees specifically, suggests a potential  relationship between filing and terminations that may disproportionately  impact probationary employees. As stated earlier, we did not determine   whether the disclosures and complaints filed had merit, whether  termination actions were justified, or whether the terminations occurred  before or after the filing of the whistleblower disclosure or retaliation  complaint. As such, further examination would be needed to fully  understand these relationships.

OSC Does Not Require Filers to Identify Probationary Status

OSC requires federal employees to use OSC Form-14 to submit a  complaint alleging a prohibited personnel practice or a disclosure.  Complainants begin the process by selecting a checkbox based on their  particular complaint or disclosure. Depending on their selections,  complainants are asked to provide additional information. Data fields on  the form that are marked with an asterisk are mandatory. OSC  instructions state that the agency cannot process forms lacking necessary  information.

OSC Form-14 includes a non-mandatory data field that asks whether the  complainant is currently a probationary employee. Because it is not a  required field, complainants may choose not to provide that information.  According to OSC, it has designated only a limited amount of requested  information as mandatory. OSC officials said that to avoid creating  impediments for employees to file complaints, mandatory fields are  limited to the information that is necessary for processing a complaint.

In August 2019, according to OSC officials, OSC transitioned to a new  electronic Case Management System (eCMS). This new system’s  electronic version of the complaint form includes a data field as part of the  question about employee status. Here employees can check off  probationary status for OSC to capture and input complainants’  probationary status. According to OSC, when complainants provide this  information, the agency is able to track the information in eCMS. OSC  officials estimated that a number of filers voluntarily provide information  on probationary status; however, the officials could not specify to what  extent filers provide that information in their initial filings, or the extent to  which this data is collected during processing of the case.

OSC’s mission is to “safeguard the merit system by protecting federal  employees and applicants from prohibited personnel practices, especially  reprisal for whistleblowing.” Additionally, OSC’s 2017-2022 strategic plan  includes an objective to ensure agencies provide timely and appropriate  outcomes for referred whistleblower disclosures. One of the agency’s  strategies to help achieve that objective is to monitor all whistleblower  disclosures and referrals to agencies to identify trends or systemic  challenges. Further, Standards for Internal Control in the Federal  Government states that management should use quality information to  achieve the entity’s objectives. OSC officials stated that OSC’s routine  administration of disclosures and complaints allow them to identify trends.  However, this process does not consistently use standard, structured  data to identify trends, but rather relies on the personal experience of  investigators. Without consistent quality information, including information  on probationary status, OSC cannot have reasonable assurance that it is  adequately identifying trends and challenges.

OSC told us that because of limited resources it currently has no plans to  conduct data studies or analyses of employees in their probationary  period who file whistleblower claims. As previously discussed, the higher  rates of termination we found for complainants, and in particular for  probationary employees, suggests a potential relationship that warrants  further examination. However, without consistent identification of  probationary employees who file whistleblower claims, OSC will continue  to lack complete data that would enable this analysis and support OSC’s  goal of identifying trends and systemic challenges. Collecting and  maintaining such information on every claimant, which could now be more  easily done under eCMS, would provide OSC or other entities the ability  to analyze termination rates or other issues related to a whistleblower’s  probationary status. Having more complete information on trends and  challenges could help OSC to ensure that its current level of resources  are being distributed to support its mission.

Probationary employees, by definition, are relatively new to their positions  and are thus uniquely vulnerable to retaliation from employers due to the  limited protections afforded them. Our estimates demonstrate that  employees who file whistleblower disclosures and complaints of  retaliation are terminated at a higher rates than employees government- wide, and suggest that these differences may be more pronounced for  probationary employees. OSC has roles and responsibilities related to  understanding key trends and challenges for whistleblowers, and could  potentially further investigate whether these differences indicate a  particular risk for probationary employees. However, they are not  collecting data on probationary status that would enable them to do so.  Without consistent information on probationary status, OSC is unable to  properly analyze the effect of that status on those who file whistleblower  disclosures, retaliation complaints, or both; and thus, cannot have  reasonable assurance there is equal treatment of probationary  employees.

The Office of Special Counsel should require federal employees who are  filing whistleblower disclosures or retaliation complaints to identify on their  complaint forms their status as a permanent or probationary employee.

We provided a draft of this report to OSC for review and comment. In its  written comments, reproduced in appendix III, OSC disagreed with our  conclusions and recommendation. While we continue to believe that our  conclusions and recommendation are fully supported by the evidence— as discussed below—we made minor clarifications to our report to more  clearly state the nature of our findings in response to OSC’s comments.  OSC also provided technical comments, which we incorporated as  appropriate.

In its written comments, OSC expressed a concern that our report  overreaches. OSC stated that our report appears to draw its conclusions  based on correlative instead of causative data. Specifically, OSC stated  that our report appears to connect the expected greater rate of  termination of probationary employees to whistleblower retaliation, based  on correlative data and without taking into account key factors such as  justification for the termination, timing in relation to the disclosure or the  filing of a complaint, or the merit of the individual’s complaint. Absent this  type of crucial, detailed analysis that could help determine causation,  OSC stated that few, if any, conclusions can be drawn regarding alleged  retaliation experienced by probationary employees.

As stated in our draft report, and noted by OSC, our estimates  demonstrate that employees who file whistleblower disclosures and  complaints of retaliation are terminated at higher rates than employees  government-wide, and the estimates suggest that these differences may  be more pronounced for probationary employees. Our draft report  acknowledged that we did not assess certain factors: (1) whether the  disclosures and complaints filed had merit, (2) whether the termination  actions were justified, or (3) whether the termination actions occurred  before or after the filing of the whistleblower disclosure or retaliation  complaint. Because we did not control for these factors, we did not  speculate about what caused these differences to occur or make causal  claims about the relationship between probationary status and  whistleblower retaliation.

Instead, we stated that further examination and analysis would be needed  to fully understand this indicator of potential risk. As we noted in the  report, such analysis would require complete and accurate data on  probationary status—data which OSC does not currently collect.  Therefore, we recommended that OSC collect more complete data so  that OSC could, if it chose, do exactly the type of crucial, detailed analysis  that it says could help determine causation. Accordingly, we continue to  believe that our recommendation for OSC to collect complete and  accurate data on probationary status is warranted as such analysis is not  possible without it.

OSC also expressed a concern that our report appears to suggest that it  perhaps may not be doing enough to protect probationary employees.  OSC asserted that it already has reasonable assurance that it is  appropriately protecting probationary employees from unlawful retaliation.  We did not assess OSC’s review of the filed disclosures and complaints,  and we made no claims or implications about whether OSC’s protection  of whistleblowers is adequate or appropriate. Our report uses one specific  outcome (terminations) as an example of an adverse employment action  that could potentially signal retaliation. We did not present any findings  about whether terminations were warranted, whether employees were  appropriately protected, or any other information related to OSC’s  handling of cases. We continue to believe, however, that OSC’s ability to  run relevant data reports is constrained when the necessary data are not  collected for the total population of filers. Without consistent quality  information, including information on probationary status of all filers, OSC  cannot have reasonable assurance that it is adequately identifying trends  and challenges.

Lastly, OSC stated that making employment status fields mandatory is  onerous and unnecessary and that singling out probationary status from  the list seems arbitrary and incomplete. The agency stated that the form  includes the option for the individual to self-identify as a probationary  employee, which OSC believes is sufficient. We do not believe that  changing a field from optional to mandatory would place an undue burden  on filers or OSC.

We are sending copies of this report to relevant congressional  committees, the Special Counsel and other interested parties. In addition,  the report is available at no charge on the GAO website at  http://www.gao.gov.

If you or your staff have any questions about this report, please contact  me at (202) 512-2717 or jonesy@gao.gov. Contact points for our Offices  of Congressional Relations and Public Affairs may be found on the last  page of this report. GAO staff who made key contributions to this report  are listed in appendix IV.

Appendix I: Objectives, Scope, and Methodology

Our objectives were to (1) analyze the extent to which employees who  filed whistleblower disclosures and retaliation complaints were in a  probationary status, (2) analyze the extent to which these filings were  associated with differences in termination rates, and (3) examine Office of  Special Counsel (OSC) procedures related to probationary employees.

We reviewed the Office of Special Counsel’s OSC 2000 database design  documentation and submitted questions to OSC officials to determine  what data were available. OSC does not collect or maintain data that  identify whistleblowers and retaliation complaints filed by employees in  probationary status in OSC 2000. In late August of 2019 OSC officials  state that in late August of 2019 OSC launched a new system called the  electronic Case Management System (eCMS) to replace OSC 2000. We  submitted a series of questions pertaining to how OSC will collect and  maintain probationary status information of employees filing complaints in  eCMS. These questions pertained to the functionality of and reporting  capability of eCMS in addition to OSC’s ability to conduct analysis of  complainants who are in probationary status using eCMS.

We obtained all closed whistleblower disclosure case data and closed  prohibited personnel practices complaint data with allegations related to  whistleblower retaliation from 2014 to 2018 from OSC’s previous  electronic case management system (OSC 2000). We also requested and  obtained 2014 to 2018 OPM Enterprise Human Resources Integration  (EHRI) data. OSC 2000 is a case management system, so it was  necessary to use combinations of variables associated with complaints  filed, such as first name, last name, agency, email address, and job  series to identify individual employees. We analyzed employees from  federal agencies that submit human resources information to OPM.  Factors such as complaints filed anonymously, name changes, and  spelling variations could affect the precision of these counts of  employees. However, because we are presenting these data in broad  ranges throughout the report, these limitations do not likely affect our  overall findings and message.

After identifying employees in the OSC 2000 data, we then matched OSC  2000 data to OPM’s EHRI data. This was necessary because the OSC  2000 database does not include the probationary status of people filing  complaints with OSC. We started by matching unique name and agency  combinations. If that was not sufficient, we attempted to match using  variables such as state, job series, and employee work email address.  We matched OSC 2000 data to EHRI data using case data from OSC  2000 and federal probationary status as of the end of the fiscal year date  from EHRI. We acknowledge that matching using these dates may not be  precise, but because we present our results in ranges, we do not believe  a more precise matching of dates would have resulted in substantive  differences in the results overall.

We matched 82 percent of the complaints in OSC 2000 to employees in  EHRI. . Because it is not possible to determine the probationary status for  unmatched cases, the rates of filing among matched cases may not  precisely reflect the overall rates for all probationary employees. To  account for this uncertainty, we estimated minimum and maximum rates  of filing for permanent and probationary employees, and present these  ranges in addition to the specific matched rates. Further, we calculated  the number of instances in which matched employees who filed either a  whistleblower disclosure or a retaliation complaint were terminated from  federal employment. As we did with filing rates, we also estimated  minimum and maximum termination rates to account for the uncertainty  introduced by unmatched cases. Terminations were used because they  represent adverse consequences for employees which could indicate  retaliation. While other indicators, such as transfers could represent a  potential retaliatory action, we focus on terminations because this is the  most serious adverse action for which probationary employees have the  little protection, and because OSC officials indicated that complaints with  termination are prioritized. We did not determine (1) whether the  disclosures or complaints had merit, (2) whether the termination actions  were justified, or (3) whether the termination actions were before or after  the filing of the whistleblower disclosure or retaliation complaint. Because  these estimates do not consider the timing or merit of terminations, or  other factors potentially associated with terminations, they do not  represent proof of a causal relationship between filing and terminations,  but rather one indicator of potential risk.

To produce reasonably conservative estimates, we made certain  assumptions in estimating the minimum and maximum rates in our  ranges. Specifically, for unmatched cases we assumed that unknown  characteristics, including probationary status and termination rate could  be as much as 3.5 times their observed rate in known data. We believe  these assumptions are reasonably conservative. While it is not impossible  for this small group of unmatched complaints to be even more skewed,  there is no evidence to suggest such an extreme assumption would be  warranted.

We assessed the reliability of the OSC 2000 and EHRI databases for the  purposes of using limited data from these databases for our own analysis.

We reviewed agency documents, electronically tested data for missing  data and outliers, and submitted questions to agency officials about these  databases. These two databases are the only sources of data that can be  compared to determine the probationary status of individuals filing  complaints with OSC. We determined that OSC’s data were sufficiently  reliable to present the number of complaints filed by type. With regard to  probationary status, the data were not available in OSC 2000. As a result,  probationary status and termination rates were drawn from EHRI, which  we found to be sufficiently reliable for this purpose.

Appendix II: Employees Filing Whistleblower Disclosures and Retaliation Complaints, Fiscal Years 2014-2018

The figure shown below details the distribution of probationary matched,  permanent matched,and unmatched complaints for fiscal years 2014- 2018.

Appendix III: Comments of the Office of Special Counsel

Appendix IV: GAO Contact and Staff Acknowledgments

In addition to the contact named above, Clifton G. Douglas Jr. (Assistant  Director), Katherine Wulff (Analyst-In-Charge), Michael Bechetti, Karin  Fangman, Steven Flint, Robert Gebhart, Steven Putansu and Wesley  Sholtes made key contributions to this report.

Federal employee whistleblowers—people who report legal or ethical violations or mismanagement—help fight fraud, waste, and abuse. Laws seek to protect them from reprisal, but probationary employees, usually those with 1 to 2 years on the job, have fewer protections.

More than 14,000 federal workers filed whistleblower cases from FY 2014–2018. Each year, about 120 to 270 of them were probationary.

Our estimates suggest that probationary employees who filed complaints had higher termination rates than other whistleblowers and other employees generally. However, we didn’t assess whether terminations were related to filing complaints in any way.