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Paternity testing at DNA Paternity Testing Labs is conducted to determine if a man is an individual’s biological father.While several different ways to establish paternity were used in the past, DNA testing isnow the most accurate and accepted method and the only method admissible in mostcourts.People seek paternity tests from DNA Paternity Testing Labs for reasons varying from curiosity to settling custody andfinancial disputes. Determining paternity also is necessary to give children access tofamily medical histories and information about potential genetic diseases, and to anyveteran and social security benefits or medical insurance available through the father.
Considering the life-altering information that paternity testing can provide, it isimperative that laboratories perform the tests accurately and reliably. DNA Paternity Testing Labs uses the number one DNA Paternity Testing Laboratory in the country, Laboratory Corporation of America.The American Association of Blood Banks (AABB) offers
accreditation of the quality and operational systems of the laboratory, including itscollection, processing, testing, distribution, and administration methods.
If a paternity test is to be used in a court of law, a legal process called chain of custody of the DNA samplemust be verified. This means that every step of the paternity testing process andanalysis is documented, from the collection of the DNA sample by an independent partythrough the processing of the sample. DNA Paternity testing Labs takes care of all of this process and completes all DNA Paternity legal documents an individual will need for court.
Paternity testing is carried out on DNA from the child, the alleged father, and, forgreatest accuracy, the mother. DNA can be acquired from blood and buccal (cheek) cells.Prenatal paternity tests from blood from the mother and father is also available from DNA Paternity Testing Labs.Important Information about DNA Paternity Testing
Department of Health and Human ServicesOFFICE OFINSPECTOR GENERALInspector GeneralSEPTEMBER 1999PATERNITY ESTABLISHMENTState Use of Genetic Testing
OFFICE OF INSPECTOR GENERAL
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is toprotect the integrity of the Department of Health and Human Services programs as well as thehealth and welfare of beneficiaries served by them. This statutory mission is carried out through anationwide program of audits, investigations, inspections, sanctions, and fraud alerts. TheInspector General informs the Secretary of program and management problems and recommendslegislative, regulatory, and operational approaches to correct them.
Office of Evaluation and Inspections
The Office of Evaluation and Inspections (OEI) is one of several components of the Office ofInspector General. It conducts short-term management and program evaluations (calledinspections) that focus on issues of concern to the Department, the Congress, and the public. Theinspection reports provide findings and recommendations on the efficiency, vulnerability, andeffectiveness of departmental programs.
To obtain copies of this report, please call the Dallas Regional Office at 214-767-3310.Reports are also available on the World Wide Web at our home page address:
This inspection describes State policies and practices regarding the use of genetic testing toestablish paternity and highlights innovative strategies for overcoming barriers to testing.
Widespread use of genetic testing has contributed to increases in the number of paternitiesestablished in recent years. However, barriers may exist that inhibit the effective use of testing.Federal legislation requires States to empower their child support agencies with authority to orderparties to submit to genetic testing. States agencies must make genetic testing available uponrequest of any party in a paternity case, pay for testing in some cases, and affirm that test resultscreate a presumption of paternity. The Federal government matches State funds to cover testingexpenses, and States may recoup these costs from the father once paternity is established. Toobtain information on how States use genetic testing, barriers to its use, and strategies tosurmount barriers, we surveyed child support agency directors in all States. Additionally, in sixfocus States, we surveyed local child support office managers and interviewed local managers andstaff during site visits to twenty-four offices.
States Use Genetic Testing in a Large Number of Paternity Cases.
State child support agencies widely agree that genetic testing should be used when anyuncertainty about paternity exists, and report using genetic testing in a significant number ofpaternity cases. All but one State typically tests all three parties - child, mother and putativefather - maximizing the precision of test results. Forty-three State child support agencies have theauthority to administratively order parties to submit to genetic testing, while eight State agencieshave no such authority, or must gain approval from the courts before requiring parties to test.Testing is occasionally used in cases in which paternity has already been established throughvoluntary acknowledgment or by default.
Many Mothers and Putative Fathers Have Incentives Not to Test and Other Barriers, Such asInconvenient Testing Locations, May Inhibit the Use of Genetic Testing.
The greatest barrier to the effective use of genetic testing is a desire on the part of mothers andputative fathers not to establish paternity. Putative fathers may simply wish to avoid paying childsupport, and mothers may prefer informal support. Other barriers that inhibit use of testinginclude: client fear of needles, lack of transportation, inconvenient testing locations, fees chargedfor testing, difficulty scheduling appointments for submission of DNA samples, and intentionaldelays by parties attempting to prolong or avoid paternity establishment.
Some Promising Strategies to Surmount Barriers Are Used Only In Limited Areas.
Some child support staff immediately collect DNA samples from parties at their local office,thereby avoiding future delays and transportation problems. Many areas use buccal swab (cheekcells) sampling, instead of drawing blood, alleviating client fear of needles as a barrier to testing.To eliminate expense as a concern for putative fathers’ use of genetic testing, some States do notseek to recoup testing costs, or allow local staff discretion to waive recoupment. However, fewareas in the country appear to use all of these strategies.
Encourage All States to Give Agencies Administrative Authority to Order Genetic Testing.
Child support agencies in eight States do not have the full authority to administratively ordergenetic testing as required by welfare reform. Having authority to order testing is a necessaryfirst step for child support workers to administratively establish paternity.
Encourage States to Use Innovative Strategies, Such as Buccal Swab Sampling at Local ChildSupport Offices.
Sample collection at local child support offices and use of buccal swab sampling help childsupport workers surmount barriers to the use of genetic testing. Staff report that collectinggenetic samples from parties at the child support office helps avoid delays and transportationproblems. Buccal swab sampling appears to be safer, easier and faster than drawing blood, andoften meets less resistance from parties who may be afraid of needles.
Encourage States to Exercise Care in Allowing Genetic Testing in Cases in Which PaternityHas Already Been Established.
Routine use of genetic testing in cases in which paternity has already been legally establishedthrough voluntary acknowledgment or by default may have serious long-term consequences.Such practice could weaken the legal standing of acknowledged or defaulted paternities. Statechild support agencies should be encouraged to work with their legislatures, vital records agenciesand court systems to develop consistent procedures regarding use of genetic testing whenpaternity has already been established.
The Administration for Children and Families (ACF) agreed with our recommendations that allStates should grant their child support agency authority to order genetic testing, and should beencouraged to use innovative testing strategies. Regarding our recommendation that theyencourage States to exercise care in genetic testing when paternity has already been established,ACF prefers to leave this to State discretion but agreed to advise States that our findings suggestthe need to review their own policies and practices. We have withdrawn a recommendation thatOCSE encourage States to review their recoupment policies.
This inspection describes State policies and practices regarding the use of genetic testing toestablish paternity, and highlights innovative strategies for overcoming barriers to testing.
Congress and States have taken advantage of modern scientific advances by encouraging the useof genetic testing in paternity establishment efforts. The Family Support Act of 1988 mandatedthat States require all parties in paternity cases to submit to genetic testing upon request of anyparty. The Act also set the Federal matching rate for genetic testing at 90 percent.1 Subsequentlegislation required that genetic testing create a presumption of paternity, when test results meetthresholds established by the States. The Personal Responsibility and Work Opportunity Act of1996 required that States adopt expedited procedures that give child support enforcementagencies authority to order genetic testing “... without the necessity of obtaining an order fromany other judicial or administrative tribunal...”2 Federal law also gives State agencies permissionto recoup the cost of testing “... from the alleged father if paternity is established...”3
Legislation designed to encourage genetic testing has had a profound effect on the paternityestablishment process across the nation. Child support staff now have a highly reliable method ofdetermining whether a man is the father of a child. While genetic testing cannot prove paternity,it can exclude with certainty a man wrongly named as the father. Further, test results candemonstrate the probability that a child is the offspring of a man with the exact geneticcharacteristics of the man tested, up to a probability of 99.9 percent. As a result of theseadvances, every State will now legally establish paternity when a man is not excluded by testing.
When a child is born to an unmarried woman, paternity may be established through variousmethods. Many unmarried parents sign voluntary acknowledgments of paternity immediatelyfollowing birth in hospitals, or sometime subsequent to the child’s eighteenth birthday. Genetictesting is typically not required in conjunction with voluntary acknowledgments. A secondmethod of establishing paternity involves the parties voluntarily consenting to genetic testing andagreeing to abide by the results. These are common in administrative paternity establishments. Athird method involves contested cases in which the parties are either administratively or judiciallyordered to submit to genetic testing.
Several topics regarding the use of genetic testing in paternity establishment warrantconsideration, including the legal authority to order genetic testing, the mechanics of testing, andits effect on children, mothers, putative fathers and child support staff. Barriers may exist thatmake testing more difficult for parties, which is important, considering the possible consequencesof failure to test when ordered. Potential barriers may include inaccessibility of test sites, fear ofneedles and drawing blood, the cost of testing, and any incentives the parties might have to avoidtesting or delay paternity establishment.
SCOPE AND METHODOLOGY
To examine the role of genetic testing in the paternity establishment process, we gatheredinformation from three groups of child support specialists: State child support agency directors,local office managers, and local office front-line staff. We reviewed the laws and regulationsgoverning the use of genetic testing. We also analyzed the processes, forms and documentationemployed by State and local child support enforcement offices regarding genetic testing.
Administrators from every State and the District of Columbia child support agency completed awritten survey on paternity establishment methods and policies. Ninety-nine local office managersin six focus States - California, Georgia, Illinois, New Jersey, Texas and Virginia - completed asurvey about their office’s paternity establishment policies and practices. Finally, we made sitevisits to four local offices in each of the six focus States. During these visits, we conducted 47interviews which included over 99 local office child support staff who work directly with clients.
We purposively selected the six focus States to include a variety of implementation strategies andexperiences regarding paternity establishment. To achieve this variety, we considered manycriteria including, non-marital birth rates by State and locality, State Paternity EstablishmentPercentages (PEP), performance of voluntary acknowledgment programs, outstanding programcharacteristics (innovation, privatization, etc.), status as State-administered or county-administered, and geographic region. We also purposively selected local child support officeswithin these States to provide a mix of urban, suburban, mid-size and rural locations.4 Since thenumber of local offices varies significantly by State, we surveyed all local offices in some Statesand a portion in others.5 For on-site interviews, we visited offices in one or two cities and theirsurrounding areas in each focus State. The selection of focus States does not purport to berepresentative of the nation, nor do local offices represent all offices within individual focusStates. The selections do, however, allow for examination of paternity establishment processesunder conditions found throughout the country.
The pretested survey instruments and interview protocols included sections specifically aboutpolicies and office procedures related to genetic testing as well as barriers to the use of testing.Additionally, we gathered supplementary documentation including copies of State paternity policymanuals, staff training materials on paternity practices, public outreach materials related topaternity establishment, and samples of documents and correspondence regarding paternityestablishment.
This study of the use of genetic testing was conducted as part of a larger project on Statepaternity establishment methods. Companion reports discuss State use of voluntary paternityacknowledgments, the role of vital records agencies in paternity establishment efforts, and anoverall description of State paternity establishment methods.
This study was conducted in accordance with the Quality Standards for Inspections issued by thePresident’s Council on Integrity and Efficiency.
STATE USE OF GENETIC TESTING
Almost All States Use Genetic Testing in a Large Number of Paternity Cases and TypicallyTest the Mother, As Well as the Child and Putative Father.
State and local child support agencies rely heavily on genetic testing to determine paternity.Thirty-one States report using testing in “about half” or “some” paternity cases, with another 16States reporting usage in more than half of all paternity cases. Two States claim to use genetictesting in only few cases. Local child support offices in focus States report similar usage patterns,with 81 percent using genetic testing in “about half” or “some” paternity cases, and another 17percent using it in more than half of all paternity cases. Only one out of 96 local managersreported testing in just a few cases.
Policy in all but one State is to test all three parties in a paternity case: child, mother and putativefather. While paternity may be established without testing the mother, States choose to test herfor two reasons. First, genetic test results using all three parties provide a higher probability ofpaternity than motherless tests.6 Additionally, testing the mother eliminates a potential welfarefraud scheme. Local staff report that women occasionally apply for public assistance, fraudulentlyclaiming a child is hers in order to increase her level of benefits. In this case, genetic testingwould exclude her as the mother. However, States may be forced to test without the mother ifshe cannot be located, or is incarcerated or deceased.
Child Support Staff Encourage Genetic Testing in Cases in Which Uncertainty Exists.
Forty State child support agencies believe genetic testing should be used when any uncertaintyabout paternity exists on the part of any of the parties, and another six go further to say it shouldbe used in all cases. Only four State officials suggest that substantial uncertainty should existbefore genetic testing is provided. A local child support worker explains that, in practice,workers encourage genetic testing whenever doubt exists:
“If there is any doubt, I encourage them to do a blood test. Some guys areembarrassed to ask for the test, but I tell them to go ahead unless they are sure.Genetic testing does not add much paperwork or staff time to the process. So it isbetter to do it up front.”
Most, But Not All, State Child Support Agencies Have Administrative Authority To OrderGenetic Testing, Thereby Potentially Expediting the Paternity Establishment Process.
Forty-three State child support agencies have authority to order parties in paternity cases tosubmit to genetic testing, with a few States granting this authority only within the last two years.Two other States have a quasi-judicial procedure in which child support agencies may ordertesting when approved by judicial authorities. In the six remaining States, only the courts mayorder genetic testing.
Federal law requiring States to empower their child support agencies with administrative authorityto order testing is part of a general effort to expedite paternity establishment procedures. Untilrecently, paternity establishment was a highly judicial process - with family or juvenile courtshandling such cases in most States. However, because many State judicial systems wereoverloaded, paternity cases could often take many months, even after location of the putativefather. A local child support worker explains how court involvement can create significant delaysin the paternity establishment process:
“He has the right to go to court, and can request a DNA test. He can’t get aDNA test until he files an answer with the court, and requests the test. He willthen go back to court, perhaps several months later, and request the results. Itusually takes about 6-8 weeks to get the DNA results. So there could be three orfour months from the first court date. Getting court dates takes more time thangetting a DNA test result.”
States are using strategies to expedite judicial paternity procedures, such as having phlebotomistspresent on days when paternity cases are heard. If one of the parties requests testing, the judgecan order all three parties into an adjacent room to provide DNA samples. Judges may also set adate for final settlement of the case a few days after the test results are expected.
Another strategy to expedite paternity establishment is to make it predominately an administrativeprocedure, requiring little court involvement.7 Empowering State child support agencies with theauthority to order testing is a necessary first step of this approach. In those States thatconsciously attempt to make paternity establishment an administrative process handled chiefly bythe child support agency, respondents view genetic testing as quite simple. Once named as aputative father, a man may either voluntarily acknowledge paternity, voluntarily submit to genetictesting, or the agency may issue an administrative order for testing. Genetic material samples maybe submitted at the local child support office, or at a nearby location, perhaps on a putativefather’s first visit to the office. The results of testing either exclude the man or create a legallybinding presumption of paternity. Paternity is then established administratively and staff proceedto obligate the father for support. (See Appendix A for example language of State documentsregarding ordering genetic testing.)
Genetic Testing May Be Used in Cases Where Paternity Has Already Been Established.
Local child support staff we interviewed report that genetic testing is occasionally used in cases inwhich paternity has already been established by other methods. Federal law allows that paternitymay be established through voluntary acknowledgment of the mother and putative father. Whilethe parties may chose to pursue genetic testing prior to voluntary acknowledgment, they are likelyto sign an acknowledgment in the hospital immediately after the child’s birth. Congress clearlyrequires that when such a voluntary acknowledgment of paternity is signed, States conclusivelyestablish paternity, following a 60-day rescission period.8 Beyond the rescission period, avoluntary paternity acknowledgment may only be challenged based on “fraud, duress or materialmistake of fact.”9
Some child support staff interpret Federal law to mean that child support agencies and courtsshould neither order nor pay for genetic testing once paternity has been conclusively established.They argue that even if the man who acknowledged paternity is not the biological father, hevoluntarily chose to take responsibility, may already have a relationship with the child, and neitherhe nor the mother should be allowed to revoke his parentage. They warn that if paternitiesestablished through voluntary acknowledgment are commonly overturned through subsequentgenetic testing, the in-hospital voluntary paternity acknowledgment program may be jeopardized.Other child support staff argue that if a man incorrectly acknowledges paternity the State has anobligation to make testing available, even months or years after the acknowledgment. If genetictesting excludes the man, the State could reverse the paternity establishment and discontinuecollection of child support. They maintain that collection is difficult if the man believes he is notthe father, and that the best interest of the child is served by a definitive ruling based on genetictesting.
Similar concerns arise regarding the use of genetic testing in cases in which paternity has beenestablished by default. Federal law allows for paternity to be established through a default orderissued by the child support agency or the courts if a putative father does not heed a summons toappear for genetic testing or other appointment. Although States are required to provide properservice, a putative father who fails to respond could have paternity established by default with noevidence other than the word of the mother.
Some staff express concern over who pays for genetic testing and who has the authority to ordertesting in cases in which paternity has previously been established. If child support agenciesroutinely pay for these tests, total testing expenses would rise. On the other hand, if the agencyrefuses to pay, but allows genetic testing in these cases, some fear that only men with the financialability to pay for testing in advance could avail themselves of the service. Similarly, if only courtsmay grant testing in such cases, those with greater resources could petition the courts to allowgenetic testing and potentially revoke paternity.
Some have suggested that the circumstances of individual cases may be more critical thanstandardized policies. This view draws a distinction between cases in which child support staffand courts ‘routinely’ ignore voluntary paternity acknowledgments by ordering testing uponrequest, and cases in which only special circumstance can warrant paternity testing. For example,suppose an in-hospital paternity acknowledgment is signed at the time of birth, but the motherdoes not apply for public assistance or child support until the child is two years old. If childsupport staff will routinely grant a father’s request for genetic testing, the credibility of theoriginal acknowledgment may be undermined. If, however, the Federal language of “fraud, duressor material mistake of fact” is demonstrated, unique cases may be handled without discarding thevoluntary acknowledgment structure.
BARRIERS TO THE USE OF GENETIC TESTING
Many Mothers and Putative Fathers Have Incentives Not to Test.
State Child Support agencies and local staff agree that the greatest barrier to the effective use ofgenetic testing is a desire on the part of mothers and putative fathers not to establish paternity.State administrators report that putative fathers (43 States) and mothers (41 States) “do not wantpaternity established,” and therefore avoid testing. Local child support office managers in our sixfocus States express similar concerns, identifying the desire of mothers (80 percent of offices) andputative fathers (72 percent) not to establish paternity as a barrier to the use of genetic testing.
Local child support staff explain that the perspective of mothers and putative fathers oftendepends on their current relationships. A mother may have a relationship with another man andfear that paternity and child support activities may disturb that relationship. Additionally, she mayno longer have a relationship with the putative father and not want him involved with her children.
Conversely, a mother may indeed have a relationship with the putative father, perhaps with himproviding informal financial support to the family. If the mother receives public assistance, muchof the father’s formal financial support would likely go to the State as reimbursement forassistance rather than as support for the child. A putative father may have similar concerns. Hemay not want to be involved with the family, or may already provide informal support and wish toavoid participation in the formal child support system to maximize the amount of support reachinghis children. Depending on circumstances, putative fathers, like mothers, may have significantincentives not to submit to genetic testing or to establish paternity.
The effect of these incentives is to increase the chance that one or more parties will not show upfor genetic testing when scheduled. When fathers fail to appear for genetic testing, States eitherestablish paternity by default immediately (10 States), provide a second opportunity or certainamount of time for testing before establishing paternity by default (25 States), or refer the case tocourt (11 States). Once a case is referred to the courts, judges may establish paternity by defaultor re-order genetic testing. Judicial options may also include fining putative fathers, citing themfor contempt, or otherwise attempting to gain their compliance.
Mothers receiving public assistance risk being designated as non-cooperative and may facesanctions for failure to appear for genetic testing. Sixteen States immediately make thisdesignation when a client fails to appear, while 32 States allow the mother a second opportunityor certain amount of time to comply. Most States appear to allow caseworkers some discretion,depending on the circumstances that caused the missed appointment. One State indicates thattheir policy requires child support staff to communicate with a non-compliant mother beforemaking a determination of non-cooperation.10 If the mother is not receiving public assistance,States cannot compel her to cooperate and generally begin case closure procedures once she failsto keep appointments. (See Appendix A for example language of State documents regardingramifications of non-compliance.)
While the Cost of Genetic Testing Does Not Inhibit Its Use by Child Support Agencies andStaff, It May Be Seen as a Significant Barrier by Some Putative Fathers.
The cost of genetically testing all three parties to determine paternity ranges from $230 - $500across States. The Federal government reimbursesStates for 90 percent of their paternity testing expenses, although the Administration’s FY 2000budget proposes reducing the rate of reimbursement to 67 percent.
While almost all States appear to attempt recoupment of testing costs from men determined to befathers, 15 States allow local staff and courts discretion in seeking recoupment on a case-by-casebasis. Only one State indicates they do not try to collect reimbursement in any cases.11 Localstaff view cost and recoupment issues from a very practical perspective. As one worker explains,cost concerns are often viewed as secondary to establishing paternity:
“Cost is not an issue. We would never discourage someone from taking the testbecause of cost. Just the opposite. When there are any reservations, we wouldtell him it is in his best interest to have the test. We don’t ask for reimbursement,even if the test is positive.”
While some local offices may not try to recoup costs, many fathers are charged for testing, andthe cost may constitute a significant barrier for them. Eighteen State agencies report the feescharged for genetic tests are a barrier to putative fathers’ use of testing. To understand how costcould discourage use of testing, imagine a situation in which a low-income or unemployed man isalleged to be the father of a child. Suppose he questions that the child is his, yet knows paternityis a strong possibility. The effect of recoupment policies is that the man in this scenario must riskup to $300 to find out whether the child is his. His other options are to wait for a default order ofpaternity to be issued or voluntarily acknowledge paternity. In each case, he technically gives uphis right to genetic testing. For many men, the $290 gamble may prevent them from testing andlearning definitively whether they are the father. Since staff freely encourage testing, they may bewaiving the recoupment policy in similar situations. However, unless caseworkers have clearauthority to waive recoupment, some fathers may not test because of the cost.
Two factors determine the cost of genetic testing for individual paternity cases: whether the sameparties have to be re-tested for any reason; and whether multiple men have to be tested beforepaternity is established. Re-testing the same parties is occasionally required and occurs whensamples are contaminated or otherwise insufficient for conclusive results. Child support agenciestypically cover the cost of this rare type of re-testing, with no recoupment. Parties in paternitycases may also wish to re-test because they are dissatisfied with, or doubt, the results of an earliertest. Typically, if a second test is granted, the party requesting the test must pay the costs inadvance.
Testing of multiple partners may be required to determine paternity. Local staff report that whilemost women know who the father is with certainty, some women name two, three, or four men aspossibly the father. Rarely, even more men are named. In most States, paternity workers usepracticed interview skills to help a mother determine the most likely candidate from among the possibilities.
Child support offices typically perform genetic testing in the order of likelihood, andonly test others if the first man is excluded. However, in a focus State that primarily uses ajudicial process for establishing paternity, workers report testing as many as three men at the sametime before making a pleading in court. Because it took so long in this locality to arrange courtdates, it was more prudent for child support attorneys to get permission to test all alleged fathersat once than it was to go before the judge after each possible exclusion. These workers suggestedthat their decisions often involved a trade-off between time and money.
The Time, Location and Method of Sample Collection Present Significant Barriers to Testing.
State and local staff report that getting parties to testing sites is problematic. Lack oftransportation to the testing facility was identified as a barrier to mothers (41 States) and putativefathers (25 States). Inconvenient testing locations was also identified as a barrier for mothers(23 States) and putative fathers (16 States). Local office managers in focus States agreed,identifying transportation as a barrier for mothers (71%) and putative fathers (35%), andinconvenient locations as a barrier for mothers (26%) and putative fathers (12%).
About forty percent of State agencies also identified client fear of needles as a barrier to the use ofgenetic testing for both mothers and putative fathers. Some State administrators indicate areluctance to using needles for collecting samples from infants under a certain age. Additionally,many prisons do not allow phlebotomists to bring in needles for collecting samples from prisoners.
While Genetic Testing Mostly Expedites the Paternity Establishment Process, Staff areConcerned About Scheduling Delays and Parties Intentionally Using Testing to DelayPaternity Establishment.
Thirty-nine State child support agencies report that genetic testing sometimes prolongs thepaternity establishment process, yet only seven view these delays as a problem. Similarly, onlyeight percent of local child support office managers in focus States view delays attributed togenetic testing as a problem. Test results are typically returned to local offices two to four weeksafter genetic samples are submitted, but occasionally take longer. Time may be wasted prior tothe test because caseworkers report difficulty in scheduling appointments for parties to submitsamples of genetic material. Finally, mothers and putative fathers often use the genetic testingprocess to undermine or stall paternity establishment efforts. Local workers in several officesreported frustration caused by these delays:
“He comes in and wants to be drawn. I have to wait two months for a draw date,and then it’s going to take six to eight weeks for the results to come back. Well,that’s not going to meet our 90 day [goal] right there. I don’t see how it could beimproved, unless we did it weekly. So that’s a barrier, not having testing as oftenas you’d like.”
“A lot of [putative fathers] have learned if they ask for a blood test, it’s going toprolong it. So a lot of them ask for it even though they know they are the father.They’ve just learned to work the system.”
As previously noted, the major reason genetic testing delays paternity establishment is becauseparents delay testing. Mothers and putative fathers frequently fail to appear for scheduled testingappointments. This situation requires re-scheduling or may cause a case to be switched fromadministrative to judicial procedures. If only the courts may order testing, or must approveorders for testing, further delays may ensue. States attempt to overcome these delays by testingparties, especially putative fathers, the first time they appear at a local child support office or atcourt. Many offices arrange appointments with putative fathers and mothers on specific days inwhich phlebotomists are scheduled to be in the office or at court.
Cases are also delayed when mothers intentionally name the wrong man as the father. It may takeweeks or months to exclude the first putative father, before workers can get another name andbegin the genetic testing process again. To discourage these intentional delays, one focus Stateinstituted a policy of designating a mother on public assistance as non-cooperative, and imposingsanctions, if the first two men she named as father were excluded by genetic testing. This policyhas been challenged in court because it is difficult for caseworkers to determine if mothers areattempting to defraud the system, or truly do not know which of several men is the father of herchild.
STRATEGIES FOR SURMOUNTING BARRIERS
Some State agencies and local child support offices are using promising strategies to overcomebarriers to the use of genetic testing including, as previously discussed, not charging fathers forpaternity testing. Other promising strategies include: collecting genetic samples without usingneedles, and; immediate collection of genetic samples at local child support offices.
While Buccal Swab Sampling Overcomes Barriers Associated With Drawing Blood, Its Use isLimited and Some Authorities Still Prefer Blood Samples.
Only three States do not yet use buccal swab sampling, a method that uses cells swabbed from thecheek instead of drawn blood, to obtain genetic material needed in paternity testing. Despite thewidespread acceptance of swab sampling in States, clients may not have access to the method insome areas. Offices in three of our six focus States have near universal access to swab sampling,yet access in the other three States is limited with 38 percent of local offices reporting no swabsampling. There appears to be confusion among some State and local offices regarding theacceptance of swab sampling. State agency respondents in one focus State indicate buccal swabsampling is not allowed for paternity testing in their State, yet 13 local child support officemanagers (68%) report some use of the method in their areas.
Child support staff suggest three explanations for local variation in access to swab sampling. Inone respect, inconsistent implementation may simply reflect which services are provided bygenetic testing vendors. Many States contract with private companies to collect samples and testfor paternity. If a vendor handling a region of the State only uses drawn blood, parties may nothave other options. A second explanation involves possible resistance to the buccal swab methodby local judicial authorities. Many local child support offices still rely heavily on the court systemand appear to conform testing procedures to the preferences of local judges.
Buccal swab sampling is preferred over drawing blood by 29 State child support agencies and 41percent of local office managers in the six focus States.12 Swab sampling is preferred primarilybecause it is less invasive for all parties, especially children. Swabbing also avoids client fear ofneedles, which was identified by about 40 percent of State agencies as a barrier to the use ofgenetic testing for both mothers and putative fathers. The method is also viewed as easier, fasterand safer to administer than blood sampling. With no fear of the safety risks associated withhandling blood, a few local managers note that their staff has been trained to perform the simpleswabbing procedure. State administrators also indicate that swab sampling is the most acceptablemethod for collecting samples from infants under a certain age. Finally, many prisons do notallow needles, leaving swabbing as the only method for obtaining samples from prisoners. A localchild support worker describes the typical view of sample collection using swabs, reporting:
“We do buccal swab here, so I tell the client there are no needles, and no blood,and that makes it easier because sometime they have young kids and don’t want toget them stuck.”
Eleven State agencies and 23 percent of local child support managers in focus States prefer drawnblood sampling. The primary reason given for preferring blood to swabs is a misconception that itprovides scientifically more reliable results. Phlebotomists explain, however, that the DNA is thesame in every cell of the body and the accuracy of testing performed on cheek cells collected witha swab is the same as using blood.13 Another reason for preferring blood samples is that, ifperformed improperly, swabbing may not collect enough cells for paternity testing and mayrequire re-sampling. Some child support staff indicate that blood samples have stronger standingin court proceedings. One worker suggests that blood sampling is less vulnerable to fraud andanother believes it “motivates some putative fathers to sign the [voluntary acknowledgment],”because they do not want to face the needle.
Collection of Genetic Samples in Local Child Support Offices Surmounts Barriers That DelayPaternity Establishment, But This Service is Not Offered in Most Areas.
Some States are attempting immediate collection of genetic samples, on-site, at local childsupport offices or in court. Parties may submit samples of genetic material at local child supportoffices in 29 States. However, implementation is rarely Statewide and often only a fraction oflocal offices offer this service. Fourteen of these States do report that all or nearly all of theirlocal child support offices are equipped to draw blood or perform swab sampling. However, 12States report that only a few offices have sampling equipment and 20 States report that none oftheir local offices are equipped for sample collection.
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