February 2019 – Child Welfare Monitor

Crossnore With the passage of the Family First Prevention Services Act as part of the Bipartisan Budget Act of 2018, much attention has been paid to Part I, which allows jurisdictions to use federal foster care money to pay for services to a family to to prevent a child’s entry into foster care. Part IV of the Act, which drastically restricts federal reimbursement for placements other than relative homes and traditional foster care, has received less coverage.

Placements that are not in the homes of relatives or foster families are often described as “congregate care.” The term is generally used to include group homes, residential treatment, maternity homes, and other placements that are not a family home. As these placements have fallen out of favor, this label has taken on a pejorative tone.

The Administration on Children and Families stated in 2015, that

Although there is an appropriate role for congregate care placements in the continuum of foster care settings, there is consensus across multiple stakeholders that most children and youth, but especially young children, are best served in a family setting. Congregate care should be a temporary placement for young people with behavioral or mental health issues who need therapeutic services in order to become stable enough to return to a family setting.

FFPSA enshrines this view by denying federal funding for placement in congregate care settings beyond two weeks, unless the setting meets criteria for a Qualified Residential Treatment Program (QRTP) as defined by the Act. These include accreditation, a trauma-informed model, medical staff on call, and an aftercare program, among others.

Moreover, a child’s initial placement in a QRTP will not be reimbursed unless a qualified professional determines within 30 days of placement that the child needs to be placed in such a setting rather than a relative or foster family home. This assessment must use an “age–appropriate, evidence-based, validated, functional assessment tool approved by the Secretary” and the conclusion must be approved by a court within 60 days and must be reviewed at subsequent status hearings. A child cannot remain in such a setting for more than 12 consecutive months (or 6 months for a child under 13) without written approval from the head of the agency.

Keeping all but the most troubled children out of congregate care would make sense in a world with enough great foster homes to accommodate all children, including large sibling groups. But we are far from having such a world. In most states there are not enough foster homes, even including bad and indifferent ones, to accommodate all the children in need. And that means some children staying in congregate care, some in hotels, and others bouncing from one unsuitable home to another.

The shortage of foster homes is no secret, which is why foster home recruitment has been such a big topic in child welfare circles. Unfortunately, there is no sign that any of the highly-touted and often-expensive new efforts taking place around the country will make a dent in the gap between demand and supply. Society is changing in many ways, including the influx of women into the workforce, and there are simply not enough people who are willing and able to provide foster care in the same areas where it is needed.

Yet there is another model of foster care that has not drawn sufficient attention and is in great danger from the implementation of FFPSA. These are residential homes and boarding schools providing “residential (home-like) non-treatment related services to children living away from their families,” according to the Coalition of Residential Excellence (CORE), which represents such programs. These programs often consist of one or more cottage-style homes with live-in cottage parents, with or without an onsite school. Some of the well-known examples are the Crossnore School and Children’s Home in North Carolina, the Connie Maxwell Children’s Home in South Carolina, the San Pascual Academy in San Diego, A Kid’s Place in Tampa Bay and the Florida Sheriff’s Youth Ranches.

Like QRTP’s, these residential programs are generally accredited, seek to involve families, and provide aftercare services, and they often have a trauma-informed model of care. But because these programs are not designed for children with severe behavioral problems who could not flourish in foster care, they cannot receive reimbursement under FFPSA.

So what is the problem? Couldn’t the children in these programs do equally well in traditional foster care? There are numerous reasons why that may not be the case.

There are simply not enough foster homes. If cottage-based residential facilities can no longer take children, that will worsen the situation and will lead to more stays in hotels, offices, sibling separations, and foster homes that are not well-matched to children’s needs. Unfortunately, FFPSA specifically says that “a shortage…of foster family homes shall not be an acceptable reason for determining that the needs of the child cannot be met in a foster family home.”
Due to the scarcity of foster families, few jurisdictions can afford to be choosy enough about whom they accept and retain. And that is why we never stop hearing stories of abusive foster homes that were not closed despite numerous complaints. And that is why every foster care social worker (and former workers like myself) can tell you multiple stories about foster parents who simply don’t care. They may not be abusive or neglectful, but they won’t lift a finger to take the doctor, visit their schools, or drive them to and from extracurricular activities. Of course there are many great foster parents, who treat their charges as their own children but these are a minority. Many foster homes are only slightly less deprived or chaotic than the homes from which the children were removed. When you contrast these homes to the enriched environments of a place like Crossnore (with its house pets, rope-based adventure playground, on-site school, medical care, and 19 kinds of therapy (including equine assisted therapy), it is hard to imagine anyone preferring an indifferent foster home.
Many children must be separated from their siblings because most foster homes cannot take larger sibling groups. Many residential cottage-based programs like Crossnore, the Florida Sheriff’s Youth Ranches, and A Kid’s Place in Florida pride themselves on taking large sibling groups.
Even the best foster parents can have trouble making sure the children’s needs are met in school and coordinating the wide variety of educational, mental health and medical services the child may need. Many of these residential facilities, benefiting from private donations, provide high-quality mental health services and extracurricular activities on site. Those that have schools provide a seamless integration of home and school and education tailored to children’s needs and saving transportation time and funds.

Richard McKenzie, a professor of economics who grew up in an orphanage in the 1950’s, responded to the contention that children always do best in loving and responsible families as follows: “Well, duh! Clearly, families are the bedrock of all societies. The basic problem in child welfare is that many parents, biological and foster, are far from loving and responsible. Indeed, many are derelict in their duties.” (His article, The Success Story of Orphanages, is well worth a read.)

So why is Congress, along with other federal and state policymakers, so oblivious to the benefits of family-like residential settings? It is clear that the high cost of residential care contributed to Congress’ eagerness to restrict it. Savings from Part IV of FFPSA were needed to offset the cost of adding services under Part I. But cost comparisons are often deceptive and short-sighted. Residential home-like programs provide therapists, case managers, after-school activities, and more. Moreover, they bring in substantial private funding in addition to state support. And the future savings that come from providing high-quality, trauma-informed care and education will doubtless reduce future expenditures caused by dropout, crime, and drug abuse.

CORE supports amending FFPSA to treat residential programs that use a house parent model as foster homes for the purpose of federal reimbursement. It is essential that Congress make this improvement this year before the provisions of FFPSA take effect in October. (A state can delay implementation for two years, which means it foregoes receipt of TItle IV-E funds for in-home services for the same period).

Cutbacks on residential programs have already resulted in sibling separations in states like California. From 2006 to 2015, Sonoma County Children’s Village was a haven for 24 foster children who lived in four homes, with surrogate grandparents living on campus. But after California began to limit group home placements to children requiring high levels of care, the village had to close. Sixteen children, including a group of seven siblings, had to leave. Let us hope that Congress will have the compassion to prevent such senseless actions from taking place on a national scale.

On January 28, the Administration of Children and Families (ACF) released its annual report on child maltreatment. In its press release, the agency heralded “a decline in the number of victims who suffered maltreatment for the second consecutive year.” There are three problems with this. First, the alleged decrease in victimization between Federal Fiscal Years (FFY) 2016 and 2017 is so small as to be insignificant. Second, what declined was not child maltreatment but rather the number of children who were “substantiated” as maltreated–a decline that may reflect changing state practice rather than declining child maltreatment. Finally, ACF’s presentation appears designed to support a narrative that favors family preservation over child safety rather than to report the data in an objective manner.

The newest edition of ACF’s Child Maltreatment report is based on state data for FFY 2017, which ran from October 2016 to September 2017. The report shows that states received 4.1 million referrals (calls to child abuse hotlines) alleging maltreatment involving 7.5 million children in 2017. The number of referrals as a percentage of the number of children has increased annually since 2013. ACF does not discuss the reasons for this ongoing increase, nor does it present referral numbers by state, but such increases could stem from increased awareness of child abuse and neglect (often due to highly-publicized child deaths), public information campaigns, or other factors.

Of the 4.1 million referrals received nationwide in 2017, 2.4 million (or 58%), were “screened in” by state or county child welfare agencies, which means they met agency criteria for receiving a response. As a result, 3.5 million children received either a traditional child maltreatment investigation or were assigned to an alternative non-investigative track, as described below. And of these 3.5 million children, an estimated 674,000 or 19% were found to be victims of abuse or neglect. This flowchart, based on data from Child Maltreatment 2017, illustrates this funneling effect from referrals to substantiation.After rounding and a calculation to account for missing data from Puerto Rico in FFY 2016, HHS estimates that the number of children found to be maltreated decreased of 3,000 (or 0.4%) from the previous year. Such a small change is hardly meaningful; it would be more accurate to say that the number was basically unchanged. This difference from one year to the next is so small that the rate of children found to be victimized was the same in 2017 as in 2016–9.1 per 1000 children. In other words, almost one percent of all children were found to be the victims of maltreatment in 2016 and 2017.

But perhaps more important than the small size of the decrease is the fact that referring to a “decline in the number of victims” or the “victimization rate” is deceptive, which is why I have used cumbersome terms like “found to be victims of child maltreatment.” Most states use the term “substantiation” to connote that they have concluded maltreatment have occurred; some have an additional finding called “indication” that is somewhat less conclusive than substantiation. But as we all know, a finding of maltreatment is not the same as actual maltreatment. Just look back at my columns on Jordan Belliveau in Florida, Anthony Avalos in California, the Hart children in Oregon, and Adrian Jones in Kansas to find cases where horrific abuse occurred but was not substantiated until a child died.

And that is not the only problem. As ACF itself explained, changes in state policy and practice can influence the number of reports that are substantiated. Different states have different evidence thresholds to substantiate an allegation. According to the report, 37 states require a “preponderance of” evidence, 8 states require “credible” evidence, 6 states require “reasonable” evidence and one requires “probable cause.” One state changed its evidence threshold between 2016 and 2017.

In addition to different criteria for substantiation, some states treat all screened-in referrals in the same way while others have a two-track system of responding to reports. In these two-track systems (often called “differential response” or “alternative response”), some allegations receive a standard investigation, but others (usually deemed to be at lower risk of harm) receive less rigorous response, often known as a “family assessment.” The children in these cases are not determined to be victims even if they have been abused or neglected. Instead their families are offered voluntary services. About half of states reported data on children in alternative response programs. As the above flow chart shows, 639,634 children received an alternative response, almost as many as the 674,000 who were determined to be maltreated.

So a given state’s substantiation rate will be influenced by whether it has differential response in all or part of the state. And if the use of differential response in a state was expanding or contracting over a given period, this will influence the change in the number of children who are determined to be victims of maltreatment. Specifically, if states increased their use of differential response overall, that would have reduced the number of children found to be maltreated.

And indeed, ACF reports that “states’ commentaries suggest the increased usage and implementation of alternative response programs ….may have contributed to the changes noted in the 2017 metrics.” And upon review, the commentaries, included in an Appendix to the report, do suggest that the number of reports subject to differential response increased between FFY 2016 and 2017. Six states, including New York, and Texas (two of the four states with the highest number of children)¹ were ramping up their use of differential response during FFY 2017, while Massachusetts and Oregon stopped using the two-track system in FFY 2016 and 2017 respectively.

ACF also suggests that changes to state legislation and child welfare policies and practices might influence the number of substantiated allegations. The state commentaries reveal that some states experienced such changes, although it is not clear that they trended in one direction. Some states like Pennsylvania reported an increased emphasis on safety resulting in increased substantiations and others like New Jersey reporting reduced substantiations due to new policies.

As all this discussion shows, it is almost impossible to attribute a change in the number or rate of substantiation to an actual change in the amount of child abuse and neglect. Too many other things are influencing this number and rate.

Not only did ACF inaccurately herald a decrease in maltreatment but it went on to contrast this alleged decrease with the increasing number of referrals, stating “We are experiencing increases in the number of children referred to CPS at the same time that there is a decrease in the number of children determined to be victims of abuse and neglect.” Media outlets lost no time in picking up on this alleged contrast. For example, the Chronicle of Social Change reported that Child Victimization Declines as Reports of it Continue to Rise.

The interpretation of child welfare numbers to paint a picture of decreasing maltreatment in the face of increasing reporting is not an accident. It feeds into the narrative that is currently dominating in most states and on the federal level without regard to party. According to this narrative, almost all children are better off staying with their parents, no matter how egregious the maltreatment. Removals should be prevented at all costs. If maltreatment is decreasing and reporting is increasing, perhaps something should be done to squelch those pesky hotline callers.

The data presented in Child Maltreatment is extremely important. It is too bad ACF did not stick to reporting it accurately so that readers can understand what it means–and what it does not.

Colorado, Georgia, Nebraska and Washington were the other four states that expanded the use of differential response during FY 2017. ↩

Month: February 2019

Feds confuse substantiation with victimization