Seven children and all she needed was a van: large families and the blindness of the child welfare establishment

By Marie Cohen

Working in the field of child protection, it is sometimes hard to avoid the feeling of living in some type of alternate reality, where bizarre statements are accepted and obvious questions go unasked. A case in point was a hearing on the Family First Prevention Services Act (FFPSA) that took place on May 22, 2024 under the leadership of Senator Ron Wyden of Oregon, one of the original sponsors of the FFPSA. This hearing and the fundamental misunderstanding about FFPSA that it uncovered has already been discussed in a previous post on this blog. But today’s post focuses on one particularly jarring vignette–the story of a mother, her seven children, and a van–and what it means about how child welfare policy is made and discussed today.

David Reed, the Deputy Director of Child Welfare Services in Indiana, introduced the story of this family in his testimony. Reed was trying to illustrate how the provision of economic and concrete supports can make children safer–an application of the theory that much of what is called child neglect is actually only poverty, which has been questioned previously in this blog. Reed explained the Indiana Family Preservation Services (IFPS) model requires that “concrete support be provided to families when not doing so would result in children having to come into foster care.” He gave an example of how this worked in a specific case:

DCS was called about a neglect allegation involving a single mother who had seven children, all of whom were school-aged or younger. This mother worked but struggled financially. DCS was called because she was unable to take all seven of her children in rural Indiana to school and/or daycare at the same time so that she could go to work. She took them in “shifts” leaving some children home alone. This resulted in the neglect allegation and the opening of a DCS case. The provider delivering INFPS to this family recognized what this mom really needed to ensure that her children could all be transported together—a bigger vehicle—and used the concrete supports built into INFPS to purchase her a used minivan. That $3,000 van “solved’ the reason for DCS’ involvement and very likely prevented seven children from coming into foster care, which is exactly what most likely would have happened prior to INFPS.

There is something strange about this example. Is it really possible that this mother needed nothing but a van in order to parent her children adequately? The rarity of seven-child families and the association of such large families with family dysfunction, including abuse and neglect, raise doubts about this mother’s appropriateness as a poster child for the provision of material supports as a solution to child maltreatment.

The rarity of a seven-child family

Seven children is such unusual number that it raises questions about why this mother had so many children and how she managed to care for them. The National Center for Health Statistics has estimated that 28 percent of women aged 40-49 (near the end of their childbearing years) who had given birth to children had only one child, 40 percent had two children, 27 percent had three children, and only 13 percent had four or more children.¹ It is likely that the proportion with seven or more children is a tiny fraction of that 13 percent–and that is a percentage of women aged 40-48. We don’t know this woman’s age, but the younger she is, the more of an outlier she is, and the more questions this story should raise about her needs.

The association of extremely large families with dysfunction

A family of seven is not just unusual; it is often a marker for family dysfunction and pathology. Despite the rarity of families with five or more children, anyone who has worked in child welfare or juvenile justice knows that children from extra-large families are overrepresented among their clients. These families frequently consist of mothers with children by multiple fathers, with both parents often suffering from mental illness and/or drug abuse, and domestic violence is commonly present. These mothers are often too disorganized or too influenced by drugs and alcohol to use contraception; moreover, they may consciously or unconsciously get pregnant to hold onto a new man. In its Study of the Root Causes of Juvenile Justice System Involvement,” the District of Columbia’s Criminal Justice Coordinating Council interviewed youth service providers with first-hand experience working with justice-involved and at-risk youth. Quotes from these interviews include:

A social service provider described one type of youth they see becoming justice involved, “You have those that the family may have multiple children and if mom has 13 kids and I’m the oldest and mom is high or dad is not involved, then they need to eat because they are looking at me. So, I need to be able to figure out how to get the next meal.

One interviewee who works with the juvenile justice system describedthe youth as coming from families with “Four, five, six, seven children” and growing up where there are “Three kids in a room, total bedlam all the time,” and as a result “They raise each other in the streets … because … a lot of times hanging out at home isn’t the pleasant environment.”

Research has consistently supported the association of larger families and closer birth spacing with higher rates of child abuse and neglect. In a groundbreaking 2024 article, Ahn et al report on their analysis of 20 years of data on almost 200,000 first-time mothers in California. They found a strong correlation between the number of children born to a mother and the likelihood that she would be reported to CPS in the next 20. The percentage of first-time mothers reported to CPS increased from 18.5 percent for mothers with one child to 25.4 percent for mothers with two children, 39.2 percent for mothers with three children, and 63.1 percent for mothers with four or more children.

Missing the Obvious?

Obviously not all large families are characterized by dysfunction and pathology. But common sense tells us that large family size can add to stress that in turn can lead to maltreatment. Moreover, having multiple children that one cannot afford may reflect other dysfunctions that may in turn be associated with child maltreatment. Yet somehow it never occurred to Senator Wyden or any of his colleagues at the hearing to ask whether this mother had any problems with mental health, drugs or domestic violence. Senator Wyden even mused aloud that federal law discriminates against large families, complaining that the child tax credit does not reimburse families based on the number of children they have! It appeared that he actually wanted to encourage unlimited childbearing regardless of the mother’s emotional or financial readiness.

And what about Mr. Reed, who actually provided this case as his only example of how material assistance can help resolve a child maltreatment report? According to the DCS website, Mr. Reed is a “licensed clinical social worker who has spent most of his career working with foster youth and children involved with the child welfare system.” One would think he had noticed that children from very large families were overrepresented among his clients. It is also worth noting, though slightly off-topic, that if this was the best example he could find, then his argument that many neglect cases can be solved with one-time material assistance appears to be in danger of collapsing for lack of support.

Perhaps one reason for Wyden’s and Reed’s blind spot is the current ideological tendency of what might be called the child welfare establishment, including the federal Administration on Children and Families, state leaders, and large and wealthy foundations and advocacy groups like Casey Family Programs. Many posts on this blog show how these groups’ focus on race and identity has restricted discussion about how to help prevent child abuse and neglect, among other problems. There seems to be a special taboo attached to any discussion about family size as it relates to child maltreatment, or any prescription for family planning as part of the solution. This taboo likely stems at least in part from our country’s shameful history of attempting to restrict childbearing by Black and poor women through means including forced sterilization and attempts to mandate that welfare recipients use an early injectable contraceptive called Norplant. But when efforts to be sensitive to past trauma to specific groups prevents the implementation of programs to improve the lives of at-risk children, it is time to set taboos aside.

What could be achieved by seeing extra-large families through clear eyes rather than a lens that is distorted by bias? Frontline workers faced with this type of client could look a little harder to see if the lack of a van was the real issue. Even if it was, requiring the mother to adopt one of today’s safe, long acting contraceptives in return for the gift of a van would hardly be unreasonable. In general, incorporating voluntary family planning, perhaps as a condition of receiving desired benefits, into family case plans might be a good start. Senator Wyden might not know this, but a new pregnancy for a mother who is trying to get her children back from foster care is one of the frequent setbacks observed by front-line workers.

The failure to regard unusually large numbers of children as a possible sign of pathology may reflect a genuine innocence about conditions in low-income urban and rural communities–conditions that are perfectly known to people in those communities and those who work there, but perhaps not to a US Senator like Wyden or his colleagues. A more cynical view is that self-imposed oblivion is needed to stay on the right side of advocacy groups and foundations that dominate the mainstream discourse on child welfare and provide funding to state and local agencies that are willing to toe the line. Whether it is ignorance or fear of losing the support of interest groups, national and local leaders’ disregard of the perils of repeated unplanned childbearing is hurting the very children these leaders claim they want to help.

There is an error in the posted PDF of this report. The percentage of all women aged 40-49 who gave birth to three children was given as 2.4 percent instead of 22.4 percent. This was confirmed by an email to Marie Cohen from Brian Tsai, Public Affairs Specialist, Center for Disease Control and Prevention, November 21, 2024. ↩︎

The misuse of “lived experience” in child welfare

Vanessa Peoples: Gofundme, https://www.gofundme.com/f/nb2wut-help-vanessa-get-back-on-her-feet

“Those closest to the problem have the answers to solving it. Every child welfare policy and project should prioritize incorporating the expertise, perspectives and experiences of the people whose lives have been directly impacted by the system. We call this ‘centering lived experience.'” There is a lot of truth in these words from an organization called Think of Us and a lot of good in the current focus in child welfare and other fields on considering the actual experience of people affected by systems when developing new policies and practices for these systems. But the emphasis on lived experience has potential pitfalls. When experiences that support a particular perspective are highlighted and those that contradict it are not, and when evidence from data and research are ignored in favor of narratives that may be outliers, there is a risk of adopting policies and practices that hurt, rather than help, children and families.

As described in a brilliant article by Naomi Schaefer Riley and Sarah Font, it is “individuals and groups with a platform” like foundations, government agencies, and journalists, that “select the people with lived experience to serve on advisory boards, testify to Congress, give media interviews, or otherwise disseminate their story.” The “lived experiences” that are selected tend to support the views of what I call the “child welfare establishment,” which includes federal, and many state and local child welfare agency leaders; foundations and nonprofits; consulting firms; and influential commentators and writers. They tend to believe that foster care is harmful and rarely necessary, and that on the rare occasions when children are youth must be placed in foster care, they should almost never be placed in “congregate care” placements such as group homes or residential treatment centers.

Let us start with the idea that foster care is rarely necessary, and the child protective services (or the “family policing system” as author Dorothy Roberts and others put it) removes children from loving parents who just need a little bit of help, thus harming rather than helping children. The story of Vanessa Peoples illustrated this thesis so well that it was shared by numerous media outlets before being picked up by Dorothy Roberts to begin her book, Torn Apart, about how the child welfare system “destroys Black families.” Peoples was a mother of three small children who was apparently doing everything right; she was married, going to nursing school, about to rent a townhouse and was even a cancer patient. But Peoples attracted the attention of both the police and child welfare and ended up hogtied and carted off to jail by police, placed on the child abuse registry, and subjected to months of monitoring by CPS after she lost sight of her toddler at a family picnic in June 17 when a cousin was supposed to be watching him.

From the information provided by Roberts and others, it sounds like Peoples’ was the victim of a hyperactive agency and police department, but it is also possible that critical details were omitted from the narrative. Moreover, Roberts did not include any narratives from people with a very different experience, like this one from Kiana Deane writing in The Imprint: “For me, meth became the pernicious thief that stole my home, my sense of belonging and, at times, my well-being. Being placed in a foster home saved me. Though foster parenting is not for everyone, I couldn’t imagine a world without the protection of the foster care system.” The Kiana Deanes are not asked to testify before Congress, highlighted in books by trending authors, or interviewed by the mainstream media for stories on foster care. (But kudos to The Imprint, which has published many narratives from youths who are grateful that they were placed in foster care.)

Then there’s the issue of group homes versus foster family homes. We all “know” that group homes and residential treatment centers are houses of horror because that is the only thing we ever hear. In the two hearings it held on the Family First Act, the Senate Finance Committee heard from only one person with “lived experience” in a group home, and that was Lexie Gruber, who told Senators about the locked food cabinets, punitive disciplinary system, over-medication, and the lack of emotional support that characterized her group home experience in Connecticut. But Senators did not hear from anyone like Imani Young, who wrote in The Imprint: “Eventually, OCFS (the Office of Children and Family Services) brought me to a wonderful placement called St. Christopher’s. …While in the NY child welfare system, I wanted to feel safe, comfortable, respected and not neglected, and St. Christopher’s made me feel all of THOSE above. They taught me independent living skills, helped me manage my money, got the counseling I needed, and taught me that there’s more to life.”

Other than the selective presentation of lived experiences to be highlighted, another problem with using individual narratives to develop policy is that each person presents their own version of their story, which may leave out crucial details. It is rare for a journalist, author, or Congressional committee to check up on the accuracy of a story that supports the broader narrative they are seeking to portray. Vanessa Peoples’ wanted to portray herself as an innocent victim who did nothing to merit the intervention of CPS, and Roberts had no interest in finding inaccuracies in her story. Lexie Gruber, too, was intent on making the case against group care. She did not talk about the support that she must have gotten from the group home in order to get into college, or any other positive aspects of the care she received.

When the media, congressional committees or advocacy groups select only one set of lived experiences to highlight, real harm can result. Take the passage of the flawed Family First Prevention Services Act (FFPSA) in 2018 after only two hearings with a “curated” group of invited speakers who were clearly chosen to support passage of the bill. Lexie Gruber was the only former foster youth who spoke at the hearing on group homes and other congregate care placements, which was titled No Place to Grow Up: How to Safely Reduce Reliance on Foster Care Group Homes. When it was finally passed in 2018, FFPSA contained drastic restrictions on federal reimbursements for group homes and other residential placements. I wrote in a recent post about how those restrictions have contributed to a placement crisis around the country, with the most troubled foster youth spending weeks or months in offices, hotels, jails, hospitals and other inappropriate and harmful settings. I don’t claim that hearing from Lexie Gruber caused Congress to impose drastic restrictions on group homes, but it was certainly used to support that action.

Don’t get me wrong. Every individual’s story has value. Such stories allow us to visualize the reality behind dry data and statistics. But, to make policy, we need to know whether a story we hear is an outlier or representative of the average experience. It’s not that outliers don’t matter; we need to have protections to ensure that the worst possible outcomes (like the killing of 16-year-old Cornelius Fredericks in a residential treatment center run by Sequel Youth and Family Services) don’t occur. But making policy assuming the outliers represent the majority can lead to disastrous outcomes, like the congregate care provisions of FFPSA.

In contrast to individual narratives, surveying a representative sample of people with lived experience in a particular setting or system can provide information that is useful for policy purposes. Such information is not guaranteed to be accurate; survey response rates are often suboptimal and those who do respond may differ systematically from those who don’t. Nevertheless, such surveys are a much more accurate way of assessing lived experience than relying on individual anecdotes.

And it happens that in child welfare, surveys of older foster care youth and alumni present a much more positive picture than what has been presented by the child welfare establishment and the media. In four studies of former foster care youth reviewed by Barth et al, majorities said that they were lucky to have been placed in care. Most recently, the CalYOUTH study followed a cohort of 727 youth who were in foster care at age 17, with personal interviews every other year until they were 23 years old. At 23, 68.4 percent of the 621 respondents said that they were lucky to have been placed in foster care. And 57.4 percent were “generally satisfied” with their experience in foster care.

There are few studies of youth perspectives on residential care, but a recently published study in a leading child welfare journal reports on the experience of 450 youths placed in 127 licensed residential care programs in Florida between 2018 and 2019. The youths responded to a validated quality assessment that asked them to rate their facilities on elements of service quality in seven domains based on evidence and current best practice standards. Overall, youth provided high ratings of their residential programs on all seven domains. The mean ratings indicated that youths felt their facilities were “mostly to completely” meeting the standards across all domains.¹

This does not mean that there are no children who could have stayed safely with their families and not been placed in foster care had the right help been provided. Nor does it mean that there are no terrible group homes. The current placement crisis (to which FFPSA has contributed) means that more youths will be placed in neglectful or even abusive homes or facilities than if this crisis did not exist. But when advocates of one point of view choose to share only those experiences that support their viewpoint, the use of lived experience to support particular policy proposals can lead to policy choices that are harmful to the people they are intended to help.

Note

But not all surveys are based on large, scientifically-chosen samples. For example, the nonprofit,Think of Us, which has the aim of “centering lived experience,” published a report called Away from Home: Youth Experiences of Institutional Placements in Foster Care. That report is based on the responses of 78 young people residing in what it called “institutional placements, which included group homes, homes for pregnant and parenting teens, and therapeutic residential treatment facilities around the country. Among the conclusions of the report were that institutional placements were prisonlike (“carceral”), punitive and traumatic for their residents and failed to meet child welfare mandates to provide safety and wellbeing. The methodology section, relegated to an Appendix, reveals that the 78 participants were recruited through an “open call for participation through youth advisory boards and community partners.” Assuming that these are advisory boards and community partners of Think of Us, and knowing that the nonprofit and its CEO are associated with the dominant viewpoint on group care, one has to wonder whether the recruitment process produced an unbiased sample.

Family First at five: Not much to celebrate

When the Family First Prevention Services Act (FFPSA) passed as part of the Bipartisan Budget Act of 2018, it was hailed by many as a revolutionary step in the history of U.S. child welfare. Five years after the Act took effect, child welfare leaders have been weighing in with statements like this one from Rebecca Jones Gaston, Commissioner of the Administration on Children, Youth and Families: “Following its passage five years ago, the Family First Prevention Services Act has transformed our approach to child welfare and benefited families across the many states that have used it to provide concrete support and services.”¹ But for those closer to ground-level and less invested in demonstrating the act’s success, there’s not much to celebrate.

FFPSA had two major goals: to keep children out of foster care altogether through services to families and to keep more of those who do have to enter care in family homes. In terms of the first goal, the law’s impacts on services to families have been almost negligible. And in its effort to keep foster children in families, FFPSA has exacerbated the critical shortage of appropriate placements for our most troubled youth, many of whom may need placements in larger settings. In this post, I examine these two goals and their outcomes in greater detail.

FFPSA’s Part I made it possible to allocate funds under Title IV-E of the Social Security Act, previously directed mainly to foster care, to services aimed at keeping children out of care. The law allowed spending on mental health, substance abuse prevention and treatment, and in-home parenting services, “when the need of the child, such a parent, or such a caregiver for the services or programs are directly related to the safety, permanency, or well-being of the child or to preventing the child from entering foster care.”

As I explained in my 2019 post, Family First Act: a False Narrative, a Lack of Review, a Bad Law, Part I was based largely on the false premise that current law, by allowing TItle IV-E funds to pay for foster care and not for services to prevent it, incentivized states to remove children rather than keep families together. While it is true that IV-E funds were not available to pay for services to children and families in their homes, that does not mean that no money was available to help keep families together or that states had an incentive to place children in foster care. In fact, states had long been using Medicaid and other funds for services to prevent placement of children in foster care. In Federal Fiscal Year 2017, according to federal data, out of the children who received services after a CPS investigation or alternative response, only 201,680 were placed in foster care, while 1,332,254 (or more than five times as many children) received in-home services such as case management, family support, and family preservation services.²

Disregarding the role that other funding already played in child welfare, the framers of FFPSA required that Title IV-E would be the “payer of last resort,” so that any services already paid for by Medicaid could not be paid for by Family First. By doing this, they ensured that states with a generous Medicaid programs would be hard-pressed to find any service already existing in the state on which to spend their TItle IV-E money. If not for this provision, such states might have chosen to supplement Medicaid funding for some of these services. Perhaps some states would have allowed Title IV-E funds to be used to pay high-quality providers who do not accept Medicaid funding due to the program’s low reimbursement rates and high paperwork burden. (During my time as a foster care social worker in the District of Columbia, we had contracts with high-quality providers who did not accept Medicaid in order to provide therapy for our most complex clients).

The choice to fund only parenting, mental health and drug treatment services by the framers was another design flaw of FFPSA. The absence of a domestic violence service among the funded services is striking. It is universally acknowledged that drug abuse, mental illness and domestic violence are the “big three” factors that result in foster care placement. But for some reason, the words “domestic violence” are nowhere to be found in FFPSA. Perhaps even more striking is the failure to include one of the most promising services to prevent foster care–high-quality child care. As I have written, not only does quality early care and education prevent foster care placement through multiple pathways, but it also provides an extra set of eyes on the child in case of continued abuse or neglect–greatly needed if FFPSA is to achieve its goal of keeping children both safe and out of foster care. Think of what a difference Congress could have made by providing matching funds to provide quality child care to all families with in-home cases!

Perhaps the most unfortunate feature of FFPSA’s Part I is the requirement that all funds must be spent on “promising, supported or well-supported practices,” with 50 percent of the total spent spent on “well-supported practices” — a percentage that increases after 2026. The law imposes strict requirements for designating a program as promising, supported or well-supported. It set up a clearinghouse to assess the data on existing programs and approve those that met the criteria. As Dee Wilson points out in one of his essential commentaries, the law gets it exactly backwards. We have very little evidence about what works to prevent foster care placement. What we need is to invest in innovative approaches to doing this safely. But FFPSA prevents the use of TItle IV-E funds for this purpose.

Thanks to the various restrictions imposed by FFPSA, the clearinghouse is woefully incomplete. For example, Cognitive Behavioral Therapy (CBT), the therapy of choice for depression and anxiety, which has not been approved nor is it on the list of programs to be examined by the clearinghouse. (“Trauma-Focused CBT,” a newer and much narrower and short-term model, has been approved.) No residential drug treatment program has been approved or is even slated to be considered. The requirement that the practice have a manual may be at fault for the failure to include CBT and residential drug treatment programs, but I’d like to hear from readers who may be better-informed. Buphenorphine therapy for opioid use disorder, which is often preferred to methadone therapy (which is approved by the clearinghouse)because it does not require daily clinic visits, has not been approved and is not slated for consideration, according to the Clearinghouse.. Of course, these popular programs are often funded by Medicaid anyway, so they would be ruled out by the last resort provision as well.

With all these restrictions on Title IV-E spending, it is not surprising that states have been hard-put to find useful ways to spend Title IV-E funds to keep families together. In an important article, Sean Hughes and Naomi Schaefer Riley cited the latest available federal data showing that just 6,200 children across the entire country received an FFPSA-funded service in FFY 2021, costing a grand total of $29 million. That is truly underwhelming given that about 600,000 children were found to be victims of maltreatment in FFY 2021.

The other major purpose of FFPSA was outlined in Part IV, entitled “Ensuring the Necessity of a Placement that is not in a Foster Family Home.” The purpose of this part was to keep more children out of “congregate care,” a term used to designate settings other than foster homes, such as group homes and residential treatment centers. FFPSA made it more difficult to place a child in a congregate placement by imposing conditions on Title IV-E reimbusement for such placements, and by limiting reimbursement after two weeks to facilities that qualify as “Quality Residential Treatment Programs (QRTP’s), a new category defined by the act. QRTP’s must meet strict criteria that many facilities that were caring for foster youth at the time of FFPSA’s passage could not meet without major changes. The act also (perhaps inadvertently) further restricted the number of congregate care beds available to foster youth by creating a conflict with a Medicaid provision called the “Institutions for Mental Diseases (IMD) exclusion” that prevents Medicaid paying the cost of care for children who are placed in facilities with more than 16 beds.“

Like Part I, Part IV of FFPSA was in large part based on a false narrative. The myth this time was that every child does better in a family rather than in a more institutional setting. But as I described here, there are many foster youths who cannot function in an ordinary foster home, at least until after a stay in a high-quality residential treatment program or group home. These are the same young people who bounce from home to home and end up in hotels, offices, jails, and other inappropriate settings, but FFPSA made no provision for them.

Even if too many children had been placed in residential care without sufficient clinical justification (which is probably the case in at least some states), it would not be responsible to shut down congregate care placements before ensuring that appropriate foster homes were available for all the children being displaced. But just as the deinstitution movement of the 1960s closed mental hospitals before putting alternatives in place, FFPSA disregarded the question of where children would go when congregate settings disappeared.

As I described here, FFPSA exacerbated trends that were already underway. Group homes and residential treatment centers were already shutting down due to growing publicity about abusive incidents at some facilities, failure of reimbursement rates to keep up with costs, and resignation of staff due to poor pay and working conditions. Tragically, this reduction in residential capacity coincided with increased demand for care due to the youth mental health crisis and increasing levels of need in the foster care population due at least in part to delays in removing children from abusive and neglectful homes. The restrictions put in place by FFPSA added to the problem. As Hughes and Schaefer Riley put it, “If you want to understand why foster children across the country are being housed in a range of inappropriate temporary settings, including county and state offices, hospitals, hotels and shelters, FFPSA is a significant factor.”

The trends just mentioned have contributed to a foster care placement crisis that has if anything worsened since I described it last October. In Illinois, the Department of Children and Family Services (DCFS) is being sued by the Cook County Public Guardian for allowing foster children to remain locked up in juvenile detention even after they’ve been ordered released. In Maryland, a disability rights group has just filed suit against the Department of Human Services and other agencies for keeping foster children in hospitals and restrictive institutions beyond medical necessity for weeks, months, or even as long as a year. In a must-read article, Dee Wilson documents a 370 percent increase in hotel/office stays in his state of Washington since 2018 despite a federal court order to stop the practice. At an average cost of up $2,000 per night (including the cost of paying two social workers and a security guard), overnight hotel placements cannot possibly be cheaper than group homes or residential treatment centers. Similar problems are reported around the country, differing only in which inappropriate settings each state is relying on.

As is often the case, California paved the way for FFPSA by passing its Continuum of Care Reform, designed to curb the use of congregate placements, in 2015. A new article in the Los Angeles Times recounts the results. The number of children living in congregate care has dropped from 3,655 to 1,727 since implementation of the law, but the state has failed to find the foster homes to replace the congregate care settings. As a result, Los Angeles County has placed more than 200 foster youths in hotels, sometimes for months. County officials report that two social workers have been assaulted by foster youths in separate incidents this year at hotels. Moreover, it appears that care at the existing congregate facilities has grown worse as larger numbers of troubled youths are placed together in fewer facilities. The results of California’s reform and of FFPSA were predictable and indeed predicted by some commentators (including this writer), but these predictions were ignored.

As Dee Wilson puts it, “The implementation of Family First legislation has accelerated the demise of residential care, which has decreased 25% nationally during the past five years. It has been the goal of the federal Children’s Bureau and influential foundations to reduce the use of residential care (which has a bad reputation among advocates and most scholars) and they have succeeded; but without developing — or sometimes even proposing – viable alternatives.”

Anyone who chooses to celebrate the “revolution” wrought by FFPSA is living in a dream world. It’s time for Congress to recognize and correct the many errors it made in passing the law. At a minimum, Congress should add funding for early care and education and domestic violence programs to the models that can receive funding under Title IV-E, loosen the standards for evidence-based practices, modify the last-resort provision to allow payment for services to providers who do not accept Medicaid, eliminate some of the restrictions on congregate care, and provide incentives for states to boost their capacity of quality residential programs. Until such changes are made, there will be nothing to celebrate.

Alexia Suarez (asuarez@wearerally.com), [YOU’RE INVITED] Expert panel on the Family First Prevention Services Act. Email message, May 15, 2023.
These are duplicated counts as children are counted again each time they are the subject of an investigation and receive post-response services.