The foster care crisis in Massachusetts: common sense solutions, not ideology, are needed

FosterCareMass
Image: Boston Globe

An investigation by the Boston Globe’s Kay Lazar has drawn public attention to the foster care placement crisis in Massachusetts. The opioid epidemic has led to a spike in the demand for foster homes, but the Department of Children and Family Services (DCF) has been unable to recruit and retain enough foster parents. Therefore, children newly removed from their homes often have no place to spend the night, sometimes spending it in a car with a social worker awaiting a call to say a bed is available up to 100 miles away.

And the trouble doesn’t end with the first overnight placement. One third of foster children in Massachusetts were moved at least three times during their first year in the system. According to one social worker quoted, relatively healthy children come out of care with behavioral problems and attachment issues due to their devastating experiences in foster care.

Lazar and her paper are to be commended for making the public aware of these unacceptable flaws in the Commonwealth’s treatment of its most vulnerable citizens. But by interviewing only a small group of child welfare experts with similar perspectives, Lazar missed some of the obvious common sense solutions to these problems.

Take the lack of emergency foster homes, which results in many children spending their first night in foster care in a car waiting for a bed. There is an obvious solution, and that is to establish temporary regional shelters so that every child can find a warm bed and a welcoming hug on what may be the most traumatic night of their lives.

So why was this solution not mentioned? Many states have seen their emergency shelters become warehouses for children for whom a placement cannot be found. As a result, some states have closed these facilities–instead of improving them. But these closures don’t solve the problem that homes are not available.

Smarter jurisdictions, often working with nonprofits, use emergency shelters for children newly removed from their homes. A nonprofit called Amara operates temporary shelters for children who have just been removed from their homes in Seattle and Tacoma, Washington. The shelters are a haven for traumatized children where they receive loving care from staff and volunteers. And they offer social workers a much needed three to five days to find a foster home that is the best match available–not just the first to answer the phone.

There is a no obvious solution to the overall shortage of foster home beyond the first few nights of a placement. Lazar rightly draws attention to the bad treatment that foster parents receive from an agency that fails to provide information about the children who are placed with them, does not provide the therapy and services the children need, pays them too little to support the kids, doesn’t train them in caring for traumatized children, and requires them to adhere to conflicting and outdated regulations. By all means these problems must be fixed–for the sake of the children as well as the foster parents. But it is unlikely that they will rectify the shortfall of foster homes. More creative and courageous solutions are necessary. 

Providing free housing and/or salaries for foster parents might help increase the supply of foster homes. An Oklahoma nonprofit is building larger homes where foster families can live rent-free in exchange for taking in larger sibling groups.  SOS Children’s Villages Illinois operates several foster care communities in which full-time professional foster parents care for large sibling groups of up to six children. Child welfare agencies should work in partnership with local nonprofits to develop such programs. 

But Massachusetts needs to face the facts. There will never be enough high-quality foster homes for all the children who need them. As Stan Rosenberg, former President of the Massachusetts Senate and a former foster youth, wrote in the Globe,  many foster parents are loving and caring but others are in it for the stipend and the children placed with them will suffer the consequences. A high-quality group home or residential facility can be much more nurturing and family-like than a low-quality foster home.  More such facilities (often known as “congregate care”) are needed in order to prevent our abused and neglected children and youth being re-traumatized by repeated moves between foster homes.

Children who have trouble finding permanent placements tend to be older and/or have more severe behavioral, neurological and cognitive problems which stem from many years of trauma, deprivation, and often in utero substance abuse. Some of these children cannot thrive in traditional foster homes, which are not trained to deal with their difficult behaviors. There are many high-quality group homes around the country where dedicated staff devote their lives to changing the trajectories of these wounded children.

But the political climate has been opposed to such facilities for a long time, as Child Welfare Monitor has often discussed. Congregate care facilities  have been closing for years as states have deprived them of funding and stopped sending children there–even if they have to be left in dangerous homes, placed in barely-adequate foster homes, or bounced from home to home. The percentage of children in Massachusetts placed in congregate care facilities decreased from 22% in 2007 to 17% in 2017

The bias against congregate care has been enshrined in the Family First and Prevention Services Act, (FFPSA) passed as Title VII of the Bipartisan Budget Act of 2018. Under FFPSA, states will no longer be able to draw upon federal funds for congregate care except for children who have been judged too disturbed to thrive in a foster home by a “qualified professional.” These facilities must meet new criteria for licensure, and congregate care placement will be reviewed at every court hearing. Moreover, a child cannot remain in one of these placements for more than 12 consecutive months (or 6 months for a child under 13) without written approval from the head of the child welfare agency.

Sadly, ideology is reinforced by the reluctance of public officials to ask their taxpayers to find room in their hearts to fund high-quality facilities to these neediest of all children. Such facilities are much more expensive than foster homes and many have been starved out of existence around the country.

Instead of discussing the need for more congregate placements, Lazar quotes advocates who state that more children could be maintained in their own homes if adequate services could be provided to their parents. Yet, as she herself states, about 80% of the children in DCF’s caseload are living at home while the agency attempts to help their families avoid foster care. A spate of deaths of children in DCF-supervised homes since 2014 has distracted the agency from any attempt to reform foster care. Do we really want to put more children at risk to avoid spending money to nurture and house our most vulnerable children?

Reducing Congregate Care Placements: not so easy, not always good for kids

Plumfield
Image: plumfieldacademy.net

Most child welfare experts and policymakers at all levels seem to agree that our nation needs to reduce the use of group homes and other non-family placements (often called “congregate care”) for foster youth. Yet signs from around the country suggest that the drive to move foster youth quickly out of congregate care is facing some obstacles–and may be resulting in more damage to foster youth.

The child welfare establishment–including the federal Administration for Children and Families, agency leaders at the state and local level, prominent think-tanks, scholars, and foundations–is in agreement that “every kid needs a family.” These leaders acknowledge that some foster youth need a group placement to address behavioral issues that may prevent success in foster care, but such youth should be moved out of the group setting as soon as these issues are addressed.

In 2015, the California Legislature took the lead in implementing this new focus by enacting the Continuum Care Reform (CCR), which required all foster youth to be placed in families except those requiring intensive supervision and treatment for a temporary period. Such youth must be placed in Short-Term Residential Treatment Programs (SRTP’s), which must be accredited and meet rigorous standards.

Congress followed in 2018 by adopting the Family First Prevention Services Act (FFPSA, (Title VII of the Bipartisan Budget Act of 2018), which imposed similar changes on the federal level, with a temporary congregate therapeutic option called Quality Residential Treatment Programs (QRTP’s) instead of SRTP’s. To receive reimbursement for a QRTP placement, a “qualified professional” must determines within 30 days of the placement  that the child needs to be placed in such a setting rather than a relative or foster family home. The decision must be approved by a court within 60 days and reviewed at subsequent hearings (usually every three to six months). Moreover, a child cannot remain in a QRTP for more than 12 consecutive months (or 6 months for a child under 13) without written approval from the head of the agency.

California, where CCR took effect in 2017, has been widely viewed as a harbinger of what might happen after FFPSA takes effect next October. But Golden State policymakers have been “shocked shocked” to learn that children have not been moving out of congregate care settings as fast as anticipated. The reform was expected to pay for itself due to savings from moving children from pricier congregate care settings to cheaper family homes.  However, this has not happened. The Office of the Legislative Analyst has found higher than projected state spending for one main reason: instead of moving from group homes into family foster homes, children are moving into “STRTPS,” the new congregate option offered by CCR.

Although the Legislative Analyst did not speculate about reasons for the slow transition, one does not have to look far for clues. A report from San Joaquin County indicates that the county is unable to find homes for the teens with the greatest needs, who remain in group homes. Efforts to recruit foster parents willing to take on these challenging youths have so far failed.

Another jurisdiction that started eliminating group homes long before the Family First Act was New York City. The city’s Administration for Children and Families (ACF) is reeling from an alarming report about the intake center where children are taken after being removed from their families. Workers described an atmosphere of chaos, violence, weapons in plain sight, feces-smeared walls, overcrowding and “a dangerous mix of babies and young children with special needs living alongside troubled teens and even adults straight out of jail.” This intake center was was meant as a place for children to wait for a few  hours until a placement could be arranged. But staff report young people with behavioral problems or medical needs living in the shelter for months because foster families cannot be found for them. One disabled teenager lived there for a year. The president of the union representing ACF workers blamed these long stays on management decisions made years ago to close group homes, based on the belief that family homes were better for children. Unfortunately, the agency has not been able to find families to take in many children with behavioral problems, mental disabilities, and histories of trauma and abuse.

In Georgia, there are more children in foster care than ever before and not enough homes for them. Wanting to address this problem, long-time foster and adoptive parents John and Kelly DeGarmo started the Never Too Late (NTL) foster home for boys. But when they applied for a license to accept youth from the foster care system, they found it was too late. Due to the Family First Act, Georgia was not going to license any new residential group homes. State administrators instead asked NTL to serve as a Transitional Living Program, (TLP), for youth ages 16-21 as the boys transition from foster care to independent living. These programs are also needed, but one can’t help but wonder about Georgia’s plan for meeting the needs of the many children who cannot find foster homes and could have thrived in atmosphere of loving care at Never Too Late. 

In my own jurisdiction, the District of Columbia, the Child and Family Services Agency is proud of the low percentage of foster youth that are in group homes, attributing it to “the agency’s success in supporting children and youth with higher needs in traditional foster homes.”  Yet, advocates are declaring a foster care placement crisis. There is a lack of appropriate foster homes for many children, particularly older teens and those with behavioral problems. As a result, according to the Children’s Law Center, foster youth experience multiple placement disruptions, with devastating consequences to their mental health. CLC also blames the placement crisis for delayed removals of children from unsafe homes, youths remaining in poorly matched placement, and youths leaving their official placements for unofficial community settings. Yet, there is no voice advocating for more therapeutic group homes, the most appropriate setting for many such youths.

The state of Washington has about 100 youths in out-of-state facilities due to a lack of in-state beds. A scathing report recently described abusive restraint practices and other problems at an Iowa facility where Washington was sending some of its foster youth. In a letter to the legislature, Ross Hunter, director of the Department of Children Youth and Families, acknowledged that the agency has an insufficient array of therapeutic group homes and residential facilities for children with severe behavioral problems that make it impossible to maintain them in foster homes. Among the consequences of this shortage, Hunter cites the following: (1) children being repeatedly placed in homes that can’t handle them, resulting in damage to the children and loss of foster parents to the system; (2) over 2000 office and hotel stays for children last year; and (3) use of expensive one-night placements “at extraordinary cost and detriment to the child,” in addition to the out-of-state placements. Hunter proposes to bring all of Washington’s children home and eliminate office and hotel stays by expanding the number of therapeutic group home beds, as well as increasing the quality of existing congregate placements.

Oregon is also reeling from reports of abusive out-of-state placements. After being sued for housing foster kids in hotels, it stopped that practice but sent more high-needs children out of state. Reports of a nine-year-old being injected with Benadryl to control her behavior have led to a public outcry that over 80 Oregon foster kids are in out-of-state facilities, many of them troubled for-profits, because the state lacks residential programs to provide the treatment they need.

Washington and Oregon are among the states with the highest proportions of foster children placed in families, according to federal data cited in a recent report from the Annie E. Casey Foundation that drew extensive press coverage.  The report provided state-by-state numbers, generating media coverage (but not in Washington and Oregon) that praised those jurisdictions with lower group home percentages and chastising those with higher rates. But nowhere did the authors mention the fact that eliminating too many congregate placements may lead to foster youth staying in offices, hotels, emergency placements, and abusive out-of-state facilities.

We are not taking this opportunity to argue that many group homes (especially those using the house parent model) are more family-like than many foster homes–which we have argued elsewhere. Even if we accept the premise that no young person should be in a group home one minute longer than necessary once ready to function well in a foster home, there are several problems with implementing this premise in the real world.

  • We don’t have a diagnostic instrument capable of determining in advance who “needs” a congregate placement and who does not. As of now, it is a subjective determination, making it difficult to project a specific decline in congregate care placement. There is concern that the FFA may make it too difficult for children to gain access to the therapeutic placements they need.
  • Whether a child is “ready” for family life depends upon the families available. Some very gifted, well trained and dedicated foster parents can nurture high-needs youth who would not thrive in the average foster home. But when such a parent is not available, a child might be better off in a high-quality therapeutic group placement.
  • Often a family simply cannot be found that is willing to accept a teen with troubling behaviors or a history of residential treatment or delinquency. The most ridiculous sentence in FFPSA is this one: “A shortage or lack 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. ” What should be done then with a child that has no place to go?
  • A year (or six months for a preteen) may not be enough time for a troubled child to become “family-ready.”. Many children and teens in foster care have suffered years of trauma in their homes, and perhaps multiple placements in foster care. The time required is more likely measured in years than in months.
  • It may be difficult for smaller, high quality group homes to meet the criteria for QRTP’s.

There is no doubt that many congregate care facilities are of poor quality–witness the horrors suffered by Washington and Oregon youths who were shipped out of state. The framers of FFPSA were right in wanting to ensure that these facilities entrusted with our most fragile youth are up to the task, although they  adopted a blunt instrument for doing this. Let’s hope that other states follow Washington’s plan and respond to FFPSA by ensuring that therapeutic group homes are adequate in quality and quantity rather than eliminating them.

 

Supporting homelike residential settings: a needed correction to the Family First Act

CrossnoreWith 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.

  1. 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.”
  2. 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.
  3. 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.
  4. 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.

The misuse of data and research in child welfare: home visiting and infant removals in New York State

Healthy Families New YorkData and research have tremendous potential to inform policymaking, allowing us to identify population trends and to assess the effectiveness of programs. Unfortunately the increasing importance placed on these tools has resulted in their frequent misuse. One recent article in the Chronicle of Social Change, a major online child welfare publication, exemplifies typical errors often made by public officials and accepted uncritically by the media.

The article is called The Program New York Says Helped Cut Newborn Removals to Foster CareIn it, Ahmed Jallow reports that the number of infants removed into foster care in New York State has “plummeted” while the same indicator has been increasing in the majority of states. Jallow quotes unnamed “state officials” that a home visiting program called Healthy Families New York (HFNY) is “the primary reason for this reduction in infant removals” and devotes most of the article to explaining and supporting this assertion. Unfortunately, the officials Jallow quotes simply don’t have the evidence to substantiate their claims. Rather than make this clear, Jallow reports these unbacked claims without qualifications and even adds additional misleading information to bolster them. These issues can be grouped into several categories.

Attributing causality without evidence. The centerpiece of the article is the claim by  New York State officials that the HFNY home visiting program is the primary reason for the reduction in infant removals in New York City. HFNY is New York’s version of one of the most popular home visiting models, which is called Healthy Families America (HFA). The difficulty of proving causality is well-known by social scientists, and journalists who write about policy should know enough to caution against accepting such blanket statements. To reduce child removals, a home visiting program would first have to reduce child maltreatment, and that reduction would have to be translated into a reduced removal rate. There are many factors that could more directly affect the number of infant removals, such as a shift in policy to prioritize keeping families together while accepting higher risks to children. And indeed, in New York City, by far the largest jurisdiction in the state, the Commissioner of the Administration on Human Services has attributed the decline in its foster care rolls to his agency’s “focus on keeping families together wherever we can.”

Making factual errors. Jallow states that “evaluations of HFNY show a significant impact in preventing further maltreatment incidents for parents involved with child protective services.” Actually, evaluations do not show a significant impact of the HFA model on child maltreatment. As a matter of fact, the respected California Evidence based Clearinghouse on Child Welfare (CEBC)  gave HFA a rating of “4” for prevention of child abuse and neglect, which means that studies have failed to find that it has any effect on child maltreatment. (The only worse rating is 5, which indicates that a program may be harmful to participants.) The only evaluation that Jallow cites is an interim report from an ongoing evaluation of HFNY suggesting that the program might reduce subsequent reports among women who had a previous substantiation for abuse or neglect. However, this study was never published in a peer-reviewed journal and therefore was not included in CEBC’s review.

Misusing evidence-based practice compilations. The CEBC and other clearinghouses of evidence-based practices can be very helpful to lay audiences by digesting and translating the results of methodologically complex studies and rating programs by the strength of their evidence. But users must be careful to read and understand the reports they are using.  Jallow states that the HFA home visiting  model (of which HFNY is an example) “has the highest rating of effectiveness on the California Evidence-Based Clearinghouse.” But he was reading the wrong report. As mentioned above, CEBC found that HFA failed to demonstrate any effect on child abuse and neglect. It is in a separate report on home visiting programs for child well-being that HFA CEBC gave HFA its top rating (“well supported by research evidence”) because of its impact on outcomes other than child abuse and neglect.

Overgeneralization: “In terms of documented proof, home visiting is the one that we know absolutely works,” Timothy Hathaway, executive director of Prevent Child Abuse New York, told Mr. Jallow. Unfortunately, Mr. Hathaway was overgeneralizing. There are many different home visiting programs which vary based on the nature of the provider, the content of the program, the goals of the program, and other factors. The effects of most home visiting programs on child abuse and neglect have been disappointing. The only program that has been found to have well-supported evidence of an impact on child abuse and neglect from CEBC is the Nurse Family Partnership program, which is very expensive and difficult to implement, and can only be used for certain populations–like first-time mothers. It is not surprising that many jurisdictions have opted to implement HFA instead.

Disregarding recent data. In addition to all the problems cited above, Jallow and his New York State informants chose to disregard the most recent data on foster care entries in New York. Jalloh reports, accurately, that the decline in infant foster care placement between 2012 and 2016 was part of an overall decline in the number of New York children entering foster care. And as Jallow states, this decline occurred while entries into foster care increased on the national level. But the pattern was reversed in 2017: nationally, foster care entries decreased slightly, while New York’s foster care entries increased. We don’t yet have the 2017 data for infants, but it seems likely that the trend in infant removals also reversed. Could it be that New York is starting to see the same kind of increase in removals that occurred earlier in many other states? Perhaps a growing opioid crisis in western New York is contributing to this, or perhaps the increase in child removals stems from concern that the focus on family preservation is endangering children.  And indeed an increase in child removals in New York City over the past 18 months has been attributed to an increase in hotline reports and a more aggressive response to these reports by investigative staff in the wake of  the highly-publicized child abuse deaths of two children who were known to the system but not removed. Disregarding the most recent year of data certainly makes for a clearer picture, but but it may be a less accurate one.

Jallow’s article illustrates how a flawed understanding of research and data can lead to faulty conclusions. A grandiose claim that one program is responsible for large changes in an indicator like child removals  deserves initial skepticism and rigorous vetting. Uncritical acceptance of such claims can lead to misguided policy decisions, like a decision to direct more funding to a program that is unproven. The press should scrutinize such claims assiduously, rather than accepting them credulously, presenting them without qualifications, or adding  flawed arguments in favor of these claims.

 

Sibling Separation: An Unintended Consequence of the Family First Act?

siblings.pngI recently read a book that should be a must-read for all involved in child welfare policy. In Etched in Sand, Regina Calcaterra tells of being left at the age of eleven to care for her two younger siblings while her mother disappeared for weeks at a time. When she was home, her mother savagely beat the children. Chronically malnourished and living in fear, Calcaterra was responsible for feeding, clothing, and protecting her younger siblings–and making sure they looked clean and well-fed so as not to draw the attention of the authorities who might place them in foster care.

Despite her horrific childhood, the goal of Regina and her older siblings, as she said in an interview for Youtube TV, “was to never to be picked up by the authorities because when the authorities found out how we were living, they would separate us.” When Regina was finally unable to satisfactorily explain the results of a savage beating, the children were indeed taken into care and separated.

No maltreated children should have to hide their plight in order to avoid separation from each other. Yet, this is undoubtedly the situation facing many children even while you read this. I myself know two girls who, for fear of being separated, remained for two years with an uncaring guardian who diverted her guardianship stipend to her own needs. The girls only recently broke the silence, and were removed from this toxic home.

Sibling relationships are known to be critically important in emotional development in childhood and beyond, as documented in a useful publication from the Child Welfare Information Gateway. In abusive and neglectful families, sibling relationships can be even more important as siblings support each other through adverse circumstances.

Keeping siblings together in foster care provides an important element of continuity for children who have already suffered a traumatic removal from the home they had known. As the the brief cited above puts it, “For children entering care, being with their brothers and sisters promotes a sense of safety and well-being, and being separated from them can trigger grief and anxiety.” Some studies have reported poorer outcomes for children separated from their siblings in foster care.

We don’t know how many siblings are separated in foster care. Older studies indicate that a large proportion of foster children were separated from at least some of their siblings, but the proportions varied by location. Current, national data are not available.

In most cases siblings are separated for no other reason than the lack of foster homes that can accommodate siblings, especially larger sibling groups. There is a nationwide shortage of foster parents, but foster parents who are able to take more than two siblings are even more scarce.

In some states, like North Carolina and Florida, family-style group homes have been an important vehicle for keeping siblings together.  Many of these homes, such as Crossnore School and Children’s Home in North Carolina and A Kid’s Place in Florida provide highly enriched services to their residents with the help of public and private philanthropic funding. These homes often use a family-style model based on houseparents that mimics a family home. Group homes are serving sibling groups in many other states, including CaliforniaTexas and New York.

Unfortunately, the recently passed Family First Prevention Services Act (FFPSA) threatens these important havens for sibling groups and may result in mass separations of siblings. That’s because FFPSA eliminates federal funding for placement of children in congregate-care settings such as group homes beyond two weeks, unless an assessment shows that a child’s needs cannot be met with family members or in a foster family home. Moreover, group facilities must meet criteria as “Qualified Residential Treatment Programs” designed to meet the needs of “children with serious emotional or behavioral disorders.”

FFPSA is based on the widely-held belief in child welfare circles that most children do better in a family than in another type of setting. However, experts such as Dave Bundy, President and CEO of the Children’s Home Society of America, believe that it is better to keep siblings together in congregate care than to split them up among separate foster homes.

Moreover, many legislators and executives pressing for closing group homes have much more than children’s best interests at heart. The greater cost of congregate care has clearly contributed to its growing unpopularity and to the bipartisan support of FFPSA. But these comparisons are often deceptive.  Facilities like  Crossnore and the Florida Sheriffs Youth Ranches provide therapists, case managers, after-school activities, and other services, such as therapeutic riding. Moreover, they bring in substantial private funding in addition to state support. And no matter how expensive they are, they cannot cost more than keeping children in hotels and offices when there are no homes for them, which is happening around the country.

Siblings have already been separated due to the policies against congregate care that have already taken hold in some states. From 2006 to 2015, Sonoma County Children’s Village was a haven for 24 foster children, including sibling groups, who  lived in four homes staffed by “village parents,” with surrogate grandparents living in onsite apartments. But after California began to limit group home placements for children requiring high levels of care, the village had to close.  Sixteen children, including a group of seven siblings, had to leave. The children were devastated. They sent out appeals to the likes of Barack Obama and Taylor Swift, but to no avail.

There is another approach to housing large sibling groups which in practice looks very similar to family-style group homes. Some child welfare agencies contract with private agencies, such as Neighbor to Family in Florida and Georgia, that provide homes where siblings can live together in foster care. Some of these programs actually provide larger houses in clusters or “neighborhoods” to foster parents willing to care for large sibling groups but who don’t have the space. This clustering provides the added benefit of community support and shared facilities for recreation and other activities. Such programs include the SOS Children’s Villages in Illinois and Florida. New homes are currently being built in locations around the country including Oklahoma,  and Southwest Florida. However these programs are too few and far between to make a dent on the national problem of sibling separation in foster care.

Perhaps all the group homes that keep siblings together could eventually be replaced by family foster homes with housing provided by public and private agencies. The feasibility of this approach would have to be investigated; it might be even harder to find good foster parents than it is to find good houseparents, because the latter generally have a schedule that allows time off to return to their own residences, while being replaced by a substitute couple. In any case, such a transition would take years to accomplish and could not occur in the short period preceding the implementation of the FFPSA provisions, which go into effect on October 1, 2019. States can apply for a two-year delay in implementing these provisions but then they must forego the opportunity to received federal matching funds for services to prevent foster care placements. (For a detailed explanation, see the “Cliffs’ Notes on Family First” from the Chronicle of Social Change.)

The sponsors and supporters of FFPSA likely had no idea that sibling separation might be a consequence of their legislation. Once they understand what they have done, I hope they will consider amending FFPSA to make  congregate care allowable for sibling groups and provide a new funding stream to encourage jurisdictions to build foster home communities where siblings can thrive together.

 

No, family separations are not all the same

child protectionThere is an old political adage that you should “never let a crisis go to waste,” meaning that a crisis can awaken public interest and create an opportunity to advance policies that might otherwise be unachievable.

President Franklin D. Roosevelt, for instance, was able to pass much of his New Deal – including a dramatic expansion of the country’s social safety net via the Social Security Act – in the wake of the Great Depression with the American economy in shambles and the American public desperate for government support.

Unfortunately, in a cruel twist of irony, some child advocates are now using the devastation wrought by the Trump administration’s separation of children from their parents at the U.S.-Mexico border to advance arguments undermining a key part of the Social Security Act – support for children who cannot be cared for in their own homes.

Several weeks ago, Sherry Lachman, the executive director of Foster America, authored a Time essay suggesting “family separation is not just a problem at the border.” In this piece, Lachman bizarrely equates the separations at the border with removals of U.S. children from their homes by child protective services, suggesting even the latter are “inherently toxic.”

And last week, Vivek Sankaran associated the two systems, misleadingly citing statements in an opinion piece that were made about the border separations to attack child removals by child protective services – without disclosing that these statements actually referred to the latter rather than the former. Sankaran quotes Dr. Charles Nelson, professor of pediatrics at Harvard, as follows: “[T]here is so much research on [child removal] that if people paid attention at all to the science, they would never do this.”

Finding it hard to believe that a distinguished Harvard professor would suggest that children should never be removed into foster care, we contacted Dr. Nelson, who explained that his words were taken out of context, as he was referring to separations at the U.S.-Mexico border and not the removal of children from abusive or neglectful homes. Dr. Nelson agreed that any comparison of the two systems is misconceived, noting: “It is inappropriate to compare children experiencing forced separations from their parents in the context of migration to children removed from parental care due to maltreatment (abuse, neglect).

The separation of children from their parents at the U.S.-Mexico border was an ill-conceived policy that arose from the desire to discourage migration. Rather than being aimed at protecting children, this policy was adopted despite the obvious fact that it would be extremely harmful to them.

The child welfare system, on the other hand, was created to protect children from harm inflicted by their own parents or guardians. It is a sad fact that some homes are dangerous to their own children. Forty-nine states reported 1,700 child fatalities due to abuse or neglect in 2016, and there is wide consensus that this is likely an under count. We don’t know how many more are severely injured but survive; it is doubtless much higher.

And deaths and severe injuries are only the tip of the iceberg. There is extensive literature on the lifelong consequences of child abuse and neglect. These include chronic health conditions, impaired brain development, poor mental and emotional health, social difficulties, juvenile delinquency and adult criminality, alcohol and drug abuse, and an increased likelihood of abusing one’s own children.

Moreover, foster care is a rarely-used intervention by CPS. Most systems try hard to keep children at home by providing services to the parents to help remedy the conditions that caused the maltreatment. In 2016, according to federal data, agencies placed slightly over 200,000 children involved in maltreatment investigations in foster care and provided other post-investigation services to about 1.1 million children and families.

Yes, removing children from their parents is often traumatic to the child. But it goes without saying that in some terrible home situations, the damage to a child of staying in the current home would be greater than the damage caused by removal.

As Dr. Nelson puts it:

Of course we would like to see the biological parents be successful in changing the family dynamics and preserving the parent-child relationship but if that is impossible, and the harms to the child continue, then the child should be removed from the home, either temporarily, if the home situation can be remedied, or permanently.

But, it is of utmost importance to act with alacrity – I think in many cases children are left for far too long in their biological homes and by the time they are placed into foster care or adoptive care, they may be irreparably harmed.

Setting aside the vastly different reasons for, and targets of, family separations at the border and child removals by child protective services, there are huge differences between the two sets of policies. Cathy Senderling-McDonald recently wrote an instructive and comprehensive summary of the distinctions, outlining the vast differences in living conditions, objectives, legal structure and oversight.

Using the suffering of parents and children at the border to denigrate foster care is not merely an illogical comparison, it is a harmful one that can result in suffering, lifelong damage, and even death to children. Moreover, it is offensive to those professionals who have devoted their lives to protecting children, and to the children who have suffered and died for lack of such protection.

Let us be clear: we want to prevent children from being removed from their parents whenever it is safe and appropriate to do so.

But let us be equally clear: until we eliminate serious child maltreatment and endangerment from every home, there will always be a need for foster care to keep kids safe. To pretend otherwise is naïve, dangerous and irresponsible.

This op-ed was published in the Chronicle of Social Change on September 6, 2018. I wrote it with Sean Hughes, the director of government relations for the consulting firm Social Change Partners. 

 

Child Welfare Myths: Black/White Disproportionality in Child Welfare is due to Racist Child Welfare System

Graph: http://www.childrends.org

According to federal data, black children were 13.8 percent of the total child population in the United States in 2014. Yet, they constituted 22.6 percent of those identified as victims of maltreatment, and 24.3 percent of the children in foster care. In Minnesota, the disparities appear to be even greater. Citing these disparities, two legislators have proposed the Minnesota African American Preservation Act.

The Act would create an “African American Child Well-being Department” within the Department of Human Services to receive notification of all cases involving African-American children and “directly  oversee, review, and consult on case plans and services” offered to these children. It would also create an African American Child Welfare Oversight Council.  Similar to the Indian Child Welfare Act, it would set a higher bar for removing African American children from their homes than white children and require greater efforts to reunify children once removed from their families.

The bill’s sponsors argue that racial disparities in child welfare are caused by differential treatment of minority families in terms of how allegations of maltreatment are investigated, resolved, and responded to. This is belief, which was supported by early research, has become accepted by the child welfare establishment.

The idea of racial bias in child welfare found support in the first two National Incidence Studies of Child Abuse and Neglect, which were published in the 1980s and 1990s. These studies, which attempt to count all episodes of abuse and neglect rather than just those that are reported and substantiated, suggested that there was no difference in black and white child maltreatment rates. The study authors suggested that black families received differential treatment by child welfare systems, resulting in their over-representation in these systems.

Starting about 2004, a coalition of foundations, nonprofits, and academics formed around the idea that this disproportional representation of black children in child welfare stemmed from a racist system. This coalition launched a well-funded campaign to reduce the representation of black children in child welfare and especially foster care. They issued reports, held conferences, and provided training and technical assistance to help states analyze their disproportionality problems.

As a result of this work, agencies around the country have adopted strategies like staff retraining, creating special administrative structures to advance racial equity, and special data collection efforts. As a social worker in the District of Columbia, I was subjected to multiple, often poor-quality trainings that tried to help me discover my hidden biases so that they would not affect my treatment of families. 

The fact that child welfare workers in many jurisdictions are disproportionately African American has not influenced the consensus in favor of such strategies, as pointed out in an excellent article by Naomi Schaefer Riley. When I pointed out in a training class that most District of Columbia child welfare social workers were African-American, I was told that did not matter, as Black social workers could be as racist as white ones.

But a cascade of new research has cast grave doubts on the accepted theory of disproportionality. The third (larger and more rigorous) National Incidence Study published in 2010 estimated that black child maltreatment rates are almost twice as high than those of whites. Further analysis showed that this difference was present in the earlier study, but due to small sample sizes, the differences were not statistically significant and hence not reported.

conference, convened in 2011 by Harvard, Chapin Hall at the University of Chicago, the National Council of Juvenile and Family Court Judges and the National Court Appointed Special Advocates, brought together leading scholars on child welfare and race in front of an audience of child welfare leaders from around the country. A research brief summarizing the conference that was published by Chapin Hall concluded that “there is a significant black/white maltreatment gap, one that roughly parallels the gap in official maltreatment reports. This evidence contradicts the belief that black children are included at high rates in the child welfare system because of bias.”

The brief’s authors based their conclusions on the National Incidence Study as well as other empirical work reinforcing the conclusion that child maltreatment rates are significantly higher for black children. They suggested that the higher rate of maltreatment among African-Americans stems from the history of slavery and racism, which led to higher poverty and concentration in impoverished neighborhoods characterized by crime, substance abuse, unemployment, and limited community services.

In other words, disproportionality is rooted in racism. But It’s not a racist child welfare system that results in disproportional representation of black children in the child welfare system. Rather, it is the racist history of our country that has created the difference in child maltreatment which in turn resulted in disproportional representation.

The researchers concluded that trying to reduce racial bias in the system is not the way to address the inequity between blacks and whites in child welfare. Instead, we need to address the underlying social conditions. And until we can do that, we need to protect children, both by preventing maltreatment and by providing appropriate protective services.

Since the Harvard conference, the evidence continues to accumulate that black and white maltreatment rates differ. A recent study published in the journal Pediatrics concluded that the child abuse fatality rate for children aged four and under was 8.0 per thousand African-American children, compared with 2.7 per 100,000 white children.

Unfortunately, many child welfare agencies, advocates, and legislators, including the sponsors of the Minnesota legislation, are either unaware of, or do not want to recognize, the new consensus among researchers. As The Los Angeles Times put it:

“Many left the [Harvard/Chapin Hall] conference believing that any caseworker bias against black families accounted for only a small portion of the disparity in foster care rates … Yet, Los Angeles County officials pressed forward with programs that assumed that racial bias was a significant cause for the high rate of [foster care placement] of black children.”

As I have written in the past, Native American children have been victimized by a similar type of reasoning. The Indian Child Welfare Act has been responsible for separating Indian children from loving foster families and placing them with relatives they do not know. On some occasions, these relatives have hurt or killed them.

This focus on reducing alleged systemic bias may do more harm than simply wasting child welfare resources on bureaucracy and training. If black children are more likely to be maltreated, equalizing black and white representation in the child welfare system would leave many black children in danger of years of suffering or even death. As Naomi Schaefer Riley put it, “No it’s not racist to save minority children’s lives.”