Impact of coronavirus on child welfare: a one-sided federal view

afScreen Shot 2020-04-18 at 12.58.40 PM.pngThe coronavirus is affecting every aspects of the child welfare system and its ability to achieve its three major goals–safety, permanency and well-being. In our last post, Child Welfare Monitor discussed the threat posed by social distancing to the safety of abused and neglected children who are not involved with the child welfare system. For children in the system, especially those who are in foster care, the disruptions posed by the response to the coronavirus pandemic pose a great threat to their hopes for permanency. Two top officials of the federal Children’s Bureau have expressed great concern about the effects of the crisis on permanency and their hopes that the states will prioritize family reunification both during and after the period of social distancing. Unfortunately, their formulation of the issue reveals a one-sided analysis of the problem. Moreover, they seem to have no interest in the safety of children trapped in their homes with abusive or neglectful parents.

Federal officials have rightly expressed their concern that the coronavirus pandemic will extend some children’s stays in foster care. There are three major reasons this might happen, as described in an excellent article in the Chronicle of Social Change. Services to parents, such as mental health, drug treatment, and parenting skills programs, are threatened by the pandemic. Some may have shifted to virtual services, but not all parents have the technological wherewithal to participate. Other services might not be provided at all. Secondly, reunifications must be ordered by a court, and courts have been drastically affected by the crisis. Most court buildings are closed; many are conducting virtual hearings but only for hearings deemed essential and able to be conducted virtually.

Third and perhaps most important, most visits between children in foster care and their parents have become virtual, conducted through apps like Facetime or Skype. But virtual visits are difficult with infants and young children, and for older children they cannot substitute for extended visits. Moreover, virtual visitation does not allow the normal progression from shorter and supervised visits to longer unsupervised ones, culminating in reunification as parents are able to prove that they can manage the children for extended periods of time.

The timelines written into law by the Adoption and Safe Families Act (AFSA) could result in termination of the rights of parents who through no fault of their own were unable to comply with their court-ordered case plans. These timelines require that a state must file a petition for Termination of Parental Rights (TPR) if a child has been in foster care for 15 of the last 22 months, with certain exceptions. If these timelines were strictly interpreted, the COVID-19 crisis could result in the termination of many parents’ rights because they would have been unable to complete services or demonstrate appropriate parenting skills by the end of the 15 months.

It must be noted, however, that the ASFA timelines are often honored more in the breach than in the observance even in normal times. The law allows them to be exceeded if there are “compelling reasons” to determine that TPR is not in the best interests of the child. Under these auspices, many parents have been given much more time to work toward reunification. As a social worker in the District of Columbia, this writer saw numerous cases in which children were reunified with their families after much more than 15 months in foster care.

Last week, the Chronicle of Social Change published an impassioned column by Jerry Milner, associate commissioner of the U.S. Children’s Bureau and his special assistant, David Kelly. Milner and Kelly argue that the virus itself should not be a reason to keep parents and children apart.

Despite our strong preference that all measures be taken to continue in-person family time for children in foster care and their parents and siblings, there will undoubtedly be instances where such family time is not provided. In some instances that may be appropriate due to the presence of the virus in the resource family home or home of the parent. In many more instances, there will be no known safety threat.

It appears that Milner and Kelly are advocating for in-person visits whenever there is no virus in the home of the foster family or birth parent. Governor Brian Kemp of Georgia became the focus of ridicule when he claimed on April 1 to have just discovered that as much as 25 percent of those with coronavirus might have no symptoms but still transmit the virus to others. Perhaps Milner and Kelly not yet learned about that finding. Moreover, one wonders what they would suggest if their recommendation resulted in the wholesale desertion of foster parents afraid of the risks of exposing the children in their custody to one or more family members each week.

Down the road, when families begin to bump up against their ASFA time limits, Milner and Kelly urge states to make use of the statutory exception allowing them not to file for TPR if there is a compelling reason to believe such filing would not be in the best interests of the child. That may be a reasonable prescription in many cases, considering how often this justification is used even in normal times. However, Milner and Kelly go on to anticipate attempts by unnamed nefarious forces to “use the crisis to serve their own interests or those of their constituencies. There will be those whose implicit or even explicit biases are drawn out into the light.” Thus, Milner and Kelly continue the practice of calling anyone who prioritizes the rights of children over those of their parents as racist, as Child Welfare Monitor pointed out in an earlier post.

Milner and Kelly take the opportunity to argue against the ASFA permanency timeline, arguing that it was “more the result of negotiation than what we know about the importance of parent-child relationships, recovery and trauma.” Yes, the ASFA timeline was the result of political forces, but in the opposite way from that claimed by Milner and Kelly. The earlier drafts of AFSA contained shorter timelines for younger children based on what we know about child development. These shorter timelines were eliminated because they would have made the bill impossible to pass.  Milner and Kelly warn that “child development and bonding will be used in arguments not to return children to their parents and to expedite adoptions in instances where families did not have a fair chance.” By denying the importance of bonding instead of acknowledging there is a conflict between two important values, Milner and Kelly betray that their position is based on ideology, not analysis.

Despite their misguided recommendations and hyperbolic statements, Milner and Kelly are right about the threat to timely permanency posed by social distancing and its effects. But they ignore that the social distancing imposed by the coronavirus is having a very different effect on children who have been abused and neglected but are not involved with the foster care system. Although there are strong reasons to believe that abuse and neglect are increasing, reports to child abuse hotlines are down as much as 50 percent around the country because children are not seeing the adults who usually report concerns about child maltreatment, especially school and medical personnel.  This crisis has drawn considerable media attention, as Child Welfare Monitor has described, and states and nonprofits have taken action to publicize the signs of child abuse and urge teachers who see children online and other workers who see children in person to be alert for the signs and ready to report to child protective services hotlines. But even during Child Abuse Prevention Month, Milner and Kelly have nothing to say about this issue and have issued no guidance for states and counties.  It is obvious that their minds are elsewhere.

Two of the major goals of child welfare–safety and permanency–are often in conflict. It takes wise leadership to navigate the narrow channel between endangering and separating them from the parents they love. Sadly, we are not blessed with such leadership on the federal level in these troubled times.

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Kinship Diversion: A parallel system of foster care

KinshipDiversion
Image: WAMU.org

The development of a system of informal kinship care that is parallel to the foster care system has recently begun to receive attention among academics, advocates and policymakers. This second system includes relatives who are caring for children under an informal arrangement facilitated by child welfare agencies through a practice called kinship diversion. This system has been called America’s Hidden Foster Care System by Josh Gupta-Kagan, Associate Professor of Law at the University of South Carolina.  Because most states don’t collect data on this practice, we don’t know how many children are affected, but it appears to be the most prevalent placement for children investigated by child protective services (CPS) agencies and greatly dwarfs kinship care within in the foster care system.

An issue brief from the research organization ChildTrends states that there is no agreement on the definition of kinship diversion, but in general it refers to a situation where a child welfare agency decides a child cannot be safe in a home due to abuse or neglect. But instead of taking custody of the child and requesting court approval for this move, the agency facilitates the transfer of custody to a relative outside the foster care system. This transfer is often effected through a “safety plan” or agreement between the parents, the agency, and the relative to keep the children safe. Whether stated or implied, parents know that failure to agree to the plan may result in the removal of their child and court involvement. According to Marla Spindel of the DC Kincare Alliance, sometimes the agency transfers custody of a child without the agreement of the parent, and only the agreement of the kinship caregiver.

The only national data on the prevalence of kinship diversion appears to come from a study of children who had contact with child welfare services within a fifteen-month period starting in February 2008. The researcher, Wendy Walsh, found that informal kinship care was the most common out-of-home placement for children found to be abused or neglected, accounting for almost half of children placed out of home. But these data are over ten years old. The limited data suggest that states are using kinship diversion in many more cases than they are licensing kin as foster parents. According to the most recent national data, 32 percent of children in formal foster care were in a relative home as of September 30, 2018. Gupta-Kagan cites a number of more recent studies in individual states that suggest kinship diversion is being used “with roughly the same frequency” as formal foster care overall–including relative and non-relative caregivers.

Newer data on kinship diversion are greatly needed. ChildTrends used a social worker survey to estimate the rates of kinship diversion in “several” unnamed jurisdictions. The researchers reported that “[I]n some jurisdictions, for every [ten] children entering foster care, an additional [seven] were diverted, while in others there was an equal split—for every child entering foster care, another child was diverted.” Without knowing how many and what jurisdictions were studied, and whether these were the highest and lowest ratios, it is hard to know how to interpret these data.

In addition to information about the extent of kinship diversion, we know little to nothing about how informal kinship care arrangements initiated through kinship diversion differ from foster care. Among the questions raised by ChildTrends are: Do kinship caregivers undergo a background check? Are services and supports provided and to whom? How do the services and supports differ from those provided in foster care? How long do diversion arrangements last? In their studies of three jurisdictions, ChildTrends found that agencies usually initiated background checks but often failed to complete them; an official case is not always opened; and services and supports to children, parents and caregivers are “inconsistently provided” and differ by jurisdiction. The “greatest disparity in supports” was that diversion caregivers do not receive foster care stipends and usually have to rely on welfare assistance to support the children.

As Gupta-Kagan points out, kinship diversion has raised various concerns both ends of the child welfare ideological spectrum. Those who are concerned about parents’ rights worry about the state removing children without due process protections for their parents. Moreover, unlike with foster care, there is no requirement that the agency make reasonable efforts toward reunification or develop case plans prescribing what parents must do to get their children back. Those who are concerned about children’s safety and well-being worry that kin caregivers may return the children to their parent at any time, regardless of safety, or may allow unsupervised visits with dangerous parents. Child advocates also worry that there is no permanency for these children as they move back and forth between parents and caregivers. Moreover, informal kinship caregivers may not receive the same level of screening as potential foster parents. These caregivers and the children they raise do not usually receive the same supports as they would in foster care, including stipends, case management, and mental health, drug treatment and parenting services. If not granted custody in court, these caregivers have no legal rights to obtain medical care, enroll children in school, or approve services, and a parent can come back and take custody of the child at any time. 

Some stakeholders support kinship diversion because they think it is always better to keep children out of state custody and allow families to decide their own futures. In the jurisdictions that it studied, ChildTrends found a wide variety in opinion among stakeholders but widespread agreement (over 90 percent) in favor of kinship diversion among agency social workers in five states.

Gupta argues that the “hidden foster care system” enabled by kinship diversion is “likely growing and it is certainly becoming institutionalized through federal funding incentives, new federal funding which strengthen those incentives, and state policies which seek to codify the practice.” As Gupta points out, there is a strong financial incentive for states and other jurisdictions to use informal kinship care. They avoid expensive foster care payments as well as the expenses of case management and other services to children in foster care and their families. Gupta argues that the new Family First Act further incentives kinship diversion by allowing funding for services to children and their parents for a year or more while they remain in an informal kinship placement.

Gupta fails to mention another incentive for kinship diversion–reducing the foster care rolls–which has become increasingly viewed as a favorable outcome and even (somewhat paradoxically) as a goal of child welfare systems. For example, one of the four pillars by which the District of Columbia’s child welfare agency measures its performance is Narrowing the Front Door, or reducing entries into foster care. Casey Family Programs, the two-billion dollar private foundation with an oversize influence on child welfare policy around the county, still proclaims (somewhat anachronistically) on its website that one of its four primary goals is to “Safely reduce the need for foster care by 50 percent by the year 2020.”

Some kinship diversion critics, like Gupta-Kagan, argue for more regulation of the practice to require appointment of attorneys for parents, impose a maximum length of time for safety plans that change custody, and allow parents to seek court review of safety plans.  Others, like Marla Spindel of DC Kincare Alliance, believe that kinship diversion as currently practiced is both harmful and illegal under state and federal law.

There is a case to be made for an outright prohibition on kinship diversion to eliminate the possibility that an abused or neglected child be returned to the parents before a professional can assess that the child is safe. Custody changes involving CPS would have to take place through an official removal subject to court approval, leading to formal foster care, or through a time-limited Voluntary Placement Agreement (VPA, which is allowed by federal and state law). A VPA can be used to place a child with a relative for a limited time period (such as 90 or 180 days) with the requirement that court proceedings be brought if reunification with the birth parent is not achievable in that timespan.

DC Kincare Alliance (DKA) and the law firm Ropes & Gray has filed an unprecedented federal lawsuit against kinship diversion in the District of Columbia. The lawsuit was filed on behalf of three relative caregivers and  three children they are raising. DKA argues that CFSA is violating the federal Social Security Act and several DC laws by using kinship diversion instead of removing these children formally and licensing their caregivers as foster parents. The case seeks a court ruling that kinship diversion is illegal and an order prohibiting CFSA from engaging in this practice. It also seeks damages for lost foster care payments “and other injuries.”

As policymakers debate restrictions on kinship diversion, not time should be lost in learning all we can about the extent and nature of the practice today. At a minimum, as proposed by Gupta, states should be required to track every case of kinship diversion to provide information about the total number of cases, the safety and well-being of the children, how long they remain in these arrangements, and how cases are resolved. We also need to know the policies and practices that states are following in terms of clearances, supports, monitoring, and other ways the arrangements may differ from foster care. The hidden foster care system must be brought out of the darkness and into the light of day.

 

 

 

 

 

Washington Post on foster care: old tropes and false narratives

The Donald R. Kuhn Juvenile Center in Julian, W.Va., where Geard Mitchell, now 17, spent part of his childhood. A lawsuit says 10 states’ agencies tasked with caring for children failed, “jeopardizing their most basic needs.” (Sarah L. Voisin/The Washington Post)
Image: Washington Post

Foster care has finally made it to the front page of the Washington Post, and a sad story it is. The story highlights the growing crisis in many states due to the increase in drug addiction bringing in its wake a cascade of child removals into foster care, outstripping the supply of  foster homes and other placement. The problems outlined in the article are real and urgent, but the analysis and prescriptions offered in the article and subsequent editorial reveal the authors’ lack of understanding of the issues, which results in the repetition of false narratives and common misleading tropes.

The Post‘s front-page article focused on a growing crisis caused by increased drug addiction among parents, especially the opioid crisis. The author, Emily Wax Thibodeaux, zeroed in on West Virginia, one of the epicenters of the crisis. She introduced us to Arther Yoho, a young man who spent more than two years in a detention center because there was no foster parent available to take him in. Locked up with 27 juveniles with criminal convictions, Arther was failed by the system that was supposed to protect him.

Thibodeaux reports that other desperate states are using emergency shelters, hotels and out-of-state institutions to house youth for whom there is no foster family home available. This is tragic and true, and I wrote about it in a recent post, although the placement of foster youth in detention centers along with criminally charged youth may be unique to West Virginia with its cataclysmic foster care crisis. Thibodeaux reports Oregon’s use of refurbished detention centers to house foster youth, which is certainly not ideal but is quite different from housing them with juvenile offenders. In any case, Thibodeaux is right to point out that many young people in foster care are being placed in inappropriate (and often harmful) placements because appropriate ones are not available.

However, Thibodeaux takes an unwarranted conceptual leap by linking the placement of children in inappropriate facilities to states’ use of congregate care, a term used to connote placements that are not families. These include what are generally known as group homes, as well as residential treatment centers, which are part of the accepted continuum of care for foster youth. While detention centers are never appropriate for foster youth who have not been charged with a crime, group homes and residential treatment centers may be the appropriate placement, often for a limited time, for some youths in foster care. These are the young people who cannot be maintained in a regular foster home because of their defiant, violent, or self-destructive behavior. Many of these children might be able to “step down” to foster care after spending time at a therapeutic residential facility.  It is possible that some of these young people could be helped in a professional therapeutic foster home staffed by salaried and trained foster parents, an approach that is gaining increasing interest, but programs so far are few and small and not likely to meet the need for therapeutic placements.

Thibodeaux cites the common trope that “Compared with foster children living with families, those housed in congregate care settings are more likely to drop out of high school, commit crimes and develop mental health problems.” That is very true. But it is a matter of correlation, not causation. It is the younger and less damaged children who end up in foster homes in the first place. Not surprisingly, they are likely to have better outcomes. Concluding that congregate care causes the negative outcomes may well be akin to concluding that fire trucks cause fire damage since buildings that have been visited by fire trucks are far more likely than typical buildings to have sustained fire damage. We don’t have a body of research on what happens to children with similar risk factors who spend time in foster homes compared to those who spend the same amount of time in group homes.

Thibodeaux appears to be unaware that some of the states with the lowest proportions of children in congregate care are those that are struggling the most with inappropriate placements. Washington and Oregon are among the states with the highest proportions of foster children placed in families as opposed to congregate care facilities, according to federal data cited in a recent report from the Annie E. Casey Foundation. Both states have been the subject of disturbing media reports that foster youth are staying in hotels, offices and substandard and abusive out-of-state facilities. That’s not surprising, since appropriate options are not available.  In Washington, ten years of group home closures led to the current crisis. The director of Washington’s child welfare agency has requested funding to expand the capacity of therapeutic group home beds to accommodate the children who are now staying in hotels and offices. The director of Oregon’s agency has cited a reduced number of treatment beds as a cause of children being sent to substandard and abusive out-of-state facilities.

By implying that all congregate care placements are inappropriate, Thibodeaux lays the groundwork for false conclusions about policy. Rather than saying that states need to beef up their therapeutic options, whether they are professionally-trained therapeutic foster parents or therapeutic group homes or residential treatment centers, Thibodeaux suggests that the new Family First Prevention Services Act, which makes it more difficult to obtain federal reimbursement for congregate care stays, may solve the problem.

Actually, the Family First Act may well make things worse. By making it harder to license therapeutic group homes, there is reason to fear that Family First will exacerbate the placement crisis. This has already happened when group homes closed in in jurisdictions like Oregon, Washington, New York City, and Baltimore. In California, the closure of group homes due to their Continuum of Care “reform” (a predecessor of the Family First Act) has resulted in, according to one veteran service provider, “fewer kids in group homes, but only because there are fewer group homes and counties have inappropriately been pushing challenging, difficult-to-manage youth into lower levels of care.”

The Washington Post followed Thibodeaux’ article with an editorial, “The Crisis in Foster Care,” which repeated and further distorted some of Thibodeaux’s questionable statements. Where Thibodeaux reported that 71% of foster children aged 12 to 17 are in congregate care placements in West Virginia (a high number to be sure), the editorial page erroneously stated that seven in ten of all foster children are in such foster care placements. That is a huge difference as older children are much more likely to be in such placements.

The opinion writers go on to repeat Thibodeaux’ misleading statement from the Casey Foundation about children in group homes doing worse than those in foster homes. However, they also cite discouraging outcome data about children growing up with foster parents. Because both options seem bad, the opinion writers suggest that “the least-bad option for many children” may be staying or reuniting with their parents, “unless there is abuse in the home. “They go on to cite one of the most persistent tropes of all that child protective services workers “often remove minors from neglectful parents who, while a far cry from being good caregivers, may still be better than group homes.”

The trope that child neglect is “less than ideal parenting” is belied by some of the stories that have come out of West Virginia and other states in the throes of the opioid crisis. We’ve all heard the stories: infants born addicted to drugs to mothers unable to care for them,  children who lost their parents and even their extended families due to opioid overdoses, children abandoned at home without food while parents seek drugs, children strapped in cars while their parents get high, babies and toddlers who ingest heroin, alcohol or meth; children whose parents are incarcerated due to substance abuse or dealing; and more. This is not “imperfect parenting” but something much worse. Living with an addicted parent is has a host of negative consequences that may be lifelong and is in itself considered an Adverse Childhood Experience (ACE).

One article from the Seattle Times documents the impact of the drastic increase in infants born addicted to drugs when they reach school age. “[The lives of children who grow up with drug-abusing parents are marked frequently by the presence of police, the constant fear of a mother or father’s incarceration and the likelihood of sudden death by overdose — all traumas shown to impede brain development and learning.”

To add insult to injury, the Post did not even seek to find out what is happening in its own back yard. Only two weeks before Thibodeaux’s article, a hearing was held in the 30-year-old LaShawn class action case to discuss the current placement crisis in the District of Columbia. The Judge referred to a letter from the court monitor that 31 children, including seven children between eight and ten years old, experienced a total of 60 overnight stays at the Child and Family Services Agency between April and November of 2019. All of these children had challenging behaviors that excluded them from existing placements. The agency director acknowledged that the District needs more therapeutic placements (either in family or group settings) for these children. The District is in the process of developing  a new group home and “a couple of” professional foster parents. The District is a small jurisdiction and its crisis is dwarfed by that of West Virginia, but its 60 office stays deserved a mention in our hometown paper.

The Washington Post‘s treatment of foster care illustrates the consequences of letting reporting and editorial staff without subject matter expertise tackle a complex subject like foster care. Repeating false narratives and tropes from alleged authorities is easy and saves time. But it does not help readers to understand what is wrong and what is needed and on the contrary leads them to look for “solutions” that may make things worse.

 

 

Around the country, states face shortage of foster homes for youth with greater needs

Red Rock Canyon
Image: Salt Lake Tribune

Around the country, young people in foster care–especially those with greater needs– are being housed in facilities not designed for them because appropriate placements are not available. Children who are already traumatized by abuse or neglect are being warehoused in agency offices, hotels, emergency shelters, out-of-state facilities, and even detention centers, resulting in further harm to these most vulnerable children and high present and future costs for taxpayers.

Many youth in foster care have serious emotional and behavioral issues. Many have endured years of trauma, including physical and sexual abuse, severe neglect, and living in dangerous and chaotic conditions. Some have cognitive or neurological issues caused by drug exposure in utero or severe neglect. Some have violent outbursts, many are verbally aggressive, and many have difficulty in making attachments. Around the country, these youths are being placed in inappropriate settings because the right ones are not available.

  • In the letter accompanying his annual budget request, The head of Washington‘s Department of Children Youth and Families has acknowledged the scarcity of “therapeutic group home and facility-based placements for children with severe behavioral issues that don’t enable them to be successful in private foster homes.” As a result, he states, children are being placed in foster homes that are unequipped to handle them, resulting in further damage to the child and often a loss of the foster parent to the system. The lack of appropriate placements also led to over 2000 instances last year of children staying overnight in a hotel or office accompanied by a caseworker; and “excessive use of expensive one-night placements at extraordinary cost and detriment to the child.”
  • In 2016, the discovery that some Oregon children were sleeping in hotels or offices due to a lack of other options resulted in a public outcry and a class action lawsuit. In response, the state drastically reduced its practice of sending foster kids to hotels. But at the same time, according to an investigation by Oregon Public Broadcasting (OPB), the state began sending more foster kids requiring a higher level of care to out-of-state residential treatment facilities.  The majority of these children were housed in facilities run by one for-profit company called Sequel, as reported by OPB in a second installment of its investigation. After reports of abuse and neglect by staff resulted in the closure of five Sequel Facilities, Oregon began bringing its children home. There are now 30 children (down from 84 in February 2019) at out-of-state facilities, all of them run by Sequel, according to OPB.
  • Texas has projected that by 2021 it will have only 90% of the foster homes or other facilities it needs for youths with “specialized” or “intensive” needs (including 24-hour supervision from specially trained caregivers. ) And in some regions of the state the shortages will be much more severe, meaning that children will have to be sent far away if a spot can be found at all..
  • Illinois has had a longstanding problem of children being left in psychiatric hospitals after they have been cleared for release, a practice labeled as  “Beyond Medical Necessity (BMN). The Inspector General for the Department of Children and Family Services has reported that there were approximately 308 episodes of BMN during FY 2019 involving 297 individual youths. Such long stays in such an inappropriate setting result in further damage to children’s mental health. Moreover, the state cannot receive Medicaid reimbursement for such hospitalizations, leaving the state to foot the bill. In FY 2019, children left in psychiatric hospitals BMN ranged in age from 3 or 4 to 19 or 20 with the largest number being between 14 and 16. In FY 2019, 94 youths were hospitalized between 31 and 60 days and 154 youths were hospitalized from 61 to 120 days. The longest BMN hospitalization involved a fifteen-year-old who was hospitalized for 279 days.
  • As I discussed in an earlier post, an alarming report last March indicated that New York City children with behavior problems or mental illness were staying for months at an intake center where they are supposed to be no longer than a few hours until a real placement can be arranged. Instead they were staying as long as a year in this center, where social worker have 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.”
  • In my own jurisdiction of the District of Columbia. a special hearing was recently held in a longstanding class action case to discuss the current placement crisis. The Judge, referring to a letter that is not available to the public, reported that 31 children, including seven children between eight and ten years old, experienced a total of 60 overnight stays at the Child and Family Services Agency between April and November of 2019. All of these children had challenging behaviors that excluded them from existing placements. The agency director acknowledged that the District needs more therapeutic placements (either in family or group settings) for these children. The District is in the process of developing some new therapeutic placements but it is not clear that they will be enough to meet the need.

As many are already beginning to do, states must expand their array of placements for the young people with the most serious needs. There is increased interest in developing a cadre of highly trained professional foster parents for whom caring for hard-to-place youths is a full-time job. This may be the best option for many children, but these programs, where they exist, are very small both due to cost and to a small pool of people willing to take on this difficult job. So there will still be a need for more therapeutic group settings. In states including California and Florida there have even been calls for secure therapeutic settings to be established for the most disturbed youths. Child welfare agencies should coordinate with other agencies serving the same youths. such as developmental disabilities, mental health, and juvenile justice agencies, to develop a continuum of appropriate residential placements for all the youths who need them.

Leaders from Washington State to Washington, DC have already begun increasing budgets for therapeutic options including professional foster care and therapeutic group homes. But unfortunately the task of expanding the placement array to accommodate foster youth with greater needs will be made more challenging due to the new Family First Prevention Services Act. This Act was based on a false narrative that nearly all children can succeed in foster homes and that congregate (or non-family) care is always harmful to youth. Believers in this narrative combined with legislators who supported the law because it would reduce government spending. Family First makes it more difficult to place children in congregate care facilities and requires these facilities to meet a number of criteria, such as accreditation, a trauma-informed model, and 24-hour nursing staff in order to be eligible for funding under Title IV-E.

California is one indicator of what might happen under Family First because it is deep into a similar state-level reform called Continuum of Care. So far, many group homes have been closed or have been denied a license to care for foster kids. One veteran service provider in California writes that “there are fewer kids in group homes, but only because there are fewer group homes and counties have inappropriately been pushing challenging, difficult-to-manage youth into lower levels of care.” Family First will result in a replication of the California situation around the nation. At a time when we need more therapeutic facilities, Congress has made it more difficult for those in existence to continue and for new ones to be established.

As in many other areas, America has been penny-wise and pound-foolish in its reluctance to spend money on therapeutic placements for the most damaged young people in the foster care system. The new federal funding framework makes it even more difficult to fund the placements that the hardest to place children need. Let’s hope that states recognize that failing to provide therapeutic placements for these most fragile children now will only result in much greater costs later.

 

 

Family First Act: no funding for important drug treatment and mental health services

Family First ActPassage of the Family First Prevention Services Act as part of the Bipartisan Budget Act early in 2018 was hailed as a game changer in child welfare.  For the first time, according to the celebrants, Title IV-E funds could be used to pay for services to keep families intact rather than place children in foster care. But the more we learn about Family First and how it is being implemented, the less cause for celebration there seems to be. In my last post, I discussed the problems caused by the decision to make Title IV-E the payer of last resort for foster care prevention services. In this post, I discuss the surprising omission of important mental health and drug treatment programs from the list of programs that have been approved or proposed to be paid for under Family First. The paucity of useful programs in the clearinghouse certainly will detract from the utility of Family First in preventing foster care placements.

In expanding the use of federal IV-matching funds beyond foster care through Family First, Congress wanted “to provide enhanced support to children and families and prevent foster care placements through the provisions of mental health and substance abuse prevention and treatment services, in-home parent skill-based programs, and kinship navigator services.” Family First allowed federal Title IV-E matching funds to be used for programs in these categories that meet criteria for being “evidence-based” as defined by the Act.

The categories  of mental health, drug treatment and parenting programs make sense in light of what we know about why children come into foster care. Anyone who has worked in foster care knows that parental drug abuse and mental illness are two of the major circumstances behind child removals, while a third major factor, domestic violence, was inexplicably left out of the Act. The inclusion of parenting programs makes sense because abuse in particular is often related to parents’ lack of knowledge about child development and appropriate disciplinary practices.

Family First established a Title IV-E Prevention Services Clearinghouse, which is being developed under contract by Abt Associates, to review and approve programs for reimbursement using Title IV-E foster care prevention funds. So far, the clearinghouse has approved nine programs for inclusion and is in the process of considering 21 more. A careful look at the programs that are included, under review, and not on either list raises some questions.

Take substance abuse treatment, the most common single factor behind child removals according to federal AFCARS data, which indicates that drug abuse was a factor in 36% of the child removals that took place in Fiscal Year 2018. The opioid crisis, often cited as a reason to pass Family First, seems to have peaked in most areas but is still wreaking havoc in many states and their foster care systems. Medication-assisted treatment is often called the “gold standard” for treating opioid addiction and is vastly underutilized. But strangely that Abt Associates chose to include in the clearinghouse only Methadone Maintenance Therapy and not the newer buprenorphine treatment, which is not even on the list of programs to be considered for clearinghouse listing.  According to the National Institute on Drug abuse, “Methadone and buprenorphine are equally effective at reducing opioid use.” And there are reasons to prefer the newer medication. As the federal Substance Abuse and Mental Health Administration (SAMHSA) states, unlike methadone treatment, “which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access.”

Let’s turn to mental health. It is clear that mental illness is the major factor behind many removals into foster care. AFCARS data indicate that 14% of child removals are associated with a “caregiver’s inability to cope,” but that percentage sounds small to this former social worker. It is likely that many more removals where other factors (like child abuse and substance abuse) are cited are also related to parental mental illness. Parents suffering from untreated depression, bipolar disorder, post-traumatic stress disorder (PTSD), and other mental health disorders often have difficulty providing appropriate care to their children. So it is not surprising that mental health was included as a category of services to prevent foster care under Family First.

What is surprising is the nature of the services that have been chosen so far. The clearinghouse has approved four mental health programs: Functional Family Therapy, Multisystemic Therapy, Parent Child Interaction Therapy, and Trauma-Focused Cognitive Behavior Therapy. All of these programs are geared at addressing the issues of children–not their parents. It is very odd that the clearinghouse did not include any services to address common mental disorders, such as depression and PTSD, that afflict many parents who come to the attention of child welfare agencies. After all. the California Evidence-Based Clearinghouse for Child Welfare (CEBC), the leading repository of evidence practices in child welfare, lists nine programs meeting Family First criteria as well supported, supported or promising  for treating depression and 11 programs meeting those criteria for trauma treatment for adults. Even odder, among the six mental health programs being considered for inclusion in the Title IV-E clearinghouse, only one (Interpersonal psychotherapy) could be used to treat adults although there is also a version for adolescents and the clearinghouse does not specify which one is under review.

Among the evidence based practices included in the CEBC and not included or under review by the Title IV-E clearinghouse are some well-established programs known to be effective, such as Cognitive Behavioral Therapy for adult depression and  Mindfulness Based Cognitive Therapy.  Both of these have the top rating of “well-supported” from CEBC for treatment of depression in adults. Another mindfulness-based treatment called Mindfulness Based Stress Reduction is becoming increasingly popular and supported by research for treatment of depression and anxiety. Because it is not generally covered by insurance, using Family First funds could make this treatment available to parents who could not otherwise get it. Eye Movement Desensitization and Reprocessing (EMDR), a popular trauma treatment, is also given the top rating from the California clearinghouse and not included or being reviewed by its Title IV-E counterpart.

On the other hand, the inclusion of two out of three “in-home parent skill based” programs in the Title IV-E Clearinghouse is somewhat surprising. The inclusion of Healthy Families America (HFA) raises questions because it has not yet been able to demonstrate an impact on the prevention of child abuse and neglect. There is one study with a promising result but this study was criticized by CEBC due to a very small sample size, limitation to one region, reliance on parent self-report and other factors. CEBC gave HFA as a rating of “4” (“evidence fails to demonstrate effect”) for the prevention of child abuse and neglect.

Another home visiting program, Nurse Family Partnership (NFP), has limited potential to prevent foster care among the Title IV-E eligible population. NFP is the only home visiting program given the top rating for prevention of child abuse and neglect by the CEBC; however it is approved only for first-time teenage mothers. It cannot by definition be used to prevent a recurrence of abuse or neglect. NFP can be provided under Family First in jurisdictions, like the District of Columbia, that have defined all children of teens in foster care as foster care candidates. But it is not applicable to most families eligible for prevention services under Title IV-E.

In sum, the list of programs that have been cleared by the Title IV-E clearinghouse as well as those that are being reviewed contains some disconcerting omissions and surprising entries. While some of the most exciting and promising mental health and drug treatment programs are not included, some home visiting programs with very limited applicability to the purposes of the Act have been included. When added to the decision to make Medicaid the payer of last resort, these decisions by the clearinghouse make the utility of Family First as a vehicle of foster care prevention even more dubious. Those who agree should join me in requesting that the Title IV-E Clearinghouse review and approve some of the effective practices mentioned in this post.

 

 

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.