The power of wishful thinking: the case of “race-blind removals” in child welfare

Wishful thinking is a very human pattern of thought that can even be functional at times. Thanks to wishful thinking, a placebo can actually cure an illness. Great ideas can gain support even if we don’t know they will succeed. But when wishful thinking is used to distort available data to support a given theory or policy, it becomes a problem. Such is the case with “race-blind” removals. The story of how this simple concept became viewed as a solution to the disproportional share of Black children in foster care, in relationship to their share of the general population, is a case study in the misuse of data to promote a particular viewpoint.

As reported in The Imprint and the Los Angeles Times, the Los Angeles Board of Supervisors has voted to support a project testing “race-blind removal” or “blind removal” of children into foster care. Blind removal was pioneered in Nassau County, New York in 2011 and “discovered” (as they describe it) by a team of researchers headed by Jessica Pryce of Florida State University, who were investigating the practices of two counties that were credited by New York’s Office of Child and Family Services (OCFS) with reducing racial disparities. Before the inception of blind removal, county investigative workers were presenting cases to a committee made up of supervisors, managers, and an attorney before a child could be removed and placed in foster care. Under blind removals, the members of this committee were no longer given information that might give a clue as to the race of the child and family. According to an email from a county official, the information that is withheld includes race, ethnicity, first and last names, addresses, the location of the reporter if that reflects the community where the child lives, and any other information (such as socioeconomic status or receipt of government benefits) that is not deemed to affect safety or risk.

Nassau County adopted the blind removal policy as a way to address its high rate of racial disproportionality in foster care, with Black children being much more likely to be removed and placed in foster care than White children. According to data provided by New York State, Black children were over 14 times more likely than White children to be placed in foster care in Nassau County in 2010. The blind removals policy is based on the belief that implicit racial biases affect the decision to remove a child and that removing this information from the process will remove the bias.

Unless there is strong evidence in support of such a program, one might worry about a practice that relies on people who know so little about a family. One might wonder if such a meeting is the best use of time for overburdened social workers and supervisors. Perhaps it would be better to make sure investigators have enough time to interview everyone who might be able to give them information about the family under consideration rather than burden them with another meeting. And what about emergency situations, where a child cannot be safely left in the home? An article in Children’s Bureau Express documents concerns from social workers who fear that blind removals would make it harder to do their jobs for these and other reasons. Another concern is whether race-blind removals might provide more of an opportunity for investigative workers to express any racial bias they have, since they control the information that is presented to the committee.

But if blind removal truly does cause a significant reduction in racial disparities, perhaps it is worth implementing despite the costs. And if one can believe a TED Talk by Jessica Pryce that has been viewed 1.3 million times, the practice has been spectacularly successful. According to Pryce, “In 2011 57 percent of the kids going into foster care were black, but after five years of blind removals, that is down to 21 percent.”  (At which point the audience broke into applause). Such a simple idea and such a huge impact! Casey Family Programs, the nation’s most influential child welfare funder, highlighted this program in an article on its website, stating without providing numbers that “within five years, the number of Black children removed from their families was reduced considerably, representing the most significant decrease in racial disproportionality within the county system ever.” New York State was so excited that it required all counties to develop a blind removal process effective October 14, 2020, offering a strikingly vague and yet broad description of what information must be kept from the committee: “all demographic and identifiable information (race, gender, language needs, zip code, etc. sic)).” Several other jurisdictions have expressed interest, including Los Angeles County, which is proceeding with its pilot.

Such a great result should be documented and the data made available to the public and researchers, preferably online, so it is surprising that Pryce was unwilling or unable to provide the source of the percentages at the heart of her popular talk. Instead, she referred me to the data team at Nassau County, who did not respond, nor did did the Commissioner’s Office. Nor was Casey Family Programs able or willing to provide the document referenced in their footnote to their statement about the program’s stellar results. Happily, I was able to obtain data from the New York State Office of Child and Family Services showing the percentage of children removed into foster care who were Black every year from 2009 to 2020. Those percentages are shown in Chart One.

Chart One

Source: Data provided by New York State Office of Children and Family Services

The first fact that emerges from the New York data is that Jessica Pryce’s percentages were not accurate. The 57 percent (56.7 percent) that she cites as the percentage of Black children removed in 2011 was actually the percentage of Black children removed in 2010. As for the 2016 data (the endpoint of the five-year-period cited by Pryce), 37.1 percent of the children removed in 2016 were Black, rather than 21 percent cited by Pryce–rather a large difference. There was a sharp increase in the Black share of children removed, from 45.2 percent in 2009 to 56.7 percent in 2010, the year before the program was implemented. With the implementation of blind removals, the percentage of children removed who were Black declined for two years to 45.5 percent in 2012, then rose for two years to 57.4 percent in 2014, fell to its all-time low of 37.1 percent in 2016, then rose to 49.7 percent in 2018, dipping slightly back to 45.1 percent in 2019, then popping back up to 49.5 percent in 2020–higher than it was in 2009 before the program was implemented. With such large fluctuations from year to year, as well as changes in direction, it is hard to imagine drawing any conclusions from the difference between any particular two years.

It is also important to note that the total number of children placed in foster care in Nassau County dropped precipitously from 429 in 2009 to 91 in 2020, as shown in Chart 2. This drastic drop in removals of Black and other children means that there was a lot more going on than the effort to make removals race-blind; cutting removals by three-quarters requires major changes in policy and/or practice. So it is hard to attribute any change with confidence to the race-blind policy. It also means that the numbers of children removed became smaller and smaller, resulting in a larger margin of error.

Chart Two

Source: Data provided by New York State Office of Children and Family Services

OCFS also provided data on Nassau County’s “Black Admissions Disparity Rate.” This rate, which New York State collects for all its counties, is defined as the “ratio of unique Black children admitted to foster care per 1000 Black children under 18 relative to comparable rate for White children.” According to OCFS, the disparity rate for foster care admissions went down from 14.30 (meaning Black children were 14 times more likely to be removed than White children) in 2010 to 12.60 in 2020. But it fluctuated to a surprising degree (between 24.4 and 6.16 between 2011 and 2019) that is not consistent with the percentages shown above and casts doubt on the correctness of the ratios provided. Assuming the 2020 ratio is correct, Nassau County currently has the highest disparity in foster care placement for Black children in the entire state. According to its ranking of counties based on this ratio, Nassau County was at the bottom in 2020 of all counties listed* with its disparity rate of 12.6, compared with 3.34 for the state as a whole. Hardly a role model for New York or the nation! Now this doesn’t mean we should blame Nassau County’s child welfare system for its abysmal disparity ranking. Other factors are probably behind that large disparity compared to other counties, such as the socioeconomic status of the Black and White populations in a given county. Which raises the question, how much can we expect blind removals to change racial disparities in foster care?

New York State recognizes the weaknesses of its data but focuses on the positive overall trend between 2010 and 2020. As John Craig of OCFS put it in his email to Child Welfare Monitor, “While Nassau County has seen fluctuations in the rate of Black children entering care over the past 10 years, overall, the trend has been very positive. OCFS commends Nassau County for recognizing the disproportionality of children of color in the child welfare system and implementing this innovative approach.” 

Despite OCFS’ valiant attempt to portray Nassau County’s data as “very positive,” the data do not provide a strong justification for expanding the program. While the Black percentage of children taken into foster care in 2020 was 49 percent compared to 57 percent in 2019, there were changes in both directions in the years between those two dates, and the 49 percent was actually higher than the Black percentage in 2009, two years before program implementation. There is reason to wonder whether New York, Los Angeles and others were really concerned about what the data showed. Instead, they may have proceeded in part based on the inherent logic of the approach, which addresses racial disparities directly in a way that is appealing to those who seek a relatively simple solution. Most importantly, they wanted it to work, so they decided that it did, regardless of the highly equivocal findings.

It would be wonderful if we had easy solutions to racial disparities in child welfare, but evidence suggests that higher reporting, investigation and removal rates among Black children stem from their greater needs, rather than bias among social workers. LA County would be better off studying how to make CPS decisions more accurate rather than imposing a cumbersome and unproven hurdle on social workers trying to protect endangered children.

* Certain counties were excluded because of very small number of Black children or Black children taken into foster care.

Foster care didn’t kill Ma’Khia Bryant

Makiyah Bryant Credit: Paula Bryant From People.com

It is always disheartening when people take advantage of a tragedy to support their own views or interests, even when the facts don’t support it. The tragic death of Ma’Khia Briant is an example of this tendency. As soon as it was disclosed that Ma’Khia was in foster care, advocates and pundits began to argue that her death is “indicative of deeper problems in the foster care system,” as the Washington Post put it. That the case illustrates problems with foster care cannot be denied–but most of the damage to Ma’Khia clearly occurred before her placement in foster care.

For the few who have not heard, 16-year-old Ma’Khia Bryant was shot to death by a police officer in Columbus Ohio who was responding to a 911 call from her younger sister saying that “grown girls” were attempting to fight and stab them. Officer Nicholas Reardon found Ma’Khia swinging a knife while pinning a 22-year-old woman against a car. He fired four shots, striking Ma’Khia, who died shortly thereafter.

When it became known that Ma’Khia was in foster care, many foster parents and advocates raised serious concerns about how the system contributed to her death. Noting that teens should not be unsupervised in a foster home, experts interviewed by the Washington Post raised concerns about the low standards for foster parents who care for Ohio teens, which some tied to the scarcity of foster parents willing to care for teens.

As a social worker in the District of Columbia, I had a very similar experience. Many foster parents refused to take in teens. As a result, it appeared that the standards to become a foster parent for teens were minimal. Many of the foster parents who cared for my teen clients in DC foster care provided little more than room and board, not the loving care these children needed. Few had ever visited the child’s school, doctor, or therapist. They were typically not home during the day, as foster parents are not paid enough to forego full-time work. Moreover, as in Ohio, foster parents who have enough room were often landed with several teens, each with a history of trauma–a recipe for conflict. 

Another way the system failed Ma’Khia may have been by failing to help her grandmother, Jeanene Hammonds, retain custody of Ma’Khia and her sister, who spent their first 16 months in foster care living with her. But when her landlord threatened to evict her for having too many people in the house, the Children’s Services social worker had no solution other than telling her to drop the girls off at the agency, according to what Hammonds told the New York Times. If the agency had licensed her as a foster parent, she could have moved to a larger apartment. But information from case files quoted by both the Times and the DIspatch suggests that the agency believed Hammonds was not meeting the girls’ needs or making sure they received needed therapy. I cannot assess the truth of either the grandmother or the agency’s statements, but I can say that as a social worker I was often frustrated by my inability to help relatives obtain housing needed to obtain custody of children in foster care.

Some advocates are using Ma’Khia’s death to ask for needed changes in the system, like a crisis response team, better training for foster parents, and more help for relatives willing to take custody of children in foster care.  They should also be advocating for better options for troubled teens in foster care. These teens need either professional foster parents who are paid to be home all day and and trained to work with traumatized teens or high-quality, trauma-informed residential facilities where they receive the therapeutic care that they need before graduating to a less restrictive setting. 

Less responsible or informed advocates are using this tragedy to argue for the abolition of foster care. The Washington Post quotes Hana Abdur-Rahim of the Black Abolitionist Collective of Ohio, who said that“a lot of times people’s children get taken away because they can’t afford to take care of them, or they don’t have proper housing….So if we had more resources, children would not get taken away from their families.”

Abdur-Rahim’s statement embodies the popular trope that what child welfare systems call “neglect” is really poverty, and that children are being removed due to poverty alone. Anyone who has been a social worker in child welfare will tell you that removals for poverty alone are quite rare; that neglect usually involves some combination of drug abuse, alcohol abuse, mental illness, disorganization and family violence; and, in any case, that chronic neglect can be more damaging to a growing child than abuse. 

It is not surprising that Ma’Khia’s mother, Paula Bryant, would not say why her daughter was removed in the first place. The Columbus Dispatch has reported that Ma’Khia, her younger sister, and two brothers were removed from Bryant in March 2018, after police responded to an “incident” at a residence. Police reported the four children were unsupervised and made allegations of abuse against their mother and an older sibling. A neighbor who spoke to the New York Times says she can still remember the fights between Bryant and her daughters, stating that “the girls ran out of the house terrified, and were hanging out in the backyard screaming while the mom was yelling at them.” Children’s Services already knew of the family due to repeated complaints that the two youngest children were absent from school. And in February 2017, according to the Times, Bryant brought her four children to Children’s Services saying she could no longer handle them. The grandmother, Ms. Hammond, told the Times that it was difficult having the four Bryant children because “they came from a lot of dysfunction.”

Aside from this historical information, the behavior of Ma’Khia and her sister provides evidence of their traumatic history.  According to the Post and the Times accounts, Ma’Khia’s sister Ja’Niah told police officers she called to the home 23 days before Ma’Kiah’s death that she would to “kill someone” unless she was placed in another home. Ma’Khia was killed while threatening someone with a knife, and Ja’Niah told the Times that Ma’Khia was triggered when the one of the older women spit toward her family. To anyone familiar with foster youth, these statements and behaviors suggest girls who were traumatized not by foster care itself but by a long history of neglect and violence in their home.

Children’s Services was trying to help Ms. Bryant get her children back but in court filings obtained by the Columbus Dispatch the agency reported that the mother “repeatedly failed to comply with the plan, which included mental health counseling, or even to consistently show up for scheduled visitations with Ma’Khia and her sister.” Court reports also indicate that the father did not respond to outreach by the court or agency. In December 2019, Children’s Services asked the court to suspend the mother’s visitation because of “emotionally damaging” interactions between her and her daughters, according to the Dispatch. And in January 2020 the agency filed a motion seeking permanent custody of the girls. Court action was delayed by the COVID-19 pandemic and was still pending at the time of Ma’Khia’s death.

Ma’Khia’s mother, father and grandmother are now united in calling for an investigation of Ohio’s foster care system in the wake of her death. It is depressing but not surprising that the mother who abused and neglected Ma’Kiah and the father who would not engage with Children’s Services are now blaming the foster care system for her death.

None of this exonerates the foster care system for the unacceptable quality of the care Ma’Khia was apparently receiving at the foster home where she was killed. When society removes a traumatized child from an unsafe home, it adds one more trauma to that child’s history. It owes that child more than an environment only slightly better than what she was removed from. A good system might have saved Ma’Khia from the trajectory she was on when she was removed. To that extent, a struggling foster care system, and ultimately our society’s indifference to these most vulnerable children, bears some responsibility for Ma’Khia’s death.

To argue that foster care should not exist is to say that children should be allowed to grow up in homes characterized by chronic violence, abuse and neglect. As Lily Cunningham, a mental health counselor, told the Washington Post, “The question always is Why is this child or family in foster care? But the right question should be: What can we be doing now to enhance the lives of children in foster care?” Foster care should be improved so that it can become a place of healing, from which children can return to families that have done the work needed to get their children back.

This post was edited on May 8, 2021 to incorporate new information shared by the New York Times.

When Ideology Outweighs what’s Best for Kids: the case of San Pasqual Academy

Image: Jeffery Heil, Twitter.com

In 1998, something extraordinary happened in San Diego County. Galvanized by the heartbreaking stories of local foster youth who were disgorged at the age of 18 from a system that never gave them the tools to thrive, the community came together to create a place where foster youth could prepare for happy and productive futures. In 2001, the San Pasqual Academy (SPA) opened as a result of this unique moment of community solidarity and altruism. Twenty years and over 400 graduates later, SPA is on the chopping block because of federal and state legislation that eliminates any funding for placements that are not standard foster homes, unless they are providing temporary intensive treatment for severe mental health conditions.

The story of SPA began in 1998 when James R. Millikan, the presiding judge of the San Diego Juvenile Court, arranged for a group of foster youths to speak to the County Board of Supervisors, as described in a moving video. It was a transformational moment for many of the listeners, who were essentially unaware of the plight of older foster youth. Supervisors were riveted by young foster care alumni, who described surviving as many 30 placements and being discharged to the streets at the age of 18, with no supports or tools for success. This magic moment resulted in the creation of SPA.

In a rare moment of collaboration by multiple agencies and community leaders, SPA was developed with the support of Judge Milliken, the County Board of Supervisors, the Child Welfare Director, the Office of Education, as well as attorneys, social workers, healthcare providers, educators, law enforcement, foster youth, and other community members. They found a disused boarding school for sale on 238 acres, refurbished it, and opened it in September 2001. The goal was to “provide a safe, stable and caring environment” where youth [could] work toward their high school diplomas, prepare for college and/or a vocation, and develop independent living skills.” The Academy was “designed to be a place its students can call home, providing stable relationships needed for development of social skills and future relationships during their student experience at the Academy and beyond.”

SPA services can be classified into four categories: residential, education, work readiness and child welfare.

  • Residential: The residential component is run by New Alternatives, Inc., a private nonprofit. Youths live in family-style homes with house parents for up to eight children per cottage. “Foster grandparents,” who live on campus for reduced rent, mentor, tutor and engage students in hobbies and activities. An on-campus health and wellness center provides comprehensive health care, including mental health. Housing and supportive services are also available to Academy alumni for up to 24 months. (Twelve alumni are living on campus right now, taking advantage of this crucial safety net in the midst of a pandemic.)
  • Education: The onsite high school program is operated by the County Office of Education. After-school activities include student government, athletics, yearbook, and dances.
  • Work Readiness: Provided by the San Diego Workforce Partnership, services include tutoring, career counseling, job training, internships, employment, vocational electives, and assistance in creating resumes and portfolios.
  • Child Welfare: Social workers from the County Department of Health and Human Services (DHHS) onsite provide case management, services and advocacy.

The resources provided to SPA students are enhanced by the support of Friends of San Pasqual Academy, a dedicated group of community members who provide additional financial support and volunteer work. Friends’ support pays for special events, school supplies, and personal items, all designed to give students a “normal high school experience.” The Friends raise money for maintenance and upgrades to the cottages, the pool and other parts of the facility. They have leveraged outside resources to help SPA. The San Diego Chargers helped build the football field and the Padres built the softball field for SPA.

SPA truly embodies the definition of wraparound services, and the research shows that it works. To assess the effectiveness of the SPA model, New Directions commissioned a ten-year research study that followed 478 SPA alumni, including all youth who attended the academy between February 2001 and June 2011 and left the program between July 2002 and July 2012. The results were summarized in an article titled “Comprehensive residential education: a promising model for emerging adults in foster care,” which was published in Children and Youth Services Review. The findings were impressive. As the authors put it, “Foster youth who participated in the Academy until they were 18 years old or older attained high school diplomas or GEDs at rates far above state and national standards for foster youth. Of the youth who were at least 18 years old when discharged from the Academy, 92% of them graduated with a high school diploma or GED, which greatly exceeds Californias high school graduation/GED rates for foster youth of 45% and for the general population of California youth of 79%….In fact, we are not aware of any other program serving foster youth in the United States…with such high rates of high school diploma/GED completion.”

The evaluators concluded that “the Academy provided its alumni with safety, significant relationships with adults, and well-being that exceed state and national standards for foster youth. Those youth who attended the Academy for longer periods of time through their 18th birthday and participated in extracurricular activities had the most positive outcomes, including safe housing, employment, access to healthcare, attainment of a high school diploma or GED, and attendance at institutions of higher education. The Academy appears to provide a stable, comprehensive residential education program that helps foster youth successfully emerge into adulthood.” A preliminary draft of a follow-up study focusing on current students and alumni is equally glowing.

In addition to the spectacular evaluation mentioned above, SPA has been the subject of several other flattering reports. Five San Diego County “grand juries” (groups appointed by Superior Court judges to investigate, evaluate, and report on the actions of local government) and four county Juvenile Justice Commissions have issued glowing reports on SPA. The most recent report, by the group meeting from 2016-2017, lamented the fact that SPA was operating at only 50 percent of its capacity of 184 students. The Grand Jury recommended that SPA be fully utilized to make full use of its life-saving potential. San Diego’s Juvenile Justice Commission has also issued multiple flattering reports on SPA. In its most recent report, issued in 2018, the commission stated that “SPA continues to be a model facility delivering essentially full service, wrap around services in a residential setting to foster youth.”

Despite the overwhelming evidence of SPA’s life-changing impact, the number of children at SPA declined from 139 in April 2011 to 69 as of February 1, 2021. The most important reason for declining referrals appears to have been the decline in support by child welfare leaders for what is often called “congregate care,” usually meaning any type of setting other than a foster home. This change in mindset was created in large part through influence of two wealthy organizations started by the same family, Casey Family Programs and the Annie E. Casey Foundation, that have used their financial resources to produce reports like Every Kid Needs a Family, lobby legislators, and provide free consultation with states. With the help of the “Casey Alliance,” a new narrative has been created that that all “congregate care” settings are prison-like institutions and any family home is better than a group setting for almost every child.

The change in mindset eventually resulted in legislative changes. California’s Continuum of Care Act, passed in 2015. ended the placement of foster youth in group settings except to provide short term therapeutic care. Thanks to SPA’s known track record and strong support, pilot program was authorized to allow SPA to operate through December 2021. But passage by the U.S. Congress of the the Family First Prevention Services Act (FFPSA) sealed SPA’s fate. Like Continuum of Care, FFPSA essentially eliminated federal funding for placement in settings other than foster homes except for short-term placements for youth who assessed to have a diagnosis that requires a level of care that a family cannot provide. With the implementation of FFPSA scheduled for October, the California Department of Social Services (CDSS) decided to advance the date of SPA’s closure to avoid having to use state funds to maintain it until December. In an undated letter, CDAA informed San Diego County DHHS that SPA must close by October.

Both Continuum of Care and FFPSA were based on the belief that children almost always do better in families than in other, more institutional settings. But as we have written, supporters often misuse data and research to support this belief. Research generally shows children in group care having poorer outcomes than those in foster care. But these studies do not account for the fact that children placed in group care generally have much more severe issues, which is why they were placed in group care in the first place. Moreover, supporters of “a family for every child” fail to define the concept of a family. The cottages at SPA and many other residential facilities offer a family setting, with house parents who play the parental role, as one house parent eloquently described in the video cited above. SPA homes are much more like families than many foster homes, where the foster parent has little interaction with the youth and provides little besides room and board. In fact, the residential component of SPA could be called “enhanced foster care” more accurately than congregate care.

And that raises the related concept of quality, which the reformers ignored. Quality matters much more than the type of setting. It is likely that most parents whose child had to leave home, would prefer a high-quality group setting (even if not family-style) for their children than a low-quality family setting. Anyone who has worked in foster care will know the difficulty of obtaining high-quality settings for older foster youth. Due to the scarcity of foster families, especially those willing to accept older youth, few jurisdictions can afford to be choosy enough about whom they accept and retain. What they do get more often than not are foster homes that provide little beyond room and board (and often those are barely adequate), foster parents who never set foot in the child’s school, refuse to take them to the doctor and the therapist, and quickly return difficult youths to the agency–resulting in multiple placements for each foster youth. Moreover, in my experience as a foster care social worker in the District of Columbia, few of my high school age clients participated in extracurricular activities because foster parents were unwilling to pick them up late from school or take them to weekend games, performances or other activities. Yet, engagement in after-school activities is linked with higher academic performance and college attendance, better health, and fewer problem behaviors.

Opponents of group care also ignore the problem of sibling separation. Many children placed in traditional foster homes are separated from one or more siblings because foster families do not have room for sibling groups. As I argued in Sibling Separation: An Unintended Consequence of the Family First Act, family-style group homes like those provided by SPA have been an important vehicle for keeping siblings together. In addition to providing a home for sibling groups of high school age, SPA accepts siblings of current students who are of middle-school age, allowing them to live at SPA and attend school in the community. The importance of siblings to foster children is such that even some congregate care opponents admit that it is better to place siblings together in congregate care than to separate them into different foster homes.

It is important to note that the restrictions on group care in FFPSA had another purpose aside from the alleged benefits to foster care. Restricting group care, which is more expensive than foster care, was necessary to free up federal funds to pay for the expansion of funding for services to prevent the placement of children in foster care. In other words, to find the money to preserve families, Congress took it away from services to the children who will have to be removed when family preservation fails. As long-time Congressional staffer and child welfare consultant Sean Hughes wrote in the Imprint, the focus among child welfare advocates seems to have shifted almost exclusively toward preventing entry into foster care, with little advocacy being devoted to actually improving the continuum of care for children in out-of-home care.

Current students, alumni and supporters of SPA were stunned by the CDSS letter. A petition on Change.org has obtained almost 11,000 signatures so far. Supporters of SPA have created a Facebook page and deluged public officials with letters and telephone calls. Reverend Shane Harris, the President and founder of the People’s Association of Justice Advocates, says SPA changed his life and gave him a safe place to grow up and is fighting to keep it open. One alumna is quoted on the Save San Pasqual Facebook page as follows: “I really loved living at SPA. I got to create relationships, a family and a strong support system. I also became stable by living here. I was able to attend school and catch up from how behind I was. I succeeded in sports and found outlets to deal with emotions. I couldn’t live in foster homes because the families wouldn’t treat me like their own.” Simone Hibbs-Monroe, valedictorian of the class of 2009 told KUSI News that “SPA has been a community safe haven and the only solution for many foster youth and a dedicated home for many alumni of foster care… “It’s an opportunity for children to feel normal. We are able to play sports, get jobs, have pep rallies, have our first proms, get our drivers’ licenses …..these are all the things that the caring community of San Pasqual offers its youth and its alumni….Often people [say] it takes a village to raise a child. That is San Pasqual Academy.”

Current and former staff have joined the call to save SPA. SPA’s Clinical Director, Rex Sheridan, wrote as follows in an eloquent letter to the County Supervisors and San Diego’s DHHS leadership team. “During my career in mental health and youth services, two decades of which has been in San Diego County, I have had contact with and worked in many different settings dedicated to meet the needs of our most vulnerable youth populations; yet none could even remotely be compared to what is offered at SPA. That is why I have now spent a third of my life committed to and working to develop this program because of first-hand experience witnessing lives transformed, hearts opened back up after years of disconnection, wounds healed after lifetimes of abuse and trauma, siblings reunited after separation, goals reimagined out of hopelessness, skills and knowledge crafted and nurtured out of feelings of incompetence, and new identities and possibilities replacing desperation and fragmentation. And if you think that those experiences sound overstated or dramatic, then you haven’t had the privilege of attending games where youth are cheered for the first time in their lives, one of our talent shows where they perform an original song, or a college road trip where they get to visit universities all over the state and envision a new possibility that was never previously imagined.”

What can be done to save SPA? The state and the county must adopt a stop-gap solution to keep SPA running as they work to permanently amend state law to create a category of residential schools that is eligible for reimbursement. On the federal level, advocates are already working on legislation to amend FFPSA to add residential campuses with family style homes as a placement option. We will share more information as it becomes available.

The proposed closure of SPA is a victory of ideology and greed over humanity and common sense. We need more, not fewer San Pasqual Academies. Rather than shutting it down, the state and county should be ensuring that it is at capacity and boasting that within their borders lies the most effective foster care program in the country.

New Jersey to foster parents: thanks but no thanks!

Foster Parents Needed As COVID-19 Pandemic Strains Families is a typical headline these days, as illustrated in an article from Illinois. The pandemic has imposed new impediments to recruiting and retaining foster parents, including fears of exposure to COVID-19, loss of employment and income, and concerns about supervising virtual schooling. But these issues do not seem to be affecting New Jersey, where prospective foster parents are told that they are not needed, thank you very much! While the state credits its efforts at child abuse prevention and family preservation for its lack of need for foster parents, the explanation seems to lie elsewhere. Over the course of five years, the state has cut in half its rate of confirming allegations of abuse and neglect–resulting in a similar fall in the number of children entering foster care. This is a big change, and one that demands explanation in order to ensure that the agency is continuing to fulfill its mission of ensuring children’s safety in New Jersey.

Would-be New Jersey foster parents who click on “Be A Foster Parent” on the website of the Department of Children and Families (DCF) are greeted with the following message: “Thank you for your interest in becoming a resource parent to children and youth in state care.  Due to the COVID19 Pandemic and its impact on operations, DCF has suspended all new inquiry submissions at this time. Please continue to check our website for any updates.” This is an odd message indeed, as it seems to imply that the pandemic has made recruitment and licensing impossible. But agencies around the country have adapted quickly to move vetting and training online in order to enable new foster parents to enter the pipeline. Not so New Jersey.

When we asked DCF why foster parents are being turned away, we received the following reply from DCF Communications Director Jason Butkowski. “[W]e did experience a 19.17% reduction in out-of-home placements from 2019 to 2020.  This is attributable both to New Jersey’s statewide prevention network and our ongoing work to preserve families and keep children and parents together in their homes while receiving services.”

Interestingly, a message sent earlier to prospective foster parents gave a different answer. In May, 2020, would-be foster parents received a message saying, “In New Jersey, the number of youth in foster care continues to be reduced each year because we are focusing first on kinship placements,” as quoted in an article by Naomi Schaefer Riley. We asked Mr. Butkowski which explanation was more accurate–prevention and family preservation or kinship placements–but received no answer.

So what is going on in New Jersey? Certainly, foster care numbers have been decreasing. According to the data portal maintained by Rutgers University, annual entries to foster care fell from 5,504 in 2013 to 2,525 in 2019, as shown in the chart below. The rate of decrease in foster care entries became even steeper between 2018 and 2019, with a decrease of 23.7 percent in the number of entries in that one year alone. The total number of children in foster care dropped from a high of 7,775 in May 2014 to 4,463 in February 2020–before the pandemic closures occurred. So what could be causing this drastic decline in foster care placements and caseloads?

Source: NJ Child Welfare Data Hub, available from https://njchilddata.rutgers.edu/portal/entering-placement-reports#

One possibility might be a decline in child abuse and neglect, which Butkowski is implicitly assuming by attributing part of the fall in foster care cases to DCF’s “statewide prevention network.” In that case, one might expect reports to child abuse hotlines to decline significantly. But according to monthly state reports, calls to child abuse hotlines hardly changed between 2014 and 2019, decreasing very slightly from 165,458 to 164,417. Of course we cannot be sure that reports are an accurate measure of child maltreatment; but one might expect a significant reduction in hotline calls if a large reduction in maltreatment were occurring.

DCF’s Butkowski also credited the agency’s work to “keep children and parents together in their homes while receiving services” as a reason for declining foster care entries. It is true that most substantiations of abuse or neglect do not result in foster care. Instead, DCF works with many families in their homes to help them avoid future maltreatment. But DCF has been emphasizing in-home services for years. Of all the children who were under DCF supervision in foster care or in-home services, the percentage receiving in-home services rather than foster care was 84.7 percent in May 2014 and 90 percent in February 2020. So children were somewhat more likely to receive in-home services in 2020 than in 2014, but the difference was small and not likely to explain the big fall in the foster care rolls.

So with hotline calls basically unchanged, and only a slight increase in the emphasis on in-home services, how did New Jersey manage to reduce its foster care entries by almost half in six years? One can think of the child welfare process as a funnel, starting with referrals, the child welfare term for hotline calls. As we discussed, those have fallen only slightly. Only some referrals are screened-in and accepted for investigation; many are rerouted or receive no action because hotline workers determine that they do not concern abuse or neglect. But a reduction in screened-in referrals is not part of the explanation for New Jersey’s drop in foster care placements. New Jersey reported that 60,934 referrals were screened in in FFY 2019, compared with 59,151 in FFY 2013–a slight increase.

The next step in the child welfare funnel is investigation, and here the count shifts from the number of referrals to the number of children. According to data submitted to New Jersey to the Administration for Children and Families (ACF) and published in Child Maltreatment 2019, the number of children receiving an investigation in New Jersey increased slightly from Federal Fiscal Year (FFY 2015) to FFY 2019–from 74,546 to 78,741. However there was a stunning drop in the proportion of these children who were found to be abused or neglected (known as “substantiation” in the child welfare world). In FFY 2015, 13.0 percent of the children who received investigations (or 9,689 children) were found to be abused or neglected. In FFY 2019, only 6.5 percent of the children receiving investigations (5,132 children) were found to be victims of maltreatment. In other words, among the children who were involved in investigations, the proportion who were found to be maltreated dropped by half. Similarly, the number of children found to be maltreatment victims dropped by 47 percent. (This is very similar to the 44.6 percent decrease in foster care entries between those years shown in the Rutgers data portal cited above).

Note: The substantiation rate is the number of children found to be maltreatment victims divided by the number of children who were the subject of CPS investigations. Data are from Child Maltreatment 2019, available at https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2019.pdf

It turns out that aside from Pennsylvania, which is not comparable to other states because it does not report on most neglect allegations, New Jersey had the lowest rate of substantiation per 1,000 children of all the states in FFY 2019. Only 2.6 children per 1,000 were found to be maltreated, compared to a national rate of 8.8 children per 1,000. In FFY 2015, this rate was 4.9 per 1,000 children in New Jersey–almost twice as high.

How did the number and percent of children found to be victims of child maltreatment drop so much in New Jersey over a four-year period, despite little decline in hotline calls? We asked DCF this question but received no reply. In the notes it submitted to ACF with its 2019 data, DCF acknowledged a decrease in the number of substantiated victims of maltreatment and stated that this is consistent with a continued trend–but provides no explanation. Perhaps policy or practice has changed to make it more difficult to substantiate abuse or neglect, through a change in definitions or in the standard of proof, or perhaps in training or agency culture. But such a change was not mentioned either by Butkowski or in DCF’s submission to ACF.

Let us revisit DCF’s previous message to foster parents saying that “In New Jersey, the number of youth in foster care continues to be reduced each year because we are focusing first on kinship placements.” This is an interesting statement because it implies that these kinship placements are not through the foster care system. It is important to understand that children can be placed with relatives in two ways. A child can be found to be a victim of maltreatment and placed with a relative, who becomes licensed as a foster parent. In New Jersey, 1,619 foster children (or 41 percent of the 3,951 children in foster care) were living with licensed kinship foster parents in November 2020. But these children are included in the state’s count of children in foster care, so they cannot account for the caseload drop. DCF must have been referring to something else.

Perhaps DCF’s earlier message to foster parents referred to the agency’s increasing use of a practice called “kinship diversion.” As described in an issue brief from ChildTrends, kinship diversion is a practice that occurs during an investigation or an in-home case when social workers determine that a child cannot remain safely with the parents or guardians. Instead of taking custody of a child, the agency facilitates placing the child with a relative. If this occurs in the context of an investigation, kinship diversion may result in a finding of “unsubstantiated” even when abuse or neglect has occurred, on the grounds that the child is now safe with the relative. We have no idea how widespread this practice is in New Jersey or nationwide since neither New Jersey nor other states report the number of these cases. However, the system of informal kinship care created by diversion has been called America’s hidden foster care system and nationwide it appears to dwarf the provision of kinship care within the foster care system.

There are many concerns about kinship diversion, as described in an earlier post: caregivers may not be vetted or held to the same standards as foster parents; they and the children they are caring for do not receive case management and services; they do not receive a foster care stipend and may have to depend on much-lower public assistance payments; there is nothing preventing caregivers giving children back to the parents without any assurance of safety; and parents are not guaranteed the due process rights and help with reunification that come with having their children in foster care. Because of the various concerns around kinship diversion, litigation has been filed in several states challenging this practice.

There is one other possible explanation that comes to mind for DCF’s foster parent surplus–dropping foster care rolls due to the COVID-19 pandemic. We removed data from the time of the pandemic from the above discussion to avoid confounding its effects with those of policy and practice changes but we need to ascertain whether the pandemic’s impact on calls to the hotline has affected entries into foster care. As in most states, hotline calls in New Jersey fell sharply in the aftermath of school closures and other pandemic measures. The number of child maltreatment referrals between March (the onset of school closures and quarantines) and November 2020 (the last month for which data are available on the DCF website) was 98,306, compared to 131,344 in the same period of 2019–a drop of 25 percent, based on monthly reports from DCF. It is likely that fewer calls from teachers now teaching virtually were a major factor behind this drop in hotline calls.

Entries into foster care also fell sharply in the wake of the pandemic. Foster care entries dropped from 1,949 in March through November 2019 to only 1,211 in the same months of 2020–a drop of 37.9 percent–which may have reflected in part the reduction in hotline calls and in part the continuing decrease in foster care entries that we have described. But the number of children in care did not drop nearly as much as entries into care. Between February and November 2020, the total number of youth in care decreased only 11 percent from 4,463 to 3,951. This drop is surprisingly low–in fact it is less than the decrease in the foster care caseload during the same months of 2019 (16.1 percent). The small size of this caseload decline reflects the fact that foster care exits dropped even more than foster care entries. Exits from foster care dropped from 2,754 in March through November 2019 to 1,661 in the same months of 2020. That is a drop of over 1,093, when the drop in foster care entries was “only” 738.[1] As a result, it appears that the number of children in foster care was higher, rather than lower, due to the pandemic. Therefore, it does not appear that the pandemic contributed to the decline in demand for foster parents.

One might expect to hear expressions of concern, or at least interest, in the recent precipitous drop in the number and rate of substantiations and in the foster care caseload from the court-ordered monitor charged with ensuring that New Jersey’s child welfare system is fulfilling its mission of protecting children. Since 2006 New Jersey has been operating under a settlement agreement in a lawsuit filed in 1999. The Court Monitor is Judith Meltzer, Executive Director of the Center for the Study of Social Policy (CSSP). In its most recent report, CSSP praised DCF for maintaining its progress toward meeting all the benchmarks required to exit the lawsuit, despite the challenges posed by COVID-19. Ironically, the report mentions DCF’s progress in “Prioritizing Safety.” The report does not mention the precipitous drop in foster care entries or substantiations before the pandemic or the fact that the state is turning away prospective foster parents.

New Jersey may be the first state to have stopped accepting applications for foster parents, and the reasons cited by DCF do not seem to explain this unusual event. Careful study of DCF data shows that the rate at which allegations of abuse or neglect are substantiated has been cut in half, and that there has been a similar reduction in entries into foster care. This cut in the substantiation rate could be due to policy or practice changes making it harder to confirm child maltreatment or it could be due to an increased tendency to place children with relatives without establishing officially that maltreatment has occurred. Without an adequate explanation from the state, the extent to which either of these factors is driving these trends is unknown. It is imperative to know the explanation of this trend to ensure that DCF’s new policies and practices are not compromising its mission of keeping children safe.

[1]: Reasons for this drop in foster care exits may include court shutdowns and delays and suspension of services parents need to complete their reunification plans.

Therapeutic residential care: A necessary option for foster youth with greater needs

Photo by kat wilcox on Pexels.com

The tide of opinion in the U.S. child welfare arena has been turning against institutional settings for foster youth for some time. A spate of reports of child abuse and improper disciplinary techniques in residential facilities for young people has intensified calls for the elimination of residential care as an option for foster youth. But as all who are intimately involved in the child welfare world know, therapeutic residential care is a critical part of the continuum of services that must be available for foster youth.

Media investigations have targeted abusive behavior by staff at poor-quality residential facilities around the country, with a spotlight on a for-profit company called Sequel. Concern and outrage reached a fever pitch when a 16-year-old boy died at a Sequel home in Michigan after being restrained for 12 minutes. The Imprint and the Texas Observer co-published a harrowing account of Residential Treatment Centers (RTC’s) in Texas, documenting horrific instances of abuse at multiple centers around the state.

Unfortunately, some commentators, like the author of the report on Texas RTC’s, are using reports of abuse and violence to support ending all residential care rather than getting rid of bad providers. These critics of residential care miss two basic points. First, there are children who, for a variety of reasons, are not having their needs met in a family setting. These are the children who bounce from foster home to foster home, spend nights in agency offices or hotels, or even end up sleeping in cars with their caseworkers. 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. These children need treatment delivered in a residential setting before they can function safely and thrive in a family setting.

Perhaps some of these youths could heal and thrive in a home with professional therapeutic foster parents, an option which is gaining increasing popularity. These foster parents are highly-trained and paid to take care of children with complex needs full-time. This is an option that deserves more attention but its growth is probably limited by both the lack of willing and qualified candidates and the expense.

Residential care abolitionists also miss the importance of quality. Residential programs can range from outright abusive to very high quality and highly successful in achieving positive outcomes for their clients. In an op-ed in The Imprint, Dana Dorn and Kari Sisson of the Association of Children’s Residential Centers explain that “High-quality residential interventions have the ability to change lives for the better and are a critical part of the continuum of behavioral health services. They have well-trained and supported staff who provide individualized, trauma-informed, youth-guided, family-driven care in environments that are safe, welcoming and encourage healthy relationships.” The authors stress that providers who are incompetent or “prioritize profits” over people should not be allowed to stay in business.

Opponents of residential care often use faulty reasoning to make their point. They often state that children who attend residential care have worse outcomes than those in family care without explaining that it is the most traumatized, troubled kids with complex histories who are placed in residential facilities. Those children would be expected to have worse outcomes than their peers because they have often had the worst past experiences by the time they finally have access to treatment.

The State of Washington provides a cautionary tale of what can happen when residential care in a state almost disappears. Budget pressures stemming from the 2008 recession dovetailed with the growing sentiment against residential options, as described in an excellent article in The Imprint by Elizabeth Amon. Between 2009 and 2019, over 200 residential beds in 13 locations disappeared. Unfortunately, the state lacks enough appropriate placements for youth with psychiatric, behavioral and developmental needs. These young people end up staying overnight in offices, emergency one-night foster homes, hotels, and cars–or sent to out-of-state facilities including some operated by Sequel. Not only are these arrangements anti-therapeutic, but they are extremely expensive, as Amon points out.

In Texas, where the Imprint focused on the poor quality of many RTC’s, child welfare administrators are worried about the declining number of residential centers. Every year, at least one RTC stops contracting with the state due to inadequate reimbursement, which means they cannot pay workers enough to retain them. As a result, the number of Texas foster children sleeping in offices and hotels spiked last year, according to an article in the Austin American-Statesman. These were mainly teenagers with trauma histories and/or significant behavioral and mental health issues, according to a state official.

In New Mexico, the Department of Children, Youth and Families (CYFD) contracts with ten residential treatment centers in the state, but that is not enough to care for all the foster youth who need therapeutic residential care, as the Secretary told the Santa Fe New Mexican. As a result New Mexico still sends children to out-of-state facilities. The Secretary has requested more funding for additional therapeutic residential care resources.

In Maryland, the Baltimore Sun and WYPR reported last February that dozens of children were spending weeks or even months in psychiatric units of hospitals without a medical reason because social workers had nowhere else to place them. Often these children were placed in psychiatric units after experiencing a crisis in a foster home. Most of these children are not ready to move to a foster home upon discharge and need a higher level of supervision and therapeutic care. But there are waitlists for the roughly 350 spots at Maryland residential treatment facilities, and for out-of-state facilities as well. These long hospital stays are destructive and traumatic to the children as well as extremely expensive.

Last January, I wrote about similar problems in Oregon, New York, California, and Illinois. Residential critics miss the point. If states don’t have quality residential facilities, or any residential facilities at all, they will send their kids to facilities run by operators like Sequel, put them up in offices, hotels, temporary placements or cars, or leave them in hospitals. That’s why only three out of 40 states and territories sending children to Sequel facilities have severed ties with the company, despite its awful track record.

Those who oppose all residential care for foster youths are blind to the challenging problems of some foster youth, the life-changing potential of quality therapeutic residential care and the vast differences between high and low-quality residential facilities. We need to make sure quality residential services are well funded and regulated to keep children out of offices, hotel rooms, abusive or out-of-state facilities, and hospitals. Legislators at all levels of government must recognize the need for adequate funding of this crucial service necessary to heal the wounds of our most fragile foster youth.

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, no 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 placements 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.