Tag: foster care

A disappointing report from the Senate Finance Committee

A new report by the Senate Finance Committee concludes that children in residential treatment facilities routinely suffer harms like sexual and physical abuse, unsafe and unsanitary conditions, and lack of needed therapy. Further, it concludes that these harms are endemic to residential care itself. While the fact that some residential care facilities are substandard and cause harm to children is undisputed, the SFC’s study is poorly designed and should not be used as the basis of policy. It is based on facilities run by only four companies and cannot be used to make generalizations about residential care as a whole. Both the study design and the findings of the SFC report appear to stem from a preconceived conclusion and not on a desire to describe the actual landscape of residential care for America’s youth who need intensive behavioral health care.

On June 12, 2024, the Senate Finance Committee (SFC) released a report called Warehouses of Neglect: How Taxpayers are Funding Systemic Abuse in Youth Residential Treatment Centers. The report was based on an investigation of what it calls residential treatment facilities (RTF’s) operated by four large companies, “each owning facilities with a history of public abuse and neglect allegations and a substantial facility footprint.” It does not define RTF’s, but the term clearly refers to facilities that provide behavioral health services in a residential context to children with funding from programs under SFC jurisdiction, mainly Medicaid and foster care funds under Title IV-E of the Social Security Act. The four companies include three profit making corporations (United Health Services, Acadia Healthcare, and Vivant Behavioral Healthcare), and one nonprofit, Devereux Advanced Behavioral Health.

The report describes a pattern of poor conditions and abusive practices that the SFC staff observed by reviewing media articles and company documents, supplemented by interviews with senior leaders in the four companies and visits to several facilities not operated by these companies.1 These conditions and practices include sexual and physical abuse by staff; the inappropriate and often abusive use of restraints and seclusion; staff who are unqualified and inadequately trained staff or who routinely fail to discharge their duties, leading sometimes to tragic results; “non-homelike,” unsanitary and unsafe conditions; failure to provide the treatment that children need and that states are paying for; failure to maintain connections between children and their communities and to make adequate discharge plans; use of technology to monitor children that is more appropriate to detention facilities than therapeutic settings; and the absence of adequate oversight by state and federal authorities.

The report raises valid concerns about private businesses being involved in services to the most fragile young people. Several details stand out, all of them involving the company called Vivant and its CEO, John “Jay” Ripley. Ripley is the former CEO of Precision Tune Auto Care and and cofounder of BGR the Burger Joint. Ripley previously founded Sequel Youth and Family Services, which became known for the death of 16-year-old Cornelius Frederick while being restrained at a Michigan facility in 2020 and allegations of abuse and neglect at other Sequel facilities. In 2021, according to the report, Sequel closed half of its facilities and sold the other half, including 13 facilities that it sold to Vivant, Ripley’s new company. VIvant in turn hired many former Sequel executives and staff. In a video made by the University of Baltimore’s Merrick School of Business, Ripley explained that “you can make money in this business if you control staffing.” Ripley does not seem like the kind of person who should be running facilities dedicated to healing the most vulnerable young people.

The SFC report might have been a valuable document had it not tried to apply its findings to residential care in general. “Children suffer routine harm inside RTF’s,” the authors write. “These harms include sexual, physical, and emotional abuse, unsafe and unsanitary conditions, and inadequate provision of behavioral health treatment.” Leaving aside the ambiguity of the word “routine” (does that mean every resident or the majority of residents are harmed in such a way?), such a conclusion cannot be drawn from an investigation of treatment centers operated by four large companies. We have no idea what proportion of young people receiving publicly funded RTF care are in facilities operated by these four companies. Around the country, there are residential treatment facilities operated by many providers, including many freestanding facilities that are not part of large chains. Even within the companies reviewed, the report provides no data to document whether the problems exist only at certain facilities or throughout the chains. A facility’s functioning to a large extent reflects its leadership, and there may be well-run facilities among those operated by these companies.

Going even further, the SFC concludes that “the risk of harm to children in RTF’s is endemic to the operating model. The harms children in RTFs experienced are the direct, causal result of an operating model that incentivizes providers to optimize revenues and operating and profit margin. RTF providers offer minimal therapeutic treatment in deficient physical settings with lean staff composed of non-professionals, which maximizes per diem margins…” The report goes on to say that “[a]t its core, the RTF model typically optimizes profit over the wellbeing and safety of children.” But there is no “RTF operating model.” The understaffing and lack of professionals that are common among publicly funded residential providers more likely stem from the low reimbursement rates that that these programs receive, which in turn means that staff receive low pay as well, forcing the facilities to rely on poorly educated and trained staff.

Even more extremely, the report states that “In the best of circumstances, children at RTFs receive care from under-trained and overburdened staff, are given infrequent therapy, sometimes by non-professionals, and are exposed to unsanitary, unsafe, and non-homelike environments.” It is hard to understand how the SFC is capable of describing the best residential programs when its entire methodology consisted of seeking abuses in an extremely limited universe of residential programs.

In suggesting that residential treatment is a flawed model that should not exist, the SFC report ignores the important role of residential treatment facilities in the continuum of care for young people with mental illness. The Committee’s own invited witness, Elizabeth Manley of the University of Connecticut School of Social Work, testified about the need for these programs.

Residential treatment facilities have an important role in the provision of care for young people with complex behavioral health care needs when they have a clinical or behavioral health treatment need that cannot be met in a family and community setting due to the intensity of their treatment and supervision needs. In those instances, we need the care to be delivered in trauma-responsive environments that embrace parent and caregiver engagement throughout the treatment intervention and continually focus on best practice. These residential treatment facilities can have a significant benefit to the young person and their family.

The Child Welfare League (CWLA), in written testimony submitted to the SFC, added that residential services are “a small but important part of the full array of services” that must be available to meet children’s mental health needs.” CWLA went on to explain that there “are many providers and programs providing or striving to provide trauma-responsive, time-limited, effective residential care. They are informed by the emerging literature highlighting promising practices in residential interventions..” CWLA cited the Building Bridges Initiative, which is a national initiative working to identify and promote best practice and policy in residential interventions for youth. The initiative has produced a guide called Building Effective Short-Term Residential Interventions. According to this report, a new literature has developed in the last ten years or so which documents promising practices in residential intervention which are associated with positive benefits. These include “actively engaging youth and families, ensuring active school and community connection, and keeping residential intervention as short as possible.” The authors explain that “[c]utting-edge effective residential intervention now means providers are creatively working with youth and families in the home, in the community, and as briefly as possible – often for three months or less.” The guide was developed to help organizations make the transition to the new approach, with case histories of 12 programs that are making or have made this transition.

Ignoring this new literature, the SFC claims that “studies show that home and community-based approaches produce better treatment outcomes than placing children in RTFs, and are more cost-effective than RTF placements.” In the footnote to that sentence, the writers list only one study, which concerns only one type of facility, Psychiatric Residential Treatment Facilities, a particular model the provides the equivalent of in-patient psychiatric services outside a hospital setting to young people under 21 through an agreement with a State Medicaid agency. Moreover, that study does not conclude that community-based approaches produce better treatment programs. Instead, it concludes that “evidence is insufficient to assess which interventions are effective.” It is almost impossible to conduct a meaningful study comparing residential treatment to community-based approaches, since the children who are sent to RTF’s are generally much more troubled or impaired than the children who are not, and it would be hard to control for such differences without doing a randomized controlled trial. That’s why there are few if any studies that shed light on this issue.

It is hard to avoid the conclusion that both the study design and the findings of the SFC reflect the Committee’s desire to show that residential care is harmful to young people. The SFC’s anti-residential bias is displayed in numerous passages throughout the report. One particularly inaccurate statement claims that “In some cases….., child welfare agencies place children in state custody without diagnoses in RTFs because they have nowhere else to place them.” As evidence, the report cites a 2013 report that showed 28.8 percent of children in “congregate care” had no clinical diagnoses. But congregate care (a term used to designate any placement that is not a foster home) is a more general term than RTF’s. The earlier report included many other types of facilities including cottage-style homes (often on the site of former orphanages and often providing high-quality family-style care) that are not intended for children with serious behavioral health needs, as well as emergency shelters that some states operate to house children before they are placed in a foster home. Given the relatively high cost of RTF’s, it would be very strange if states placed children in them for lack of another option.

Much more common is the opposite scenario: agencies placing children in foster homes unprepared to care for them, resulting in placement instability, or even letting them sleep in hotels or offices, for lack of residential treatment facilities. Articles about this problem appear frequently, including a recent report from the Midwest Newsroom (a collaboration between NPR and Midwest member stations) on the insufficient capacity of residential care for girls in Missouri and Iowa. The article starts with the story of a young woman who was placed in a residential treatment program called Missouri Girls Town after a traumatic childhood, placement in foster care and a disrupted adoption by a parent who could not handle her rebellious adolescence. This young woman credits Missouri Girls Town with completely changing the trajectory of her life. Sadly, this nonprofit program, which relies on private donations to supplement what it gets from government agencies, was designed to accommodate up to 50 girls but can only take 12 because of “staffing and funding challenges.” Stories like this have been appearing from around the country for years. There is not enough residential treatment for the young people in foster care who need it. Facilities have been shutting down due to failure of state reimbursement rates to keep up with operating costs, as well as the increasing unpopularity of residential care among state officials and legislators.

Despite the major flaws in the SFC’s analysis, there is little to object to in its recommendations. It’s hard to argue against recommendations that Congress act to improve conditions in congregate care facilities, that the companies reviewed raise their standards, and that states invest in community-based services for children with behavioral health needs and improve oversight over RTF’s. The need to invest in community-based services is particularly important because it might enable some children to be helped before their problems become so severe that they need residential care. It might even prevent some placements in foster care that occur when parents can no longer care for behaviorally challenging their children at home. But the findings of the report remain dangerous even if the recommendations are benign; they can be used to support attempts to defund residential care entirely, which would be disastrous for our most vulnerable young people and their families.

The SFC report confounds a group of residential treatment facilities poorly run by four large corporations with the entire field of residential treatment for youth with serious behavioral health care needs. The report presents a distorted picture of a field that already contains excellent, life-changing programs and where passionate and dedicated leaders are already providing or working toward trauma-informed, short-term, and effective residential services for these most vulnerable young people.

  1. Visits to five facilities that were not operated by the four providers being investigated were used to document physical conditions in the facilities, as well as their efforts to provide education to the residents. The finding of “non-homelike,” unsanitary and unsafe conditions was based on the visited facilities rather than on the four companies that were investigated. ↩︎

As foster care removals plummet, where’s the promised help for families?

Year after year, states and the federal government continue to release annual data showing a decline in the number of children in foster care, congratulating themselves on keeping families together. They seem to have forgotten that reductions in foster care were supposed to be accompanied by increased services so that children could be safely maintained at home. Unfortunately, there seems to be little to no interest on the part of the federal Children’s Bureau, Members of Congress, advocates, or the media in whether such services are actually being provided.

The newest report from the Adoption and Foster Care Analysis and Reporting System (AFCARS) showed that the number of children in foster care dropped to 368,530 on September in 2022–a drop of 5.8 percent over the previous year 15.6 percent since 2018. “We are encouraged by the continued decrease in the number of children entering foster care and staying in foster care and we will continue working with our state, tribal and territorial partners to ensure an emphasis on family well-being and safe family reunification,” said Jeff Hild, the Principal Deputy Assistant Secretary of the Administration on Children and Families (ACF) in a press release heralding the new numbers. ACF gave credit to the Family First Prevention Services Act (FFPSA), which “helped change the conversation to be about prevention of foster care placements and preservation of families.” 

It seems premature to celebrate the shrinkage of the foster care rolls as a triumph without knowing what is happening to the children remaining at home who would have been removed in a different year. How many of these children are living with abuse or neglect that will leave lasting scars or impair their development, if not endanger their lives? Supporters of the Family First Prevention Services Act (FFPSA), which passed in 2018, said that declining foster care counts would result from providing support to parents who needed help to address the problems (like substance abuse, mental illness and poor parenting skills) that led to their maltreatment of their children.

After an allegation of abuse or neglect is substantiated, an agency can place a child in foster care or open a case for in-home services, among other options.1 FFPSA made it possible to use the same federal funds for foster care and in-home services, allowing children to stay at home safely while their parents addressed the issues that put them at risk. A major purpose of FFPSA was to enable states to use federal funds that were formerly available only for foster care to pay for parenting support, mental health, and drug treatment that would enable children to stay safely with their families. The rationale for this change was that allowing foster care funds to be used for such services was necessary to enable states to keep kids out of foster care.

However, FFPSA has not made massive federal resources available for such services. ACF estimates that only 18,400 children in the entire country were served by Title IV-E prevention services programs in FY 2023, at a cost of $167 million. But perhaps states are using their own funds to pay for these services? After all, foster care is more expensive than services provided to families in their homes. Both require case management, but instead of the cost of room and board for foster youth, providing in-home services usually involve referring parents to mental health and drug treatment services often funded by Medicaid or paying for parenting support programs that cost less than foster care. (Of course the supporters of FFPSA ignored this basic fact and claimed the legislation would revolutionize child welfare!). States were already providing these services before FFPSA and they could have increased them without the promised federal funding.

But believe it or not, nobody knows if more children and their families are receiving in-home services as the foster care rolls decline, since the federal government doesn’t ask states for this information. While states were already required to report the number of children entering foster care, leaving it, and in care at a point in time, FFPSA did not add a requirement to provide the same data on services provided to children and families in their homes, now that they were also covered by federal Title IV-E funds.2 Hoping some states might track this data of their own accord, I searched the data publications and dashboards on the websites of the ten states with the largest number of children in foster care according to the most recent AFCARS report,3 but I was able to obtain this data for only California and Texas.

California has by far more children in foster care than any other state, 45,924 children at the end of September, 2022, which was 12.4 percent of the national total. Fortunately, there is extraordinarily good data from the California Child Welfare Indicators Project (CCWIP), a collaboration between University of California at Berkeley and the California Department of Social Services. The CCWIP dashboards include data on the number of entries into foster care and the opening of Family Maintenance cases, as in-home cases are called in California. Entries into foster care declined precipitously from April 2019 to March 2020 and continued declining, though more slowly, through March 2024. Family Maintenance case openings also declined continuously throughout the period. Thus, there was no increase in Family Maintenance case openings to compensate for the decline in removals. Or put in a different way, the total number of cases opened for child welfare services dropped from 46,264 at the beginning of the period to 29,969 at the end–a drop of 35 percent. Rather than a shift from foster care to in-home services, there has been a shrinkage of children reached by child welfare services overall.

Source: California Child Welfare Indicators Project, Entries, https://ccwip.berkeley.edu/childwelfare/reports/Entries/MTSG/r/ab636/l and Case Openings, https://ccwip.berkeley.edu/childwelfare/reports/CaseOpenings/MTSG/r/ab636/l.

Texas has the third largest state foster care caseload, after Florida. The Texas data are a bit more confusing. The number of children entering foster care dropped from 16,028 in 2021 to 9,623 in 2022, an incredible 40 percent, while the number of children entering in-home services declined steeply as well, resulting in a 35.7 percent drop in all case openings. Both drops may well have been related to a new Texas law that took effect on September 1, 2021 and changed the definition of neglect to an action or lack of action that puts a child in “immediate danger” of harm, rather than “substantial risk” of harm as the previous language read. The bill also put restrictions on child removals, requiring that children can be removed only from parents who display “blatant disregard” for their actions, or whose inaction “results in harm to the child or creates an immediate danger to the child’s physical health or safety.” Interestingly, in 2022, foster care entries actually rose slightly in Texas, while family preservation entries sprung back to where they were in FY2021, resulting a substantial increase in total case openings that year. Nevertheless, the overall trend over time was a decrease in foster care entries, family preservation case openings and the total number of children receiving help through open in-home or out-of home cases. That total dropped from 72,181 to 48,619 over five years–a drop of 32.6 percent–almost the same as the drop in California’s child welfare case openings.

Source: Texas Department of Family and Protective Services, CPS Conservatorship, Removals, https://www.dfps.texas.gov/About_DFPS/Data_Book/Child_Protective_Services/Conservatorship/Removals.asp, and CPS Family Preservation, Children Entering Services, https://www.dfps.texas.gov/About_DFPS/Data_Book/Child_Protective_Services/Family_Preservation/Children_Entering_Services.asp

Florida, the state with the second largest number of children in foster care, reports on the numbers of children entering foster care but not on the number entering in-home cases. One can, however, compare the number of children in foster care at a point in time with the number of children and young adults receiving in-home services. Both numbers have been decreasing and the number of children receiving in-home services has been consistently about half of the number of children in foster care. But these numbers don’t tell us whether declining entries to foster care have been offset by increasing entries to in-home services. In general, foster care cases last longer than in-home cases. Not knowing the average length of stays in foster care and in-home cases, and how they have changed over time, one cannot tell whether in-home case openings have made up for the reduced number of entries into foster care.

The Florida data show why point-in-time data cannot be used to answer the question of whether the decline in foster care entries has been accompanied by a rise in in-home case openings. Unfortunately, none of the other eight states with the highest caseloads provide this data on their websites. Illinois and Indiana provide point-in-time data on foster care and in-home participants. The other five states with the largest caseloads–Ohio, New York, Pennsylvania, Arizona, and North Carolina–display no data on in-home case participants at all.

If California and Texas are typical, states have not been increasing their provision of in-home services to make up for declines in foster care. Instead, the total number of abused and neglected children being helped by in-home or out-of-home services (or foster care) has declined by as much as a third in five years. But we cannot assume that California and Texas represent the entire nation. It is unfortunate that the writers of FFPSA did not requiring states to include data on in-home case openings and total caseloads, given that the legislation allowed federal funds to be used for this purpose. States have not begun tracking and reporting on this data on their own, and are triumphantly proclaiming the drop in foster care without even reporting on whether in-home services are being provided instead. When Congress considers desperately-needed fixes to FFPSA, a requirement that states report in-home case data analogous to the foster care data in the AFCARS system should be included in the new legislation.

Notes

  1. Other options include referring a family to a community provider or even doing nothing nothing if the abuse or neglect was assumed to be a one-time event unlikely to occur. The family may also refuse in-home services, and the agency would then have to decide whether to file a court petition to require such services ↩︎
  2. States must provide to National Child Abuse and Neglect Data System (NCANDS) information on how many children receive “postresponse services,” meaning services after a child protection investigation. But unfortunately, “postresponse services” includes foster care and provides a duplicated count, counting children every time they are the subject of an investigation, so it is not useful in telling us how many children receive in-home services. ↩︎
  3. State foster care data can be accessed from https://www.acf.hhs.gov/cb/report/trends-foster-care-adoption. According to the latest information, the ten states with the largest number of children in foster care on September 30, 2022 were California, Florida, Texas, Illinois, Ohio, New York, Missouri, Pennsyhlvania, Arizona, and Indiana. ↩︎

Controlling the narrative: How the state of Washington is trying to censor the foster parent voice in court

by Christina Faucett

I am honored to publish this essay from Christina Faucett. Christina has been a licensed foster parent in the state of Washington for six years and has adopted one child from the foster care system. Prior to becoming a foster parent, she was a CASA for three years. She is currently a member of the DCYF Parental Advisory Group and is passionate about fixing what is broken in our child welfare system to keep Washington kids safe. She lives in the Seattle area with her husband and daughter. You can follow her on X at @DCYFWAtch.

In 2023, the Washington State Department of Children, Youth, and Families (DCYF) completely rewrote their Caregiver Report to Court form. This form is the only voice foster parents have in the dependency process, since they are not parties to the case, and thus are not entitled to receive legal counsel, file motions, read pleadings, or speak in court unless called on by the judge. Given this, one might expect that changes to the caregiver report form would by preceded by extensive communication and feedback from caregivers as part of the editing process. This did not happen.

I first became aware of these changes in the fall of 2023 when I was provided the new form to submit in my foster child’s dependency case. I then reached out to connections I had in DCYF to ask how these changes had come about, and who had participated in the process of editing the form. After being stonewalled by DCYF employees, I submitted a Freedom of Information Act (FOIA) request, the results of which I finally received a couple of weeks ago. 

My FOIA response revealed that the committee convened by DCYF to make the changes to the caregiver report to court included only one caregiver. However, it included three representatives of birth parents, including one former birth parent who had a child in foster care, a parent attorney and a social worker from the Office of Public Defense (which represents and provides assistance and advocacy for birth parents in dependency cases), along with other court and DCYF employees, and one CASA representative. At no point were caregivers informed of this committee’s existence, invited to participate on the committee, or asked to give feedback on the committee’s proposed changes.

The only foster parent representative on the committee works with Amara’s Family Connections Program, which encourages foster parents to maintain relationships with biological parents. Although this foster parent is a representative for what is called the “1624 Consultation Team” (named for the bill that created the group), which is a group of elected foster parent representatives who are supposed to raise the questions and concerns of foster parents in meetings with DCYF, no other 1624 representatives appear to have been informed of the pending changes. The Foster Parent Association of Washington also does not appear to have been informed of the pending changes. An August 2, 2023 post to their website states, “This seems to have been a sudden change and not everyone in the system is aware of it.”

Adding to the confusion, DCYF released two different Caregiver Report to Court forms, a long form and a short form. However, the forms have some completely different questions. For example, “Are you maintaining open and viable communication with the child’s biological parent?” is only included in the short form, not the long form. Even after an entire year of work on this by the committee, the reports still have numerous typos and errors. The new report was released with instructions that caregivers could submit it to the child’s CASA, not just their social worker, even though the CASA program in some counties did not want this responsibility and refused to submit the forms to the court on behalf of caregivers.

While not all of the changes to the caregiver report form are bad, a quick look makes it clear that DCYF is trying to limit input from foster parents to information that supports reunification, while simultaneously diminishing their opportunity to highlight their own relationship with the child (whom they may have raised for years, possibly from birth).

Some examples of changes:

  • A question soliciting caregivers’ thoughts on the Department’s case plan has been replaced with a question asking “Do you have any additional information that may help reunite the child or youth successfully with their biological family?”
  • A general question about how the child’s visits with parents are going has been replaced with, “What’s working well with family time? Explain.”
  • Other changes imply that caregivers have obligations they do not have. For example: “How have you included the parents of the child in the medical and dental appointments?” It is the social worker’s responsibility, not the caregiver’s, to inform parents of medical/dental appointments. The communication question mentioned above likewise implies that caregivers have an obligation to communicate directly with biological parents. Caregivers may have many legitimate reasons (including privacy and safety reasons) not to communicate directly with birth parents.
  • The old form had two questions about the child’s relationship with the caregiver and adjustment to living in the caregiver’s home. On the new long form these questions have been replaced with one question which is relegated to the bottom of the form under “additional information.” The short form doesn’t even ask caregivers about their relationship with the child living in their home; it only asks about the child’s behavior in the home. A question asking caregivers to “Describe child or youth’s interactions with positive adults (i.e., coaches, teachers, church, mentors, other relatives)” is given higher billing on the long form than the questions about their relationship with their primary caregiver.

DCYF has lost around 800 licensed foster homes since 2019, and since their six-month pause on issuing all new foster parent licenses from November 2022, to April 2023, the number of unfilled emergent placement needs has skyrocketed. If DCYF wants to achieve their goal of eliminating short-term stays for foster children and youth in offices and hotel rooms by December 2024, they need to start treating caregivers with the respect they deserve, not trying to further stifle their voices.

Child Welfare Update: February 2024

Greetings to my faithful readers! I’m trying out a different format for Child Welfare Monitor–a monthly newsletter format that highlights events and information that catch my eye. I’m not ruling out a single-issue piece now and then, particularly when there is a major new report or data source to discuss and analyze. Please let me know what you think of the new format. If you can think of a more exciting title than “Child Welfare Update,” let me know. And if you do find this to be a useful resource, please share it with your colleagues.

Adam Montgomery convicted of Harmony Montgomery’s death

In December 2021, Manchester, New Hampshire Police announced the disappearance of Harmony Montgomery, who would have been six years old if she were alive. We learned that Harmony’s noncustodial mother, Crystal Sorey, had called the police a month earlier to say that she had not seen or heard from her daughter since April 2019, two-and-a-half years earlier. The country was rapidly transfixed by the search for Harmony. We soon learned that the little girl, who was blind in one eye, had first been removed from Sorey at the age of two months by the Massachusetts Department of Children and Families (DCF) due to Sorey’s substance abuse. Harmony’s father, Adam Montgomery, was in jail at the time. Harmony was returned to her mother at seven months, and removed again at ten months. At almost three years old, and after two straight years in foster care with the same family that fostered her from the start and wanted to adopt her, Harmony was returned to her mother for the second time. At age three-and-a-half, Harmony was removed from her mother for the third time. Since Harmony was first removed, Adam Montgomery had been released from prison and begun visiting her. In February, 2018, a judge awarded Montgomery immediate custody of Harmony, without waiting for an assessment of his wife or a study of his living situation in New Hampshire.

A shattering report by the Massachusetts Child Advocate revealed the many missteps by all the professionals tasked with keeping Harmony safe. The OCA concluded that “Harmony’s individual needs, wellbeing, and safety were not prioritized or considered on an equal footing with the assertion of her parents’ rights to care for her in any aspect of the decision making by any state entity.” 

Two years after the search for Harmony began, Adam Montgomery has been convicted of her death, thanks to the testimony of his wife. She told prosecutors that after Harmony soiled her bed at night he beat her viciously on the head in the morning of December 9, 2019 and again that afternoon in the car when she soiled herself once more. He then injected opioids and ate fast food as Harmony died of her injuries in the back of the car. He concealed Harmony’s body for months until renting a U-Haul and dumping her remains somewhere outside Boston. Her body has never been found. Montgomery is already serving 32 1/2 years in prison for another case and I hope he will never see the light of day, but what about all the professionals who failed to prioritize Harmony’s needs? And what has Massachusetts done to ensure that there will be no more Harmonies? The adoptive parents of Harmony’s brother have been speaking out; I assume Harmony’s foster parents are too devastated to do so, but their hearts must be broken.

Race trumps child welfare I: Black children don’t get attached?

Harmony Montgomery’s case illustrates, among other things, what happens when the importance of attachment for young children is disregarded. Attachment theory, which is widely accepted and taught in classes on psychology, social work and human development, posits that a strong attachment is central to the development of infants and affects their brain development and their ability to form relationships throughout life. The critical role of attachment in human development, which has been confirmed in mammals as well as humans, is the reason that the Adoption and Safe Families Act (ASFA) set a timeline requiring states to file for termination of parental rights after a child had spent 15 of the last 22 months in foster care. That is the deadline that Harmony’s team disregarded when they returned her to her mother after two years in foster care and continued to work with both parents after her return to foster care at the age of three-and-a-half. The continued disruptions were so devastating for Harmony that her foster parents, according to the OCA, could no longer meet her needs when she was placed with them for the third time, and asked that she be transferred to a specialized therapeutic home.

But some lawyers that counsel parents in child protection cases are being told that attachment theory does not apply to Black children. In Race Trumps Child Welfare, Naomi Schaefer Riley calls attention to a paper called “The Weaponization of Whiteness in Child Welfare,” originally published by the National Association of Counsel for Children. The paper calls attachment theory a “tool to justify the separation of families” and a manifestation of “racism in psychology.” The authors take aim at professionals who utilize attachment theory to argue for the adoption of Black children by White foster families who have raised them from infancy rather than returning them to their parents or placing them with kin. They argue that a Black child who has lived with a White foster family for the entire two-and-a-half years of his life should be placed with a relative who has never even seen the child. Black families, they say, belong to a collective culture, which emphasizes the needs of the group as a whole over the needs of an individual. Thus, any suffering to an individual child, they imply, is justified by the gain to the group–though it is hard to understand how Black people as a whole gain from the traumatization of young Black children.

Race Trumps Child Welfare II: ABA “addressing bias in medical mandated reporting” in Michigan

The American Bar Association (ABA) has announced that its Center for Children and the Law is piloting a new initiative in Michigan “to address overreporting by medical professionals of Black, Indigenous and Latino/a children to the child welfare system.”  Without a footnote, the ABA reports that “injuries in Black children are 9 times more likely than those in White children to be reported as abuse despite evidence that child abuse and neglect occur at equal rates across races.” (Italics are mine.) Equal across races? I wonder what data they are using. While I am the first to acknowledge that maltreatment substantiation rates may not reflect actual incidence of abuse or neglect, evidence suggests that the two-to-one Blsck-White difference in child maltreatment substantiation rates is likely an understatement, not an overstatement. Moreover, Latino children nationwide are not reported to CPS disproportionately to their share of the population.

The pilots, funded by the Children’s Bureau, will use a “multisystem approach developed by the ABA’s Stop Overreporting Our People (STOP) project” to “address each decision made from the time a medical provider has a concern about maltreatment through child welfare hotline report and investigation to the decision of the judicial officer to remove the child from the home.” In Michigan, according to Child Maltreatment 2022, of the 174,000 referrals to the hotline in Federal Fiscal Year 2022, about 68,000 were screened in, about 139,000 children received an investigation or alternative response (down 12 percent from the previous year), and 23,500 were substantiated as victims of abuse or neglect–a whopping 37.7 percent drop over the previous year. Of those “victims,” a total of 2,760 or 11 percent were placed in foster care–along with an additional 956 children who were not substantiated as victims but may have been siblings who were deemed to be equally endangered. Despite the precipitous drops in investigations and substantiations and the very low proportion of children substantiated as victims that were placed in foster care, the ABA isn’t satisfied…or doesn’t bother to look at data. The Michigan pilots will also focus on how doctors are trained to report maltreatment, according to the ABA. Discouraging doctors from reporting the signs that they are uniquely trained to spot may not strike all readers as a good idea.

Where was CPS?

Utah: Abuse in plain sight: Ruby Franke, a parenting influencer who achieved fame by promoting her strict parenting style, was sentenced to up to thirty years after pleading guilty to aggravated child abuse of two of her children. Franke rose to prominence with a youtube channel called 8 Passengers (now taken down) that documented her life with her husband and six children and was criticized for promoting abusive discipline methods. She eventually formed a business partnership with another woman named Jodi Hildebrandt, who encouraged and participated in the abuse of Franke’s children. Both women were arrested in August 2023, after one of Franke’s children escaped the home and ran to a neighbor’s house asking for food and water. The neighbor noticed the child’s open wounds, duct tape around his ankles and wrists and emaciation and called the police. After the arrest, the oldest daughter posted on social media that: “We’ve been trying to tell the police and CPS for years about this, and so glad they finally decided to step up.” “Several of us tried to help,” one neighbor told the Salt Lake Tribune. “I know people left food on doorsteps knowing the kids might not be eating; I know people were making phone calls to DCFS, to the police — people really did try and care. No one was looking the other way.”

New Mexico: $5.5 million settlement reached in eight-year-old girl’s brutal death: The Santa Fe New Mexican reports that the New Mexico Children Youth and Families Department (CFYD) has agreed to pay $5.5 million to the brother and half-siblings of Samantha Rubino, acknowledging that it placed Samantha and her brother in the care of a man (Juan Lerma) with a history of child abuse and domestic violence, who had been investigated once before for abusing her and had not seen either Samantha or her brother for two years. Samantha died of blunt force trauma to the head, and Lerma placed her body in the trash. This is the latest in a series of big-money settlements by CYFD, funded by the taxpayers. New Mexico’s system is in crisis, with a backlog of 2,000 investigations of abuse and neglect. Is it too much to hope that the legislature will decide it is better to spend money up front to keep children safe than to pay massive settlements to their survivors?

The march continues to remove protections for homeschooled children

The powerful homeschool lobby continues its crusade to eliminate the few regulations that still exist to protect homeschooled children. In Nebraska, LB 1027 would eliminate two of the three minimal documents required for homeschool enrollments. It would bar school districts and Health and Human Services from investigating educational neglect in a homeschool setting. And it would give one parent the power to make homeschooling decisions without input from the other parent. The unicameral legislature’s Education Committee heard testimony from the Nebraska Christian Home Educators Association, the president of a Christian homeschoolers’ co-op, and another homeschooling parent. There was no testimony against the bill. The Education Committee has recommended the bill, and it is headed for a floor vote.

In West Virginia, legislators have tried to bar abusive parents from homeschooling ever since an eight-year-old girl named Raylee Browning died of sepsis, possibly caused by drinking toilet water, in 2018. Teachers had called CPS multiple times because Raylee was constantly hungry and covered in bruises. To avoid further problems, her guardians removed her from school for the ostensible purpose of homeschooling, thus enabling them to torture ber to death without interference. Every year since 2019, legislators have introduced Raylee’s Law, which would prohibit homeschooling if the parent or home educator had a pending investigation for child abuse or neglect or had been convicted of abuse, neglect or domestic violence. This very modest bill, which probably wouldn’t even have saved Raylee because her guardians did not have a pending investigation when they withdrew her from school, nor were they convicted of abuse, has never gotten through the legislature. This year it was voted down in the Education Committee by 15-5 after several legislators outlined their concerns–such as the fear that it would force children to enter public school before an investigation could be completed!

This year, the sponsors of Raylee’s Law managed to get a version of the legislation included in a bill that removes certain testing requirements for homeschooled children, and it passed by a voice vote. Unfortunately the amendment that passed was watered down further from the original bill, which itself was very weak The amendment that passed requires that a parent cannot withdraw a child for homeschooling if there is a pending child abuse or neglect investigation. But if the complaint is not substantiated within 14 days, the superintendent must authorize homeschooling. And the bill to which it was attached (HB 5180) reduces protection of homeschooled children by removing the requirement that parents submit academic assessments for homeschooled children in certain grades, as well as the requirement that the parent or home educator submit evidence that they have a high school or post-secondary degree.

Readers who care about the protection of homeschooled children and the drastic disproportion of power between homeschooling parents and advocates for their children should give to one of my favorite organizations, the Coalition for Responsible Home Education. They are doing their best on a shoestring budget, but they can’t afford to go to every state where protective legislation is threatened.

From the “Are you kidding me?” department

“Safe Haven laws” are a way for new parents who are not ready to raise a child to surrender their newborns safely without any questions or legal consequences. The laws exist in all 50 states. The Committee to Eliminate Child Abuse and Neglect Fatalities has endorsed these laws as a way to protect vulnerable infants and recommended that they be amended to extend the age of protected infants to age 1 and to expand the types of safe havens allowed. And it turns out that this option has existed in Europe since Pope Innocent III required churches to install “Foundling Wheels” in 1198!

In New Mexico, mothers are told they can anonymously surrender their infants through “safe haven baby boxes” located around the state. But recent media coverage from local stations KRQE and KOB4 has revealed the state’s Children Youth and Families Department (CYFD) has been investigating these surrenders–because they are required to do so by the state’s safe haven law. CYFD Secretary Teresa Casados told KRQE that “state law requires CYFD to investigate to ensure the mother was not forced to give up her baby, to make sure she is safe, and to inform the father of the child as well.” (She was apparently not asked what would happen if the father had raped or abused the mother.) She also explained that the Indian Child Welfare Act (ICWA) requires CYFD to look into each case and notify “all the tribes and pueblos” to ensure they are following the Act’s requirement that placement with a Native family be preferred. It is not clear that any other state has interpreted ICWA this way. New Mexico legislators rushed to draft legislation to retain the right of mothers to surrender their infants safely and anonymously, but the short session ended before a bill could be passed.

Never underestimate a persistent child advocate

John Hill, the Investigative Editor at Civil Beat, a nonprofit news outlet in Honolulu, Hawaii, has never given up on his quest to find out how a six-year-old girl named Ariel Sellers was placed with Lehua and Isaac Kalua, the adoptive parents who tortured her, culminating in her murder two-and-a-half years ago. The Kaluas have been charged with murder and abuse of both Ariel and her then 12-year-old sister, among other charges. The prosecution alleges that Ariel was kept in a dog cage and denied food, and that Lehua Kalua caused her death by duct-taping her mouth and nose. For more than two years, according to Hill, the Hawaii Department of Human Services has stonewalled in accounting for its actions in the adoption of Ariel, who was renamed “Isabella Kalua” by her adoptive parents. But Hawaii’s Public First Law Center, motivated by a series of columns written by Hill, has filed a motion to receive the foster and adoption records for Ariel and her siblings. Now Hill is asking uncomfortable questions about the January 2024 death of 10-year-old Geanna Bradley, who was also allegedly tortured and starved to death by her adoptive parents.

In a bizarre twist, the Honolulu Star Advertiser has reported that the Kaluas have retained custody over Isabella’s three sisters, who were removed from the home in September 2021. But apparently the state of Hawaii hasn’t moved to terminate the parental rights of the Kaluas. A special master appointed to oversee the interests of Ariel’s sisters is concerned that the failure to terminate the rights of the Kaluas will interfere with efforts to find permanent families and educational opportunities for the girls. (And already has, I would think!)

The guaranteed income craze continues

At its February oversight hearing, the Director of the District of Columbia Child and Family Services Agency announced a forthcoming grant from the Doris Duke Foundation to a guaranteed income for some low-income families. The announcement was greeted with congratulations from the Council Chair who referenced the great results from the recent Strong Families, Strong Futures pilot, which provided 132 new and expecting mothers with $10,800 in the course of a year. I don’t know where she got her information. An article in the Washington Post reported on interviews with three of the mothers participating in the pilot. One of the mothers took the money as a lump sum. Setting aside about $5,000 for essential expenses, she used the remaining money on a $6,000 trip to Miami preceded by the purchase of new clothes, shoes, gadgets and toys for all of her three children and a $180 hair and nails treatment for herself. Another mother decided to spend $525 on a birthday party for her one-year-old, who clearly couldn’t appreciate it. Program coordinators said that the mothers reported spending most of their funds on needs such as housing, food and transportation. But I’m not sure how I feel as a DC taxpayer to see my money spent in ways that I personally find wasteful, nor am I sure that allowing such spending provides appropriate training in how to budget scarce resources. Such no-strings-attached money giveaways might not be the best use of taxpayer money, even if foundations choose to support it.

And the prize for cynical use of data goes to….

Kentucky! The State’s Cabinet for Health and Family Services (CHFS) is crowing about Kentucky’s drop from the highest rate of child maltreatment “victimization” to number 13 among the 50 states and the District of Columbia. In a statement reported by Spectrum News1, CHFS said this improvement “demonstrates the efforts made by the Department for Community Based Services and its many partners to increase the provision of child welfare prevention services and reduce child abuse and neglect within the Commonwealth.” But child advocates and family court judges are not convinced, citing a longstanding problem with hotline workers screening out cases that should be investigated–exacerbated by the adoption of an actuarial screening tool at the hotline in April 2022. The report quotes two family court judges and a CASA program director who linked child deaths to the failure to investigate prior reports involving the same families. According to one judge, “The alarm has to be sounded because I’m not joking when I say children are perishing in the state of Kentucky because of this ‘Structured Decision Making’ tool….'” The judges are right. One has only to look at Kentucky’s commentary in the Children’s Bureau’s report, Child Maltreatment 2022.

An overall decrease for child victims was observed between FFY 2021 and FFY 2022.
Kentucky has worked diligently over the past several years to implement a safety model
which includes the implementation of SDM® Intake Assessment Tool and a thorough review and modification of the state’s acceptance criteria to ensure a focus upon children and families with true safety threats versus risk factors. This shift in the approach to the work may have contributed to the decrease in child victims this year.

Children’s Bureau, Child Maltreatment 2022, p. 13

In other words, they changed the screening criteria to screen out more cases and voilà! Fewer child victims! Amazing! The percentage of referrals that was screened in decreased from 45.5 percent in 2021 to 39.9 percent in 2022, and the maltreatment substantiation rate decreased from 14.9 to 12.3 per thousand children during the same period. But both of these rates have been decreasing since FFY 2018, so more factors than the new screening tool are likely responsible. It’s unlikely that a decrease in actual maltreatment is among them.

The placement and workforce crises continue

Every month brings another crop of articles on the intertwined placement and workforce shortages plaguing child welfare. February’s news on the placement crisis included a story from Texas Public Radio reporting on the release of hundreds of incident reports about “Children Without Placements” in the state from 2021 to 2023. They include stories of children squaring off to fight each other in the hallway of a Houston hotel that resulted in the hospitalization of one youth. These incidents, occurring at a rate of about two a day, often involved injured staff, injured youth, and calls to police.

In a state that requires some social workers to supervise youths in hotels and other unlicensed placements, its not surprising that about one in four caseworkers left the job in January, according to the head of the Department of Family and Protective Services (DFPS). And even workers who don’t have to supervise unruly youths are dealing with untenable caseloads and terrible working conditions. Some states are taking action to attract and retain workers. The Governor of Maine announced a series of three one-time lump-sum payments of $1,000 to recruit and retain child welfare workers. Let us hope it is enough to reduce the state’s high caseloads.

And now for some good news: efforts to keep siblings together

It’s always nice to read about people who see a need and create a program to meet it. February brought news of two new “foster care villages” to house larger sibling groups, an idea I have promoted in the past. In California, the actor Christian Bale achieved a dream he has nurtured for 16 years–breaking ground on Together California, a new foster home community in Palmdale, Los Angeles County. The project will include a dozen foster homes built to accommodate up to six siblings and staffed by full time, professional foster parents. A 7,000-square foot community center will offer academic, therapeutic, social, and recreational activities for young people in the foster homes and the surrounding community, which is very short on such resources.

In South Carolina, a new foster care “village” called Thornwell is transforming old houses built about 100 years ago to house foster families and large sibling groups. Two homes are in use, a third is under renovation and more homes await renovation provided the funds and parents can be found. Foster parents will pay one dollar of rent per month and receive free utilities. Children will be eligible for Thornwell’s early learning center, charter school, and recreational facilities. Here’s hoping for more programs like Together California and Thornwell!

Reform, not abolish, child welfare: A science-informed path

By Antonio R. Garcia, Jill Duerr Berrick, Melissa Jonson-Reid, Richard P. Barth, John R. Gyourko, Patricia Kohl, Johanna K.P. Greeson, Brett Drake, and Victoria Cook

A note from Child Welfare Monitor (CWM): CWM welcomes submissions from authors who represent points of view that are more evidence-based and child-centered than what is typically presented by leading media outlets and other child welfare publications. We are privileged to share this commentary from an illustrious group of child welfare scholars from schools of social work and social policy around the country. While this essay does not mirror the views of CWM in every detail, we share the authors’ basic premise regarding the need to reform, rather than abolish, the child welfare system.

Over the past couple of years, while teaching classes, presenting lectures, or offering invited talks and workshops, students and participants have inquired about the need to abolish the child welfare system. Some have questioned whether they should continue their pursuit of a career in this field. They are aware of the growing calls by abolition advocates, particularly UpEND and JMac for Families, to completely eradicate child welfare services, despite offering no evidence as to its likely impact on child safety or permanency.

Abolition advocates have successfully convinced a few scholars, an unknown number of students, and a surprising number of community members and decision-makers that child protective services must be eliminated. Acting on briefs supplied only by activist groups, the United Nations has even called for all major child welfare laws in the United States to be repealed or replaced. 

Why?  The narrative built by the abolitionists includes two major parts: First, classist and racist bias largely determines who has contact with the child welfare system, with poor children as well as Black and Native American children being routinely and unnecessarily harassed.  The resounding narrative–largely offered by lawyers, not child welfare scientists–is that the interventions and intentions of child welfare services and its staff are inherently racist (e.g., Roberts, 2022).  Some child maltreatment scholars (e.g., Briggs et al., 2023) have even gone so far as to reiterate Roberts’ claim that the modern child welfare system (CWS) was intentionally designed as a mechanism of racial oppression. This conclusion flies in the face of history as documented child welfare historians (e.g., Myers, 2004). Purveyors of this narrative ignore efforts like those of pioneering African American women pursuing the development of child welfare facilities for African American children who were routinely insufficiently served by family and community (Peebles-Wilkins, 1996); they fail to mention the work of the Children’s Defense Fund, and a diverse coalition of policymakers, who helped to shape the modern CWS through their work to expand family preservation and support services. Nor do they acknowledge that the Title IVE program was, in part, explicitly developed to extend equal protections to Black children (Hutchinson & Sudia, 2002).

Second, those who denigrate child welfare services argue that CWS interventions do more net harm than good, and for that reason should be abolished.  Child welfare services are said to sever familial connections (Roberts, 2022), and unjustifiably surveil children and families (Gruber, 2023). To that end, they argue that the best way to protect children and families is to abolish the current system and replace it with family and community-based responses (Kelly, 2021). This proposed alternative to CPS is remarkable for the degree to which it is vague and undefined.  Nothing approaching a concrete plan for such a system has ever been suggested to our knowledge.  Given the historical lessons of relegating unwanted or abused children to orphanages, orphan trains, indenture, or detention centers, it is difficult to point to an example of American communities fully embracing the care of children whose parents are unable to care for them.

The abolition movement sidelines any past record of successful reforms of child welfare or hope for future evidence-based or incremental change. Anxious, perhaps, that reforms have been uneven or too slow, the proponents of abolition do not suggest improving the complex and intricate web of local, state, and national child welfare policies that have been developed over the last 40 years.  Critically, their proposals have no evidence base. Instead, they rely on ideology that disregards the best available evidence (Barth et al., 2020).

The degree to which the abolition narrative is taken seriously is troubling.  Child safety is contingent upon training qualified professionals to respond to signs of abuse and neglect – and ensuring institutions have the resources to recruit and support them. Tuition is covered for many social work students if they agree to “repay” their time by working for the state’s child welfare system after graduation. The premise is to promote and retain a highly educated, culturally responsive child welfare workforce and prepare them to rely upon critical thinking skills and the best available evidence to promote child safety and permanency. With many states facing unheard-of staff shortages following the pandemic, the additional decrease in interest in the field is distressing. 

In our paper, The Stark Implications of Abolishing Child Welfare: An Alternative Path Toward Support and Safety, we offer an alternative path – a reformist position that focuses on four key elements of child welfare that must be maintained and improved to keep children safe:

1) receiving and responding to community signals about risk or harm to children;

(2) assessment of need coupled with a proportionate response;

(3) rights protections to ensure fairness and equity when placement outside the family is required; and

(4) procedures for accountability and quality improvement.

Without these key elements, we contend that children will be left in peril.  Many community members will not know how to respond to signs of risk and harm to children.  The progress we have made in the last few decades toward developing, implementing, and evaluating prevention and early intervention services to address trauma and promote healing will be disrupted. Supports for foster parents, kin, and child welfare staff will be disbanded. The elimination of court oversight will eliminate rights protections for parents, children, and extended family.  Racial inequities in economic hardship will make it more challenging for communities of colorto develop responses, which will likely yield an even larger gap in unmet needs for children of color.

Still, many in our field are challenged by having to choose between abolition and reform. At the core of this debate, we are contending with the interplay of science, practice, ideological beliefs, and conflicting values. What types of evidence are or should be used to guide our decision-making? How do we best balance the support of families with a child’s need for safety without defending the status quo? Said another way, we see no reasonable likelihood that abolishing child welfare services would result in a world where families are better supported to provide care that is not injurious to their children and children are better protected from the harsh realities of child abuse, including fatalities.

The debate offers an opportunity to examine current practice and whether it advances the needs of vulnerable children and families. We underscore in our paper that current services and funding are inadequate. To that end, we delineate alternative pathways to abolition providing some practical, evidence-informed recommendations, including but not limited to the following:

  • Create a robust family support and prevention infrastructure outside of Child Protective Services (CPS);
  • Reduce poverty and financial hardships through universal basic income supports and targeted economic supports for families in great need;
  • Resume the child welfare waivers program to expand and test innovations in case finding and response to family needs; and
  • Continue to improve alternative systems for reporting less serious concerns and connecting families to existing resources to reduce the number of families who are subject to unwarranted CPS investigations.

As discussed in our paper, we believe implementing these recommendations offers a holistic roadmap for (1) improving outcomes for all children and families and (2) mitigating racial inequities in exposure to economic hardship and access to services and programs.

Although many jurisdictions have a long way to go in fully aligning practices with our valued principles, the child welfare system, on the whole, has made much headway. We have made progress toward reducing foster care entries, enhancing permanency, supporting youth who must emancipate from care, and developing alternative response paths for less severe cases.  The number of children in foster care is now lower by more than 175,000 children than it was in 1991, despite population growth (US DHHS, 2022; US DHHS, 2000).

We have made advances in the development and implementation of evidence-based, and culturally appropriate parenting programs, and there are innovative approaches to screening and collaboration with other systems such as family drug courts and other models that are  being adopted around the country. Research indicates that families are better served by caring and competent child welfare staff. At a minimum, this means we need trained child welfare professionals to determine if abuse or neglect are occurring and how best to provide services to mitigate risk factors. If removal to foster care is required, trained social work and legal professionals need to be engaged in reunification services and the determination if it’s safe for children to go home.

Finally, it is critical that these efforts are continuously evaluated. Abolition would end the now-routine national reporting of the number of victims of child maltreatment, and their characteristics (i.e., NCANDS; Children’s Bureau, 2023). We would not know if new family- and community-based approaches were helpful or harmful, particularly for the families of color for whom both reformists and abolitionists are concerned. State-level systems that track the provision of services and outcomes would also end, meaning that trends in family needs and gaps in response systems would likely go undetected. We would also lack data to influence policy to end harmful practices and expand funding for effective prevention and intervention services.

As we note, “it is difficult to imagine how eradicating the only structures that exist to address this issue [child maltreatment] would result in any outcome other than jeopardizing the safety and well-being of children as well as reducing accountability to the families that CWS [the child welfare system] serves.”

This is a contentious moment in the journey to create opportunities and healing for all children and families. We hope our message conveys a sense of urgency to engage in critical, evidence-informed practice and policy – and to reflect upon how values, biases, and morals can impact decision-making.  The famous words of Nelson Mandela may be instructive: “There can be no keener revelation of a society’s soul than the way in which it treats its children.” In efforts to enhance practice and policy, we need child welfare professionals to gain the skills, cultural humility, self-efficacy, and motivation to ensure children live lives free of violence and abuse. Policymakers need to stay grounded in the pathway that has led to significant improvements in child welfare services and rely on research-based reforms. Our children deserve nothing less.

References

Barth, R. P., Jonson-Reid, M., Greeson, J. K. P., Drake, B., Berrick, J. D., Garcia, A. R., Shaw, T., & Gyourko, J. R. (2020). Outcomes following child welfare services: What are they and do they differ for Black children?. Journal of Public Child Welfare, 14(5), 477-499. https://doi.org/10.1080/15548732.2020.1814541

Briggs, E., Hanson, R., Klika, J. B., LeBlanc, S., Maddux, J., Merritt, D., … & Barboza, G. (2023). Addressing systemic racism in the American Professional Society on the Abuse of Children publications. Child maltreatment, 28(4), 550-555.

Children’s Bureau. (2023). National Child Abuse and Neglect Data System (NCANDS). U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families. https://www.acf.hhs.gov/cb/data-research/ncands

Gruber, T. (2023). Beyond mandated reporting: Debunking assumptions to support children and families. Abolitionist Perspectives in Social Work, 1(1). https://doi.org/10.52713/apsw.v1i1.12

Hutchinson, J.R. (2002).  Failed child welfare policy: Family preservation and the orphaning of child welfare. Washington DC: Child Welfare League of America.

Kelly, L. (2021). Abolition or reform: Confronting the symbiotic relationship between ‘child welfare’ and the carceral state. Stanford Journal of Civil Rights & Civil Liberties, 17(2), 255–320. https://heinonline.org/HOL/P?h=hein.journals/stjcrcl17&i=271

Myers, J. E. B. (2008). A short history of child protection in America. Family Law Quarterly, 42(3), 449–463. https://www.jstor.org/stable/25740668

Peebles-Wilkins, W. (1996). Janie Porter Barrett and the Virginia Industrial School for Colored Girls: Community response to the needs of African American children. In E Smith and L Merkel-Holguin (Eds.), A history of child welfare. Washington, DC: Child Welfare League of America.

Roberts, D. (2022). Torn apart: How the child welfare system destroys Black families, and how abolition can build a safer world. Basic Books.

U.S. DHHS. (2022). The AFCARS Report. Washington, D.C.: Administration for Children and Families.

U.S. DHHS. (2000). The AFCARS Report. Washington D.C.: Administration for Children and Families.

The child placement crisis: It’s time to lose the slogans and find real solutions

By Judith Schagrin

A note from Child Welfare Monitor: It is a privilege to publish this important essay by Judith Schagrin. Judith earned an undergraduate degree from the University of Pennsylvania and a master’s degree in social work (MSW) from the University of Maryland School of Social Work.  She unexpectedly found her passion in public child welfare, and more specifically, foster care after helping start an independent living preparation program for young people in care. After a decade as a foster care social worker specializing in adolescence in a large Maryland county department of social services, she supervised two different units before becoming the county’s director of foster care and adoptions, serving in this position for twenty years.  She also worked part-time for the Agency’s after-hours crisis response for a decade.  For almost 10 years, she served as a respite foster parent for a private foster care agency, and since 2008, has mentored a young person who aged out of care in California and came east for college.  In  2001, with a little help from her friends, Judith founded Camp Connect, a weeklong sleepaway camp to reunify brothers and sisters living apart in foster care and provide memorable experiences siblings can share for a lifetime.  For the past 23 years – one year virtual – she has spent the week at Camp Connect immersed in the care of Maryland’s foster children and youth.

The closing of children’s mental hospitals in the 1980s, the subsequent closure of detention centers leaving foster care to take up the slack, the movement to shutter all group homes and residential treatment programs and the prohibition of out-of-state placements have created a slow-motion train wreck whose results could have been predicted easily at every new chain in the sequence. Those results include children and youth staying in psychiatric hospitals long after being ready for discharge, “boarding” in emergency rooms and “placed” in hotels at a cost of $30,000 to $60,000 per child per month. From my 35-year vantage point as a caseworker, supervisor, and then running foster care and adoptions in a large Maryland county, I’ve had a front row seat to the evolution of this crisis and the failure to come up with real solutions. 

Deinstitutionalization

The first in a series of events that created this crisis occurred in the 1980s, when the deinstitutionalization that began for adults in the 1960’s with the civil rights movement expanded to include children.  Until then, youth remained in state hospital facilities for as long as a year or even more.  The closure of those state facilities led to the expansion of Medicaid-funded residential treatment centers (RTC’s), that stepped in to provide the longer term care once provided in the state hospitals.  In turn, group homes proliferated to meet the needs of youth discharged from RTC’s.  The advent of Medicaid was instrumental in expanding prIvate psychiatric treatment options, including hospitals.  But over time, Medicaid stopped funding even 30 days of treatment, limiting payment to only  a few days of crisis intervention. 

Today, many youth, especially older youth, are entering foster care not because of what we traditionally think of as maltreatment, but due to parental incapacity or unwillingness to care for them due to acutely problematic behavior, and behavioral health and/or developmental needs.  Services to meet these needs are often missing or inadequate, and parents of children with high-intensity needs cannot find residential treatment except through the child welfare system.  Medicaid doesn’t pay for treatment and care in a group home of any kind; access in Maryland requires the child welfare system’s physical or legal custody.

New approach to juvenile justice

In the early 2000’s, a series of Supreme Court decisions brought welcome changes to juvenile justice and shifted the country from the ‘get tough’ approach of the ‘80’s and 90’s to the ‘kids are different’ era.  Moving from punishment to rehabilitation and minimizing detention in favor of community services makes sense on both humanitarian and neuroscience grounds.  But it meant that youth who once fell under the purview of Juvenile Services now required child welfare intervention when parents or other caregivers were unwilling or unable to continue to provide care. The mother evicted from four apartments because of her son’s property damage; the grandmother who stepped in years ago and is no longer able to cope with her granddaughter after the third vehicular misuse charge and chronic episodes of running away; or a parent with younger children afraid that an older sibling known to have rages and episodes of violence will harm his siblings, are examples of desperate caregivers I have come across.

In Maryland, the first alarm that child welfare was ill-equipped to care for these youth was sounded in 2002 by local department directors in a memo to the head of the Department of Human Services.   Closing detention centers was a good thing, but alternatives weren’t developed for those youth unable to live at home, and no resources were provided to help child welfare accommodate its new clients. As the closure of state psychiatric facilities and detention beds was widely celebrated, the belief that every youth had a family eager and able to provide a home was more than a touch naive, as would soon become clear. 

Group home closures

Another domino fell in the early 2000’s, when group homes, many poorly administered with little oversight, became a scandal in Maryland.  A series of articles in the Baltimore Sun exposed the flaws of many group care programs, and some were forced to close.  With the scandals around bad group homes, the timing was perfect for state leadership, encouraged by a national advocacy group with deep pockets and the laudable dream of a family for every child, to lead a movement to shutter congregate care placements.  Funding constraints, too, forced some providers out of business.  Reimbursement rates did not keep up with costs, and some programs closed their doors due to inadequate reimbursement.   The state lost roughly 450  beds in five or six years, including entire residential treatment center programs.  Rate-setting ‘reform’, which began in October of 2021, will not be completed until July of 2026 if it stays on schedule.

At the same time group homes were being closed in Maryland, state agency leadership began to frown on out-of-state placements for youth with highly specialized needs when no placement in Maryland to meet those needs was available.  Public officials with little understanding of placement resources pronounced these out-of-state placements to be evil incarnate, and an overwhelming number of bureaucratic obstacles made them nearly impossible.  

With the loss of group homes as an option, we were urged to ‘re-imagine’ care for children, yet discouraged from developing individualized plans of care because insufficient flexible funding was allowed to make that happen.  We’re fond of slogans in child welfare, as if words will change outcomes, but too many initiatives are about clever slogans and not about substance.  If only we would review every child in group care, we were told, we would realize how many had other options.  With consultation from the national advocacy group, we spent hours seriously poring over the needs of our children in congregate care and attempting to find matches with kin or foster families.  Not at all surprising to our staff, “low hanging fruit” didn’t exist.   

We also initiated a rigorous “Family Finding” practice, in hopes of finding kin willing to become providers with services and supports.  What we learned is that youth in congregate care had  already exhausted family and “kin of the heart” resources.  Today it’s not clear that public officials and child welfare leaders grasp that children and youth wouldn’t be in hotels if there were any kin – fictive or otherwise – willing and able to provide care, or if parents could and would be a safe resource.

Youth with intensive, complex needs

As other doors closed, the child welfare system became increasingly tasked with providing residential behavioral health care for children and youth with high-intensity and complex needs for supervision and treatment.  The differences between those involved with the juvenile justice system (and may have gone to detention centers in the past) and those who are not are often hard to discern.  Both groups tend to engage in behaviors that pose a serious safety hazard  to themselves or others.  These  behaviors may include physical violence; property damage; compulsive self-harm such as cutting or swallowing objects; chronic truancy; frequent runaway episodes; sexual victimization of siblings; aberrant sexual behaviors such as public masturbation; molesting younger siblings; participating in petty crimes; harming family pets; and generally oppositional and dysregulated behavior.  

Contrary to the popular notion that the public child welfare system is tearing families apart, these are children whose families are typically frustrated, exhausted, and often eager to place their child.  Some even view foster care as a much-needed punishment, imagining that when the youth is ready to “behave,” they can return home.  Of course these young people have many strengths to be nurtured, but they need intensive supervision and therapeutic intervention by professionals trained to evaluate and address their special needs and work with families.

The gist of the matter is that we are serving two different out-of-home placement populations with very different needs.  One is a younger population in foster care primarily due to maltreatment stemming largely from parental substance abuse and/or untreated mental illness. The other is older youth with complicated behaviors, and behavioral health needs and/or developmental disabilities.  The parents and kin of the older group are asking for placement, not objecting to it, and are typically worn out and adamantly opposed to more in-home services.  In spite of the stark differences in these two populations, our policymakers and those upon whom they rely have failed to recognize their needs are not the same.

In Maryland and other states, treatment, or ‘therapeutic,’ foster care stepped in to accommodate this new population of older, harder to serve foster youth. To some extent this approach has been effective as an alternative to congregate care, but it’s not the panacea some would like to believe.  The desperate need for foster families willing to care for these youth means there’s a certain amount of pressure to lower expectations and even turn a blind eye to foster parents that do a less than stellar job.  Tales of locked refrigerators and youth left sitting on the stoop at the end of the school day until the caregiver came home soon proliferated.  However, we were told by representatives of a national advocacy group that, “Youth are better off moving from shabby foster home to shabby foster home than in the very best congregate care.”   In my own experience, instability begets instability and there’s little more soul-sucking than being rejected from family after family.

Setting aside the question of quality, foster care, whether treatment or not, has great challenges recruiting homes for youth with weapons charges, those with a history of drug dealing, or whose parents have refused to pick them up from the police after another runaway episode. “Cutters” and “swallowers” need 24/7 supervision to keep them safe and in general, kin have already tried to provide care long before the child’s entry into state custody.  With the closure of group homes and residential treatment centers in Maryland and the prohibition on out-of-state placements, finding placements willing to accept youth with high-intensity needs became literally impossible.  As a result, for years now children have been left in psychiatric hospitals (sometimes for months) after “ready” for discharge, and others are ‘boarding’ in emergency rooms for weeks or months.  

A failure to recognize reality

Instead of recognizing the lack of capacity to serve those youth with nowhere to go after being hospitalized, hospital representatives, public officials, and legislators blamed caseworkers for not ‘picking children up’, as though they were simply lazy and incompetent.   “Advocates” proposed legislation imposing more caseworker accountability as the solution, as though if caseworkers worked harder and filled out more forms, placements that didn’t exist would magically appear.  Fortunately, none of the legislation passed, but being a lonely voice trying to explain the source of the problem wasn’t lazy caseworkers or enough forms was painful.  Public officials, leaders and advocates also clamored for more “prevention” services, not recognizing the acute needs of older youth developed over many years and that new services authorized today are not going to keep them safely at home.

During my 20 years as the director for my county’s foster care and adoptions program, I can’t count the nail-biting times we came close to not finding a placement for a child – but we were always able to pull something together.  The state made funding available for a 1:1 staff person (or sometimes 2:1) we could offer existing providers, allowing us to use that as a bargaining chip. Of course, increasing reimbursement rates and staff salaries would have been far less expensive than millions for extra staff to support ill-equipped placements, but that change in fiscal allocation has yet to happen. 

Five years have now passed since I retired, and hotel placements have become not a rarity but a regular necessity.  At the rate of $30,000 to $60,000 per child each month (not including damages to hotels) to warehouse children in hotel rooms supervised by an untrained aide – one can only imagine what that kind of money could be doing productively for children.  Caseworkers are overseeing the most precarious and risky “placements,” and being ‘hotel reservation clerks’ isn’t the reason competent social workers choose to do the work.  We’ve all heard the tales of youth stealing their 1:1’s car; or youth locking themselves in their rooms doing what we don’t know; a youth who overdosed on his medication; parties taking place with the acquiescence of the 1:1; youth harassing guests; and the youth who leaped over the reservation desk to try to steal cash.

Over the years there have been many, many meetings among high ranking state officials and others; ironically, these meetings didn’t include the experienced and knowledgeable child welfare staff responsible for the children.  Lots of strategies, goals, and plans too – a personal favorite was the goal of instructing local department staff on hospital discharge planning, as if they weren’t already experts.  Despite all the meetings and all the hand-wringing, progress meeting the needs of the children in our care, or soon to be in our care when parents abandon them at the hospital or elsewhere, has been negligible. Years that could have been spent on developing and promoting new model programs have been wasted. In the meantime, Congress saw fit based on testimony from well-heeled advocacy groups to pass the Family First Prevention Services Act,  which limited congregate care even more by restricting funding to approvable options based on criteria seemingly pulled out of a hat.   

Today, the deepening and pervasive placement crisis is affecting nearly every state and attracting media attention around the country.  Given the financial resources dedicated to keeping children in hotels, finances clearly aren’t the issue.  And it certainly isn’t about quality of care, since hotel rooms, overstays in hospitals, and boarding in emergency rooms rank far below a quality congregate care program as a suitable home for a child.  

What is to be done?

In the short run, Maryland and other states need respite programs for young people awaiting placements in hospitals, emergency rooms, and hotels.  In the long run, we must acknowledge child welfare’s responsibility not only for maltreated children, but also those with high-intensity needs for supervision and treatment once served by other child-serving organizations.  We need to bring the finest minds together to reimagine how residential care is provided, and its role in the continuum of child welfare resources to meet the needs of older youth entering foster care because of needs related to behavioral health and/or developmental disabilities. That process should include some of the scholars who have been studying the use of congregate care in other countries where it is more highly valued as a treatment and a professional field.  Exploring the development of real alternatives to congregate care is also a worthy investment.  Finally,  the unintended consequences of the Family First Prevention Services Act that disincentivized needed placements without a credible replacement must be remedied.

How many more years until we wake up?  And how many children will have to be harmed?  A colleague had a quote in her office that stays with me always, “when we are doing something with somebody else’s child we wouldn’t do with our own, we need to stop and ask ourselves why.”  Who among us would consent to our own children boarding in emergency rooms, on overstay at hospitals, or ‘placed’ in hotel rooms?  If that’s not okay for our own children, it shouldn’t be okay for the children in our state’s custody either.


Diverse opinions not accepted: Censorship by a contractor of the U.S. Children’s Bureau

Instances of censorship and restrictions of free speech from both ends of the political spectrum have drawn increasing concern as the country’s polarization has increased. I have been very grateful that a digest of child welfare news and opinion articles funded by the federal government has for years been sharing my work–which often takes aim at the ideology prevailing in child welfare. But last July, the government contractor that prepares these digests declined to share one of my opinion pieces–while continuing to share other commentaries with a different perspective. My attempt to get an explanation has resulted in a series of bizarre communications that only heighten my fears that a government-funded organization is censoring the views that it shares.

Child Welfare in the News (CWN), a daily email sponsored by the US Children’s Bureau, has contributed significantly to Child Welfare Monitor‘s growth from its creation in 2016. CWN is an “email subscription service that provides a daily collection of news stories and opinion pieces from across the country and around the world.” It is an activity of the Child Welfare Information Gateway (CWIG), which is part of the Children’s Bureau and is managed by a consulting firm called ICF. For several years, I have been sharing links to Child Welfare Monitor commentaries with the ICF librarians who put together CWN and they have in turn provided links to these pieces, along with excerpts, in their daily mailings. At least until last July.

On July 24, 2023, I published The Misuse of Lived Experience in Child Welfare. The gist of the piece was that while all lived experiences are valid and valuable, their use can be problematic when experiences that support a particular perspective are highlighted and those that contradict it are not, or when evidence from data and research are ignored in favor of curated narratives. When I shared the blog post with the CWN staff as usual, I received a message saying “We’ll get back to you in a few days with a response on this article.” This was unexpected. When I checked for an update on July 31, an ICF librarian responded that “we are still working to review this article, and expect to have a response soon.” I emailed again on September 7 and heard that “We’ve not yet received a response or decision on this article.”

I replied asking to whom my commentary had been submitted and why, what the review criteria would be, and when I could expect a response. Receiving no answer, I wrote on September 14 to the Communications Director of the Administration on Children and Families, parent agency of the Children’s Bureau. I also submitted a Freedom of Information Act request asking for any emails that contain my name or that of Child Welfare Monitor.

On September 22, I received a response from Kai Guterman, the “Senior Manager of Knowledge Management” at ICF, which included the following:  “As you know from your past submissions, The Child Welfare Information Gateway is a service of the Children’s Bureau and as such, as part of our standard process our team reviews all requests submitted. Upon our review, this request was not selected for posting as it contains personal fundraising links.” I was totally baffled by this response. I was not aware of any “personal fundraising links” in my piece, but an alert reader informed me after I published this blog that the photo I used of the family of Vanessa Peoples (the mother whose bad experience with CPS was cited by Dorothy Roberts in her book), came from a GoFundMe page set up to help her and her family. Not realizing that at the time I replied, asking Mr. Guterman to describe these links so I could remove them and allow the post to be shared by CWN. Thirteen days later I received the following response:

Thank you for following up and agreeing to exclude the fundraising link. 

We have conducted a review of the Misuse of “Lived Experience” in Child Welfare blog submission request.  While we appreciate your submission, it has been determined that it will not be included in the Child Welfare in the News since this specific blog post has a strong emphasis on storytelling, calls out individuals [sic] names, makes personal opinion statements about individuals, and focuses on editorial and opinion-based content. 

As you consider future submissions, please review how much editorial or opinion-based content is included and ensure the content is not driven by or connected with fundraising purposes.   

Email from Kai Guterman, Senior Manager of Knowledge Management, ICF, October 5, 2023

This message from Mr. Guterman was even more confusing than the previous one. It is certainly true that my blog post names several individuals, including the writer Dorothy Roberts and several people who have shared their lived experience with the child welfare system in writing and/or in oral testimony, and I included links to all of their writings. But not many news or opinion articles shared by CWN fail to name individuals. And my post does not make any “personal opinion statements” about these individuals other than summarizing or quoting their views and saying that other types of experiences also exist. The “strong emphasis on storytelling,” leaves me totally baffled. Indeed, the major point of the essay was to question the use of individual stories to make policy. Is it possible that Mr. Guterman missed the point of my blog or did not read it at all? Moreover, removing articles that tell stories would probably exclude more than half the content that is currently included in CWN–pretty much every news story and many opinion pieces as well.

And finally, Mr. Guterman asserts that my piece “focuses on editorial and opinion-based content.” Yes, most of my blog posts are opinion pieces and are labeled as such in the CWN emails, along with opinion pieces by other authors. Since I published my lived experience blog, the newsletter has shared numerous opinion pieces. At least four of these commentaries were by a writer named Richard Wexler. From beginning to end, Wexler’s essays “focus on editorial and opinion-based content,” as Mr. Guterman put it. Here is one example from Child abuse: the surge that wasn’t, a commentary from August 17, 2023 that was shared by CWN.”The American family policing system, a more accurate term than “child welfare” system, is built on ‘health terrorism’ – misrepresenting the true nature and scope of a problem in the name of ‘raising awareness.'” Some of Wexler’s pieces “have a strong emphasis on storytelling.” For example, in Child Well-Being Doesn’t Require Family Policing, also shared by CWN, Wexler devotes seven paragraphs to the story of one family that he says was victimized by a false accusation of child abuse.

As far as “calling out individuals,” CWN shared a piece by Wexler entitled Attn: New Hampshire “Child Advocate – there are horrendous institutions in your state too.” In that commentary, Wexler “calls out” the New Hampshire Child Advocate by name, telling readers that she was “understandably proud of herself” for getting two New Hampshire teenagers out of an abusive institution. But she “took matters too far” when she said according to a local news station that she and her staffers could finally get a good night’s sleep after removing the two teenagers from the institution. But nobody should be getting a good night’s sleep as long as “children are institutionalized,” according to Wexler. “And [the Child Advocate], of all people, should know it” because last year her predecessor issued a report exposing abuse at a New Hampshire institution. He goes on to label as “disheartening” her proposal to form a commission to address the issue of residential care.

It is noteworthy that Wexler’s pieces tend to endorse the prevailing ideology about child welfare, albeit often in an extreme way, while mine tend to challenge it. But Wexler is not the only author of opinion pieces that tell stories and mention individuals and nevertheless are shared by CWN. In addition to commentaries by Wexler, the newsletter has shared opinion pieces with titles like “The Child Welfare System Is Failing Children, Separating Black and Brown Families,” and “What To Do When Children’s Services Comes to the Door,” which also endorse the prevailing view. But my essay has been rejected, ostensibly for the same characteristics that these pieces display. Could it be that the creators of CWN are discriminating based on viewpoint?

As Mr. Guterman mentioned, ICF produces CWN under contract for the Children’s Bureau, which has wholeheartedly endorsed the prevailing view of child welfare promoted by a group of well-heeled foundations and nonprofits, consulting firms and influential commentators. This narrative portrays a racist child welfare system that disproportionately investigates, intervenes with and separates Black children and families. It disregards the evidence that the need for protection is also much greater among Black children, suggesting that they are more likely underrepresented in relation to their need. The dominant viewpoint asserts that foster care is harmful and rarely necessary and that “prevention services” including financial aid can eliminate the need for most child removals. It holds that children should almost never be placed in non-family placements such as group homes or residential treatment centers. Proponents of this perspective hailed the Family First Act, which has failed to add significant preventive services while catastrophically reducing the availability of placements for the most troubled and traumatized young people, resulting in an explosion in the number of youths staying in offices, hotels and other inappropriate placements.

In my censored commentary, I provided examples of how the child welfare establishment and its preferred authors tend to share only the lived experiences that support their views, while ignoring experiences that support different viewpoints. And I gave examples of foster care alumni who have shared experiences of foster care and group homes that contradict the ones that have been repeatedly highlighted. Instead of choosing only the personal stories that support preferred views, I suggested that it is more useful to survey large samples of foster care youths or alumni. And I reported that such surveys result in much more positive views of foster care and group homes than those of the individuals who have been highlighted.

Over the years, Child Welfare Monitor has consistently expressed views that sharply question those of the child welfare establishment. But the CWN staff has never declined to share a piece because of its content. The website description of CWN states that the inclusion of a link “does not imply endorsement of any view expressed in a story and may not reflect the opinions of Child Welfare Information Gateway, the Children’s Bureau, or either organization’s staff.” So they clearly do not need to vet submissions for viewpoint.

The reason for the sudden change in practice (without notification or a change in the website language) remains a mystery, but one might speculate that it has something to do with a decreased tolerance for diverse views. But ICF or the Children’s Bureau would be violating the spirit and possibly the letter of the First Amendment if it were purposely excluding from a government publication content that does not fit the prevailing view. The Supreme Court has ruled that the government cannot discriminate against speech based on viewpoint, stating that: “When the government targets not subject matter but particular views taken by speakers on a subject, the violation of the First Amendment is all the more blatant. Viewpoint discrimination is thus an egregious form of content discrimination. The government must abstain from regulating speech when the specific motivating ideology or the opinion or perspective of the speaker is the rationale for the restriction.”

The possibility of viewpoint discrimination by the federal government or its contractor is deeply disturbing. But ICF’s dishonesty is also concerning. I was told for weeks that the article was still under review. When I persisted, I was told that my piece was censored because of “personal fundraising links” that I could not identify. When I asked to be shown the links so I could remove them, I was then given an entirely different explanation. And the new explanation was equally absurd, citing issues with my blog that either did not exist or were common to many other pieces shared in CWN. So there must be another reason they have not given me, and discrimination based on viewpoint is the only one that comes to mind.

It is unfortunate that my attempt to tell the truth about child welfare has finally come up against the increased intolerance for diverse views, even in a government-funded clearinghouse. Unless I find an organization that wants to take my case to court, it is unlikely that “The Misuse of Lived Experience” will be published in Child Welfare in the News. I’ll have to rely my readers to share my writing with their colleagues. Please share this blog and my censored post and urge people to follow Child Welfare Monitor. We cannot let the censors win.

The misuse of “lived experience” in child welfare

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

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

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

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

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

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

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

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

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

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

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

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

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

Note

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

Residential care in child welfare: An international perspective

In my last post, Family First at five: Not much to celebrate, I discussed how the Family First Prevention Services Act (FFPSA) made it more difficult to provide residential care (often pejoratively called “congregate care” by the Act’s supporters) for the most troubled foster youth while doing little to ensure the development of alternatives. The result has not been surprising–an exacerbated placement crisis, with foster youth around the nation sleeping in hotels, offices, jails and other inappropriate settings. An important new book provides an international perspective on residential care. It shows that the U.S. ranks very low in the percentage of foster youth that are in residential care, casting doubt on the advisability of trying to further reduce residential placements. The obvious conclusion is that we would do better to increase the quality of residential care by raising standards for staff.

The new book, Revitalizing Residential Care for Children and Youth, is a compilation of research on residential care in 16 high and middle-income countries, edited by James K. Whittaker, Lisa Holmes, Jorge F. Del Valle, and Sigrid James, who are professors at universities in the US, England, Spain, and Germany, respectively.1 The editors define “residential care” as “any group setting where children spend the night,” encompassing settings that vary in size and function and that operate under the auspices of child welfare, juvenile corrections, or mental health. The 16 countries are viewed through a common template, making comparisons possible. However, there are problems with such comparisons. As explained in the second chapter, countries differ in the terms they use for different types of care and how they define these terms, among other things. The editors’ definition of “residential care” does not ensure that the same facilities are being counted across nations. A small group home with paid staff might be classed as “foster care” in some countries, and some facilities (like those for youth offenders) might be counted in the residential totals for some countries and not others.

Keeping in mind the impossibility of obtaining data that is totally comparable across countries, there appears to be a striking variation between nations in the utilization of residential care for youths who are in out-of-home placements. The editors defined the residential care utilization rate as the proportion of out-of-home care dedicated to residential care rather than family foster care or other types of out-of-home placements. This percentage ranged from seven percent in Ireland and Australia to 97 percent in Portugal, as shown in Figure 29.1, which is reproduced below. The United States had the third lowest residential care utilization rate, with ten percent of children in out-of-home placements being in residential settings. Moreover, the number of children in U.S. residential care fell by about 25 percent between 2015 and 2019. According to the editors, it appears that countries in the low-utilization category have made legislative changes (like FFPSA and California’s Continuum of Care Reform in the US) that have led to drastic reductions in residential care. But the countries with medium utilization rates (between 30 and 55 percent) seem to be focused on improving residential care by strengthening the elements believed to be associated with quality care rather than reducing the utilization of residential care.2

Source: James Whittaker et al, Revitalizing Residential Care for Children and Youth, page 430.

The authors also found great variability in the education and training requirements for residential care staff. These range from no minimum qualification in the United States, Canada and Australia, to high school level (Israel, Argentina and Portugal), to rigorous multiyear vocational training and/or university education in the other countries. A number of countries use both vocationally trained and university educated staff. For example, in Germany, about 70 percent of residential care staff hold a 3.5 to five-year vocational degree as educators (or in fewer cases two years as assistants) and 30 percent have Bachelors’ degrees in social work or “social pedagogy.”3

The editors found that it is countries with lower educational requirements for staff that have turned against residential care and have sought a drastic reduction of its use. Among those countries was, no surprise, the United States, along with Australia and England. In contrast, countries with a high qualification requirement have higher utilization of residential care. This correlation is not surprising. There is no doubt, say the volume’s editors, that “the quality of the services is directly related, in any field, to the qualifications, training and experience of the professionals who provide them.” In child welfare, they argue, “[I]t is difficult to carry out the work without a qualification based on the learning of very diverse theories related to child development, the clinical expressions of trauma, listening and helping techniques, the framework of family relationships, and ecological theories.” The editors suggest the existence of a vicious cycle, where low staff qualifications may led to poor quality and outcomes, which in turn lead to reduced funding, making it harder to recruit well-qualified staff.

Unfortunately, available data do not tell us what proportion of children and youth in residential care in each country are there for time-limited treatment for behavioral issues with a plan to “step down” to a family setting. Available data suggest that a majority or large minority of children and youth in residential care in the middle-utilization countries have a mental health diagnosis, which does necessarily mean that they are in a time-limited therapeutic setting. Most likely, the residential care population in the middle-utilization countries is a combination of youths with issues that require treatment in residential care and those who could be in family foster care if available As one of the editors notes in the introductory chapter, “residential care across the globe …does not seem to be limited to the narrow treatment-oriented and time-limited setting it is generally reduced to in several Anglo-American nations. In fact, in many countries,…., children and youth still spend years in residential care programs.”

The assumption that family foster care is always the better choice unless a child cannot function in such a setting may be unique to the English-speaking countries. Small, family style group homes, whether freestanding or part of a campus of such homes, may be difficult to distinguish from foster homes, especially if they use a house-parent model. In fact, the authors say, some countries classify “a small “family group” home, staffed by paid staff” as a foster home. I have argued in the past that high-quality family-like group homes may be better for children than mediocre or poor-quality foster homes and are especially appropriate for siblings. Indeed, as discussed in the book, France has 28 children’s villages, which are family-like units especially for siblings.

The evidence shared by Whittaker et al. has important implications for the United States. Given our low position on the scale of residential care utilization, one might logically conclude that further lowering the number of children in residential care would be unrealistic. In the two countries with lower residential utilization rates than the United States, Ireland and Australia, news accounts document an urgent need for more foster parents, with young people being separated from siblings, moving from one emergency placement to another for lack of a suitable home, and spending nights at hotels. Instead of trying to bring the residential share of foster care even lower, the U.S. might be better advised to follow the example of countries like Germany and Finland, which are focusing on improving residential care programs rather than eliminating them.

Cross-national comparisons are valuable in many policy areas, and the absence of such comparisons in child welfare debates is particularly unfortunate. Reading this book brings home the lack of international comparisons informing Congress when it passed the FFPSA. As far as I know, the supporters of FFPSA’s drastic restrictions on residential care never referred to other countries’ use of residential options; that’s not surprising as such comparisons may have led to uncomfortable questions about the premise that too many foster children and youth were in residential care.

Some members of Congress who supported the residential restrictions in FFPSA may have been more concerned about budgets than ideological objections to residential care. Improving residential care costs money, while cutting it may appear to help balance budgets. FFPSA was designed to be budget-neutral, so that restrictions for funding of residential care were required in order to offset the increase in spending for services to families. And it apparently did not matter to Congress if those costs were by necessity picked up by states that had no other options: the federal government would see the savings.

Perhaps the federal coffers have benefited from the restrictions on federal funding for residential care, especially because federal spending for the “prevention services” side of Family First has been negligible. But it is hard to believe that states have gained financially from the new law. Spending as much as $2,000 a night for a hotel room complete with staffing and security for foster youth, as Washington State is reportedly doing, cannot possibly be a better use of funds than improving and expanding residential care. And the effects on children and youth are disastrous. One can only hope that state leaders will be brave and smart enough to take the first steps in the direction of revitalizing residential care to be a nurturing and therapeutic environment for children and youth and a field that is a source of pride for its practitioners.

Revitalizing Residential Care for Children and Youth should be required reading for anyone involved in making policy or drafting legislation regarding foster care. But it is probably too much to hope that the anti-residential crusaders will choose to read this important book. They find it more comfortable to continue believing that cutting funds for these programs without providing an alternative will save money and help children at the same time.

Notes

  1. The countries studied include Argentina, Australia, Canada, Denmark, England, Finland, France, Germany, Ireland, Israel, Italy, the Netherlands, Portugal, Scotlad, Spain, and the United States.
  2. Portugal, with 97 percent of its out-of-home youth in residential care, is in violation of its own law establishing residential care as the last option for out-of-home care. It appears that the country has not developed the supply of foster parents needed to shift the system toward home-based care. Argentina, with 86 percent of children separated from their families living in residential care, is only in the early stages of developing family-based foster care. In Israel, a system of residential facilities or “youth villages” developed as a means of social integration of immigrant groups, starting with survivors of the Holocaust. This system of residential care operates under the MInistry of Education. A separate child welfare system developed later under the Ministry of Labor, Social Affairs and Social Services, to serve the needs of maltreated children, and 63 percent of the children in this system are also in youth villages.
  3. According to the editors, “[s]ocial pedagogy is grounded in a holistic understanding of the person and espouses participation, democratic processes, self-determination, and social and moral education within the context of everyday life as guiding values and principles for practice. Individualization (n contrast to standardization) and professional decision-making are further hallmarks of this approach.”

Family First at five: Not much to celebrate

Photo by Ivan Samkov on Pexels.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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