Getting Serious About “Foster Care Reform”

Foster Care Reform has been a smoking hot issue the last few years in California and at the federal level. Of course, in my 40 something years of working in the foster care system, it’s always been an issue, and for good reason.

There are two distinct perspectives on why the Foster Care System needs to be reformed: one, from the Human Services perspective, the system does not effectively serve children and youth; and, two, from the legislative-bureaucratic perspective, it cost too much.

The most important reason why Foster Care needs to be reformed is because it does not effectively serve children and youth. Without overwhelming you with data, it boils down to this: the system makes too many expedient, inappropriate placements; it has substantially overused group homes and institutional care; it seriously lacks oversight, supervision and accountability; it has traditionally served as a roadblock to rapid reunification and permanency; and it does not provide adequate treatment and therapeutic services needed to overcome the negative impacts of trauma on children and youth. Using a river analogy, our foster care system basically attempts to rescue children after they’ve gone over the falls in hopes of saving their lives, instead of preventing them from entering the falls in the first place!

Exacerbating the problem in a very insulting fashion, are the power mongers, bureaucrats and control freaks we call “public servants” and legislators–they don’t want to pay for it! A prime example is California’s Continuum of Care Reform (CCR-AB 403) recently passed into law. The primary impetus for initiating the whole CCR process was to save the state money because California lost a lawsuit which required them to significantly increase reimbursement to group homes in order to comply with federal regulations, NOT to do great things for kids. Basically, the initiation of CCR appears to be a wolf in sheep’s clothing ruse. And while everyone stands around patting each other on the back saying, “We are doing wonderful things for California’s kids,” the real test will be if they bring their checkbook to the table in order to make it a true “Reform Effort!”

So what can reasonably and effectively be done to truly our Reform Foster Care system? As I see it, there are five changes which must be made: 1) foster placements must be driven by an assessment process and an appropriate initial placement—not expediency; 2) we need to redefine and restructure the use of congregate care; 3) family/home-based placements need to be effectively and appropriately increased; 4) implementation of early “upstream” interventions and services needs to happen; and 5) there needs to be a substantially increase in oversight and accountability requirements. All of these initiatives will require additional funding, but they will significantly decrease public expenditures in the long term while greatly improving outcomes for the children and youth being served through foster care. It will be money well spent.

Let’s begin with reforming what happens when a child or youth comes into the purview of Child Protection Services. Traditionally, when a child/youth is taken into protective custody they are immediately placed in institutional or home-based shelter care. Much has improved in this regard, but the default action should be to locate a relative, next of kin or a non-relative family the child is familiar with. Finding these placements takes time and effort, and usually must be done after hours! Of equal importance is something California’s CCR program has done well: requiring an appropriate assessment process to determine what the child’s needs are before dumping them in the most conveniently available bed. This type of process, governed by the goal to rapidly achieve permanency, will not only reduce the number of placements, but will ensure that the appropriate placement is executed.

Concerning group homes, California has also gotten this right with AB 403. Unfortunately, there are certain youth who manifests such extreme high needs behavior that it is unsafe or unreasonable to place them in a family-based setting. However, group homes must never be viewed as a long-term placement option, which, unfortunately, is standard practice across our country right now. Rather, congregate care must only be used as a “short term treatment option,” as a clearly defined step in the permanency/treatment process. This will require group home providers to have the capacity to provide “short-term treatment” and not just warehouse kids for as long as they can keep the bed full. These providers must also learn to be team players in a broader collaborative planning process and be willing to step down children/youth as quickly as possible to a less restrictive, permanency facilitating home.

The obvious and only alternative to institutional care is expanded use of family/home-based services, especially Therapeutic Foster Care (TFC). On the surface, TFC is a great placement, as we know that kids are better served in families. But there are some significant problems which need to be resolved in order for family-based services to really work.

First, there is a very pronounced shortage of appropriate foster families throughout California and the United States. You cannot shift kids from group care to families which don’t exist. One solution to this shortage is to expand the use of kin/relative care, and treating and paying for these placements the same as TFC placements—providing the same type of training services, support and reimbursement to relative/kin caregivers which are provided to TFC families. I believe this equal treatment will require changes in both federal and state regulations to make this an allowable option.

Second, “resource families”—as California is now calling them—need to be reimbursed at a much more substantial level in order to enable there to be one full-time parent at home. Traumatized children with high needs should not be treated as latchkey kids, but, rather, have a caregiver who is readily available and who is able to participate in the treatment team process.

Lastly, every foster child and youth comes into the system with an adverse childhood experience—they have been traumatized! Therefore, there needs to be treatment services and supports readily available to address their needs; otherwise, their move to permanency and stability will be dramatically impeded and they will continue to consume public funding for a much longer period of time.

Due to the draconian, archaic federal regulations and funding rules, federal funding for these children is triggered only when they enter the child welfare system. As I stated earlier, it’s intervening after the child is already “gone over the falls.” Instead, the system needs to be completely retooled to allow early intervention and family preservation services designed to strengthen families and provide treatment services in order to prevent children’s entry into the system. Currently, the Hatch-Wyden “Family First Act” pending in Congress would make these necessary changes. Unfortunately, given the morass of partisan nonsense and the inability of Congress to pass any meaningful, effective legislation; passage of this legislation is tenuous at best.

Finally, there needs to be far greater accountability for everyone delivering foster care services, in both the public and private sector. News story after news story paints a very negative picture of our foster care system. Children disappearing; rampant abuse and neglect; excessive use of psychotropic medication to manage behaviors; kids being recruited right out of group homes for prostitution and sexual exploitation; overcrowding; and even childhood deaths. Sadly, yes, these occurrences represent a very small percentage of the total number of children being served in foster care; but regardless, these instances should not happen at all! The rest of the nation should follow California’s lead and require that all foster care providers be nationally accredited. Accreditation would raise the bar substantially in terms of the quality and integrity of service providers. This requirements should also be applied at the county and state level where these agencies provide foster care services. Accountability requires greater funding! There needs to be much greater oversight and supervision, agencies need to have smaller, more reasonable caseloads, and foster care payment rates need to include the cost for accreditation and increased accountability.

Foster Care Reform is long overdue and much needed—but let’s do it right this time! Legislators need to put the money where their mouth is and fully fund the foster care system. Not only is this reform the best thing to do for children and youth, but in the long-term, it will produce substantial cost savings to the public.