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Rightsizing Foster Care

(Originally published March 2021)

The idea that a large reduction in the number of children in foster care should be a goal of public policy has been widespread among child welfare leaders and child advocates for at least two decades, for good reason. The doubling of the U.S. foster care population between 1986 and 1999 overwhelmed underfunded and understaffed child welfare and judicial systems and created unmanageable workload pressures that undermined practice standards in all programs. There was a period 20-25 years ago when New York City, Los Angeles County and the state of Illinois each had 50,000 children in foster care!

The number of children in foster care in the U.S. peaked at 567,000 in 1999 before steadily declining to about 396,000 in 2012, despite the extension of foster care eligibility from 18 to 21 in many states. The number of children in foster care increased steadily from 2013-17 (due, in part, to the opioid epidemic) to more than 440,000 before declining to almost 424,000 in care in FY 2019, a rate of 0.06%, i.e., 6 per 1000 children. Surprisingly, given what may seem to some readers like a low rate of children in foster care, studies in recent years have found that 6% of all American children, 11% of black children and 15% of Native American children have been in foster care for varying lengths of time by age 18. (Berger & Slack, 2020)

For most of the past two decades, Washington State’s foster care population was 9,000-10,000 children on any one day. Currently, the number of children in foster care in Washington has declined to less than 7,500, the lowest foster care population in the past 20 years. Ross Hunter, the head of the Division of Children, Youth and Family Services, has declared his goal to be a reduction of children in foster care by 50%, in line with Casey Family Programs (CFP) foster care reduction goal.

The goals of foster care

In the U.S., discussions of foster care usually assume or assert that children are placed in foster care due to immediate safety threats, i.e., danger, resulting from abuse or neglect. In these discussions, out-of-home placements are assumed to be child removals, i.e., coercive actions taken in concert with law enforcement agencies or courts. This description applies to most, but not all, foster care placements in the U.S., in part because child welfare systems have gradually become more concerned with child protection than with other child vulnerabilities, and because of policies that have discouraged use of brief voluntary placements during a family crisis. However, at least one-fifth of children entering foster care in the U.S. are placed for reasons other than abuse or neglect, e.g., behavior problems or physical disabilities. Foster care in the U.S. (or Washington State) has never been solely a response to child abuse or neglect. For several decades, Washington’s child welfare system placed more than a thousand children annually in Crisis Residential Centers (CRCs) due to parent-child conflict for up to 5 days (by policy) and often for longer when alternative placements could not be found. During the years I worked in child welfare in Washington (1978-2004), large numbers of develop-mentally disabled children were placed in foster care without a legal finding of child abuse and neglect.

There is no inherent reason why foster care must require involuntary child removal, legal structure provided through dependency actions, or be used primarily as a tool in child protection. These characteristics of U.S. foster care systems are the result of public policies and common practices that developed over several decades, in part to facilitate permanent planning. Such policies and practices can be altered. “Foster care” is an abstraction that takes on different forms in various countries and time periods.

Is there an optimal rate of foster care?

I occasionally hear or read assertions from child advocates and scholars who maintain that many children are placed unnecessarily in foster care by CPS caseworkers due to the confusion between poverty and neglect, or due to racism, or because of other biases and/or poorly articulated placement standards. These assertions are often supported by compelling stories of parents whose children were placed in foster care for questionable reasons, and who remained in foster care for unreasonable periods of time. Many of these stories are undoubtedly true with a valid point to make, i.e., some children are placed by CPS caseworkers unnecessarily without active efforts to prevent out-of-home placement with great cost to children and families. However, every experienced CPS caseworker is likely to encounter many examples of children who needed to be placed in foster care but were left in dangerous circumstances, much to their detriment. Some of these children suffered severe injury or death, or experienced devastating cumulative developmental and emotional harm due to chronic neglect or chronic maltreatment, i.e., combinations of neglect and physical or sexual abuse.

There are many true stories of both types: children placed out-of-home unnecessarily and children whose lives and development were endangered by being left with abusive or neglectful parents. Unfortunately, there have been very few comparison group studies over several decades that shed light on the question, “are too many or too few children placed in foster care?” Currently, there is no sound research-based answer to this question. Many scholars and advocates have strong opinions regarding this issue, but they have weak arguments, for the following reasons:

There have been few, if any, studies of large samples of at-risk or maltreated children placed out-of-home by CPS caseworkers up against an explicit standard of child safety.
The capacity of CPS programs to protect seriously maltreated children in the parents’ home depends on the resources available to support in-home service and safety plans. It is foolish to make any judgment regarding a CPS entry into care rate absent information regarding available family support services and practice guidelines for in-home safety and service plans. A relatively low rate of foster care may reflect a lack of understanding of the supports required to protect a child in the parents’ home, while a high placement rate may be due to a lack of good alternatives, especially therapeutic child-care for infants, toddlers and other preschool children.
Child welfare agencies have been unwilling to develop sound, credible measures of child safety. As a result, there is no way to know with reasonable confidence how effective, or ineffective, in-home safety and service plans are at achieving child safety. It is disgraceful that child welfare agencies with vast amounts of administrative data are failing to measure child safety in meaningful ways; and that the federal Children’s Bureau continues to employ a virtually meaningless measure of child maltreatment recurrence as a performance indicator of child safety. It cannot be said too often that the lack of adequate measures of child safety has led to fundamental uncertainty regarding whether child protection programs are steadily improving, doing worse or staying the same in protecting children from injury, death or emotional/developmental harm resulting from abuse or neglect.

Safe reduction of the foster care population

When child advocates insist that child protection programs place too many children in foster care, they sometimes mean that, given the right investments in prevention/early intervention and therapeutic services, many more children reported to CPS could be safely maintained in their parents’ home, and they’re right. This is not the same as asserting that children are being removed from their parents unnecessarily, despite widely available family support services.

There are two main packages, i.e., categories, of services needed to safely reduce foster care for abused and neglected children and youth:

Services and supports for parents of young preschool children, with a focus on protection of infants and toddlers.
Services and supports for parents of “high needs” behaviorally troubled and/or physically disabled school age children.

Services and supports needed to support parents of children, 0-5, include:

Residential substance abuse treatment for mothers and their babies.
Parent advocacy programs, such as Washington State’s Parent Child Assistance Program (PCAP), that deliver services to mothers beginning in the prenatal period until their child is 3.
Therapeutic childcare programs, such as Oregon’s crisis nurseries or Seattle’s Child Haven and/or early childhood education services.
Housing services and income support for severely poor parents.
Implementation of Safe Baby Courts or Family Treatment Drug Courts.
Foster parents who serve as coaches and provide respite care as requested by a child’s parent.

Family First legislation has created the opportunity of funding this package of services and supports with IV-E funds.

Behaviorally troubled and physically disabled children who have grown up with periodic abuse or neglect and/or with parents who have chronically relapsing conditions such as substance abuse and depression, often combined with domestic violence, are often poor candidates for foster care in communities that lack professional foster parents or high quality therapeutic foster care programs. Nevertheless, it may be obvious to school staff and human service professionals who have contact with these youth that they are having difficulty surviving in school, have little or no respect for their caregivers or other authority figures and are headed toward anti-social life trajectories. Some of these adolescents are likely to be placed for most of their adolescence in residential care, psychiatric facilities or juvenile institutions, a sad fate. In less extreme cases, parent- child conflict may lead to running away, youth homelessness or drug/ alcohol abuse.

Child welfare agencies have a miserable track record in assisting behaviorally troubled, psychiatrically impaired and anti-social youth despite (or because of) extreme community pressure to “do something” about these populations. Every child welfare system needs the capacity to provide crisis intervention mental health services to behaviorally troubled youth and their caregivers (frequently relatives), and to provide family reconciliation services in response to parent-child conflict that threatens family disruption. In addition, multiple community agencies and schools need to come together to offer opportunities for pro-social development to youth clearly headed for school drop-out and/or delinquency.

Communities capable of enlightened self-interest should invest in job training or employment opportunities for youth, 16-21, who have left high school without a degree or GED. Every effort should be made to prevent homelessness or incarceration in this population of older adolescents and young adults. Furthermore, child welfare agencies must think more broadly about the meaning of child protection when serving adolescents. It is crazy public policy to investigate parents for alleged minor abuse of adolescents while tolerating youth homelessness without a second thought.

Rightsizing foster care, residential care and institutional care

During the past decade there has been a concerted attack on residential care (sometimes referred to as congregate care) by influential foundations, advocates and scholars that led to onerous regulations in Family First designed to reduce or eliminate residential care programs. Even prior to the passage of Family First, policymakers in Washington State deliberately undermined residential care programs by paying inadequate rates and turning a deaf ear to BRS providers even as some facilities closed. These same policymakers in both the Governor’s Office and legislature have refused to consider professionalizing some percentage of foster care, or funding a large expansion of therapeutic foster care, while tolerating increased use of costly hotel placements and 24-hour placements.

Washington State has been ahead of most other states in reductions of residential care; and has become a glaring example of what not to do in rightsizing foster care systems, i.e., don’t undermine residential care programs until there is a good alternative. Some child advocates and policymakers have engaged in wishful thinking regarding the potential of kinship care, targeted foster care recruitment and expanded family preservation programs to replace the need for all residential care, while refusing to consider the only two workable alternatives: (1) developing a cadre of professional foster parents, 10-25% of licensed homes, either salaried or paid higher rates for children following certification; and/ or making large new investments in BRS therapeutic foster care for behaviorally troubled and developmentally disabled children and youth.

In 2019, The Washington State Ombuds Office issued its annual report which summarized the views of DCYF regional administrators (R.A.’s) regarding the state’s foster care crisis. The R.A.’s pointed out that placement shortages are not primarily due to a lack of foster homes, as some foster homes have no foster children while many high needs children and youth are placed in hotels or DCYF offices overnight, or in 24-hour placements. The R.A.’s stated that DCYF lacks adequate resources not just for behaviorally troubled and/or mentally ill youth but for develop-mentally disabled children and youth as well. According to the Ombuds report:

“The R.A.’s also identified an increase in serving youth with developmental disabilities and in protecting children with extreme forms of autism. The R.A.s once again described dwindling resources and community supports resulting in families finding themselves unable to care for their DD child.”

“They also noted that there were previously far more placements through the developmentally disabilities administration … these (DD) children are finding themselves in DCYF care, even though there are no allegations of child maltreatment.”

“These children often need specialized care that exceeds the ability of most foster homes … these children are in DCYF care because of their special needs.”

Further, “The R.A.’s repeatedly noted that … children and families who should be served by the mental health, developmental disabilities and juvenile justice systems are often forwarded to DCYF which becomes the provider of last resort. The R.A.’s stated that these are families that clearly need help … but the DCYF system is not equipped to serve them.”

Smaller foster care systems are not better than larger ones when these systems cannot come close to providing adequate care to “high needs” children and youth, more than 40% of the foster care population, according to a 2019 foster care needs assessment in Oregon and many more children and youth who are not in foster care. The Oregon needs assessment should be replicated in Washington State asap. In the meantime, child advocates and policymakers should reflect on the Oregon report’s findings and recommendations:

42% of Oregon’s foster care population was classified by an expert panel as “high needs”, that included both many serious physical health and mental health conditions.
The percentage of “high needs” children increased dramatically with age.
Family foster care was viewed as the optimal form of placement resource for 72% of youth, 11-14, and only 35% of youth,15-18.
The report recommended an increase of 122 DD foster care beds and 46 DD group home slots to serve a foster care population of about 7500 children.
The panel recommended an increase of 99 BRS “slots”, and an increase of 72 psychiatric residential care beds, mostly for
youth,18-21,aging out of foster care.
It is a highly likely that the needs of Washington State’s foster care population matches or (more likely) exceeds the needs of foster children identified in the Oregon report.

References

Berger, L. & Slack, K., “The Contemporary U.S. Child Welfare System (s): Overview and Key Challenges,” The Annals of The American Academy of Political and Social Science, vol. 692, issue 1, 2020. available on-line

“Foster Care”, Child Trends, published on-line March 24,2018

Dowd, P., 2019 Annual Report , Office of Family and Children’s Ombuds, December 2019.

"Identifying Capacity Needs for Children within the Oregon Child Welfare System," Office of Reporting, Research, Analytics and Implementation, Oregon Department of Human Services, 2019. available on-line

“The AFCARS Report, # 27," Children’s Bureau, Administration for Children, Youth and Families, U.S. Department of Health and Human Services, 2020.

Dee Wilson©

Deewilson13@aol.com