DEE WILSON CONSULTING

(Originally published April 2025)

​

This commentary is the third in a series about knowledge, values and public policy in child welfare policy and practice from 1962-2025. The initial commentary discussed the creation and development of the U.S. child protection system between 1962-1984. Last month’s commentary addressed the large increase in the U.S. foster care population from 1986-1999 and the response of child welfare agencies to that increase, as well as passage of the Adoption and Safe Families Act (ASFA) in 1997. This commentary discusses issues in foster care reform during the past two decades and proposes goals and guidelines for reform initiatives.

 

A framework for understanding the causes and outcomes of child welfare reform.

 

Major changes in policy and practice in human service systems may occur when:

​

 1) New knowledge from research or from better understanding of existing research becomes widely available to direct service providers, including caseworkers, therapists, educators, etc..

​

2) There is a dramatic shift in social values that effects how direct service providers and courts implement existing law and policy.

​

3) Ample new resources and/or financial incentives for services and staffing are made available through legislation or philanthropy to achieve a specific goal.

​

4) Direct service providers and their supervisors strongly believe in a reform initiative and are highly motivated to implement the initiative as designed; and are persistent and adaptive when confronted with challenges.

​

5) Outcomes of a reform initiative receive widespread approval, acclaim and additional fiscal support from policymakers and advocates.

​

There have been numerous reform initiatives in states following child maltreatment fatalities during recent decades that did not meet any of these conditions, i.e., no new knowledge, resources, major increases in staffing, or “buy in” of caseworkers for a ‘top down’ initiative, and were quietly abandoned once external scrutiny came to an end. 

 

Foster care reform: 2005-2025

​

The US foster care population began to steadily decline in the early 2000s from a peak of 567,000 to 513,000 in 2005, still an overwhelming number of foster children for child welfare agencies to manage. Almost a third (32%) of children in foster care on September 30, 2005 were Black vs. 42% in 2000, compared to 16% of the country’s child population.  According to AFCARS, 311,000 children entered foster care, and 287,000 children exited foster care during FY 2005.

​

In FY 2022, about 187,000 entered foster care and 200,000 children exited care, more than a 40% reduction in both entries and exits compared to FY 2005.; 23% of children in foster care were Black in FY 2022 vs. 14% of the child population.   

​

AFCARS data indicates that there were 369,000 children in foster care on September 30, 2022, almost 70,000 fewer children in foster care than at the end of FY 2017, and more than 140,000 fewer children in foster care than in 2005.   It is likely that the US foster care population has continued to decline during fiscal years 2023 and 2024. What makes the large reduction in foster care since 2000 even more remarkable is that the US foster care population increased by 14% from 2013-2017, due most likely to the opioid epidemic; and included placements of youth, 18-21, an age group that was not eligible for federal foster care reimbursement during the early 2000s.

​

The large reduction in the US foster care population from 2000-2025 followed a doubling of the number of children in foster care from 1986-1999, possibly reflecting (in part) a regression to the mean resulting from changes in patterns of substance abuse and other social conditions affecting entries into foster care.  Nevertheless, changes of this magnitude require more than changes in the social environment, beginning with leadership, as well as resources, staff commitment to permanent planning goals and the cooperation of judicial systems.

​

For at least two decades, there has been widespread agreement among leaders of child welfare systems and influential foundations that child welfare reform required a large reduction in foster care. At various times, many state and large county run child welfare systems have collaborated with Casey Family Programs (CFP) to reduce their foster care population by 50%, an arbitrary goal often stated as “safe reduction.” However, it has been easy to measure progress toward a numerical goal, but difficult to determine the effect on child safety, for which child welfare systems have inadequate measures. In practice, child welfare leaders have been recognized for the extent of foster care reduction in their jurisdiction, with little or no reference to child safety in most instances.

​

One of the most puzzling features of child welfare reform initiatives during recent decades has been the lack of interest in developing better, easy to understand measures of child safety.  Despite frequent affirmations that child safety is the main goal of child protection, most US child welfare systems lack reliable, credible measures of child safety and cannot know with reasonable certainty whether their child protection programs are improving, becoming worse, or performing much the same. Nevertheless, the uncertainty regarding child safety outcomes has been a political asset for agencies that have made large reductions in their foster care populations through risky practices. How can agencies be held accountable for child safety outcomes that are not measured?

​

From 2000-2019, child welfare agencies engaged in multiple initiatives to reduce the number of children in foster care:

​

• Separated safety assessment from risk assessment, and sought to describe thresholds on which to base Safe vs. Unsafe assessments

• Reduced brief placements of a few days or weeks through family support services or timely identification of kin caregivers

• Emphasized timely permanent planning and adoptions which increased from 51,000 in 2005 to 66,000 in FY 2019, as the percentage of foster children exiting to reunification declined to 47% while adoptions increased to 26% of exits.  Federal adoption incentives provided resources for state initiatives to increase adoptions.

• Many states made investments in evidence-based programs, most of which utilized different approaches to coaching parents during parent-child interactions. However, very few evidence based programs had been tested for their effects on entries into foster care.

​

Family First, which authorized the use of federal IV-E funds for placement prevention, became law in 2018. Despite widespread expectations that Family First would transform child welfare services, states made limited use of IV-E funds to fund in-home services for several years due both to onerous regulations and the requirement for state match.  The US foster care population of children, 0-17, increased by about 11% from 2013 to 2017 before beginning to decline in FY 2018, in part because of the increase in adoptions but mostly due to negative attitudes toward foster care.  

​

After 2019, the sharp decline in foster care both nationally and in Washington state was caused mainly by reduced entries into care, a decline which began during the pandemic and continued in subsequent years. From 2010-2019, AFCARS data indicates that 250,000-270,000 entered foster care annually vs. 187,000 entries in FY 2022. Entries into care declined sharply in Washington from 2019 to 2024 despite a significant increase in child fatalities and near- fatalities, caused (in part) by fentanyl overdoses, and without an increase in substance abuse treatment services and family support services, according to reports from the Department of Children, Youth and Family Services (DCYF).

​

Entries into care had begun to decline in Washington State before the Implementation of the Keeping Families Together Act (KFTA) in July 2023. KFTA accelerated the reduction in foster care entries, especially the reduction in placements of infants, but the legislation (which became law without significant opposition) was itself the product of a dramatic change in social attitudes regarding child removal and foster care, a shift in social values that took years to reach a tipping point. What has occurred in Washington State and nationally is not a pendulum swing to family preservation of the sort that occurred in past decades, but a sea change in social values that has created a new social milieu for child welfare policymakers. To understand this change, it is necessary to reflect on concerns regarding residential care that have that have been widespread among scholars, advocates and practitioners for decades, and the persistent attack on foster care that has occurred during recent years.

​

The rejection of residential care

​

Confidence in residential care has been undermined in Washington State (and many other states) by tort actions that revealed years of systematic physical, sexual and emotional abuse by staff and residents in several facilities. In one facility, OK Boys Ranch in Olympia, WA, youth who entered the facility during the 1980s and early 1990s were subject to physical and sexual abuse by older stronger youth and staff as a type of initiation. Washington State paid out many millions of dollars to victims of this abuse over more than a decade. Even within the past year or two, Washington has agreed to another multi-million- dollar tort settlement for abuse of youth placed in a residential care facility decades ago. There have also been facilities in other states that deprived youth of adequate food, or in which staff members engaged in the sexual exploitation of youth placed in the facility.

​

During the years I worked in Washington’s child welfare system (1978-2004), there was widespread agreement among caseworkers and program managers that residential care, with a few notable exceptions, was not therapeutic, and that the most that could be hoped for was humane care and timely reunification with a caregiver or member of the youth’s extended family. In addition, residential care was (and is) extremely expensive, several times more expensive than foster care, sometimes exceeding $10,000 per month per child. Nevertheless, there have always been a few outstanding well- managed facilities in Washington and in other states. However, these outstanding programs have been few and far between and difficult to replicate due to the importance of exemplary leadership and vigilant managerial practices.

​

Given this experience with residential care, i.e., frequent abuse of residents, large tort settlements, poor therapeutic outcomes and high costs, Washington was one of the first states to reduce the percentage of children and youth in residential care to 5-10%, far below the national average. By doing so, Washington became a “canary in the coal mine” for what occurs when a state child welfare system makes large reductions in residential care without developing a viable alternative for placement of behaviorally troubled youth.

​

Initially, large numbers of youth were sent to out-of-state facilities, hundreds or thousands of miles from Washington where it was impossible to adequately monitor their safety and well-being, at costs which far exceeded in-state costs. After DCYF brought back youth from out-of-state facilities, youth continued to be placed in hotels or offices, and for several months slept in cars as DCYF staff drove them around the state. These were not emergency measures entered into temporarily until other options became available. Hotel placements in large numbers continued in Washington for almost a decade, until DCYF opened three facilities to house youth with no other placement options, while declaring that these youth are not “placed,” possibly to bypass licensing regulations and/or Family First regulations on use of residential care. Nevertheless, I have been assured by DCYF staff in a position to know that these facilities provide excellent care for youth with severe mental health problems. I have been impressed with their managers’ commitment to implementation of trauma informed care.

​

Similar events have occurred in numerous other states following large reductions in residential care, strongly supported by the Annie E. Casey Foundation (AEF), arguably the most influential voice in child welfare reform during recent years. AEF was instrumental in establishing onerous restrictions on the use of residential care in Family First legislation passed in 2018. Through Family First, it has become federal policy to severely restrict use of residential care, but without offering a viable alternative. Nationally, the percentage of children placed in institutions or group homes declined from 19% in 2005 to 9% in 2022. 

​

AEF has also opposed the widespread use of professional foster care, in my view the only realistic alternative to reinvestment (and rethinking) of residential care. The result of these policies has been increased use of hotel placements, office placements, use of jails, or leaving youth with serious mental health problems to sleep in hospital emergency rooms or on the street. This is a national child welfare disgrace from which (it seems) many policymakers and child advocates across the US have learned little or nothing.

​

An alternative strategy

​

The lesson for policymakers and child welfare leaders of the past decade is that residential care, with all its flaws and inherent challenges, is an essential part of child welfare services, and that to pretend otherwise is a type of negligence that creates intolerable stress on child welfare managers and threats to staff safety.

​

There was a period 10-20 years ago when initiatives to greatly reduce use of residential care were much needed in many states and large cities. However, the resistance to new investments in residential care and to identifying exemplary models and best practices led, during the past decade, to a child welfare fiasco in Washington and many other states. Washington’s recent experience with creating and staffing small group homes to care for youth with severe behavior problems, some of whom have been released from locked institutional facilities, is additional evidence that it’s possible to provide high quality care for mentally ill youth with histories of violence.  This is a daunting challenge, but it can be done.

​

The recent history of hotel placements and of youth housed in DCYF facilities is that the lack of institutional care or residential care for 50-75 mentally ill (and sometimes also developmentally delayed) youth has created enormous pressures in at least two DCYF regions. This is a ridiculous state of affairs in a state whose child population is close to 1.8 million. It is the result of ideological resistance to new investments in residential care, not funding constraints.

​

Recent experience in Washington suggests that perhaps 1% of the foster care population needs to be in institutional care; 5-7% of the foster care population need redesigned residential care, while another 5% of children and youth in foster care could be placed in therapeutic foster homes or with professional foster parents.

​

A good source of information regarding residential care in other countries is the recent book, Revitalizing Residential Care for Children and Youth: Cross-National Trends and Challenges, ed. by Whittaker, et al., which contains chapters on residential care practices in 16 countries. There is no excuse for the insularity of policy discussions that ignores the experience of other nations at a time when the U.S. is struggling to find solutions to intractable problems in child welfare and other areas of public policy.

Next month’s Sounding Board will continue the discussion of foster care reform, as well as reflecting on in-home services and the administrative reorganization of child welfare.

​

References

​

AFCARS Reports # 10 and # 30, Administration for Children, Youth and Family Services, U.S. Department of Health and Human Services, Washington, D.C.; available online.

​

Ammons, D., “Boys Ranch Victims to Get $5.5 Million, State Reaches Settlement with Former Group-Home Residents,” Associated Press, November 1, 1998.   

​

Cohen, M., “The fundamental misconception at the heart of the Family First Act,” Child Welfare Monitor, September 9, 2024.

“Keeping Families Together Act, April 2024,” Washington State Department of Children, Youth and Family Services, Olympia, Washington; available online.

​

“Trends in Foster Care and Adoption, FY 2010-2019,” Administration for Children, Youth and Families, U.S. Department of Health and Human Services, Washington, D.C.; available online.

   

Whittaker, J., Holmes, L., del Valle, J. & James, S., Revitalizing Residential Care for Children and Youth: Cross-National Trends and Challenge (2022), Oxford University Press, Oxford, England.   

 

​See past Sounding Board commentaries     

​

©Dee Wilson     

  

deewilson13@aol.com

    

​