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Dissecting U.S. Foster Care Systems

(Originally published January 2018)

''Foster care” and “foster care systems” are abstractions, comparable to “law enforcement” or “public education”. Any generalizations regarding foster care or pronouncements regarding foster care outcomes that do not specify time, place, child characteristics (especially age and developmental status), and length of stay should be viewed skeptically. References to foster care in scholarly articles or opinion pieces sometime refer to all types of out-of-home care, including non-kin licensed families, licensed and unlicensed kinship care, residential care and even (sometimes) institutional care, or compare foster family care to residential care or non-kin family foster care to kinship care. In addition, foster care systems in developed countries vary markedly in their legal frameworks, in their rates of residential care and kinship care, and in the uses of foster care. Given these differences, both within the U.S. and internationally, it would be remarkable if meta-analyses of foster care outcomes found consistent patterns and uniformities. Not surprisingly, comprehensive reviews of foster care outcomes often conclude that foster care has “mixed” results (see Maclean, et al, 2016), a conclusion of little practical use to practitioners and policy makers despite its accuracy. Hopefully, some useful lessons from research, class action lawsuits and from the vast experience of child welfare agencies with foster care can be developed by focusing on specific age groups of children and on the developmental status and behavior of children placed in foster care.

The History of Foster Care

Catherine Rymph's Raising Government Children: A History of Foster Care and the American Welfare State (2017), is an eye opening account of the development of U.S. foster care systems during the early 20th century through the 1970's. According to Rymph, in the early 20th century “the term “foster care” was used much more capaciously than is common today.” Foster care included “boarding homes (where ... families received minimal board payments), free homes (where no board was paid) and work homes (where children worked in exchange for their support).” Foster care, as the term was used in the early 20th century, also included 1500-1600 orphanages in which as many as 140,000 children were placed at any point in time. “Many of these “foster care” arrangements were actually sought by (rather than imposed on) desperate parents who lacked the resources to care for their children ...”, Rymph asserts.

In the United States, the early history of foster care in the orphan trains (which relied on the need of farm families for child labor) was a solution to the destitution of immigrant children in large Eastern cities. However, by the 1950's child welfare reformers felt that government assistance to low income mothers had severed the connection between child poverty and foster care, which they aspired to transform into a professional service. Reformers (and foster parents themselves) were ambivalent about the idea of compensating foster parents for the care of children, an ambivalence that remains to this day. Rymph asserts that “Sixty or seventy years ago, child welfare reformers were far more hopeful that they could formalize, rationalize and modernize existing child welfare practices and provide appropriate services that would truly help children and families.” Bureaucracy was viewed as an asset rather than an obstacle to reform. Foster care was not yet viewed as a “system” of laws, licensing procedures and child welfare practices but as “a tangle of practices with roots in much earlier efforts of public authorities, charities, entrepreneurs and private families.” Rymph believes that “by the late 1960's and early 70's, the New Deal era vision had collapsed. Foster care was overwhelmingly serving poor children and becoming increasingly punitive toward biological parents.” In addition, foster parents were essentially subsidizing the cost of care. Rymph asserts that “Foster care would become a disparaged form of “welfare” that would stigmatize the women who provided it, the children who received it and their families.” It appears from recent news stories that child welfare practitioners have also become stigmatized in public opinion, a development that must be combated to recruit and retain young caseworkers and supervisors with bright futures in child welfare employment.

When foster care does more harm than good

In 2015, federal district court Judge Janice Jack asserted that “foster children in Texas almost uniformly leave state custody more damaged than when they entered.” Judge Jack presided over a class action lawsuit on behalf of foster children and youth in Texas, a state that currently has almost 30,000 children in all types of substitute care. The Texas class action lawsuit found rampant abuse and neglect of foster children in Texas, so much so that an editorial writer scathingly suggested that the new head of child welfare in Texas, a former Texas Ranger, bring criminal action to incarcerate public officials for operating a state sanctioned rape factory! The class action lawsuit found widespread use of many of the same practices that are steadily undermining the reputation of foster care across the country, such as:

placement of children and youth in hotels
overnight stays of youth in child welfare offices
multiple placements and placement disruptions, especially for behaviorally troubled youth
overuse and misuse of psychotropic medications for lengthy periods of time
children who grow up in foster care, or who re-enter care after failed reunifications
adolescents exiting foster care without completed permanent plans and/or aging out of care

Routine use of out-of-county placements should be added to this list, a common practice for children of all ages placed in states with chronic and acute foster care shortages.

Most of the practices bulleted above are far more likely to be experienced by (a) school age children, 9 and older, and (b) children and youth with severe behavior problems when they enter into care or following experiences in foster care. It is useful to view the U.S. foster care population in a four part grid:

Age of child Developmental status of child

0-8 No or minor developmental delays

no or minor behavior problems, no

physical disabilities

9-17 Major developmental delays, or

serious behavior problems or

physical disabilities

Children, 0-8, are far more likely to be stabilized in foster care than older school age children unless they have serious behavior problems or other hard to cope with conditions. A recent study of Connecticut's foster care system found that foster youth, (12-17) had rates of placement change per 1000 days almost double or more than double the rate for children, (0-5) for recent entry cohorts. Nationally, the placement change rate for foster children as a whole is a little more than 4 per 1000 days in care. Percentages of children experiencing 4 or more placements greatly increases with extended lengths of stay in foster care. This data probably underestimates the differences in placement disruptions, i.e., unplanned placement moves, between younger and older children in foster care.

Bad things happen to youth in foster care with increasing frequency as they (1) become older and (2) engage in oppositional behavior. School aged behaviorally troubled children and youth in foster care are more likely to be abused and neglected than younger, developmentally on track, easier to manage children. They are also more likely to be moved from home to home on short notice, more likely to experience hotel stays or overnight stays in offices in some states, more likely to be given psychotropic medications (including “cocktails” of powerful mind altering drugs) and, by adolescence, more likely to exit foster care to “other” rather than reunification, adoption or guardianship.

There are undoubtedly islands of excellence in residential care and therapeutic foster care programs in many states but, in the aggregate, all types of foster care in the U.S. are risky, frequently unsafe and developmentally damaging for older school age behaviorally troubled children and youth. Child welfare administrative data has underestimated rates of abuse and neglect in out-of-home care and in birth families as well. Older foster youth and foster care alumni report prevalence rates of abuse and neglect several times higher than rates indicated by public agencies' administrative data. An adolescent female testifying before a legislative committee in California during 2017 referred to foster care as “a dark place.” This kind of testimony from foster care alumni is too frequent to ignore, especially when it is supported by self report survey data such as from Chapin Hall's Midwest Youth Study.

Many child welfare systems around the country have made a concerted effort in recent years to reduce the use of residential “congregate” care, which is a positive development when child welfare agencies make large investments in well supported, adequately funded therapeutic foster care programs. In some states, however, reduced use of residential care has occurred without these investments, which has had the effect of cutting the legs out from under child welfare systems, several of which have been forced to resort to using hotel placements, office stays and 24 hour placements for youth who, in past years, would have been placed in residential care or receiving care. In addition, policymakers and top managers intent on reducing use of congregate care often remain adamantly opposed to the professionalization of even a small percentage of foster parents to eliminate hotel placements and 24 hour placements of children entering foster care or who experience unplanned placement disruptions. Rational, thoughtful policymakers cannot have it both ways, i.e., greatly reduced use of residential care and total dependence on volunteer foster parents. Sooner or later, policymakers must choose between funding shelters for a large number of children entering foster care and greatly increasing investment in residential care, or professionalizing some percentage of foster parents, either by paying salaries and/or by compensating certified professional foster parents at much higher reimbursement rates.

Child welfare policymakers and managers can and should seek to reduce the use of foster care for behaviorally troubled children of all ages, but to do so requires more than rhetoric regarding family centered practice and pointing out the deficiencies of foster care. Homebuilder type family preservation programs are useful in some situations but not to protect young abused and neglected children in homes with parents who have chronically relapsing conditions such as substance abuse and mood disorders. Crisis nurseries, day treatment therapeutic child care programs, parental mentors (e.g., peers, paraprofessionals or foster parents), safety monitors, resource families which provide respite care on demand and housing programs are needed for this purpose. It is time to experiment with a new generation of family support programs and to reinvest in research regarding in-home safety planning and safety oriented services for abused and neglected children.

In past years, many state child welfare systems employed wrap around programs to reduce use of residential care, but the same “mixed” findings that have characterized foster care research have also appeared in research of wrap around programs. During the years I was a child welfare manager, I discovered that public agencies willing to fund support services for foster families and unlicensed kinship families, regardless of cost, could almost always develop stable homes for even the most difficult youth. However, enormous effort was usually required to create these arrangements on an ad hoc basis. It is remarkable what can be achieved with adequate funding! Child welfare agencies that have forgotten about or given up on wrap around programs should revisit this alternative to residential care, especially out-of-state residential care given its huge cost and the inherent problems in ascertaining the quality of care for youth placed in other states.

Children who benefit from foster care

David Rubin's, et al, research regarding foster care outcomes (which used a sample from the National Study of Child and Adolescent Well-Being) found that children who entered foster care without marked behavioral problems and who remained in care for some time, often experienced more positive developmental gains than similar children who were quickly reunified with their birth parents. Children who did not pose difficult child care challenges were more likely to be quickly stabilized in foster care; they were far less likely to experience

multiple placements than behaviorally troubled children. This study found that children with few or no behavioral problems were more likely to be reunified with birth parents in a timely way, or to be adopted, than behaviorally troubled children. Foster care often works as intended by policymakers for these children, i.e., foster placements are safe, nurturing and time limited. Furthermore, reunification is not followed by re-entry into care at the base rate of 15% in the 12 months following reunification. Of course, some children and youth who enter care without behavioral problems develop internalizing or externalizing mental health conditions as a result of their experiences in foster care. However, when children are quickly stabilized in care and are emotionally rewarding to care for, the potential for developmental harm resulting from harsh and/or non-nurturing foster parenting is greatly reduced.

Rubin's, et al, research suggests a useful generalization regarding foster care outcomes:

children who remain in foster care for longer than a few weeks and who (developmentally) need foster care the least, experience the most benefit from their foster care experiences, while children and youth who (developmentally) need foster care the most, experience the least benefits, and are often harmed by their foster care experiences, harm that increases with longer lengths of stay.

Summary

It is useful to separate foster children and youth, foster care practices and foster care outcomes into four categories: (1) babies, toddlers and other young children, (2) school age children, 9 and older, (3) developmentally on-track children with few or no behavioral problems, and (4) children with severe developmental challenges and/or behavioral problems. The benefits and harms that occur in and through foster care are markedly different for these four groups of children and youth. This is the place to start when considering how to improve foster care, mitigate the harm some foster children and youth experience, and develop safe and effective alternatives to foster care.

In the next Sounding Board, I will discuss issues related to safety and well-being for babies, toddlers and other pre-school children placed in foster care.

References

Havlicek, J. & Courtney, M., “Maltreatment histories of aging out foster youth: a comparison of official investigated reports and self reports of maltreatment prior to and during out- of- home care,” Child Abuse and Neglect, Vol. 52, February 2016.

Luczak, S., Updegove, N. & Ruth, L., “Between People and Places: Reducing Upheaval for Children Moving Around in Connecticut Foster Care, Connecticut Voices for Children, January, 2018.

Maclean, M., Sims, S., O'Donnell, M. & Gilbert, R., “Out-of Home Care Versus In Home Care for Children Who Have been Maltreated: A Systematic Review of Health and Wellbeing Outcomes, ” Child Abuse Review, Vol. 25, 4, July- August, 2016.

Rymph, Catherine, Raising Government Children: A History of Foster Care in the United States, The University of North Carolina Press, 2017.

Rubin, D., O'Reilly, A., Hafner, L., Luan, X. & Localio, A., “Placement Stability and Early Behavioral Outcomes Among Children in Out-of-Home Care, Chapter 10 in Child Protection: Using Outcomes to Improve Policy and Practice, ed. by Haskins, Wulczyn & Webb Brookings Institution Press, 2007.

Shutze, J. “Horrors of Texas Foster Care Are Not Materially Unlike Better Known Atrocities, Dallas Observer, April 18, 2016.

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