Streamlining Child Welfare

Printer-friendly versionPrinter-friendly versionSend by emailSend by emailPDF versionPDF version

James Kenny, PhD and Peter Kenny, JD

Abstract

All children have the right to a permanent home within child time. Federal law has set appropriate deadlines for permanence. Yet the average time spent in foster care is approximately two years. The solution to prolonged foster care should be obvious. Either return the child to his birth home or find a new one with minimal delay. Time is not on the side of a growing child. Why the delay? Because the system is flawed, currently structured to offer a better recompense for maintaining a child in long-term foster care than for finding a permanent home. Practical suggestions to change the foster care system are offered that involve adapting a business model to include clarifying the desired outcome, quality control, redirecting funding, treating long-term foster care itself as a problem, bonuses for permanence, and other successful business strategies.

Main Text

The Adoption and Safe Families Act (ASFA) has been federal law since 1997. The timelines on ASFA’s road to permanence are based upon a solid understanding of developmental psychology and statistics about poor outcomes for children when they are allowed to remain overly long in temporary care.

Seventeen years after ASFA, the results are mixed. Comparing the data from 1999 to 2012, the Adoption and Foster Care Reporting System (AFCARS) provides us with a report card. Improvement has been steady, but progress has been slow. Children still remain in temporary care well in excess of ASFA’s standards. As the critical time of development passes, unnecessary delays, laced with multiple moves and interrupted bonding, amplify the harm done to already damaged children.

Encouraging news is a drop in the number of children in foster care from 567,000 to 400,000. The average age has dropped from 9.9 to 9.3 years. Not so encouraging is the average time of almost two years spent in foster care. Even one year would be a long time. When you’re in third grade, it’s a long time till lunch. Still more difficult to accept, children today wait in temporary care for an additional one to two years after parental rights have been terminated. And most disturbing of all, the percentage of children aging out of foster care increased from eight to ten percent. 23,439 foster children left the system in 2012 without a permanent home. They represent our failures. We know better. We can do better.

Why the Delays?

The goal is permanence within child time. Every child has the right to a permanent home within one year. Yet despite our verbalized concern for foster children, we tolerate unacceptable delays. Why? We become pre-occupied with outdated policies. Entangled with red tape. Focused on details. In an effort to “get it right,” we allow ourselves to become sidetracked from our ultimate goal. ASFA has set sensible research-based deadlines for termination of parental rights and requires a contingency permanency plan for all children in temporary care when the initial plan runs into problems. Yet too often we simply fail to follow the law.

Reunification and adoption are the only two truly permanent outcomes. We have sometimes excused ourselves by accepting “Another Planned Permanent Living Arrangement” (APPLA). Emancipation to “Independent Living” has even been accepted as a permanency plan. This is an oxymoron. Fortunately, federal funding for APPLA was eliminated in 2014 (PL 113-183) for children under 16, thereby ending any suggestion that emancipation to independent living might be considered as providing a permanent home. Guardianships have sometimes been relabeled as “permanent.” While an improvement on foster care and independent living, guardianships lack the legal force of reunification and adoption. They can be dissolved and are not generally lifelong. Follow-up research shows that former foster children are more apt to require continuing parental support well into their adulthood.

The remedy for prolonged foster care should be obvious. Either return the child to his birth home or find a new one with minimal delay. As ASFA makes clear, the child’s rights are paramount. The child is the client, not the state nor the birth parents nor the foster parents. Time is not on the side of a growing child.

What else holds us back from a timely resolution while we stay focused on administrative policies and procedures? Three further obstacles complicate the issue. The first is a strong historical bias for the biological family. “Children belong with their real parents. We should give birth parents as many chances as they need.” ASFA supports this concern by specifying that the birth family and reunification are the initial goal. For the child’s sake, however, timely deadlines are set.

To move things along, let’s give the parent an immediate plan to remedy the reasons for removal so he or she can begin at once. Check compliance weekly from the start. The child’s developmental clock is ticking. ASFA’s deadlines were formulated for the stability and protection of the growing child. Continuing relapses into substance abuse are especially time-consuming and offer minimal hope for successful reunification. Birth parents cannot be allotted indefinite time.

A second obstacle is inertia. “We’ve always done it this way.” “Old ways are best.” “Hope springs eternal.” As any engineer will tell us, it takes a considerable amount of energy to get a stable object into motion. Without considerable effort, neither rational nor emotional appeals are likely to move an entrenched system.

Finally, our success is diluted by a lack of clarity concerning the desired outcome. While the child welfare system may name the ultimate goal as permanence “within child time,” we somehow become sidetracked by sub-goals. We become immersed in time-consuming policies and procedures, we fail to check regularly on progress, and we give the birth parents an often unlimited time to improve.

More than providing motivation to do a better job, major changes need to be made to the child welfare and foster care system.

Adapt a Business Model

Profit-making is the goal of business. A thriving company will keep its eyes on the prize. Child welfare agencies are in the business of helping children in foster care find safe and permanent homes. Unfortunately, our foster care system is currently structured to offer better monetary compensation for maintaining a child in long-term foster care than for finding a permanent home. This is counter-productive. Why not use approaches that have proved effective in the marketplace? We offer seven suggestions from the business world that might be adapted to achieve better results.

1. Clarify the outcome. Good companies work to increase profit. They work as a team, seek advice from all the players, and are serious about quality control. For child welfare agencies, the goal is not financial, but human healing and well-being. Success can be measured in how safely and timely we can find permanent homes for our vulnerable young citizens in temporary care. A first step for public and private foster care agencies is to be clear about the ultimate desired outcome in a way that infuses the entire system.

2. Involve all the “players.” A good business encourages cooperation from all the important players. Management invites input from customers, suppliers, and workers. This is less true in the foster care system. Foster parents may be the only ones with 24/7 knowledge of the children in their care and may be one of the options for a permanent home. Yet they are frequently ignored when decisions must be made about schooling, medical treatment, and placements. They are the only team members with no standing in court. Better child-centered choices could be made if all the key players worked as a team.

3. Recognize effectiveness. The best strategy for dealing with a specific problem is to focus primary attention, not on the problem, but on the desired result. Attention, when centered primarily on shortfalls and failures, can provide a subtle reward for the very behaviors that need to be eliminated. Behavior that attracts attention is likely to continue. “Pay” most attention to those activities that enhance and ultimately achieve permanence.

Supervisors need to be positive in recognizing case manager performance. Encourage the CM to check weekly on the birth parent’s progress in following the case plan. Note the presence of a contingency plan for permanence in the file. Recognize when the CMs client is on track to meet the ASFA timelines. Publicly applaud each reunification and adoption.

Rewards come in many forms. Use bulletin boards to display CM progress toward permanency goals. Recognize a “CM of the month”. Keep a scrapbook for each CM with pictures of those children he or she helped to find a permanent home. A day off might be earned with a sufficient number of token points. Points could be considered toward promotion. A cooperative staff might treat the effective CM with a lunch or dinner to celebrate each small success.

4. Provide goal-focused quality control. Whenever we buy something on the Internet or stay at a hotel, we are asked to comment on our experience. The child welfare department can accomplish this rather easily in several ways. Learn what works and what does not from the clients and others involved in the system. Feedback from foster parents, older children, and other involved agencies should be welcomed. Both positive and negative letters should be reviewed, responded to, and filed.

Supervisors can add to this effort with regular or monthly performance reports. These evaluations should be in writing and go in the CMs personnel file. Feedback is essential to improvement. Effective CMs will welcome the fact that note is taken of their efforts.

5. Get beyond the psychological cure. Foster care is an abnormal and disabling situation and needs to be addressed directly. The damage done by long-term temporary care is reflected in the significant increase in rates of adult mental illness, crime, and homelessness for former foster children. To be truly effective in treating foster children, we first need to focus on the situation itself, the temporary nature of foster care.

Like an Emergency Room, foster care provides a necessary remedy to a serious immediate problem. The ER is a valuable place to go in a crisis but not the place to stay. Once the crisis has been handled, the true remedy is to change the situation that caused the problem and get back to normal.

In teaching therapists who treat foster children for “adjustment disorders,” the authors always stress that the primary therapeutic goal must be to find a permanent home for the child-patient. To continue to try to help the child adjust to an untenable situation is like trying to fill a canteen with a hole in the bottom. You can try endlessly but it won’t work. Start by filling the hole. Or find a more serviceable canteen.

6. Redirect the funding. A good company will spend its money on those programs that are most likely to enhance its profitability. The foster care system might copy this strategy by directly funding services related to permanence without first requiring that the child be diagnosed with a medical/mental disorder.

Here are some interventions that might shift the focus from helping a child adjust psychologically to foster care and focus on finding him or her a permanent home:

  • Homemaker services and other in-home behavioral support for the birth parent.
  • Parent training for reunification.
  • Pre-placement planning.
  • Home-finding.
  • Recruitment of good foster and adoptive homes.

Why not ask Medicaid to pay for those services? The possibility of administrative changes to expand treatment funding to cover services focused on permanence are already being discussed with the Centers for Medicaid and Medicare (CMS) by advocacy groups like the Foster Family-based Treatment Association (FFTA).

Here are other ways to redirect monies that might improve foster care. Why not provide a bonus for successful reunification or adoption to agencies? Make the bonus comparable to the cost of an additional six months spent in foster care. Agencies and welfare budgets should be compensated for success on a par with any future time that might otherwise be spent in foster care.

Redirect the reimbursement for agencies from a daily overall rate to a fee-for-service model. Currently, many agencies are compensated by combining the additional and important services they provide by an accounting process called “bundling.” Although bundling is a simple way to reimburse agencies for the care and support they provide, it may inadvertently reward long-term foster care. Instead of paying agencies for the time a child spends in foster care, pay them with a fee for each specific service provided. If the reimbursement is adequate and based specifically on each intervention rather than on the days in care, such services might be more consistently provided and lead to better outcomes.

7. Provide continuing subsidies for adopted foster children. Foster-to-adopt parents are willing to take on a lifetime commitment. By paying per diem for foster care, however, and denying them a continuing daily subsidy after adoption for minors, the would-be permanent parents face a clear financial disincentive to adopt. Why would we want to punish them by withdrawing any financial support?

Case managers have sometimes tried to save the state money by discouraging foster-to-adopt parents from seeking post-adoption subsidies. They may fail to tell the prospective parents that they are entitled to a subsidy, or even worse, they may try to induce guilt by suggesting that the adults are adopting to get money rather than out of love for the child. No case manager should withhold funds which properly belong to the child, and no prospective parent should forego what is due to the child.

The North American Council on Adoptable Children (NACAC) provides detailed state-by-state information about post-adoption subsidies. Continuing financial incentives for adoption should be at least equal to the per diem for foster care. This redirecting of funding would require major changes. But it is the type of systemic change that could significantly improve foster care outcomes.

Conclusion

Every child has the right to a permanent home. Despite good laws, foster children remain in care for an average of nearly two years. That represents a flawed system and is unacceptable. We can change the system by using successful strategies from the business world to focus more directly on the desired outcome of permanence.

References