The best chance in decades
to get serious about reducing the number of children torn from their families
each year is being undermined by the agency that is supposed to make it work.
Last September, Congress restored the authority of the
Department of Health and Human Services to issue “waivers” from
rules that restrict a huge proportion of federal child welfare aid to funding
foster care and only foster care.
Under current law, the foster care money is an open-ended
entitlement. For every “eligible” child
placed in foster care – and that’s nearly half of all foster children – the
federal government picks up a large share of the cost. This creates a horrendous incentive: Though
foster care costs more than better alternatives in total dollars, there are
times when it might cost a state or county less to use foster care because the
federal government picks up so much of the tab.
States that receive waivers get the chance to spend the
money on better alternatives, as well as on foster care. In exchange, they accept the money as a flat
grant instead of the current open-ended entitlement. The state gets the same amount of money, plus
inflation, for every year of the waiver (typically five years), even if there
are fewer children in care. So as foster
care is reduced, the state gets to keep the savings, as long as those savings
are plowed back into child welfare.
The Congressional Research Service estimates that, had this
deal been made available to every state back in 2005, and had every state
accepted it, the states would have had $5
billion more to spend on child welfare by 2010 than they actually got under
the current entitlement.
So the fact that Congress now is allowing ten states per
year over the next three years to receive these waivers seemed like a real
breakthrough. But the devil is in the
details – in this case, the
guidelines issued by the Administration on Children, Youth and Families
(ACYF). The guidelines appear to have been written to undermine any effort to
use waivers to prevent children from entering foster care or to speed
reunification. They will be
discussed at a so-called “town hall meeting” at the ACYF offices in Washington
this afternoon.
A BIGGER BAND-AID FOR A
GAPING WOUND
For starters, the guidelines accept the false premise that
all children in foster care have been abused or neglected. The guidelines emphasize addressing the
trauma caused by that abuse. Nowhere do
the guidelines recognize that many children in foster care have not, in fact,
been abused or neglected (unless one considers poverty itself to be neglect)
and it is foster care itself that often causes the trauma.
So it’s no wonder that instead of encouraging states to curb
needless foster care – indeed, that’s not
even listed as a goal - the guidelines give top priority to doing no more
than providing a bigger Band-Aid to cover the gaping wounds opened by needless
foster care placement. The second
priority is to create still more incentives to push adoption.
For page after page, the guidelines prattle on about
improving “well-being outcomes.” In
other words: Try to undo some of the harm already done by bouncing children
from home to home by providing more “counseling.” Or try to undo the harm done
by moving foster children from school to school with mentoring programs and
tutoring.
To the extent that helping families is mentioned at all, it
is in a context that strongly implies providing more “counseling” for them – after their children already are in
foster care.
Thus, for example, the guidelines state that
in order to achieve better
outcomes for children who have experienced maltreatment it is essential to
engage families, whether biological,
foster or adoptive, in the process of healing and recovery. [Emphasis added.]
Note first the use of the pejorative, offensive term
“biological parent,” instead of “birth parent,” which is value neutral. The rest of the sentence makes clear the
author’s view that all children in foster care have been abused and need help
to heal from what the abusers did to them.
THE TROUBLE WITH BAND-AIDS
At least one study actually has tried to measure how much
good this Band-Aid approach would do.
The answer? Not much.
The study, done by Casey Family Programs in cooperation with
Harvard Medical School, found that only about 20 percent of former foster
children are “doing well” as young adults. (There is a complete analysis of the
study and a link to the full study on our website here.)
The authors went on to design a complex
mathematical formula to attempt to figure out how much they could improve these
outcomes if they could invent and use
the perfect Band-Aid and every single problem besetting the foster care system
magically were fixed. Their answer: 22.2 percentage points. In
other words, if tomorrow, foster care miraculously became perfect, it would
churn out walking wounded only three times out of five, instead of four. Yes, that’s worth doing – but not at the
expense of better solutions.
To see why Band-Aids don’t work, one need look only at an
example from the ACYF guidelines concerning an issue they propose to target:
the misuse and overuse of psychiatric mediation on foster children. This is a very serious, very real problem –
but it is a problem inherent in foster care.
We know this because when children with exactly the same kinds of needs
are placed in kinship foster care – that is with relatives – the percentage
placed on meds is far lower. It’s not
hard to figure out why. Grandparents are
a lot more likely to love these children than total strangers – so grandparents
are a lot more likely to put up with behavior that would prompt a stranger to
demand a prescription to make the child more docile.
Thus, the solution to the misuse and overuse of psychiatric
medication on foster children is to keep more children out of foster care and,
where that’s absolutely unavoidable, do more to place them with relatives. But the guidelines are seeking proposals not
to curb foster care but only to provide that bigger Band-Aid, in this case
“behavioral and psychosocial interventions [that] are considered first line or
concurrent treatments for children for whom psychotropic medication is being
considered or used.”
PERMANENCE SHOULD MEAN MORE
THAN ADOPTION
The second priority is using waiver funds to further
increase adoptions.
Since 1997, the American child welfare system has been
fanatical about equating permanence for children with adoption. The federal
government even has offered states a bounty of up to $12,000 for every
finalized adoption of a foster child over a baseline number – sometimes with awful
results. There is no similar
incentive for reunifying families.
Instead of trying to balance the scales by asking for waiver
proposals that emphasize quickly and safely reunifying families, the guidelines
seek proposals that will further tilt those scales toward adoption. Indeed, in a section discussing the need for
programs to address permanence, every example
deals with adoption.
Still another section deals with changing financial
incentives for the foster care-industrial complex, the network of private
foster care agencies, professional helpers and assorted hangers-on that lives off
a steady supply of foster children.
The guidelines call for proposals that will implement
“performance based payments.” Often
called performance-based contracting, this has enormous potential to reduce
needless foster care. A state with a
waiver could use flexible funds to reward agencies for keeping children out of
foster care or increasing the number of children reunified with their
parents. But the guidelines ignore those
possibilities. Instead, the one and only
example offered is this:
A state could condition
provider payments … on measurable improvements in child well-being outcomes or
increased numbers of successful adoptions among the longest-waiting children in
foster care.
REAL WAIVERS STILL ARE
POSSIBLE – IF STATES FIGHT FOR THEM
On one level, this fundamental betrayal of the primary
purpose of waivers shouldn’t be surprising.
These priorities are a perfect reflection of the priorities Bryan
Samuels, the commissioner of ACYF, the agency which drafted the
guidelines. His unfortunate priorities
have been noted
on this Blog before.
Fortunately, Samuels’ boss knows better. His boss is George Sheldon, commissioner of
the Administration for Children and Families (ACYF is a division of ACF and both are within HHS). As Secretary of Florida’s Department of
Children and Families Sheldon and his predecessor, Bob Butterworth implemented
the only statewide waiver granted the last time they were made available in
2006. They used the waiver to cut significantly
both the number of children in foster care on any given day and entries into
care. They did it by emphasizing
permanence in all its forms – reducing the number of children who entered care,
bolstering reunification and adoption.
Few people in child welfare seem to have a better
understanding of the need to prevent needless foster care than Sheldon. And Sheldon championed waivers both before
and after taking the job at ACF.
That suggests that a state that really wants to use its
waiver to actually reduce foster care through prevention and reunification
probably still can do it – and should not be discouraged from trying by these
guidelines. The guidelines have lots of
wiggle room. And, frankly, it’s possible
there won’t be much competition for the ten waivers available each year.
So a state with gutsy leadership and a strong commitment to
prevention and family preservation still should be able to get a waiver. But the state will have to emphasize what Bryan
Samuels already should know:
● The best way to improve
the “well-being” of children at risk of foster care is to make sure they are
never placed in foster care.
● And the best way to
improve the “well-being” of foster children is to get them the hell out of foster care.
