In the middle of the last
decade, the State of Florida and two counties in California got a head
start on the pack in developing and implementing the modern era of child
welfare waivers. These waivers allow federal funds now reserved for foster care
to be used on better alternatives, including family preservation strategies.
Key
measures tracked in evaluating waivers include: entries into care, number of
children in foster care on a given day, re-abuse of children left in their own
home and re-abuse of children after they are returned from foster care.
So, how
did they fare?
§ In
Florida, entries into care declined significantly, and the independent evaluation of the waiver found
that child safety improved.
§ In
Alameda County, Calif., there was a big drop in entries into care, and both key
safety measures improved, according to the California Child Welfare Indicators Project.
§ In Los
Angeles County, foster care entries barely changed; the point-in-time number
actually declined more slowly than before the waiver. One safety measure
stayed the same, one got worse.
The conclusion is
obvious, right? Get rid of the waivers – they’re endangering children!
Only in
the upside-down, inside-out world of American child welfare would anyone think
that makes sense.
What
also makes no sense is how we fund child welfare now. The giant, open-ended
entitlement reserved for foster care dwarfs the meager amount of federal aid
available to keep families together.
This does not mean, as
some on the far right say, that governments make money on foster care. But
it does mean that even when safe, proven alternatives cost less in total
dollars, it can cost a state or a county less to place a child in foster
care. And many private agencies, paid for each day they
hold a child in foster care, do indeed make their money that way, creating a
perverse incentive to prolong foster care.
Waivers
are a very small effort to redress this imbalance, because anything bigger is
routinely defeated by lobbying from agency trade associations such as the Child
Welfare League of America.
So, how do we know
waivers won’t encourage a mad rush to keep children in dangerous homes? It
didn’t happen in Florida. And it didn’t happen in Alameda County.
It also
didn’t happen in Illinois, which didn’t wait for a waiver and moved to change incentives
for private agencies on its own. In 1997, there were 50,000 children trapped in
foster care in that state, proportionately more than any other.
Then, instead of simply
paying per diems to private agencies, Illinois started
rewarding them for permanence – adoption and reunification – and penalizing
those that didn’t deliver. Today there are about 17,000 children in foster
care in Illinois, and independent court-appointed monitors found that child
safety improved.
What about L.A.? The
results tell us only that in one of the most dysfunctional, highly politicized
systems in America – with, at the time of the waiver, possibly the worst governing body in all of child
welfare – it’s going to take more than a few years to get a waiver right.
The Other Incentives
The
other reason the Chicken Littles are wrong about waivers is that while
financial incentives are an important incentive, they’re not the only
incentive. All the other incentives encourage needless removal of children as
well.
Personal incentives: When
a worker sees a child living in poverty, the first instinct is often to
“rescue” the child on the assumption that the child is bound to be “better off”
in care.
The child in that
impoverished home is a reality before the worker’s eyes. The dangers of foster
care, physical and emotional, are an abstraction. The problem is
compounded by the class bias and racial bias that permeate child welfare. If
keeping families together really is everyone’s first priority, as everyone
claims, why is it that the only form of permanence most ever celebrate is adoption?
Political incentives: Many
child welfare workers like to say they’re “damned if we do and damned if we
don’t.” But it’s not true. Caseworkers and administrators don’t get
fired, suspended, demoted or even slapped on the wrist for taking away too many
children. All of those things have happened
to workers and agency chiefs who “allowed” a child to die on their watch.
When it comes to taking
away children, you’re only damned if you don’t. Indeed, one reason the waiver
changed so little in Los Angeles was because of ongoing, inaccurate media coverage in
the Los Angeles Times. Something similar is happening now in Florida.
But while entries into care now are increasing again, they have not increased
at nearly the rate they did under almost identical circumstances in 1999 – when
there was no waiver.
Ideally,
there would be no “external” incentives pushing child welfare decision-makers
in any direction. But that’s impossible. So as long as so many
incentives push workers to take the child and run, a change in financial
incentives is needed to push back, just a little, the other way.
The “Compared To What?” Factor
The trashing of waivers
also suffers from the same double standard that crops up whenever someone tries
to change the foster care status quo. A few
examples:
A whole lot of studies of
Intensive Family Preservation Services programs that follow the Homebuilders
model find them safe and effective, while a few studies of
programs that don’t follow the model do not. Critics focused only on the studies
of programs that don’t follow the model.
There are 26 studies
of differential response, and 25 find that it
does not compromise child safety. But one finds that that it does, so
critics focus on that one – and accuse everyone else of bias! (In fact, the only study I know
of to look at scholarly bias in child welfare suggests the bias goes in a very different direction.)
And
when one evaluation after another finds that waivers don’t compromise safety,
critics focus on the one indicator from one evaluation that does.
That
pernicious double standard allows things like the appalling rate of abuse in
foster care itself to go unchecked.
We can’t measure how many
Los Angeles children were saved from abuse in foster care itself by being sent
home sooner. But given the number of studies that show abuse in
one quarter to one third of foster homes (with a worse rate in institutions),
it probably was a lot.
Even those studies are
likely underestimates. Read the scathing 200 page decision by a federal judge
in Texas in a class-action lawsuit against that state’s system – a decision
finding that abuse in foster care isn’t just common, it’s rampant – and tell me
why we shouldn’t be demanding changes in the financial incentives that
encourage needless placement.
The
real problem with waivers is that they don’t go nearly far enough. At a
minimum, every state should be allowed to trade in its foster care entitlement
funding for a flat amount of funding, adjusted for inflation, that could be
used for prevention and family preservation as well as foster care.
Ideally, such a change would be mandatory.
Isn’t
it time, finally, for the burden of proof to switch to those who want to keep
on shoveling money into a foster care system that does so much harm to so many
children?
