Sunday, February 24, 2008

Maybe someone should ask the mule

“I've flogged the Department of Children and Families like a rented mule. Where has it gotten us?”

--Sam Cook, columnist, Fort Myers News-Press, after another child “known to the system” died
in spite of all his previous columns excoriating the agency.

“The definition of insanity is doing the same thing over and over and expecting a different result.”

--Unknown, sometimes attributed to Albert Einstein.

Monday, February 18, 2008

The never-ending game of "May I?"

Last month, The New York Times published a column about a teenager torn between a “mentor family” that wasn’t prepared to adopt him and someone he barely knew in a state far away who was.

Most of the column revolved around how the institution in which he was living was pressuring him into an adoption he didn’t really want. The column didn’t say why, but getting those adoption numbers up would help the institution get a good evaluation from government officials – and, of course, it might help the state collect a bounty of $4,000 to $8,000 from the federal government.

But it was one small part of the column, mentioned only in passing, that was truly striking. And it is that one small part that sheds light on a battle now underway here in Virginia. (That battle, and the issues in this post are discussed in detail in NCCPR’s new report on Virginia child welfare.)

Here’s what one of the parents in the “mentor family” remembers of the first time they invited the young man to spend a weekend with them:

His first visit we're all waiting for him to come down to breakfast. I go up, he'd been in the group home so long, he was making hospital corners on his bed. He thought he couldn't eat breakfast until the bed was perfect.

And here’s a former resident of a group home in California, writing in L.A. Youth, in an essay reprinted in the trade journal Youth Today:

You have to ask permission for everything: to get food from the fridge, cook, watch TV, use the phone, go in the backyard or take a shower.

If the mountain of research such as the Surgeon General’s review of the literature, and the University of North Carolina review of the literature showing the failure of “congregate care” be it in group homes, orphanages or “residential treatment centers” (which are essentially orphanages rebranded) isn’t enough reason to get rid of a lot of them and scale back the rest, listening to the young people describe life there ought to be. Even when the residents are not abused by staff or abusing each other, which happens all too often, life in congregate care is an almost sadistic, never-ending game of “May I?”

No wonder one study found that seven years after getting out of institutions, 75 percent of the residents were back in the only setting where they knew how to live: Institutions. They were in jails or psychiatric centers.

Of course the residential treatment providers, who scarf up huge sums of government money, have a euphemism for this regimentation of day-to-day living. They call it “structure.” Whenever you hear a residential treatment provider babble about how his program provides young people with “structure” what he means is: Nobody gets breakfast until they get those hospital corners right!

Children don’t need this kind of rigidity – but institutions do. They need it in order to keep large numbers of troubled children in line and prevent their institutions from descending into chaos. So they turn around and claim that, by amazing coincidence, all the things that ensure that their institutions run smoothly happen to be “therapeutic” for children.

If that were true, we wouldn’t have that mountain of evidence showing institutionalization doesn’t work. If that were true, even Shay Bilchik, the former head of the trade association for residential treatment providers and other child welfare agencies, the Child Welfare League of America, would not have been compelled to admit that they lack "good research" showing residential treatment's effectiveness and "we find it hard to demonstrate success.”

But then, common sense should be enough to figure that out. Imagine if we were starting from scratch to figure out how best to help severely-troubled young people. And suppose somebody said, “I’ve got a great idea! Let’s take teenagers with the most difficult problems and throw them all together in one place – just at the time in their lives when they are most influenced by their peers.” If anyone suggested that, people might well wonder about his mental health. And yet, thanks to an accident of history – and the enormous political clout of the group home industry - that is exactly what we do.

To top it off, residential treatment is a prime example of an iron law of child welfare: The worse the option, the more it costs. Residential treatment bleeds child welfare systems of huge amounts of money, leaving very little for better alternatives.

Occasionally, institutions themselves have crises of conscience, shut down most of their institutional beds and embrace better alternatives. But then they come up against what the director of one such conscience-stricken institution called “the group home industry” which opposes any attempt to change government funding formulas to redirect money from their largely worthless, incredibly expensive institutions into better alternatives.

And that brings me to what’s happening in Virginia right now. Virginia is one of the states in which individual counties run child welfare systems. Governor Tim Kaine is proposing to reduce the state share of reimbursement for placements in group homes and institutions, while increasing the state share for better alternatives – in other words, families.

The group home industry has mobilized in opposition.

How do they fight reform? The group home industry will never say no to reform. Rather, they try to “Yes, but…” it to death.

First, they pretend they’re not institutions at all. How can you call us an institution? they say. Look how beautiful the grounds are. The children live in pretty cottages. They have “house parents.” It’s so “home-like.”

But children are not fooled by pretty buildings. Children know the difference between “home-like” and home. They know the difference between a Potemkin Village family and a real family.

No matter what it may look like, a building that houses large numbers of children, most of them strangers to each other, to be cared for by paid staff hired to dispense indiscriminate pseudo-love to whoever walks in the door - staff likely to change every year or two or, in some cases, with every shift - is not a home. It's a dormitory. And a collection of dormitories is an institution.

Then, they’ll claim that the institution provides “structure” and “stability.” Stash the children in our institution, they say, and they won’t bounce from foster home to foster home.

But stability means that the human beings in a child’s life remain constant. Between the shift changes and the staff turnover, a child in an institution may have to cope with ten different caregivers – none of whom loves him – in a single day.

Even in institutions using “house parents,” those house parents typically quit every year or two, making an institution every bit as unstable as multiple foster home placements.

The way to prevent children from bouncing from foster home to foster home is to take away fewer of them in the first place, and provide the necessary support for the rest.

As for “structure,” that’s where I started on this post – it’s just a euphemism for that never-ending game of “May I.”

The group home industry will piously proclaim that they, too, favor alternatives. They, too love foster homes, and therapeutic foster homes – just as long as these siphon not a single child, or dollar, from their institutions. That is essential, they claim, because, after all, there always will be some children who need to be institutionalized, they’d hate to see a system that didn’t have a full “continuum of care,” we must guard against anything that smacks of “one size fits all” blah, blah blah.

The argument goes beyond disingenuous all the way to Orwellian. One-size-fits-all is what Virginia has now, and the one size is institutionalization.

According to the Annie E. Casey Foundation’s Strategic Consulting Group, which studied the Virginia system and recommended changing financial incentives, ideally no more than ten percent of children should experience a first placement in a group home or an institution. The national average is 18 percent. But in Virginia it’s 24 percent – and for teenagers it’s 52 percent. (The Casey Foundation also funds NCCPR).

Furthermore, even though Virginia’s Comprehensive Services Act funds programs that involve far more than children in the child welfare system, congregate care eats up 45 percent of the entire CSA budget. In contrast, only nine percent is spent on community-based services.

It is, of course, impossible to get away from one-size-fits-all when the group home industry is scarfing up all the money that could be used for alternatives.

Then the group home industry cites what it claims is the severity of the children’s problems. They piously proclaim that they wish these children could be cared for by families – really they do – but it’s just impossible; the children’s problems are too severe. After all, they say, many of the children already have been through multiple foster home placements and it didn’t work – or to use the charming phrase often heard by RTC operators, “these children blow out of foster care.”

In fact, often the children’s problems aren’t so severe. Children wind up stashed in residential treatment because that’s where the beds are.

But even for children who do have very serious problems, there are far better alternatives. Yes, sometimes such children fail in families. But that is almost always because those families – be they birth families or foster families – didn’t get the help they needed. And that’s because the money that could buy that help is being thrown away on institutionalizing children.

The group home industry’s reasoning is circular, and it is cruel: Deny families the support they need to make a placement work, then justify your institution’s enormously-expensive existence on grounds that the children couldn’t stay in families.

It was all explained remarkably well by Dr. Ronald Davidson, Director of the Mental Health Policy Program at the University of Illinois at Chicago Department of Psychiatry.

“Sadly,” says doctor Davidson, “there is a certain element within the child welfare industry that tends to look upon kids in the way that, say, Colonel Sanders looks upon chickens…”

If anything, Governor Kaine’s plan does not go far enough. Just as foster homes are better than institutions, safe, proven programs to keep children in their own homes are better than foster homes. So the money the Governor wants to spend on another initiative recommended by Casey’s Strategic Consulting Group, a pay raise for foster parents, would be better spent on such alternatives.

But the proposal to reduce the state subsidy for largely worthless institutions is a good first step. No one should be allowed to “yes, but…” it to death.

Sunday, February 10, 2008

The baby market is booming

The Chapin Hall Center for Children maintains its own database of child welfare statistics. About 20 states provide all sorts of data beyond what they are required to give to the federal government. Chapin Hall analyzes the numbers and puts out reports full of broad general statements about broad general trends. They can’t say much more because, while Chapin Hall can list which states are part of the database, in exchange for providing the data, the states demand that Chapin Hall not link particular trends our outcomes to a given state.

Since states volunteer, the states in the study are not necessarily a representative cross-section, but enough states, including some very large ones, contribute data to suggest that trends nationwide probably are similar.

Chapin Hall is not prone to explaining the reasons behind the trends that show up in these data, however.

So they offer no explanation for a couple of startling figures about infants found in a new report they’ve put out on foster care trends. In a nutshell: Infants are far more likely than any other age group to be torn away from their parents – and far less likely ever to go home again.

Of all children entering foster care in 2004-2005, fully 20 percent were infants. No other age group, not even children aged one to two, represented more than seven percent of all children entering care.

Even more disturbing is the trend concerning exits. For children who enter foster care over age one and under age 17, between 40.5 and 46.4 percent exit to reunification. In contrast, about ten percent typically exit to relatives and another ten percent exit to adoption.

The figure for reunification drops for children who were already 17 when they entered care, which is understandable since many of them will “age out” of the system entirely. (And some of them will return home after aging out, something that won’t show up in the figures.)

But there is a much greater drop among infants. Indeed, the figure is staggering. Among children who enter foster care before their first birthday, only 28.6 percent return home. Another 9.5 percent exit to relatives and 30 percent are still in the system after turning one. In contrast, fully 24 percent exit to adoption.

But how can that be? After all, we are constantly assured that the system is careful and objective. There’s that line in almost every news story in which someone questions the system in which the child welfare agency piously responds that “We never make these decisions on our own, a court has to approve everything we do.” Yet somehow, if that is true, then parents must suddenly become vastly more “fit” after the child turns one year old.

It’s hard to believe that parents of infants are inherently more abusive and less capable than parents of children of any other age.

I can imagine child welfare agencies claiming that all this is just because infants are more vulnerable – so someone who can be a good parent to a 12-year-old might not be a good parent to an infant. But children aren’t exactly self-sufficient at 18 months – yet even by that age, child welfare systems are far more prone to return a child to birth parents. Among children aged one to two years old 40.5 percent return home and only 13.6 percent are adopted.

So the real answer is as obvious as child welfare agencies are desperate to deny it: Supply and demand.

Infants are, by far, the most marketable of commodities in child welfare. There is far more likely to be a “nice” (translation, affluent, white professional) couple - people like us – anxious to adopt, so it’s much easier to take them away forever from parents who are “unfit” – translation, poor, minority and so, presumably, nothing like us.

And, of course, the federal government will pay the child welfare agency a bounty of $4000 to $8,000 for every finalized adoption over a baseline number. There is no comparable incentive for returning that adorable infant to her or his own parents.

In Britain, where former Prime Minister Tony Blair imported much of the worst of U.S. child welfare policy, the press has been a lot more willing to take its collective blinders off. Newspapers from the liberal Guardian to the conservative Daily Telegraph have zeroed in on the trend to tear infants from impoverished birth mothers and hand them over to more affluent adoptive parents.

In the United States, as early as 1999, the Pittsburgh Post-Gazette did an excellent series on the propensity of one county in Western Pennsylvania to rush impoverished infants out of their homes and into the arms of affluent adoptive parents who sometimes had connections to the county’s child welfare and court systems. The Lexington Herald-Leader has done excellent reporting on a similar scandal in parts of Kentucky.

But other than that, discussing why infants, once torn from their parents, are so much less likely ever to go home again, is apparently taboo. Maybe that has something to do with how many reporters have friends or colleagues who are adoptive parents – and how few are ever likely to have a friend or a colleague who once had a child taken away by child protective services.

Sunday, February 3, 2008

"We are a better country than that"

Because NCCPR is non-partisan, and we take that seriously, I did not post the item below on this Blog when it happened, during a Democratic presidential debate on January 21. But now that the candidate who uttered the words, John Edwards, is out of the race, I thought I’d share this excerpt from the debate transcript:

JOHN EDWARDS: You know, we talk about 37 million Americans who live in poverty -- that's more than the population of California -- in the richest nation on the planet.

I've been to hundreds of places around this country who take care of the poorest of the poor, extraordinary, wonderful places. But I'll never forget, just a year or so ago, I was with a woman in Kansas City who told me the story -- worked full-time, worked full-time. She had several children.

Every night in the winter, she could not pay both her heating bill and her rent. She had to choose. Single mom, working full-time, she had to put her kids in all of their winter clothing, in their coats, bundle them up in the bed together, put as many blankets on top of them as she could.

And she'd get them out of bed in the morning and send them off to school. And the last thing she would say to them? "Please, for goodness's sakes, don't tell anybody at school what's happening here, because they'll come and take you away from me."

No mother in America should have to live like that. We are a better country than that.