Monday, June 7, 2010

Curbing needless foster care: Does the Obama Administration even have a clue?


Ok, I get that with two wars, the worst environmental disaster in our history, health care, the economy, etc. President Obama may not be paying a lot of attention to child welfare. But is it too much to ask that his administration not make things even worse?

For starters, the Administration took the terrible financial incentives that encourage foster care and discourage better alternatives and did, indeed, make them worse. I don't think they did it on purpose. Rather, my guess is they were intent on increasing state reimbursement for Medicaid and weren't paying attention to the fact that this also automatically increases reimbursement for foster care. (The House and Senate have split on whether to continue this increase, so here's a modest proposal for a compromise: Extend the increase for Medicaid, but not foster care.)

Now, according to The Columbus Dispatch, the Administration may refuse to extend a waiver that gives 18 counties in Ohio the same flexibility that has allowed Florida to vastly improve its system. (That success, already cited by The New York Times, also was a key focus of an Associated Press story Friday.)

The "ProtectOhio" waiver has been around for 12 years. It's due to expire at the end of July, and there's no word from the federal Department of Health and Human Services concerning whether they will grant another extension.


An early evaluation found that, on average, the counties did not perform as well as Florida. But that changed. And even early on there were improvements; and, in two counties, the improvements were particularly significant.

What made the difference in those counties? In a word: Leadership.

As we discuss in our report on Ohio child welfare, according to the evaluation:

The two most successful counties…share a pattern of strong leadership and careful planning of systemic reforms. Both demonstrated an early and ongoing commitment to expanding resources for child welfare activities other than foster care board and maintenance, well beyond the flexible funds generated by Waiver participation. They also sharply reduced placement utilization, instead serving children in-home or through referral to community agencies.

The evaluation found that, in Lorain County, the child welfare agency had been engaged in a comprehensive planning process, geared toward safely reducing entries into foster care, even before the waiver. So the county knew how to make the best use of flexible funds to enhance services to families. In addition to reducing needless removals of children, when a child really needed to be taken from his or her parents, the county also significantly increased placements with relatives instead of strangers.

"Overall," according to the evaluation, "the flexibility of the Title IV-E waiver seems to have reinforced the reform agenda of Lorain County Children Services."


The other counties learned from those early experiences. According to a new report from Casey Family Programs, now:

Demonstration counties in ProtectOhio have consistently shown briefer lengths of stay in children's first placements, greater success in completing permanency plans for children in long-term foster care, higher rates of adoption, and a higher proportion of children exiting foster care to extended family caregivers without a decline in child safety measures. For the two-year period ending September 30, 2009, the ProtectOhio demonstration group generated internal savings of 329,441 placement days.

In other words, children spent a total of 329,441 fewer days in foster care than they would have had there been no waiver – with no compromise of safety. And that includes the children who had zero days in foster care because, thanks to the waiver, the services were available to keep them out of foster care in the first place.

It also probably helped that Ohio's largest county, Franklin, eased out the mediocre longtime leader of its child welfare agency. His replacement has done a better job taking advantage of the waiver. That's the whole point of reforming child welfare financing: It can't make up for mediocre leadership. But it allows good leaders to swim with the tide instead of against it.

Speaking of mediocre leadership: HHS apparently hasn't been paying attention. No surprise there. The federal leadership team on child welfare is incomplete and what there is of it is undistinguished.


The problem goes all the way to the top. When the secretary of HHS, Kathleen Sibelius, was governor of Kansas, a state with one of the highest rates of removal in the nation, she turned a blind eye as her state fudged the figures it sent to HHS. She also didn't lift a finger when the head of her human services agency was caught in a bald-faced lie. (We don't know which of two flatly contradictory statements was the lie, we just know he lied. Details are in our report on Kansas child welfare.)

The one time I heard the HHS Assistant Secretary in charge of the Administration for Children and Families, Carmen Nazario, speak on the funding issue, her comments amounted to: I can't wait to give the Child Welfare League of America exactly what it wants! Since CWLA is the giant trade association for agencies, including many that live off a steady supply of foster children, that's always bad news for kids. For details, see our report on child welfare financing.

And now, whether through indifference or hostility, HHS is threatening one of the few areas where federal child welfare policy actually has helped children – waivers from federal funding rules that provide a huge, perverse incentive to place children in foster care and keep them there.

So, if the people who occasionally pay attention to child welfare in the Obama Administration (if any) really are too distracted to do comprehensive reform of child welfare – like making the Florida waiver the way child welfare is financed nationwide, or at least making such a waiver available to any state that wants one – could they at least let the states and counties that were smart enough to get these waivers in past years keep them?

It's simple. Just sign the relevant forms. Then you can go back to the wars, the oil spill, the economy and all the rest.