Thursday, July 29, 2010

Foster care finance reform: The charge of the “Yes, but…” brigade

During his opening statement at a Congressional subcommittee hearing on child welfare finance reform this morning, the Secretary of the Florida Department of Children and Families spoke about a meeting he had with fifteen former foster children. He said it was those former foster children who convinced him of the need for Florida's current reforms:

Child after child after child told me I would have rather stayed at home and dealt with the issues in that home than gone into a foster care system where I was moved from home to home and school to school.

Today, children are far more likely to be able to stay in their own homes in Florida because of its highlysuccessful waiver from federal funding rules. The waiver lets Florida spend about $140 million a year in federal funds normally reserved for foster care on better options as well. The result has been a significant reduction in entries into care and, according to independent evaluations, improved safety outcomes

But for the rest of the 90 minute hearing, almost everyone else who spoke forgot about those young people, as they sought to "yes, but…" to death any plan to let other states do what Florida has done. The Florida wavier itself expires in 2011 if it's not extended by the Department of Health and Human Services.

Among those joining the "Yes, but…" brigade was the chairman of the subcommittee holding the hearings, Rep. Jim McDermott, (D-Washington).

At the start of the hearing, McDermott announced he would introduce legislation to restore HHS' authority to grant a limited number of new waivers. He spent the rest of the hearing wringing his hands over his own bill. Over and over he expressed the classic fear of the foster care-industrial complex: Somehow or other this means we don't get as much money. He obsessed over the possibility that states might use the waivers to cut child welfare spending and use savings from putting fewer children into foster care on other government services.

Suppose, he argued, a state was spending $100 to keep a child in foster care and could spend only $40 to keep that child safely in his own home. What's to stop a state from diverting the other $60 to highway construction or something else besides child welfare. (This is my recollection of the hypothetical, his figures and examples of other spending may have been a little different).

Even assuming that were possible (and for reasons discussed below, it is not) that still would be an improvement over the status quo. That's because the $40 intervention – keeping the child safely in his own home – almost always would produce better results for the child than the $100 intervention: foster care. Yet this is virtually incomprehensible to McDermott and other of my fellow liberals who can't conceive of something being better if it doesn't involve spending more money.

Part of the problem is that too many of us on the left are stuck in a 1960s mindset, in which letting states make decisions meant segregation forever and enlightened policy – from the New Deal to the civil rights laws to the Great Society – came only from the federal government. The irony is that now this mindset is perpetuating one of the worst civil rights violations of the 21st Century, the needless confiscation of poor, minority children from their parents. And we're thwarting states who want to do better. We're never going to win the war of ideas with the right until we get it through our heads that it's no longer 1968.

But in any event, what McDermott fears can't happen under child welfare waivers like the one in Florida. Indeed, over and over, Sheldon and another witness – one from McDermott's home state – tried to explain that in the real world of child welfare, the opposite was the case.


Sheldon explained how the Florida waiver had a strong "maintenance of effort" provision which required that the state maintain its own level of funding for child welfare. He talked about how DCF had, indeed, taken hits in other areas, but not child welfare, because the waiver would not allow it. So any savings from reducing foster care in Florida had to go into further improvements in child welfare services.

In contrast, State Rep. Ruth Kagi (D-Washington) expressed her enormous frustration at the fact that, now that Washington State finally was reducing its foster care numbers, that state was being penalized for it financially. Since Washington State gets its foster care money the old fashioned way, as an open-ended entitlement, it can't keep the savings from reducing foster care – the money never even gets to Washington State. As a result, they're having enormous problems trying to spend on services to keep children out of care.

She cited an example:

I was with a caseworker in Vancouver a few months ago, who had been with a young mom with a baby, and the risk, she felt, was high, but she wanted to get a public health nurse in there to support the mom, and felt that would make the difference. She was unable to get a public health nurse. So she took the child, and placed the child in foster care.

So to sum up:

Florida: Has waiver – CAN'T cut child welfare

Washington State: No waiver – CAN cut child welfare.

Somehow, this didn't seem to sink in.

And no wonder, given the comments from some of the other witnesses.

For starters there was Fred Wulczyn, from the home of advocacy "scholarship" the Chapin Hall Center for Children. He hemmed and hawed about what evaluations showed, suggesting that only the evaluations of waivers involving subsidized guardianship really produced outstanding results. He dismissed the comprehensive evaluations of Florida's waiver because they're not yet "final."


This is a perfect example of the double standards that plague child welfare scholarship: We've known about the dreadful failure of foster care and institutions for a century – that should be "final" enough. Yet these interventions are allowed to scarf up almost all the money because alternatives haven't dotted every i and crossed every t on their "final" evaluations.

Even more galling, of course, are Chapin Hall's own double standards. Wulczyn's "Yes, butting…" of prevention waivers comes only weeks after his colleague Deborah Daro co-authored a letter passionately urging President Obama to fund certain "home visiting" programs that have a lot less evidence of success than the Florida waiver. And Daro failed to disclose in the letter that one of these programs, Healthy Families America, is a program she helped to develop when she was at Prevent Child Abuse America.

In the same vein, one of the programs Rep. Kagi rightly praised, and wants to expand is the original Intensive Family Preservation Services program, Homebuilders, a program which has an outstanding evidence base proving effectiveness, but which probably would be dead by now had some of the advocacy-scholars at Chapin Hall had their way. (In fairness to Wulczyn, while I believe he applies the wrong standard when comparing innovation to the status-quo, he's been consistent and honorable in his own evaluation work.)

But the leader of the Charge of the "Yes, but…" Brigade was Rutledge Q. Hutson, who has ping-ponged between the Center for Law and Social Policy, where she works now, and the Children's Defense Fund, a group whose slogan should be "no dollar left behind."

For starters, Hutson offered up a favorite scare number from those whose 19th Century counterparts proudly called themselves "child savers" – the one about how, in 40 percent of cases in which investigators "substantiate" maltreatment, the family received no "services." This, of course, conjures up images of parents beating, raping and torturing their children as caseworkers check the "substantiated" box on a form and walk away.

Far more likely, the overwhelming majority of these cases are situations in which no "help" from the government was required. They may be cases in which the worker only checked the "substantiated" box because she was afraid to do otherwise if something later went wrong – in some states you're supposed to check this box even when there is more evidence of innocence. Or they may be situations in which a mother rushed to a toddler twin crying in one room, and the other twin hurt himself while unattended for those few minutes. Or a young child unlatches the back door and wanders away for a few minutes – and by the time the child protective services worker arrives to "investigate" the parents have put a better lock on the door, etc. etc.

In a classic example of the narrow range of ideas that characterizes the child savers, Hutson insisted that waivers can't possibly work until an entire array of alternative services is in place and ready to go before even one child is kept out of foster care. She suggested this even as Florida's experience proves this simply isn't so. It doesn't take that long to bolster basic prevention and family preservation. And Hutson's thesis assumes that every child in foster care needed to be there in the absence of "services." In fact, there are foster children who never should have been taken away at all – and the savings from keeping them out of foster care can be used immediately to bolster prevention and family preservation.

Hutson also erred in claiming we don't know what happens to children not taken into the system under waivers. On the contrary, Florida's waiver evaluation measures the proportion of children with substantiated allegations of maltreatment who are maltreated again within six months – and that figure has improved under the waiver.

But the fact that Rutledge Q. Hutson ignores the research of others is not nearly as disturbing as the fact that she's ignored the research of – Rutledge Q. Hutson. In 2003, Hutson wrote a report on the dramatic improvements in the county-run child welfare system in El Paso County, Colorado. Absolutely vital to making that work was the fact that a visionary leader of that system, David Berns, took full advantage of the flexibility in state aid provided by Colorado to the counties – in fact, he pushed the envelope as far as it would go in mixing and matching those funds, adopting a "better to apologize afterwards than ask permission beforehand" approach.

But today, Hutson spent most of her time effectively seeking to put obstacles in the way of the next Dave Berns to come along and try to transform child welfare in a county or a state.

All of those in the "Yes, but…" brigade kept saying that waivers are no substitute for comprehensive reform of child welfare finance in general. That's true – but the vision of reform the "Yes, but…" brigade is pushing would add a lot of new spending and do almost nothing to encourage shifting that spending from foster care to better alternatives. Indeed, under some scenarios, things could get even worse. Details are in our report on child welfare financing.

And, as Rep. Kagi pointed out toward the end of the hearing, in a tone that suggested some exasperation: There is no consensus on what "comprehensive reform" should look like – so at least states that want to move ahead should get a chance through waivers.