Tuesday, May 29, 2012

Foster care in America: The threat to waivers is even worse than I thought

As is discussed in the previous post to this Blog, when I read the guidance issued by the Administration on Children Youth and Families (ACYF) concerning the kinds of proposals they want to see for child welfare waivers, I was worried.

Now that I’ve heard ACYF Commissioner Bryan Samuels give a presentation about this guidance, I’m even more worried.

Samuels’ approach to child welfare in general, and waivers in particular, is one more classic example of good intentions gone wrong.  Samuels spent a large part of his own childhood in “the system.” I’m sure there is nothing he wants more than to transform the lives of other vulnerable children.  He’s devoted his life to it.  But Samuels’ personal experience was very different from most, and it’s blinded him to the fact that, for most children, the system is unfixable.  It’s blinded him to the fact that the first priority needs to be keeping children safely out of that system.

Last week, I listened by phone to one of several presentations Samuels has given around the country.  Here’s why it was so discouraging:

● Over and over and over again Samuels demeaned the notion that keeping children out of foster care is an end in itself; in effect, dismissing the mass of evidence that foster care is so inherently harmful that its safe reduction should be the top priority for waivers.   “That should not be the measure of success,” Samuels said.  “We want outcomes other than ‘we prevented foster care.’”

● Over and over and over he said that the two standard federal measures of progress – and of child safety -  reducing reabuse of children “known to the system” and foster care recidivism (the proportion of children returned home from foster care who are placed again) - are not valid measures of whether children are better off.  Rather, he prefers inherently more subjective measures of children’s “well-being.”

This ignores the fundamental fact that if you reduce reabuse and foster care recidivism you are improving children’s “well being.”  The whole point of the child protection system is to prevent child abuse.  If you reduce reabuse you have accomplished your primary goal.

That should, in fact, be the primary goal of a system aimed at children and families that includes the ultimate element of coercion.  Any system that can take away your children forever should not be involved in the highly-subjective assessment of whether children are happier or smarter.  Because if you allow that, then you allow coercive systems that have near absolute power and are permeated with racial and class bias to start judging whether impoverished Black children would have improved “well-being” if only they were confiscated from their families and assigned to live with middle-class white strangers.  The problems with that should be obvious.

That doesn’t mean “well-being” should be ignored.  But it should be addressed through a strong network of well-funded services made available to families on a voluntary basis.


● Samuels belittled the achievements under current waivers – including the only  comprehensive statewide waiver – the one in Florida.  “Their crowning achievements are modest,” Samuels said.

The Florida waiver was implemented by two former secretaries of the state Department of Children and Families, Bob Butterworth and George Sheldon.  There is nothing modest about their achievements in using the waiver to dramatically reduce the number of children in foster care on any given day and entries into foster care over the course of a year, while improving child safety (as documented by independent evaluations).  It’s probably one of the reasons Sheldon was named to run the Administration for Children and Families – making him Bryan Samuels’ boss.  But Samuels apparently doesn’t think much of his boss’ work.

● Samuels derided one round of waiver proposals (I couldn’t make out over the phone if it was past proposals or those they may have received already for the current round), criticizing them because they “focus almost exclusively on deflecting children from entering care” – which is exactly what waivers should do.

Yes, Samuels couched all this in terms of providing more “help.”  He argued that children in foster care get more “services” than children in their own homes, and focusing on outcomes other that reducing reabuse and foster-care recidivism would push states to provide more “services” to children in their own homes.

But that is sophistry.  As I noted above, the whole point of having a child protective services system is to stop children from suffering from child abuse.  There are three ways to accomplish this:

--Stop taking children when they were not abused in the first place (when, for example, poverty is confused with neglect).  Instead, provide help to ease the worst of the poverty.
--If stress is building in a family that might lead that family to mistreat a child, provide the help that will ease the stress.
--Where there really has been maltreatment, provide families with the actual help they need so they don’t do whatever it was they did before. 

All of these already require more services.  Reducing reabuse is an excellent, relatively objective surrogate measure for whether the family is getting more help and whether the child’s “well-being” has improved.  Certainly it’s a better measure than some therapist’s subjective assessment – particularly if the therapist is being paid for every session of therapy she or he administers, or works in a group home or institution paid for every day it holds onto the child.


● Samuels again made his distorted priorities obvious when he gave some examples of relatively low cost ways states could spend their waiver money, making clear these are things he’d like to see in proposals:

            --More “parent education.”
            --More effective “counseling” that might not be covered by Medicaid.
            --Helping young people in “independent living” develop relationship skills.
            --Training foster parents in understanding trauma.

In other words, use the money to make foster care “better” instead of to further reduce it. 

Notice also that these are the kinds of services likely to warm the hearts of the “foster care-industrial complex” – the network of counselors, parent educators, and operators of group homes and institutions who live off a steady supply of foster children.  They’re so-called “soft” services in which the family is “diagnosed” with an “illness” and cured through the beneficence of people who, in the 19th Century, proudly called themselves “child savers.”  There was no mention of the kinds of concrete help like housing and child care and emergency cash that most families caught up in the system really need.

● Perhaps most appalling, Samuels even suggested that the waiver funds could be used for “redesigning how group homes work” and making residential treatment centers better.  Once again, Samuels ignored the mountain of research showing that institutions not only do not work, but also are inherently harmful.


That was the great paradox of Samuels’ presentation.  It was slathered in stultifying, au courant child welfare jargon.  Indeed, Bryan Samuels seems to believe there is no problem in child welfare that can’t be solved by throwing buzzwords at it.  One slide in the inevitable power-point presentation was headed: “Initiative to Improve Access to Needs-Driven Evidence-Based/Evidence-Informed Mental and Behavioral Health Services in Child Welfare.” 

The good news: A state that loads up its proposal with enough buzzwords probably will be able to do what it wants.

The bad news: Though Samuels constantly chants the mantra of “evidence based/evidence informed” he refuses to face up to the evidence about substitute care.

For example, in proposing that states waste waiver dollars on making residential treatment centers better, he cites one study of one institution that supposedly improved outcomes – but  the study did not follow up to see what happened to the residents after they were discharged.  In contrast, dozens of studies show the enormous inherent harm of residential treatment.  But Bryan Samuels pretends that evidence base doesn’t exist.

Only at the very end of his presentation, in response to a specific question, did Samuels make comments that appeared to be favorable toward some of the things one community, Los Angeles, tried to do to curb entries using its waiver.

What accounts for this?  Probably the tyranny of personal experience.

Samuels was institutionalized – living in the same institution for 11 years.  Unlike most, he was able to cope with it.  And in a system in which only one in five alumni does well, he became one of the one in five. 

But that, apparently, has left him incapable of facing up to what the system does to the other four in five; and, in particular incapable of getting beyond a notion that boils down to:  If we just make the foster homes and the group homes and the institutions “better” the other four in five will do just as well as I did.

The evidence base says otherwise.  And someone needs to make sure Bryan Samuels faces up to that, before a whole lot of money – and children’s lives – are wasted on waivers designed to “fix” foster care.  Because the evidence base is overwhelming: The only way to fix foster care is to have less of it.  And that is what waivers should be all about.