Tuesday, April 5, 2016

The IV-E “lookback” is a bureaucratic nightmare. Here’s why we should keep it.

Suppose for a moment you’re on a runaway train. It’s out of control, the speed keeps increasing and there’s a sharp bend in the tracks ahead. But the only brake on the train is a clumsy, complicated contraption that only Rube Goldberg could love.

You’d probably try to use the brake anyway.
As I’ve argued in my previous two columns about child welfare finance for this project, there are profound personal, political and financial incentives to needlessly tear apart families and consign the children to the chaos of foster care. There are brave people who push back against these incentives, and sometimes they succeed.
But there are only two real brakes on this runaway trainOne option is a waiver, allowing funds from Title IV-E, the giant open-ended entitlement program for foster care, to be spent on better alternatives as well.

Nationally, there’s something called “the look back.” Before a state can be reimbursed for much of the cost of a given placement under Title IV-E, the state has to “look back” and determine whether the birth parents from whom the child was taken would have qualified for Aid to Families with Dependent Children – based on income limits in effect when that program was abolished in 1996. Because eligibility is linked to this standard, getting rid of this approach is called “delinking.”
The look back is a clumsy, cumbersome, bureaucratic brake.
But it’s the only national brake we’ve got on a structure filled with incentives for foster care. And in recent years, it’s begun proving its value.
Just ask Sean Hughes. In one of his columns for this project, he wrote that “for the first time ever, proposals to create child welfare block grants are originating from within the advocacy community itself.”
That’s not because the foster-care industrial complex – full of private agencies living off of endless per diem payments for holding children in foster care, and their army of trade associationshigh-powered lobbyists and consultants – suddenly saw the light.

No, to the extent that anyone in mainstream child welfare is showing any flexibility on this issue, it’s thanks to the look back. Because thanks to the look back, if nothing at all changes, the federal government will be out of the funding-for-foster-care business in about half a century or so.
“I Suspect” Is Not An Evidence-Based Practice
The look back is part of the reason states lost out on $5 billion between 2005 and 2010, when Congress refused to consider letting states volunteer to take their IV-E money as a flat grant. The other reason, of course, was that states succeeded in reducing the number of children in foster care.

Hughes argues that can’t possibly continue. He writes:
I suspect that we’ve pushed foster care caseloads as low as we can without compromising child safety, especially since there is no data suggesting that maltreatment rates themselves have decreased.

“I suspect” is not an evidence-based practice, suitable for decision-making. And there are several problems with Hughes’ “suspicion.”
First, there are data showing that maltreatment rates have declined. As I noted in my previous column, the federal government’s annual “child maltreatment” reports show that rates of known child abuse peaked in 1993, they’ve declined in most years since, and never returned to that level.

And it’s known child abuse that is relevant here, since a state can’t take away an allegedly maltreated child it doesn’t know about. In addition, the federal government’s most recent National Incidence Study shows that child abuse not reported to authorities also is declining.

Iowa: Cesspool of Depravity?
Furthermore, while many factors contribute to increases and decreases in the number of children taken from their homes, actual child abuse ranks low on the list.
I know of no evidence that people in one state are vastly more prone to abusing children than people in another. Yet rates of child removal vary enormously, and that’s true even when you factor in rates of child poverty.
For example, Iowa tears apart families at a rate four times higher than Illinois. But it’s Illinois where independent, court-appointed monitors found that rebuilding the system to emphasize family preservation improved child safety.
So either Iowa is a cesspool of depravity with four times as much child abuse as Illinois, or Iowa is taking away too many children.
There are similar wide differences among counties within a state and among big cities. Phoenix takes away children at four times the rate of New York City. Does anybody seriously believe children in Phoenix are four times safer from abuse than children in New York?

Not only do rates of removal vary from place to place, they can skyrocket for reasons unrelated to actual child abuse. There is no evidence that actual child abuse in Florida shot up 50 percent between 1998 and 1999, yet 50 percent more children were torn from their homes in that time. Because that’s how child welfare systems often respond when horror story cases make headlines.
A high rate of removal almost always indicates a bad child welfare system. But a low rate of removal doesn’t necessarily indicate a good one. One has to achieve it the right way, as in Illinois and Alabama, another state where independent monitors found that a family preservation approach improved child safety. (The Bazelon Center for Mental Health Law brought the lawsuit that led to the Alabama reforms. The center's legal director is a member of NCCPR's volunteer Board of Directors.)

If every state took away children at the same rate as Alabama, instead of taking away 264,000 children in a single year, we would take fewer than 169,000. If every place in America took away children at the rate of Chicago, fewer than 79,000 children would be taken away nationwide.
So there is, in fact, plenty of room to do more, by following the lead of places that already have done it while improving child safety. But it is extremely difficult to change child welfare without changing financial incentives. And “de-linking” would move the incentives the wrong way.
If the look back simply ended, funding for the foster-care entitlement would more than double. No matter how many children a state took away, a large part of the expense would be covered for every single child. And while foster care costs more in total dollars, that kind of reimbursement can make it cheaper for a state or county than safe, proven alternatives for which the state must pick up the entire tab.
Add that to the existing personal and political incentives, and the foster care population would skyrocket.
Another option, presented as cost-neutral, is to end the look back but reduce the reimbursement rate per case. But that’s not really cost-neutral. With the one brake on removing more and more children gone, more and more children would be removed. So the cost to the federal government will go up.
Either way, de-linking equals unlimited feeding time for a foster care-industrial complex led by private agencies whose very survival depends on getting paid for taking in more children and holding them in care longer.
Right now, our largest single commitment of federal funds to our most vulnerable children comes only after we tear them from everyone they know and love. That’s not something to be proud of. That’s an obscenity.

Eliminating the look back would, at a minimum, perpetuate that obscenity.
This analysis originally appeared as part of a series in the Chronicle of Social Change series entitled: “Dollars and Priorities: The Financing of Child Welfare” where it can still be found for the moment. Since the Chroniclethe Fox News of child welfarehas taken to suddenly moving much of my work behind a paywall, I'm reprinting it here, with some changes to the links.