Thursday, June 30, 2016

Family First Act institutionalizes institutions, sets up prevention to fail

Now that there finally is a bill, it is clear who has the greatest reason to oppose the so-called Family First Prevention Services Act: environmentalists.

That’s because of how many forests will be destroyed to provide the paper for all the new plans, reports and assorted other documents that the bill mandates as a substitute for real change.
In some respects, discussed below, the bill is an improvement over previous versions, and I’m sure those who worked so hard to craft this legislation meant well. But mostly, the Family First Act proposes to solve the problems of child welfare by throwing paperwork at them.
Provide a plan for this, a certification for that, and a report on something else, and America’s foster-care-industrial complex can keep doing what it’s been doing for more than a century: failing vulnerable children.
The bill also enshrines in law the double standard that pervades American child welfare: services to keep families together must meet tests that are almost impossibly high before being deemed “evidence-based.” But to keep right on using the worst form of care, group homes and institutions, no evidence is required; just more paperwork.
So it’s no wonder most of the foster-care-industrial complex favors the bill, and those who don’t want to make it even weaker.
One major supporter of the bill is the Alliance for Strong Families and Communities, a group that has little to do with either one. Rather, it is a trade association made up largely of private agencies that oversee foster homes and run group homes and institutions. These agencies typically are paid for each day they hold a child in foster care. They know a good deal when they see one.
Institutionalizing Institutionalization
In the earliest stages of developing what would become the Families First Act, there was an idea for dealing with the misuse and overuse of institutions that was simple and smart: Sen. Orrin Hatch (R-Utah) suggested simply refusing to fund such placements for any child under age 13. Other smart proposals over the years have included reducing federal aid for institutionalization month by month – the longer the placement the fewer the dollars.
But once the foster-care-industrial complex got through with it, what emerged was a muddled mess.
If the bill becomes law, the federal government would stop reimbursing states for part of the cost of group home and institutional placement after two weeks. But it creates a giant loophole: funding would continue for something called a “Qualified Residential Treatment Program.”

What does it take to become a QRTP?  Very little:

§  Write lots and lots of plans filled with appropriate buzzwords. (Drop the word “trauma-informed” into every third paragraph and you should be fine.)
§  Hire nurses during working hours and have them on call the rest of the time.
§  Get a rubber-stamp seal-of-approval from an accrediting agency. I say rubber-stamp because one of the groups a QRTP can choose is the so-called “Council on Accreditation.” COA is a creation of another agency trade association, the Child Welfare League of America. Its “site visits” are announced well in advance and “accreditors” interview people who can be hand-picked by the agency under examination. Everything else is based on the agency’s paperwork. COA doesn’t accredit agencies, it accredits file cabinets.

Perhaps that’s why, in the 1990s, COA accredited a private agency in Ohio in which, the Dayton Daily News found, children lived in squalid group homes and the agency director had a conviction for contributing to the delinquency of a minor. More recently, COA accredited this agency.

Take these simple steps and voila! That cruddy old group home is now a “Qualified Residential Treatment Program”!
Similarly, the Family First Act goes on for paragraphs about how an independent “qualified individual” will determine if a child needs to be institutionalized; unless, that is, the public child welfare agency gives its solemn word that someone associated with the institution itself can do the evaluation and still be objective. Then, the independence requirement can be “waived” by the Department of Health and Human Services.
In short, the Family First Act institutionalizes the process of institutionalization.
Perhaps that’s why the Congressional Budget Office estimates that, were it to become law, the Family First Act would barely reduce the proportion of institutionalized foster children on any given day. It would decline from the current 14 percent to 11 percent, over ten years.

Yet even these minimal requirements apparently are too onerous for some providers of institutional care and their acolytes in government.

Whatever Happened to “Evidence-Based”?

What is missing in these requirements for becoming a “Qualified Residential Treatment Program” is anything forcing the “providers” to prove that what they provide actually helps children.
There’s a reason for that, namely
§  review of the scholarly literature by the office of the U.S. Surgeon General found only “weak evidence” for the success of residential treatment.
§  second review, by the University of North Carolina, found “when community-based services are available, they provide outcomes that are equivalent, at least [to residential treatment].”
§  Still another study, of children institutionalized for mental health problems, found that seven years after discharge from residential treatment, 75 percent of the children were back in the only settings they could understand: institutions. They were in psychiatric centers or jails.
§  Even former CWLA President Shay Bilchik admitted there is a lack of “good research” showing residential treatment’s effectiveness and “we find it hard to demonstrate success…” (though he claimed this was only because foundations don’t want to fund the research and children aren’t institutionalized soon enough.)

Some of those who think even the minimal restrictions in the Family First Act go too far don’t even pretend that institutionalization is good for children. Rather, they claim there’s no alternative because they can’t recruit enough foster homes.
But, as I’ve noted before, the real problem is not too few foster parents, it’s too many foster children. For example, Los Angeles seems to be the epicenter of the whining about the congregate care restrictions. But Los Angeles takes away children at triple the rate of Chicago, even when rates of child poverty are factored in. Yet it’s Illinois where independent court-appointed monitors have found that reforms emphasizing family preservation improved child safety.

No Real Help for Prevention

That brings me to the second set of failings in the bill: the increased support for prevention is minimal and largely misdirected.
For starters, while residential treatment programs need provide no evidence at all of effectiveness to be funded, 50 percent of all new prevention spending under the bill would have to go to programs that meet a standard, created for clinical trials in medicine, so high that almost nothing qualifies. (This is an improvement from previous drafts, where it was 100 percent.)
Lisbeth Schorr, senior fellow at the Center for the Study of Social Policy, has several excellent articles on why this is an unwise approach in human services. And in child welfare, there is the additional problem of a profound bias among many of the “scholars.”

Even worse, the kinds of programs that can be funded are limited to three categories, two of which, mental health and parenting skills, are precisely the “public health approach” that has failed for more than a century. So after the reams of new paperwork required under this section are filed and it turns out that this failed approach failed again, it will become an excuse for the advocates of traumatizing children with needless foster care to run back to Congress and demand even more money to warehouse even more children in foster care. This bill doesn’t aid alternatives; it sets them up to fail.

In contrast, even though study after study finds that 30 percent of America’s foster children could be home right now if their families simply had decent housing, housing aid was eliminated from the bill early on. There is not even funding for the kinds of simple, sensible and very inexpensive approaches advocated by Joanne Samuel Goldblum in the Chroniclelast month.

So again, it’s no wonder the CBO thinks the new spending on prevention will be a drop in the bucket – an average of $130 million per year. Even with that new funding, the federal government still would spend vastly more on tearing families apart than on trying to keep them together.
What’s Good About the Bill

There is one thing the bill gets right: the third category of funds for which states could get reimbursement under the Families First Act is drug treatment. That almost certainly got into the bill, and probably has appeal to most members of Congress, because the latest “drug plague” – opioid addiction – has a whiter, more affluent face than the drug plagues that preceded it.

The other argument for the bill is that it’s better than nothing, and a floor on which one can build in the future.
But it’s not better than the waivers available to states now, which allow them to spend a lot more money on a much wider variety of alternatives to foster care. The waiver process, which is set to expire in 2019, also includes a vital incentive that Family First Act lacks: it caps the giant open-ended entitlement to foster-care funding.
This bill is more likely to be a ceiling than a floor. Once the bill becomes law, all the pressure for real reform would go away, and the ceiling will only get lower. Because from here, the bill can only get worse. Having come so far, the members of Congress behind this bill are likely to appease those who want to make the congregate-care restrictions even weaker, rather than see the whole thing fall apart.
Better Alternatives
I’ve written elsewhere about the best long-term alternative: end the foster-care entitlementand turn it into grants indexed to inflation that states can use for foster care and for better alternatives.
Short term, Congress should
§  Salvage the one part of the Family First Act everyone seems to agree on and provide $130 million per year in additional funding for drug treatment – targeted toward families at risk of losing their children to foster care.
§  Restore the federal government’s authority to grant child welfare waivers, which has expired, with current waivers scheduled to end in 2019.

As for whether we ever can really get major reform, there is one hope: the lookback. That’s the clumsy, bureaucratic detail that has the effect of reducing the number of children eligible for federal foster-care assistance by a tiny amount each year. If nothing at all is done, the federal government will be out of the foster-care funding business in about half a century or so.

The longer this persists, the greater the pressure on the foster-care-industrial complex to accept real reform, not a pale imitation like the Family First Act.