NCCPR in Youth Today on child welfare's "mouse that may roar"

It’s been hyped as “revolutionary,” a “landmark” and a law that “blows up the nation’s troubled foster care system.” But the so-called Family First Preservation Services Act is none of those things. Yes, the law allows some federal money formerly limited to foster care to be shifted into better alternatives. But the limits on what can be funded are so severe that the Congressional Budget Office  estimates that, out of the billions of federal dollars lavished on foster care, only $130 million per year will be moved into better options. ...

But while everybody was paying attention to Family First, the federal Administration for Children and Families (ACF) made a policy change that has the potential to do vastly more to help children and families. Indeed, if Family First is the lion that squeaked, this policy change is the mouse that may roar

Read the full column in Youth Today

Two new NCCPR op-ed columns: Child welfare finance and fixing foster care in Texas

The Chronicle of Social Change has begun a series of columns and stories about child welfare finance.  First up, pro and con columns concerning child welfare waivers.

Here's NCCPR's column in favor of waivers

And at TribTalk, the op-ed division of the Texas Tribune, Johana Scot and I have a column on how to fix the hellscape that is foster care in that state.

Read the TribTalk column here

Do waivers work? Compared to what?

In the middle of the last decade, the State of Florida and two counties in California got a head start on the pack in developing and implementing the modern era of child welfare waivers. These waivers allow federal funds now reserved for foster care to be used on better alternatives, including family preservation strategies.

Key measures tracked in evaluating waivers include: entries into care, number of children in foster care on a given day, re-abuse of children left in their own home and re-abuse of children after they are returned from foster care.

So, how did they fare?

§  In Florida, entries into care declined significantly, and the independent evaluation of the waiver found that child safety improved.

§  In Alameda County, Calif., there was a big drop in entries into care, and both key safety measures improved, according to the California Child Welfare Indicators Project.

§  In Los Angeles County, foster care entries barely changed; the point-in-time number actually declined more slowly than before the waiver.  One safety measure stayed the same, one got worse.

The conclusion is obvious, right? Get rid of the waivers – they’re endangering children!

Only in the upside-down, inside-out world of American child welfare would anyone think that makes sense.

What also makes no sense is how we fund child welfare now. The giant, open-ended entitlement reserved for foster care dwarfs the meager amount of federal aid available to keep families together.

This does not mean, as some on the far right say, that governments make money on foster care. But it does mean that even when safe, proven alternatives cost less in total dollars, it can cost a state or a county less to place a child in foster care. And many private agencies, paid for each day they hold a child in foster care, do indeed make their money that way, creating a perverse incentive to prolong foster care.

Waivers are a very small effort to redress this imbalance, because anything bigger is routinely defeated by lobbying from agency trade associations such as the Child Welfare League of America.

So, how do we know waivers won’t encourage a mad rush to keep children in dangerous homes? It didn’t happen in Florida. And it didn’t happen in Alameda County.

It also didn’t happen in Illinois, which didn’t wait for a waiver and moved to change incentives for private agencies on its own. In 1997, there were 50,000 children trapped in foster care in that state, proportionately more than any other.

Then, instead of simply paying per diems to private agencies, Illinois started rewarding them for permanence – adoption and reunification – and penalizing those that didn’t deliver. Today there are about 17,000 children in foster care in Illinois, and independent court-appointed monitors found that child safety improved.

What about L.A.? The results tell us only that in one of the most dysfunctional, highly politicized systems in America – with, at the time of the waiver, possibly the worst governing body in all of child welfare – it’s going to take more than a few years to get a waiver right.

The Other Incentives

The other reason the Chicken Littles are wrong about waivers is that while financial incentives are an important incentive, they’re not the only incentive. All the other incentives encourage needless removal of children as well.

Personal incentives: When a worker sees a child living in poverty, the first instinct is often to “rescue” the child on the assumption that the child is bound to be “better off” in care.

The child in that impoverished home is a reality before the worker’s eyes. The dangers of foster care, physical and emotional, are an abstraction.  The problem is compounded by the class bias and racial bias that permeate child welfare. If keeping families together really is everyone’s first priority, as everyone claims, why is it that the only form of permanence most ever celebrate is adoption?

Political incentives: Many child welfare workers like to say they’re “damned if we do and damned if we don’t.”  But it’s not true.  Caseworkers and administrators don’t get fired, suspended, demoted or even slapped on the wrist for taking away too many children. All of those things have happened to workers and agency chiefs who “allowed” a child to die on their watch.

When it comes to taking away children, you’re only damned if you don’t. Indeed, one reason the waiver changed so little in Los Angeles was because of ongoing, inaccurate media coverage in the Los Angeles Times.  Something similar is happening now in Florida.  But while entries into care now are increasing again, they have not increased at nearly the rate they did under almost identical circumstances in 1999 – when there was no waiver.

Ideally, there would be no “external” incentives pushing child welfare decision-makers in any direction. But that’s impossible. So as long as so many incentives push workers to take the child and run, a change in financial incentives is needed to push back, just a little, the other way.

The “Compared To What?” Factor

The trashing of waivers also suffers from the same double standard that crops up whenever someone tries to change the foster care status quo. A few examples:

A whole lot of studies of Intensive Family Preservation Services programs that follow the Homebuilders model find them safe and effective, while a few studies of programs that don’t follow the model do not. Critics focused only on the studies of programs that don’t follow the model.

There are 26 studies of differential response, and 25 find that it does not compromise child safety. But one finds that that it does, so critics focus on that one – and accuse everyone else of bias! (In fact, the only study I know of to look at scholarly bias in child welfare suggests the bias goes in a very different direction.)

And when one evaluation after another finds that waivers don’t compromise safety, critics focus on the one indicator from one evaluation that does.

That pernicious double standard allows things like the appalling rate of abuse in foster care itself to go unchecked.

We can’t measure how many Los Angeles children were saved from abuse in foster care itself by being sent home sooner. But given the number of studies that show abuse in one quarter to one third of foster homes (with a worse rate in institutions), it probably was a lot.

Even those studies are likely underestimates.  Read the scathing 200 page decision by a federal judge in Texas in a class-action lawsuit against that state’s system – a decision finding that abuse in foster care isn’t just common, it’s rampant – and tell me why we shouldn’t be demanding changes in the financial incentives that encourage needless placement.

The real problem with waivers is that they don’t go nearly far enough.  At a minimum, every state should be allowed to trade in its foster care entitlement funding for a flat amount of funding, adjusted for inflation, that could be used for prevention and family preservation as well as foster care.  Ideally, such a change would be mandatory.

Isn’t it time, finally, for the burden of proof to switch to those who want to keep on shoveling money into a foster care system that does so much harm to so many children?

Child welfare in Wisconsin: Lame excuses for trying to divert funds from Milwaukee

Last month on this blog, I reported that the Wisconsin Department of Children and Families (DCF) is trying to misuse a federal waiver process to siphon child welfare funds from Milwaukee to the rest of the state.

Last week, the news website Urban Milwaukee followed up and reported on DCF’s excuse.  Fredi-Ellen Bove, a DCF division administrator, first tried to claim that “any savings realized by Milwaukee [through reducing foster care] would have reverted back to the federal government.”

That’s grossly misleading.  Savings revert to the federal government under the current system, in which states are reimbursed for every eligible child they place in foster care.  But a key advantage of a waiver is that you get to keep the savings from reducing needless foster care, as long as the funds are reinvested in child welfare.

Urban Milwaukee wasn’t suckered.  The website reports that when she is pressed on the matter …

Bove concedes the state made a choice to spend the money in a different way. “We reached the conclusion we don’t need waiver dollars to meet the needs in Milwaukee.” Bove says Milwaukee has a stronger support system than other counties, with 12 months of “post-reunification” care by counselors after a child’s case is over, while other counties lack this.

But this, too, is an evasion.  For starters, it was DCF’s own stupid decision to seek only a narrow waiver focused exclusively on post-reunification services. (The Wisconsin proposal and proposals from other states are available here.)  Second, the existence of this one program has not magically wiped out all of Milwaukee’s child welfare problems.

Indeed, it strains credulity to think that Milwaukee, where children are torn from their families at a rate significantly higher than many other cities and where the child poverty rate is more than 34 percent, really needs the money less than, say, Ozaukee County, where the child poverty rate is six percent.

But if Wisconsin DCF really believes the issue is spending waiver money most efficiently, that’s all the more reason for the U.S. Department of Health and Human Services to turn down Wisconsin’s waiver proposal entirely.

Thirteen states have applied for ten waivers.  Massachusetts, for example, is proposing to spend $20 million per year on its five-year waiver initiative.  Wisconsin, in contrast, proposes to use only $7.1 million in funds for its waiver, and the total doesn’t get that high until the fifth year.

Since the law only allows ten waivers per year for three years, surely the federal government owes it to American taxpayers to use those waivers to provide the most real benefit to the greatest number of children.  So it would be a huge waste of taxpayer money to waste a waiver on Wisconsin’s current proposal.

Fortunately, the federal government can issue ten more waivers in 2013 and another ten in 2014.  Wisconsin should go back to the drawing board and return with a comprehensive proposal to serve all children who otherwise might be placed in foster care or remain trapped there.

If Wisconsin DCF needs some help, the current proposals from Arkansas, Utah and Washington State are good models.  You can read about them in NCCPR’s Report Card on all of the publicly-available waiver proposals, on our website here.

Foster care in America: NCCPR issues Report Card on child welfare waiver proposals

Today, NCCPR releases a Report Card evaluating, and grading, all nine publicly-available proposals for waivers from federal child welfare funding rules. These are the grades:

Arkansas                  B+

Colorado                    B-

Illinois                        F

Massachusetts          B

Michigan                   C-

Pennsylvania             B-

Utah                            B+

Washington State    B+

Wisconsin                 F

The full report card is available on our website here. 

Child welfare in Wisconsin: State wants to rob Milwaukee to aid other counties

HHS should reject Wisconsin’s 

child welfare waiver proposal

            There is nothing unusual about a rivalry for resources between a big city and the rest of the state.  Think New York City vs. Upstate, Chicago vs. Downstate, Philadelphia and Pittsburgh vs. rest-of-state etc.

            But I’ve rarely seen anything as blatant as what the Wisconsin Department of Children and Families proposes to do to Milwaukee.  In shocking, explicit detail, its proposal for a child welfare funding waiver describes how the state would confiscate savings made by improving Milwaukee child welfare and use that money in every Wisconsin county – except Milwaukee.

            Wisconsin is one of 13 states that have submitted formal proposals to the U.S. Department of Health and Human Services (HHS) for waivers from federal child welfare funding rules, though only eight of the proposals currently are available on the HHS website.   Under the waivers, federal money that normally can be spent only on foster care can be spent on better alternatives as well.  Since the better alternatives also cost less, reducing foster care generates savings.  Under a waiver, the state can keep the savings, as long as the money is reinvested in child welfare.

            In most states, child welfare is run directly by the state.  In about a dozen states, individual counties run child welfare.  Wisconsin is among those dozen, but it’s a curious hybrid: At least partly as a consequence of a lawsuit by the group that so arrogantly calls itself “Children’s Rights,” the state Department of Children and Families runs child welfare in Milwaukee directly, through a division known as the Bureau of Milwaukee Child Welfare (BMCW). 

            The Wisconsin proposal is a slapdash, slipshod effort. (Contrast it to, for example, the much bolder, far-reaching proposals from Arkansas, Utah and Washington State.) Wisconsin proposes to make extremely limited use of waiver funds to finance only one innovative service: help to families after they have been reunified to prevent the children from reentering foster care.  And the services they propose to provide appear to be largely “soft” services, like counseling, instead of the concrete help families need most.

Even if everything goes the way the state wants, by the end of the  waiver period, only $7.1 million per year of what now is spent on foster care would be shifted to better alternatives.  That’s less than ten percent – and it would take five years even to achieve that.

            But here’s where Wisconsin’s plan goes from merely pedantic, mediocre and unambitious to appalling: Of that $7.1 million, $1.2 million, or 17 percent, doesn’t come from the waiver at all – it comes from money that is, in effect, stolen from the vulnerable children of Milwaukee County to be redistributed to the rest of the state.

DCF is arguing that in Milwaukee County they’ve already done such a great job putting plans in place, that they’re sure they will reduce reentries even without the waiver.  Since the waiver lets them keep money saved through this reduction, DCF plans to take these savings and divert the money to Wisconsin’s other 71 counties, instead of spending it on bolstering services in Milwaukee.

Or, as the waiver proposal itself puts it, on page 13:

To the extent that [the Bureau of Milwaukee Child Welfare] BMCW experiences success in reducing its re-entry rate, the IV-E demonstration project waiver will build on the successful experience in BMCW to replicate and expand post-reunification support to the 71 non-Milwaukee counties.  Specifically, federal IV-E and state matching funds that are not utilized for [foster care] maintenance costs in Milwaukee due to lowered out-of-home care caseloads will be reallocated to non-Milwaukee counties to fund the administrative and service costs of twelve months of post-reunification support.  [Emphasis added.]

And check out pages 21 and 22, where the state seems almost gleeful as it explains in detail how Milwaukee savings will be siphoned off to the rest of the state.

As far as I know, the group that so arrogantly calls itself “Children’s Rights” (CR), has been silent about Wisconsin’s waiver proposal – I don’t know if they’ve even read it.  Will they actually stand silent as the state of Wisconsin proposes to siphon child welfare funds away from the county where they have a consent decree?  Unfortunately the answer may be yes.  These are funds to keep children out of foster care, as opposed to funds to “improve” foster care.  And, of course CR has made clear over and over that it is indifferent, at best, and hostile, at worst, to keeping kids out of the system.

CR may well remain silent even though CR has a special responsibility to speak up.  It was CR’s lawsuit that set in motion the chain of events that led to the state taking over child welfare in Milwaukee.  Were county government still responsible for child welfare it would have been a lot harder for the state to pull a stunt like this.

            Under federal law, HHS can award up to ten waivers per year for the next three years. There are 13 proposals for this first round of waivers. The Wisconsin proposal should be sent immediately to the scrap heap.  The state should be informed that the federal government will not be an accomplice to siphoning funds from one part of a state to another.

Next week NCCPR will issue a Report Card on all eight publicly-available waiver proposals.

Foster care in America: Rutledge Q. Hutson is gloating - and that’s never good news for children

Regular readers of this blog might remember Rutledge Q. Hutson.  Her formal title is Director of Child Welfare Policy at the Center for Law and Social Policy.  A better title would be Leader of the “Yes, but…” Brigade that tried to stop Congress from enacting waivers from federal child welfare financing restrictions.  Those restrictions limit a huge pot of federal child welfare aid to funding foster care and nothing else.

Hutson is an expert practitioner of a standard tactic of America’s latter-day “child savers:” never say no to a good idea, just “yes, but…” it to death.

Despite her best efforts, Congress passed a law restoring the authority of the Department of Health and Human Services to issue up to ten child welfare waivers per year for the next three years.  But what Rutledge Q. Hutson and her allies couldn’t do in Congress, they managed to do through their man on the inside, Bryan Samuels, who runs the Administration on Children Youth and Families within HHS.  As is discussed in previous posts to this blog, Samuels has issued guidelines that effectively undercut the intent of waivers – to reduce needless foster care.  Instead, the guidelines seek to turn waivers into a program to make foster care “better” by providing more “services” to improve children’s “well-being.”

So it’s no wonder that last week, Rutledge Q. Hutson couldn’t resist gloating.  She took her victory lap during a meeting of representatives of various child welfare organizations.  For starters, she admitted the obvious: That she had, in fact, been against the waivers all along.  But not anymore.  Bryan Samuels had so radically altered their true purpose that Hutson was thrilled.  In particular, she’s ecstatic over the fact that waivers won’t be evaluated based on whether they keep children safely out of foster care and prevent reabuse. Instead, for a waiver to be successful it will have to show it also improved these children’s “well-being.”

This ignores two salient facts:

● The purpose of child protective services, the agency that can come into your home and take away your child, is not, in fact, to apply subjective judgments about that child’s “well-being.” Rather, its purpose is to prevent children from being abused.

● One of the best ways to improve any child’s “well-being” is to get him out of foster care if he’s already there and keep him out if he’s never been taken away.

Like almost all child savers, Hutson means well.  After all, the very first child saver, Charles Loring Brace, who, in the 19^th Century, engineered the confiscation of thousands of poor Catholic immigrant children and shipped them off to the south and Midwest to be raised by Protestant families, also meant well.  He sincerely believed Catholic immigrant parents were genetically inferior, and his scheme was essential for their children’s “well-being.”  Both Charles Loring Brace and Rutledge Q. Hutson have devoted much of their professional lives to a vision for helping vulnerable children.  The problem isn’t the good intentions, the problem is the lousy vision.

INVASION OF THE “WELL-BEING POLICE”

Turning child welfare agencies into Well-Being Police sets up both waivers, and parents, to fail.  It actually risks increasing entries into care in states with waivers.

That’s because it compounds one of the biggest problems in the system right now: the fact that once a parent loses a child to foster care that parent actually is held to a higher standard than a parent who never had child protective services in her life in the first place.

For example, no law says that a person who is unemployed can’t have a child.  But once a child is in foster care, getting a job – not just any job, but a job that satisfies the whims of a caseworker - often is a condition for getting the child back. Similarly, no law says that parent who lacks housing deemed suitable by a caseworker can’t have a child.  But once the child has been taken away, regardless of the reason, “suitable housing” often is a condition for getting a child back.  Witness these cases from Texas and South Carolina.

Now, under the Samuels waiver guidelines, the bar for getting a child back and being allowed to keep that child is raised still higher.  Waiver success, and therefore, parental success, is to be judged not only based on whether the parent does not abuse the child, but also on the basis of whether all sorts of “well-being” indicators improve.  So if a waiver keeps children safely at home but they still do poorly at school, that’s a failure.  If a waiver keeps children safely at home but they still have the same emotional problems (plus those that may have been caused by foster care) that, too, is considered a failure of the waiver and the parent.

Obviously, that ratchets up the pressure on parents.  And it creates a back door to bring the coercive power of child protective services far deeper into a family’s life.  In short, it gives child protective services even more grounds to tear apart families and hold children in foster care.

Gwendolyn Clegg, a parental defense attorney in Oklahoma, aptly summed up the problem with this approach in a recent article in the Tulsa World:

"Social workers want to fix all the issues in the whole family. I'm not saying that's a bad thing. …[but] The law only requires you be a D-plus parent, meaning it only requires them to correct the reasons their kids came to us.”

Of course that kind of statement gives a lot of my fellow liberals (especially Rutledge Q. Hutson-type liberals) apoplexy.  After all, shouldn’t every child have A-plus parents?

Well yes.  But not by government force or fiat.

There are all sorts of ways government can and should improve children’s well-being.  Government could ensure that every American has decent health care.  Government could pour funds into low-performing inner city schools (and, by the way, stop scapegoating the people who teach there.)  Government could guarantee access to high quality day care and preschool.  Government could ensure that no American is homeless or lacks decent housing.

Every step the government takes to reduce the scourge of poverty will improve all children’s well-being and help parents do an A-plus job.  And not one of those steps involves imposing on families the extremely dangerous, coercive power of the state.

When it comes to what government should be able to do by force of law to a family, it should indeed require no more than D-plus parenting.  There are a lot of good reasons for that, not least the fact that, foster care so often produces D-minus outcomes for children.

The idea of government as Well-Being Police also plays right into the hands of those on the far right who love to stereotype all liberal ideas, and undercut all efforts of government to offer a true helping hand, by exploiting the extremism reflected in the Hutson-Samuels approach.

WATCHING THE WAIVERS

Does this mean waivers are doomed to do more harm than good?  Not necessarily.  The actual federal law creating the waivers includes none of this nonsense perverting their intent.  What Samuels has issued are guidelines.  Waiver proposals that focus on their rightful purpose, safely reducing foster care, and on measuring success by seeing if foster care is, in fact, safely reduced (as determined by things like reabuse rates and rates at which children are returned to foster care) still can be approved, particularly if there turns out not to be a lot of competition for the ten available each year.

And the public will have some voice, at least in theory.

The first round of waiver proposals are due on July 9.  At some point thereafter, ACYF will post the proposals on its website and solicit public comment.  So check back then and see if your state has submitted a waiver proposal.  Then speak out – for it if it meets the true purpose of waivers, and against it if it’s the kind of waiver that would make Rutledge Q. Hutson and her latter-day child saver allies jump for joy.

Because the final decision rests with someone who understands what a waiver is supposed to do.

ACYF is part of the Administration for Children and Families, which is run by George Sheldon.  Back when he was running the child welfare system in Florida, which implemented a classic waiver with great success, he testified at that same hearing as Rutledge Q. Hutson.  During that hearing Sheldon talked about meeting with former foster children:

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.

So the best hope, maybe the only hope, for what should have been the biggest change for the better in American child welfare in decades is that George Sheldon will show Bryan Samuels who’s boss.

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 BELITTLES HIS BOSS’ WORK

● 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.

MUSIC TO THE EARS OF THE FOSTER CARE-INDUSTRIAL COMPLEX

● 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 19^th 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.

IGNORING THE “EVIDENCE BASE”

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. 

Foster care in America: HHS guidelines undermine child welfare waivers

The best chance in decades to get serious about reducing the number of children torn from their families each year is being undermined by the agency that is supposed to make it work.

Last September, Congress restored the authority of the Department of Health and Human Services to issue “waivers” from rules that restrict a huge proportion of federal child welfare aid to funding foster care and only foster care.

Under current law, the foster care money is an open-ended entitlement.  For every “eligible” child placed in foster care – and that’s nearly half of all foster children – the federal government picks up a large share of the cost.  This creates a horrendous incentive: Though foster care costs more than better alternatives in total dollars, there are times when it might cost a state or county less to use foster care because the federal government picks up so much of the tab.

States that receive waivers get the chance to spend the money on better alternatives, as well as on foster care.  In exchange, they accept the money as a flat grant instead of the current open-ended entitlement.  The state gets the same amount of money, plus inflation, for every year of the waiver (typically five years), even if there are fewer children in care.  So as foster care is reduced, the state gets to keep the savings, as long as those savings are plowed back into child welfare.

The Congressional Research Service estimates that, had this deal been made available to every state back in 2005, and had every state accepted it, the states would have had $5 billion more to spend on child welfare by 2010 than they actually got under the current entitlement.

So the fact that Congress now is allowing ten states per year over the next three years to receive these waivers seemed like a real breakthrough.  But the devil is in the details – in this case, the guidelines issued by the Administration on Children, Youth and Families (ACYF).  The guidelines appear to have been written to undermine any effort to use waivers to prevent children from entering foster care or to speed reunification.  They will be discussed at a so-called “town hall meeting” at the ACYF offices in Washington this afternoon.

A BIGGER BAND-AID FOR A GAPING WOUND

For starters, the guidelines accept the false premise that all children in foster care have been abused or neglected.  The guidelines emphasize addressing the trauma caused by that abuse.  Nowhere do the guidelines recognize that many children in foster care have not, in fact, been abused or neglected (unless one considers poverty itself to be neglect) and it is foster care itself that often causes the trauma.

So it’s no wonder that instead of encouraging states to curb needless foster care – indeed, that’s not even listed as a goal - the guidelines give top priority to doing no more than providing a bigger Band-Aid to cover the gaping wounds opened by needless foster care placement.  The second priority is to create still more incentives to push adoption.

For page after page, the guidelines prattle on about improving “well-being outcomes.”  In other words: Try to undo some of the harm already done by bouncing children from home to home by providing more “counseling.” Or try to undo the harm done by moving foster children from school to school with mentoring programs and tutoring.

To the extent that helping families is mentioned at all, it is in a context that strongly implies providing more “counseling” for them – after their children already are in foster care.

Thus, for example, the guidelines state that

in order to achieve better outcomes for children who have experienced maltreatment it is essential to engage families, whether biological, foster or adoptive, in the process of healing and recovery. [Emphasis added.]

Note first the use of the pejorative, offensive term “biological parent,” instead of “birth parent,” which is value neutral.  The rest of the sentence makes clear the author’s view that all children in foster care have been abused and need help to heal from what the abusers did to them.

THE TROUBLE WITH BAND-AIDS

At least one study actually has tried to measure how much good this Band-Aid approach would do.  The answer?  Not much.

The study, done by Casey Family Programs in cooperation with Harvard Medical School, found that only about 20 percent of former foster children are “doing well” as young adults. (There is a complete analysis of the study and a link to the full study on our website here.)

The authors went on to design a complex mathematical formula to attempt to figure out how much they could improve these outcomes if  they could invent and use the perfect Band-Aid and every single problem besetting the foster care system magically were fixed. Their answer: 22.2 percentage points.  In other words, if tomorrow, foster care miraculously became perfect, it would churn out walking wounded only three times out of five, instead of four.  Yes, that’s worth doing – but not at the expense of better solutions.

To see why Band-Aids don’t work, one need look only at an example from the ACYF guidelines concerning an issue they propose to target: the misuse and overuse of psychiatric mediation on foster children.  This is a very serious, very real problem – but it is a problem inherent in foster care.  We know this because when children with exactly the same kinds of needs are placed in kinship foster care – that is with relatives – the percentage placed on meds is far lower.  It’s not hard to figure out why.  Grandparents are a lot more likely to love these children than total strangers – so grandparents are a lot more likely to put up with behavior that would prompt a stranger to demand a prescription to make the child more docile.

Thus, the solution to the misuse and overuse of psychiatric medication on foster children is to keep more children out of foster care and, where that’s absolutely unavoidable, do more to place them with relatives.  But the guidelines are seeking proposals not to curb foster care but only to provide that bigger Band-Aid, in this case “behavioral and psychosocial interventions [that] are considered first line or concurrent treatments for children for whom psychotropic medication is being considered or used.”

PERMANENCE SHOULD MEAN MORE THAN ADOPTION

The second priority is using waiver funds to further increase adoptions. 

Since 1997, the American child welfare system has been fanatical about equating permanence for children with adoption. The federal government even has offered states a bounty of up to $12,000 for every finalized adoption of a foster child over a baseline number – sometimes with awful results.  There is no similar incentive for reunifying families.

Instead of trying to balance the scales by asking for waiver proposals that emphasize quickly and safely reunifying families, the guidelines seek proposals that will further tilt those scales toward adoption.  Indeed, in a section discussing the need for programs to address permanence, every example deals with adoption.

Still another section deals with changing financial incentives for the foster care-industrial complex, the network of private foster care agencies, professional helpers and assorted hangers-on that lives off a steady supply of foster children.

The guidelines call for proposals that will implement “performance based payments.”  Often called performance-based contracting, this has enormous potential to reduce needless foster care.  A state with a waiver could use flexible funds to reward agencies for keeping children out of foster care or increasing the number of children reunified with their parents.  But the guidelines ignore those possibilities.  Instead, the one and only example offered is this:

A state could condition provider payments … on measurable improvements in child well-being outcomes or increased numbers of successful adoptions among the longest-waiting children in foster care.

REAL WAIVERS STILL ARE POSSIBLE – IF STATES FIGHT FOR THEM

On one level, this fundamental betrayal of the primary purpose of waivers shouldn’t be surprising.  These priorities are a perfect reflection of the priorities Bryan Samuels, the commissioner of ACYF, the agency which drafted the guidelines.  His unfortunate priorities have been noted on this Blog before.

Fortunately, Samuels’ boss knows better.  His boss is George Sheldon, commissioner of the Administration for Children and Families (ACYF is a division of ACF and both are within HHS).  As Secretary of Florida’s Department of Children and Families Sheldon and his predecessor, Bob Butterworth implemented the only statewide waiver granted the last time they were made available in 2006.  They used the waiver to cut significantly both the number of children in foster care on any given day and entries into care.  They did it by emphasizing permanence in all its forms – reducing the number of children who entered care, bolstering reunification and adoption.

Few people in child welfare seem to have a better understanding of the need to prevent needless foster care than Sheldon.  And Sheldon championed waivers both before and after taking the job at ACF.

That suggests that a state that really wants to use its waiver to actually reduce foster care through prevention and reunification probably still can do it – and should not be discouraged from trying by these guidelines.  The guidelines have lots of wiggle room.  And, frankly, it’s possible there won’t be much competition for the ten waivers available each year.

So a state with gutsy leadership and a strong commitment to prevention and family preservation still should be able to get a waiver.  But the state will have to emphasize what Bryan Samuels already should know:

● The best way to improve the “well-being” of children at risk of foster care is to make sure they are never placed in foster care.

● And the best way to improve the “well-being” of foster children is to get them the hell out of foster care.