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Children, Families, and Foster Care

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Children, Families, and Foster Care: Analysis and Recommendations

All children do best when they live in safe,stable, and nurturing families, yet far toomany children lack this fundamental foun-dation. Every year, millions of children are

abused or neglected—close to 300,000 so egregiouslythat they are removed from their homes by the stateand placed in foster care. For too many of these chil-dren, foster care is no safe haven. Instead, the childrendrift from foster home to foster home, lingering in carewhile awaiting a permanent, “forever family.” In 1998,The Future of Children examined the problem of childmaltreatment and offered recommendations for pre-venting abuse and neglect. This journal issue focuseson the challenges of helping children after abuse andneglect has occurred by strengthening the web of sup-ports for children and families in foster care.

Public opinion polls reveal that the public is largelyuninformed about foster care, yet highly critical of thesystem. In a 2003 poll of voters by the Pew Commis-sion on Children in Foster Care, most respondentswere generally unfamiliar with the child welfare systemthat administers foster care, but more than 50%believed it needed major changes, if not a completeoverhaul.1 These impressions are no doubt fueled bymedia accounts of tragic incidents, such as the death of2-year-old Brianna Blackmond in Washington, D.C.,two weeks after a judge returned her to her mother’scustody without reviewing the child welfare agency’sreport recommending that she not be reunified;2 or the

inability of child welfare workers in Florida to find 5-year-old foster child Rilya Wilson and 500 others likeher over the past decade;3 or reports of Brian Jackson,a 19-year-old adopted foster youth in New Jersey whoweighed only 45 pounds and was found rummagingthrough a garbage can for food because he and hisbrothers were apparently being starved by their adop-tive parents.4

Media reports of system failures are tragic, heartbreak-ing, and at times, chilling. In their wake, public calls to“do something” about foster care are made, andchanges in organizational leadership, policy, and prac-tice often follow. Yet policymaking in the aftermath oftragedy is often over reactive and piecemeal. Effectingenduring change requires a thoughtful understandingof the inherent challenges the child welfare systemfaces on a daily basis. As Judge Ernestine Gray states inher commentary in this journal issue, truly under-standing the child welfare system and pursuing mean-ingful and lasting reform require a close examination ofhow the system works “when the cameras are off andthe reporters are gone.”

This journal issue examines the current state of the fos-ter care system and finds that it is really not a cohesivesystem but a combination of many overlapping andinteracting agencies, all charged with providing servic-es, financial support, or other assistance to children andtheir families. Lack of coordination among agencies,

Volume 14, Number 16

Analysis and Recommendations

chronic underfunding, and low morale have led to asystem that exacts a toll on everyone it touches. Chil-dren may suffer, as the incidents described above sug-gest. But so do foster parents and the relatives who stepin to care for children who cannot remain with theirbirth parents; so do harried caseworkers; and so dobirth parents who would like to reunite with their chil-dren but find the path difficult. Too few of the playersin the system have adequate training for their responsi-bilities and, as a result, children and families frequentlydo not receive the services and supports they need.Instead, the child welfare system labors in an atmos-phere of distrust, impending failure, and reflexive, uni-form solutions that rarely succeed for anyone. Recentreforms have shifted some of the priorities within thesystem, but much more needs to be done. This articlediscusses the major challenges faced by the child wel-fare system and offers policy and practice recommen-dations that can improve how children and familiesexperience foster care.

The Current State of Foster CareFoster care is intended to serve as a temporary havenfor abused or neglected children who cannot safelyremain with their families. However for some children,the journey through foster care is characterized by fur-ther trauma and abuse; and even in the best situations,foster care is inherently fraught with uncertainty, insta-bility, and impermanence. The number of children andfamilies who require foster care services has grown sub-stantially over the past two decades, and these familiesare typically contending with a multitude of complexand interrelated life challenges such as mental illness,unemployment, substance abuse, and domestic vio-lence. Child welfare agencies face chronic organiza-tional challenges that undermine their ability toprovide appropriate case management, services, andsupports to the children and families in their care.Reports of children being injured while in care thrustthe system into crisis and reaction, yet reforms inresponse to tragedy have generally failed to result inmeaningful change.

A Child’s Journey Through Foster CareChildren enter foster care for a number of reasons.For some children, the journey begins at birth, whenit is clear that a mother cannot care for her newborn

infant. Other children come to the attention of childwelfare when a teacher, a social worker, a policeofficer, or a neighbor reports suspected child mal-treatment to child protective services. Some of thesechildren may have experienced physical or sexualabuse at the hands of a loved and trusted adult. Moreoften, parents battling poverty, substance addiction,or mental illness woefully neglect their children’sneeds.5

In 2001, approximately 3 million referrals were madeto child protective services, and more than 900,000children were found to be victims of maltreatment.6

When child maltreatment is substantiated, caseworkersand courts must decide whether the child can safelyremain home if the family is provided with in-homeservices, or whether the child should be placed intostate care. In 2001, 290,000 children entered the fos-ter care system.

The term foster care commonly refers to all out-of-home placements for children who cannot remain withtheir birth parents. Children may be placed with non-relative foster families, with relatives, in a therapeutic ortreatment foster care home,7 or in some form of con-gregate care, such as an institution or a group home.Nearly half of all children in foster care live with non-relative foster families, and about one-quarter residewith relatives. More than 800,000 children spent sometime in the foster care system in 2001, with approxi-mately 540,000 children in foster care at any onetime.8

After children are removed from their homes andplaced in foster care, caseworkers develop a permanen-cy plan based on an assessment of the child’s individualneeds and family circumstances. The plan is thenreviewed by the court. For most children, the primarypermanency plan is reunification with their birth par-ents. According to federal law, states must make “rea-sonable efforts” to provide birth parents with theservices and supports they need to regain custody oftheir children. However, there are exceptions to thisrequirement. States are not required to pursuereunification under certain conditions.9 In these cir-cumstances, alternative permanency options such asadoption or legal guardianship are the goal for thesechildren.


7The Future of Children

Under current law, if children are in foster care for 15out of the previous 22 months, states are to recom-mend that parental rights be terminated and the childbe made available for adoption. In 2001, there were126,000 children who were no longer legally connect-ed to their parents awaiting adoption.10 However, thechild welfare agency can waive the termination require-ment if birth parents are making progress in their caseplans and workers believe they can reunify with theirchildren soon, or if workers believe that another place-ment that does not require termination of parentalrights, such as legal guardianship, is in the child’s bestinterests.

The average length of stay for children in foster care isapproximately 33 months, but some children stay amuch shorter time and some much longer. Accordingto 2001 data from the Adoption and Foster CareAnalysis and Reporting System (AFCARS), approxi-mately 38% of children who exited foster care in 2001had spent 11 months or less in the system. At the otherend of the spectrum, approximately 32% of childrenhad been in care for 3 years or longer. The longer achild remains in care, the greater the likelihood that heor she will experience multiple placements. On aver-age, approximately 85% of children who are in fostercare for less than 1 year experience 2 or fewer place-ments, but placement instability increases with eachyear a child spends in the system.11

More than half (57%) of the children in foster care exitthrough reunification with their birth parents,although in recent years, reunification rates havedeclined.12 Children who entered the system in 1997had a 13% slower rate to reunification than those whoentered in 1990.13 During this same period, the num-ber of children who were adopted from foster careincreased substantially. As reported in the article byTesta in this journal issue, most states have more thandoubled the number of adoptions from foster care overthe last seven years and some states reported triplingthe number. Additionally, many states have increasedthe number of children achieving permanence by offer-ing caregivers the option of becoming legal guardians.

The Child Welfare SystemWhen entering foster care, or the “child welfare sys-tem,” a child does not enter a single system, but rather

multiple systems that intersect and interact to create asafety net for children who cannot remain with theirbirth parents. State and local child welfare agencies,courts, private service providers, and public agenciesthat administer other government programs (such aspublic assistance or welfare, mental health counseling,substance abuse treatment), and Medicaid all play crit-ical roles in providing supports and services to childrenand families involved with foster care. Indeed, familiesoften find themselves juggling the requirements andpaperwork of multiple systems.

Child welfare agencies are central to the system, buttheir policies and practices vary significantly from stateto state. For example, each state determines its owndefinition of maltreatment, its own laws based on fed-eral regulations, and its own level of investment inchild welfare services. The organization of child wel-fare agencies also varies significantly across states. Insome states the child welfare system is administered atthe state level, whereas in others it is administered atthe county level.

In every state, the courts also play a significant role inchild welfare cases, from the initial decision to removea child to the development of a permanency plan to thedecision to return a child home or terminate parentalrights and make the child available for adoption. It canbe challenging to ensure that courts have the capacityand case-specific knowledge to hear cases in a timelyand thoughtful manner, as many different perspectivesmust be considered in the process. Each party involvedin a foster care case—the birth parents, the child, andthe government—is represented by a different attor-ney. Each attorney is responsible for representing theinterests of his or her client, but the adversarial natureof legal advocacy can at times sharpen conflict betweenthe various parties.

Many jurisdictions rely on volunteer court appointedspecial advocates (CASAs) to ensure that children infoster care have a voice in the legal decision-makingprocess.14 CASAs are assigned to one child (or a siblinggroup) for an extended period of time and are trainedto serve as mentors and advocates. CASAs are requiredto submit written reports to the judge at each courthearing, detailing the child’s progress in foster care,and, in their role as advocates, are often asked to



address the court on behalf of the child. Currentlymore than 900 CASA programs operate in 45 states,and more than 250,000 children have been assignedCASAs.15

Private agencies, typically through contracts with pub-lic agencies, provide a significant proportion of fostercare services to children and families. The use of privateagencies to provide services such as family-based fostercare goes back to the very origins of child welfare in theUnited States.16 Some states, such as Kansas, have pri-vatized nearly all of their foster care services, whereasothers rely on a mix of public and private serviceproviders.

To assure the best outcomes for children, all of theagencies in the system must work together. Each mustrely on the others to provide the necessary informationand resources. Child welfare agencies, though ulti-mately charged with the responsibility of caring formaltreated children, cannot provide optimal care with-out the collaboration and support of other agencies.But currently no overarching mechanism for governingthe system or managing resources exists. Instead, mostagencies have established either formal or informalcooperative agreements.

The emergence and convergence of several significantsocial problems in the mid-1980s had a tumultuouseffect on the child welfare system. The crack epidemic,homelessness, the rapidly growing incarceration rate,and HIV/AIDS proved devastating for poor familiesand communities. In turn, families contending withmultiple problems were unable to appropriately carefor their children, and the number of children enteringfoster care rose. In 1980 approximately 300,000 chil-dren were in foster care; by 1998 that number hadclimbed to an unprecedented 568,000.17

Today, children and families who enter the foster caresystem continue to wrestle with these complex andinterrelated problems. Additionally, the population ofchildren in the system has shifted. Children of colorcompose the majority of children in foster care, withdisproportionate representation of African-Americanand American-Indian children. The changes in theseverity of the needs of children in the system and inthe diversity of populations that are represented, tax

the system to provide appropriate services, delivered bytrained workers, and in foster care homes that are tai-lored to children’s individual needs.

The Push for ReformCritics of the child welfare system are not hard to find,and efforts to reform the system are numerous. Class-action lawsuits against child welfare agencies are a fre-quently used tool to push agencies to change. In 2000,more than 100 lawsuits were pending in 32 statesagainst some element of the child welfare system.18 Atleast 10 child welfare departments are currently oper-ating under directives of the court or consent decreesas a result of legal action. A number of states have com-missioned investigative panels to examine the childwelfare system and recommend reforms.19

Given the high level of scrutiny and intense pressure, itis not uncommon for child welfare administrators toserve short terms in office. A study conducted by theUrban Institute in 1999 found that in nearly half of the13 states they reviewed, a leadership change in the statechild welfare agency had occurred within the last 3years.20 At the same time, many agencies have alsointroduced innovative programs, such as community-based foster care, foster parent to birth parent mentor-ing, and shared family care, in an effort to addressshortcomings.21

Over the past decade, new federal policies have provid-ed a strong impetus for reform. These policies have ledto significant changes in child welfare practice and inthe methods and measures used to evaluate states’ per-formance. Two of the most influential and far-reachingpolicies are the Adoption and Safe Families Act (ASFA)of 1997 and the Child and Family Services Reviews(CFSRs).

ASFA. This law introduced sweeping changes in childwelfare, as detailed in the article by Allen and Bissell inthis journal issue. The most significant changes attrib-utable to ASFA include:

◗ Shortening timelines for making decisions aboutpermanency;

◗ Eliminating long-term foster care as a permanentoption;



◗ Clarifying when states do not have to make reason-able efforts to reunify children with their birthparents;

◗ Requiring action to terminate parental rights in cer-tain situations;

◗ Recognizing kinship caregivers as a legitimate place-ment option;

◗ Providing states with incentives to encourage adop-tion;

◗ Placing increased emphasis on accountability.

CFSRs. These reviews, mandated by Congress in1994, are the first attempt to evaluate how well statechild welfare agencies are meeting established nationalstandards. States are assessed on a broad range of sys-temic, family, and child outcome measures to deter-mine how well they are meeting the goals ofpromoting safety, permanency, and well-being for chil-dren in foster care. States that do not meet federal stan-dards are required to submit performanceimprovement plans to the government mapping outhow they plan to address their deficiencies. States thenhave two years to demonstrate that they are makingprogress toward meeting national performance stan-dards. At the end of the two-year period, states mayincur financial penalties if they do not demonstrateimprovement. Of the 32 states that have completed thereview process, none has yet met all federal perform-ance measures. The remaining reviews will be complet-ed in 2004, and it is expected that no state will meet allthe national standards.

Early reports suggest that the child welfare system isresponding to the directives of ASFA and the CFSRs.For example, ASFA provisions that shortened theamount of time children can spend in foster care beforetheir birth parents’ parental rights are terminated haveencouraged child welfare agencies to plan concurrent-ly for both family reunification and an alternative per-manency option such as adoption. ASFA provisionsthat recognize kinship care as a legitimate placementoption have contributed to a growing reliance on rela-tive caregivers. Whether or not these changes willresult in better outcomes for children remains to beseen. Several states, such as California, enacted initia-

tives similar to those in ASFA years before the passageof the federal law, yet they have seen little substantivechange in how children and families experience the fos-ter care system. ASFA and the CFSRs hold promise forinitiating positive change; however active steps must betaken to translate policy into practice.

In sum, the child welfare system faces daunting chal-lenges in the 21st century. Not a single system at all,but a network of multiple intersecting and overlappingagencies, the overtaxed child welfare system has had totake on more children who are suffering more complexproblems than ever before—all under the white-hotspotlight of media scrutiny. The crisis orientation thatpervades the child welfare system can be discouragingto many hard-working professionals in the field, andthis is reflected in high turnover rates among child wel-fare leaders and caseworkers. However, crisis can alsobe a window of opportunity for change. The challengebefore the child welfare system is how best to capital-ize on the momentum initiated by crisis, mobilizeagents for change, and steer the system toward reformsthat will truly improve the lives of children who comeinto foster care.

Addressing the Needs of Children in Foster CareWithout question, preventing abuse, neglect, andentry into the foster care system is the best way to pro-mote healthy child development. It is also true that fos-ter care is a necessary lifeline that undoubtedly savesthousands of maltreated children each year. Neverthe-less, placing children into state custody is an extremelyinvasive governmental intervention into family life and,as such, the government bears a special responsibilityfor children placed in state care. When the stateassumes custody of a child, in effect the government isstating that it can do a better job of protecting and pro-viding for this child than his or her birth parents can.When children are placed in foster care only to sufferadditional harm, it undermines the rationale for gov-ernment intervention and is an egregious violation ofthe public trust. For this reason, as Badeau writes inthis journal issue, the first principle of the child welfaresystem should be to do no harm. The lives of childrenand families should be enhanced, not diminished, bythe foster care experience.



This point is particularly significant given the vulnera-ble status and differing developmental needs of chil-dren who come into foster care. To uphold thegovernment’s responsibility to children in foster care,addressing children’s needs must begin at entry withinitial health screening and continue with regularassessments throughout a child’s time in care. Caseplans must be designed with a child’s individual needsin mind so that services and supports are age-appropri-ate. In addition, child welfare agencies must incorpo-rate cultural sensitivity into all aspects of practice tobetter serve the growing number of children of colorin foster care.

Assessing Developmental and Health Care NeedsMost children who enter foster care have already beenexposed to conditions that undermine their chances forhealthy development. Most have grown up in povertyand have been maltreated—conditions associated withdelayed development and, in the case of maltreatment,problems with behavior regulation, emotional disor-ders, and even compromised brain development.22

Once in foster care, the foster care experience itself caneither exacerbate or ameliorate a child’s problems

Children in foster care are more likely to have behav-ioral and emotional problems compared to childrenwho live in “high-risk”23 parent care, and are at muchhigher risk of poor educational outcomes. One studyfound that a substantial number of children in the childwelfare system had low levels of school engagementand were less likely to be involved in extracurricularactivities.24

Children in foster care also have more physical andmental health problems than children growing up inother settings. Although children in foster care are morelikely to have access to health insurance and receiveneeded health care compared to children in high-riskparent care, they often receive spotty or inconsistentcare and suffer from a lack of continuity in healthcare.25 For example, a report by the U.S. GeneralAccounting Office (GAO) found that 12% of childrenin care had not received routine health care, 34% hadnot received any immunizations, only 10% receivedservices to address developmental delays, and eventhough three-quarters of the children were at high riskof exposure to HIV, fewer than 10% had been tested.26

Placement instability is one factor that negativelyimpacts continuity of care for children in foster care, asit is often difficult to track what services children havereceived when they move from placement to place-ment. Limited coordination and information sharingbetween the multiple service agencies that serve chil-dren in care also contributes to the problem.

In 2000 and 2002, the American Academy of Pedi-atrics issued guidelines on meeting the developmentaland heath care needs of children in foster care. Theguidelines recommend the following:

◗ Children should receive a health evaluation shortlyafter, if not before, entering foster care to identifyany immediate medical needs;

◗ Children should receive a thorough pediatric assess-ment within 30 days of entry;

◗ Children should be assigned a consistent source ofmedical care (referred to as a “permanent medicalhome”) to ensure continuity of care;

◗ Children should receive ongoing developmental,educational, and emotional assessments.

Child welfare agencies should adopt these guidelines asa starting point for ensuring that children in foster carereceive the health and educational supports they need.

RECOMMENDATION: Health Assessments

Child welfare agencies should ensure that all children in foster care

receive health screenings at entry, receive comprehensive pediatric

assessments within 30 days of placement, are assigned to a permanent

“medical home,” and receive ongoing assessments and related treat-

ment.

Monitoring Developmental ProgressFor more than 20 years, child welfare scholars havecalled for monitoring the developmental progress andeducational performance of children in foster care.27

The U.S. Children’s Bureau has consistently empha-



sized that safety, permanence, and child well-being arethe primary goals of the child welfare system. Yet, asJones Harden discusses in her article in this journalissue, historically the system has focused on child pro-tection, placement, and permanence, and has not fullyaddressed child functioning and healthy development,even though research demonstrates that these goals areclosely intertwined.

The failure to focus on healthy development is due, inpart, to the lack of well-being indicators for children infoster care. For example, CFSR reviewers are instruct-ed to evaluate any available data on the well-being ofchildren in foster care, but in most states, this informa-tion is contained in narrative form within individualcase files. Few states have incorporated evaluativemeasures into administrative databases. The absence ofstandard indicators may also reflect the inherentdifficulty of measuring child well-being and the reluc-tance of child welfare agencies to have their perform-ance evaluated based on indicators that are affected byfactors outside their control, such as the quality ofschools and health care services.

Without standardized data, there is no base for thedevelopment of national standards to monitor childwell-being. More could be done to support greaterstandardization to better monitor the healthy develop-ment of children while they are in state care.28 Forexample, with the CFSRs, the federal government hastaken an initial step toward assessing how well statesare promoting child well-being, but further steps areneeded to ensure that child well-being indicators areincorporated into state database systems. For the past10 years, the federal government has made matchingfunds available to states for the development ofStatewide Automated Child Welfare Information Sys-tem (SACWIS).29 Currently, 47 states are in theprocess of implementing SACWIS.30 Now is an oppor-tune time to ensure that child well-being measures areincorporated into these systems.

In addition, the Department of Health and HumanServices (DHHS) should examine ways of providingbetter guidance and technical assistance to states toensure the quality, accuracy, and completeness of dataon child well-being. Some states have found thatDHHS assistance in developing SACWIS has focused

too narrowly on the quantitative measures currentlyincluded in the CFSRs. DHHS should encourage andsupport state efforts to incorporate child well-beingindicators into their statewide systems. DHHS couldlook to various local programs as potential models forassessing child functioning, school performance, healthstatus, and access to needed services. In San Diego,California, for example, a computerized health andeducation passport system allows agencies to monitorthe well-being of children in foster care and determinewhether they are receiving needed health, education,and counseling services.31

RECOMMENDATION: Measures of Well-Being

States should quantitatively measure how well the health and educa-

tional needs of children in foster care are being met and include these

measures in their administrative data systems.

Providing Age-Appropriate CareChildren’s developmental needs change significantly asthey progress through childhood. Appropriate serviceplans for preschoolers are inappropriate for teenagers.Yet far too often, foster care services are not sensitive tochildren’s differing developmental needs. Very youngchildren and adolescents, in particular, face uniquechallenges and may require concerted attention toensure that their developmental needs are met. Provid-ing families with the necessary training and tools tomeet a child’s developmental needs, ensuring greateraccess to existing programs, and devising more creativeways of utilizing existing funding streams can result inbetter-tailored services and better outcomes for thesetwo groups.

Infants and ToddlersThe foundation for healthy child development beginsat birth, yet for some children, these early years aremarred by maltreatment. Infants and toddlers are atmuch higher risk than older children for abuse andneglect and for entry into foster care. In 2001, nearlyone-third of maltreated children were under the age of3 and 40% of all child fatalities due to child abuse wereinfants under age 1.32 Over the past 10 years, the num-



ber of infants and toddlers coming into foster care hasincreased by 110%.33 Approximately 1 in 5 of the childrenentering foster care for the first time are infants underage 1.34 In urban areas, 1 in 20 infants younger than 3months old enters foster care. Moreover, the very young-est children in foster care stay in care the longest time.35

These statistics are particularly worrisome given thedevelopmental vulnerabilities of infants and toddlers.The fragility of children in foster care in the zero-to-three age group has been demonstrated in numerousstudies.36 More than 40% of infants who enter fostercare are born premature or low birth weight, and morethan half of these babies experience developmentaldelays.37 Children who experience abuse and neglectduring this stage of development are more likely toexperience abnormalities in brain development thatmay have long-term effects.38 Young maltreated chil-dren are also at greater risk of developing behavioraldisorders, which can have a significant bearing on theirsocial functioning later in life.

Special efforts must be made to ensure that these veryvulnerable children grow up in healthy and nurturingenvironments. Foster parents of infants and toddlersshould receive training on the special needs of youngchildren and be informed of the supports available tothem. A number of federal programs, if used creative-ly, could provide such training. For example, in addi-tion to being eligible for monies from ASFA,Temporary Assistance for Needy Families (TANF), andMedicaid, young children with disabilities and theircaregivers are entitled to receive such services as parenttraining, home visits, and respite care through theEarly Intervention Program for Infants and Toddlerswith Disabilities (Part C of the Individuals with Dis-abilities Education Act). These monies and servicescould be used to provide families caring for infants andtoddlers with training on the vulnerabilities of veryyoung children in foster care and on developmentallyappropriate parenting of infants and toddlers.

Research on early-childhood programs demonstratesthat they greatly improve educational, behavioral, andhealth outcomes for disadvantaged children.39 Morepromising, a recent study suggests that participation incertain types of early-childhood education programscan be especially beneficial for children at risk for abuse

or neglect. A longitudinal study of the Chicago SchoolDistrict’s Child-Parent Centers found that children inthe program had a 52% lower rate of maltreatmentcompared to children who had participated in otherearly-education programs in the Chicago area.40 Chil-dren from high-poverty neighborhoods who attendedthe program experienced even greater reductions inchild abuse and neglect than children in lower-povertyneighborhoods.41 However, the Chicago program issomewhat unique among preschool programs. It isbased on heavy parental involvement, relies on pre-school providers with college degrees, and its partici-pating families may not be representative of typicallow-income families. Thus, the positive effects of thisprogram may not be generalizable.42 However, thesefindings do suggest that certain childhood educationprograms may help prevent maltreatment and improvedevelopmental outcomes for children at risk.

Older ChildrenAdolescence is a critical stage in child development.During these years, children begin to discover whothey are, their place in the larger society, and theirown empowerment. Special efforts are needed toencourage and promote the healthy development ofthis age group. Children between the ages of 11 and18 constitute almost half (47%) of the foster carepopulation. Approximately 17% are over age 16.43

These children need help in establishing healthy con-nections with other youth and caring adults, and inacquiring educational and life-skills training that canassist them in the transition to adulthood.

Older children in foster care face unique challenges.Children who enter foster care after age 12 aresignificantly less likely to exit to a permanent homethan are all other children in foster care, includingchildren with diagnosed special needs,44 and they aremuch more likely to simply age out of the system (toleave the system when they reach adulthood). Olderchildren are less likely to live in a foster family andmore likely to live in congregate care such as a grouphome.45 However, the group home experience can bedifficult for older youth. Like their younger counter-parts, older youth crave the stability and nurturance afamily environment can provide. They may perceiveplacement in a group home as a form of punish-ment.46



Many foster youth demonstrate remarkable resilienceand transition out of the system to become healthy andproductive adults. However, studies of youth who haveleft foster care indicate that they are more likely tobecome teen parents, engage in substance abuse, havelower levels of educational attainment, experiencehomelessness, and be involved with the criminal justicesystem compared to youth in the general population.47

Research suggests, however, that a number of steps canbe taken to improve the experience of older childrenwhile they are in the foster care system and improvetheir outcomes as adults.48 First, it is important todevelop individualized permanency plans that address ayouth’s unique needs. Children who enter care later inchildhood face a different set of challenges than thosewho enter at a younger age, and case plans shouldacknowledge these differences. Second, it is importantto include youth in the decision making regarding theircase. Giving youth a voice in their care helps them todevelop a sense of their future and can be empowering,as Massinga and Pecora note in their article in this jour-nal issue. Third, it is important to explore a broad arrayof permanency options and possibilities for connected-ness to improve the foster care experience of olderyouth. The need for a family does not end when a childenters the teen years. However, caseworkers need tothink creatively to connect older youth to supportivefamily ties. For example, older youth often have alonger history with and clearer memory of their birthfamilies. For that reason, relatives, siblings, and evenclose family friends can play an important role in creat-ing a healthy social network for these teens. Other pos-itive adult mentors can also be vital sources of socialsupport for older children.

As Pérez discusses in his commentary in this journalissue, few youth are prepared for full independence atage 18, and most continue to rely on family supportswell into their twenties. Because older youth in fostercare are less likely to have such family supports, it isimportant to provide them with independent-living-skills and life-skills training to help them in their tran-sition to adulthood.

In the Foster Care Independence Act of 1999, Con-gress appropriated $140 million per year to supporttransitional services and extended eligibility for transi-

tion assistance to former foster children to age 21.49 Todate, states are not fully accessing these funds or usingthem as effectively or creatively as they could.50 Innov-ative programs provide a creative means of assistingyouth in the transition to adulthood. Examples of suchprograms include money management training andIndividual Development and Education Accounts,which provide youth with incentive pay for accom-plishments and teach them how to manage theirmoney. Additionally, as discussed in the article byMassinga and Pecora, with the creative use of availablefederal funding streams, former foster youth may beable to cover most of the costs of attending a publicuniversity.

In sum, both very young and older children in fostercare face unique challenges. The early years of child-hood are a particularly vulnerable period developmen-tally, yet infants and toddlers are frequently victims ofmaltreatment, and their numbers in foster care havemore than doubled in the last decade. Older childrenin foster care have their own specific developmentalneeds that must be met while in care, and they oftenface the additional challenge of aging out of the systemwithout connections to a permanent family. However,more can be done to leverage existing resources tomeet the needs of these children.

RECOMMENDATION: Specialized Services

States should use existing programs to provide specialized services for

children of different ages in foster care, such as providing very young

children with greater access to early-childhood preschool programs,

and providing older children with educational and transitional supports

until age 21.

Providing Culturally Competent Care for Children of ColorSince the 1960s, children of color51 have been dispro-portionately represented in the child welfare system.Dramatic demographic shifts over the last two decadeshave also resulted in a greater number of children fromdiverse backgrounds entering the child welfare system.The long standing problem of racial disproportionality



and the growing diversity of children in foster carerequire that the child welfare system make concertedefforts to ensure that all children are treated fairly andreceive culturally competent care.

Children of color represent 33% of the children underage 18 in the United States, but 55% of the children infoster care.52 Although African-American and Ameri-can-Indian children are overrepresented, Latino andAsian or Pacific Islander children are underrepresentedin foster care based on their numbers in the generalpopulation. Nationally, African-American children arerepresented in foster care at nearly three times theirnumbers in the population, and in some states thisratio can be as high as five times the population rate.53

American-Indian children are represented in foster careat nearly double their rate in the general population.According to the official data, Latino children areslightly underrepresented in child welfare based ontheir numbers in the population, but the number ofLatino children in foster care has nearly doubled overthe last decade.54 The disproportionate representationof some groups of children of color in foster care is par-ticularly disturbing given that research demonstratesthat families of color are not more likely to abuse orneglect their children than white families of similarsocioeconomic circumstances.55

It appears that poverty and poverty-related factors, highrates of single parenthood, structural inequities, andracial discrimination contribute to the disproportionaterepresentation of children of color in foster care.African-American, Latino, and American-Indian chil-dren are much more likely to live in poor families, andpoverty contributes to disproportionality both directlyand indirectly. Although most poor families do notabuse their children, poor children are more likely toenter the foster care system, in part because poverty isassociated with a number of life challenges, such as eco-nomic instability and high-stress living environments,which increase the likelihood of involvement with thechild welfare system. Poor families are also more likelyto have contact with individuals who are mandated bylaw to report child maltreatment, so questionable par-enting practices are more likely to be discovered.56

Family structure may also contribute to disproportion-ality. Some evidence suggests that children of color are

more likely to come from single-parent households andhouseholds where a parent or child is disabled—typesof households that are also disproportionately repre-sented in the child welfare system.57

Finally, the legacy of racial discrimination and its lin-gering manifestation in the form of institutional andsocial bias cannot be discounted; as such bias can leadto differential treatment. For example, one study foundthat although the prevalence of positive prenatal drugtests occurred at roughly the same rate for white andAfrican-American women (15.4% versus 14.1%),African-American women were 10 times more likely tobe reported to health authorities after delivery for sub-stance abuse during pregnancy.58

The growing diversity of the child welfare populationand the problem of racial disproportionality haveimplications for both service provision and civil rights.Children of color often receive differential treatment atcritical junctures in the child welfare system. As StukesChipungu and Bent-Goodley note in their article inthis journal issue, “Children of color receive fewerfamilial visits, fewer contacts with caseworkers, fewerwritten case plans, and fewer developmental or psycho-logical assessments, and they tend to remain in fostercare placement longer.” In addition, families of chil-dren of color have access to fewer services. For exam-ple, as Stukes Chipungu and Bent-Goodley report,even though substance-abuse rates are high amongAfrican-American families involved in foster care, com-munity-based substance-abuse treatment frequently isnot available or accessible to these families. Despite evi-dence that children of color receive differential treat-ment in the foster care system, remarkably littleresearch has examined why this is so. Additionalresearch on why children of color receive fewer servic-es and less support compared to white children is need-ed to better understand the factors that lead todifferential treatment and to eliminate barriers to pro-viding appropriate and equitable care.

Efforts must also be made to address the unique devel-opmental needs of children of color in foster care.Racial identity formation and finding one’s place in asociety that often categorizes and discriminates basedon race are critical to healthy child development. Cele-brating different cultures is a valuable practice, but cul-



tural competency encompasses a range of attitudes,perspectives, and practices that prepare children ofcolor to live within their culture of origin as well as inthe larger society.

For some children of color, language barriers may poseadditional difficulties. As Suleiman Gonzalez notes inher commentary in this journal issue, language access isboth a cultural concern and a civil rights issue. Chil-dren from families with limited English proficiency arefrequently placed with English-only families. This cancreate significant cultural confusion for the child dur-ing placement and undermine family reunificationefforts should the child lose the ability to speak andunderstand the parents’ native language. Moreover, asSuleiman Gonzalez notes, language difficulties thatresult in differential treatment for families with limitedEnglish proficiency represent a violation of their civilright to equality under the law.

To identify and provide appropriate services for chil-dren of color in foster care, child welfare agencies mustembrace cultural competency as a central element oftheir mission and ensure that their organizational polices,practices, and procedures reflect sensitivity to the diver-sity of cultures they serve and to the ways in whichindividual families express their cultural heritage. Childwelfare agencies need to take specific measures toinfuse cultural competency throughout the child welfaresystem to better address the needs of children of color.

RECOMMENDATION: Cultural Competency

Child welfare agencies should enhance their cultural competency by

recruiting bilingual and culturally proficient workers and foster families,

ensuring that workers are sensitive to cultural differences, and incorpo-

rating assessments of cultural competency skills into worker perform-

ance evaluations.

Strengthening Families’ Ability to Protectand Enhance Development

Before they enter foster care, children often have beenexposed to inappropriate, inconsistent, or, at worst,

destructive parenting, which can itself lead to long-term problems.59 But the promise of foster care,backed by research, is that loving, positive, and consis-tent caregiving can, as Jones Harden writes, “compen-sate for factors that have a deleterious impact onchildren.” To give children in foster care the greatestchance at healthy development, the system must pro-vide caregivers with the emotional and financialresources they need to play a healing role for the chil-dren in their care.

Healing Fragile Birth FamiliesChildren that come to the attention of child welfareagencies are typically from families with multiple prob-lems and minimal resources. These fragile families areoverwhelmingly poor, live in high-risk environments,and are often simultaneously grappling with suchintractable problems as substance abuse, mental illness,physical illness, violence in the home, and inadequatehousing.

Child welfare agencies often do not provide an appro-priate array of services and supports to meet the needsof these fragile families. Needed services may not beavailable or accessible, limiting the ability of birth fam-ilies to meet their case plan requirements and regaincustody of their children. For example, one studyfound that a lack of substance-abuse treatment pro-grams, affordable housing, and other services wereamong the barriers birth families must overcome to bereunified with their children.60 Overcoming these bar-riers within the shortened timelines instituted underASFA can be even more daunting.

Many child welfare agencies are building partnershipswith community-based agencies to provide more phys-ically and culturally accessible services for families. Forexample, with the support of the Annie E. Casey Foun-dation, several child welfare agencies have begunimplementing a community-based model of foster carecalled “Family to Family” that draws on communityresources so that children can be placed with familiesand receive services in their home communities.61

“Strengths-based” family interventions are anothertool that child welfare agencies can use to provide indi-vidualized supports and services to birth families. Asseveral authors in this journal issue describe, too often



child welfare workers prescribe the same services to allfamilies despite their widely disparate needs, eventhough child welfare policy allows for more individu-alized services; and, too often, family assessmentsfocus on deficits rather than strengths. As a result,birth families often experience the child welfare systemas adversarial and may be reluctant to engage with asystem they view as punitive. A strengths-based per-spective identifies a family’s positive qualities—such asemployment, an extended family support network, oraccess to child care—and works to activate thesestrengths and incorporate them into the case plan.

In addition, strengths-based practices such as familygroup conferencing actively incorporate family inputinto the decision-making process. A family group con-ference is a formal meeting in which the child’s imme-diate family, extended family, and communitymembers come together to develop a plan for care.Early evaluations suggest that family group conferenc-ing can be an effective tool for developing appropriatecase plans and achieving permanency.62 Moreover,such practices can temper the adversarial nature of thechild welfare system and provide a basis for more con-sensual decision making on the child’s behalf.

As Wulczyn notes in this journal issue, although theoverall rate of family reunification has declined inrecent years, returning children safely to their birthfamilies is an important goal of the child welfare sys-tem and remains the primary means of achieving per-manence for children in foster care. Even whenchildren are not reunified, birth families can be animportant resource for children after they age out ofthe system. Significant investments in services areneeded to help birth families overcome their problemsand to prepare them to be reunified with their chil-dren or be a resource as their children transition outof care.

RECOMMENDATION: Services for Birth FamiliesChild welfare agencies should improve services to birth families by

building partnerships with community-based organizations and inte-

grating family-focused models, such as family group conferencing and

mediation, into child welfare practice.

Supporting Nonrelated Foster Families and Kin CaregiversEach year thousands of families open their homes andtheir hearts to children who have been removed fromtheir birth families. Families often find the foster par-enting experience both rewarding and overwhelming.Caring for children in foster care is a complex endeav-or that requires families to navigate many systems andagencies. Although their needs may vary, nonrelatedfoster families and kin caregivers could both benefitfrom supportive services to help them nurture the chil-dren in their care.

Nonrelated Foster FamiliesFoster parenting is one of the most demanding jobs aperson can assume. Foster parents are expected to pro-vide a home for the children in their care; work withchild welfare agencies, schools, and other serviceproviders to ensure that children’s needs are met; andsimultaneously establish relationships and arrange visi-tation with birth parents, which may eventually resultin the children leaving their custody. The difficulties offoster parenting are compounded by the high level ofcare foster children often require, the low reimburse-ment rates most states give foster parents, and the inad-equate support foster parents receive fromcaseworkers.

Given these challenges, it is no surprise that child wel-fare agencies often experience difficulties recruitingand retaining foster families. In recent years, the num-ber of children placed in nonrelative foster homes hasdeclined significantly. Currently, less than half of chil-dren in care live with licensed nonrelative foster fami-lies.63 Although the number of children in foster caregrew by nearly 68% between 1984 and 1995, the num-ber of foster families decreased by 4%.64 Moreover,according to a 1991 national survey commissioned bythe National Commission on Family Foster Care, near-ly 60% of foster parents quit within their first year. Alack of support from child welfare agencies was the pri-mary reason given for leaving fostering.65

There are two key ways child welfare agencies can bet-ter support foster families. First, child welfare agenciescan provide foster families with quality training thatcandidly discusses the challenges of foster parentingand the resources available to them. Better training



would increase the likelihood that families would retaintheir licenses and continue to foster parent.66

Second, child welfare agencies can provide foster fami-lies with appropriate and accessible case managementservices. As discussed in the article by Stukes Chipun-gu and Bent-Goodley, even though ASFA provisionscall for foster parents to participate in court proceed-ings for the foster children in their care, evidence sug-gests that some courts and caseworkers may beresistant to including foster parents in the process.67

Focus groups conducted in California found that socialworkers, attorneys, and judges were often ambivalentabout including foster parents in decision making.Moreover, foster families regularly report that case-workers are inaccessible, nonsupportive, and at timesdisrespectful.68 To improve case management, childwelfare agencies need to view foster parents as vitalpartners and take steps to be more responsive andinclusive. Keeping the lines of communication open,helping foster families access needed services and keep-ing foster parents informed about the progress of achild’s case are concrete means of providing support.Additionally, providing foster parents with alternativecaregivers or respite care, is particularly important forreducing stress levels and preventing “burn-out.”

Kin CaregiversKinship care is one of the oldest human traditions, yetonly since the passage of federal welfare reform in 1996and ASFA in 1997 has it been formally recognized as alegitimate placement option for children in foster care.Since then, the number of children formally placedwith kin has increased, and more services and dollarshave been directed toward this group of caregivers.Available data suggest that kin caregivers are also thefastest-growing group of foster care providers, increas-ing from approximately 18% in 1986 to 31% in 1990.69

The best estimates are that approximately 500,000children who have had some involvement with thechild welfare system are currently living in kinship carearrangements.70

Kinship care has several distinct advantages for childrenin care. Usually children have established relationshipswith kin, so the trauma of being removed from theirbirth parents may be less acute than when children areplaced in nonrelative care. As kin share the same racial

and ethnic heritage of birth parents, familial and cul-tural traditions can also be preserved. Children livingwith kin also tend to experience greater placement sta-bility than children in other placements.

However, kin caregivers differ in significant ways fromnonrelative foster parents, and these differences sug-gest that kin often face more challenges as foster par-ents compared with nonrelative caregivers. Kin tend tobe older, are more likely to be single, have lower edu-cational attainment, and are more likely to be in poorhealth than nonrelative caregivers. Kin also have exist-ing relationships with the birth parents, who are oftenthe caregivers’ own children. These ties can complicateefforts to control birth parents’ access to their children.Children who live in kinship care are more likely tohave unsupervised parental visitation than are childrenin nonrelative care, which may put the children atgreater risk of being re-abused.

Despite the greater challenges and more complicatedand emotionally wrenching situations many kinshipcaregivers face, they are likely to receive less financialassistance and case management services than nonrela-tive caregivers receive. This is due in part to the incon-sistent and haphazard development of licensing andfoster care payment policies for kin caregivers. All kinwho serve as foster parents are required to be licensedby their state. To receive federal reimbursement, statesmust license kin under the same standards as nonrela-tive foster families, and kin must be caring for childrenfrom income-eligible households. However, for kinwho will not receive federal reimbursement, states havebroad discretion in determining licensing criteria andfoster care payments. As Geen notes in his article in thisjournal issue, licensing criteria and payment policiescan vary significantly across states. In some states, suchas California and Oregon, only kin caring for fosterchildren who are eligible for federal reimbursementreceive foster care payments. In other states, kin whocannot receive federal foster care monies may be eligi-ble for state payments; however, they may not receivestate assistance if they are licensed under kin-specificlicensing criteria. Moreover, it appears that caseworkersare not doing enough to inform kin about theresources available to them. In fact, research suggeststhat many kin caregivers may be unaware that they areeligible for financial assistance.71



Research also indicates that kin request fewer servic-es—and receive fewer of the services that they dorequest—compared with nonrelative foster families.Kin are often reluctant to contact child welfare agen-cies and may do so only when circumstances havereached the point of crisis. As a result, not only do theyreceive fewer services overall, but once they do requesthelp, their needs may be more intense and immediatethan those of nonrelative foster parents.72 Thus, thisvulnerable group of caregivers often do not receiveadequate resources to attend to the children in theircare.

In sum, both nonrelated foster families and kin care-givers require specialized supports to optimize thehealthy development of children in their care. Furtheraction is required to identify and respond to the uniqueservice and support needs of these vitally importantcaregivers.

RECOMMENDATION: Services for Foster Families

Child welfare agencies should develop an array of supports and servic-

es tailored to the needs of nonrelated foster families and kin caregivers,

such as foster parent training and respite care, and ensure that their

workforce is adequately trained to identify and respond to these fami-

lies’ needs.

The Importance of After-Care ServicesEach year, about 260,000 children leave foster care:57% to reunite with parents, 18% to be adopted, 10%to live with other relatives, and 3% to be cared for inlegal guardianship arrangements.73 For most children,these families prove stable and lasting. But for somechildren, their new living arrangements fail shortly afterthey exit the system, especially when they reunify withtheir birth parents. In 2000, nearly 10% of childrenreunified with their parents returned to foster carewithin a year.74 In its most recent review of child out-comes, the Department of Health and Human Servicesfound that states that had a high percentage of childrenreunified with their parents within 12 months ofremoval also had a high percentage of reentries into thefoster care system.75 Of the 21 states that met the

national standard for reunification timing, only two—Wyoming and South Carolina—also met the goal forreentries into foster care.76 Although, for methodolog-ical reasons, caution must be exercised in drawingdefinitive conclusions, these findings suggest that moreservices may be needed to support successfulreunification.

Recent research also suggests that children who arereunified with their birth parents may experience poor-er outcomes compared to children who exited to otherpermanent placements.77 Again, these findings must beconsidered with caution. Determining what factorsaffect poor outcomes for maltreated children is oftendifficult to disentangle.78 However, research does indi-cate that the reunification process, and the reasons chil-dren may not thrive when they are reunified, warrantfurther study. At a minimum, these findings suggestthat the availability, duration, and quality of servicesand supports provided to families in thepostreunification period may be inadequate.

Less is known about reentry rates for children who exitto adoption, legal guardianship, or kinship care, butthe available data suggest that reentry rates are quitelow. According to the article by Testa in this journalissue, data from one state, Illinois, indicate thatbetween 1998 and 2000, only 1.5% of children whowere adopted,79 and only about 2% of children placedwith subsidized legal guardians, reentered foster care.Although the study did not include data on the stabil-ity of kinship care placements, these placements gener-ally tend to have lower reentry rates than reunificationwhen children are reunified. Nevertheless, kin place-ments are not immune to disruption, particularly whenkin caregivers do not receive postpermanency servicesor financial assistance.80

When children are reunified with their birth parents orexit to another permanent placement, families needservices to support the permanency process. Reunifiedfamilies tend to need basic resources such as housing,employment, and income in addition to counseling,health services, and educational services.81 Adoptiveparents report that they need more information onservices available to them, assistance with educationalservices, access to after-school activities, and mentalhealth counseling.82 Much less is known about the



needs of kin families, but kinship caregivers and legalguardians probably need services similar to thoseneeded by reunified families. Regardless of the type ofplacement, individualized case management and mon-itoring after placement are essential to ensure thatfamilies receive an appropriate array of services and toreduce the number of children returning to fostercare.

RECOMMENDATION: Support to Preserve Permanency

Child welfare agencies should continue to support families following a

permanent placement to promote children’s well-being after exiting the

system, whether that happens through reunification, adoption, or legal

guardianship.

Reforming the Child Welfare System

There is no shortage of innovative child welfare pro-grams and practices, yet in the past, innovations havebeen implemented as additions to the existing systemrather than attempts to change child welfare at the sys-tems level. As one child welfare expert notes, innova-tive and promising practices and programs are often“subverted and swallowed up by a pathological sys-tem.”83 To move child welfare from a crisis-driven sys-tem to true reform and renewal, systemic change isessential. Key elements in achieving systemic changeinclude enhancing accountability mechanisms; improv-ing the federal financing structure; providing avenuesfor greater services coordination and systems integra-tion; and transforming how children and families expe-rience foster care by rethinking the roles of courts andcaseworkers.

Enhancing AccountabilityStrengthening public oversight and encouraging orga-nizational self-examination through enhancedaccountability are critical elements for effectively trans-forming the child welfare system. Two key tools forimproving accountability are external review boardsand the CFSRs.

Under the 1993 amendments to the Child Abuse Pre-vention and Treatment Act (CAPTA), states arerequired to create external review boards to evaluatefoster care policies. However, to date, no comprehen-sive evaluations of the role, function, or effectiveness offoster care review boards have been completed. Onereview of California’s public citizen review boardsquestioned whether the oversight system met federalregulations.84 Additional research on the function andeffectiveness of review boards is needed to ensure theyare fulfilling their public oversight function.

In addition, as mentioned earlier, the CFSRs are agroundbreaking step toward evaluating states’ per-formance. The ability of the reviews to initiate truereform is linked to the quality and depth of states’ per-formance-improvement plans and the investment statesare willing to make to implement comprehensivereforms.

RECOMMENDATION: Enhanced Accountability

To enhance accountability, states should strengthen public oversight by

effectively utilizing their external review boards, and ensure that ade-

quate investments are made to fully implement their performance-

improvement plans.

Improving the Federal Financing Structure for Child WelfareThe federal financing framework for the child welfaresystem is quite complex, with funding coming fromseveral different sources, each with its own require-ments and limitations. The largest pot of dedicatedfunds for the child welfare system comes from Title IV-E of the Social Security Act.85 In 2000, Title IV-E pro-vided 48% of all federal spending on child welfare.86

Under Title IV-E, the federal government reimbursesstates for a portion of the costs associated with out-of-home care, but not for costs associated with preven-tion, counseling, and drug-abuse treatment.87

Income eligibility for Title IV-E is tied to the status ofthe birth parents, and the number of income-eligiblechildren varies widely across states.88 Currently, Title



IV-E income ceilings are derived from the eligibilityrules for the Aid to Families with Dependent Children(AFDC) program in 1996 (without adjustments forinflation), even though this program no longer exists.In 1999, approximately 55% of children in foster carewere eligible for Title IV-E, but as the benchmark datefor income eligibility moves farther into the past, morechildren are at risk of losing their eligibility. Addition-ally, American-Indian tribes that provide foster careservices to tribal children are not directly eligible forTitle IV-E reimbursement.89

Finally, critics argue that the constraints of Title IV-Efunding favor placing children in out-of-home place-ment, and that this may result in too many childrenbeing placed in foster care. Although it is unlikely thatthe constraints placed on federal funding directly affectcaseworker decision making, these constraints maysquelch innovation and the incentive to investresources in alternatives to foster care, and may thusreinforce the status quo of out-of-home placement.90

After the Social Services Block Grant, which accountsfor about 17% of federal spending on child welfare, thenext largest source of funds is Temporary Assistance forNeedy Families (TANF). TANF currently accounts forabout 15% of federal foster care dollars. In fiscal year2000, states spent approximately $2.3 billion (14% ofall TANF funds) on child welfare.91 Between 1996 and2000, the amount of TANF funds used for child wel-fare purposes increased by approximately 317%.92 Thisis due in part to declining public-assistance caseloadsand in part to the flexibility of TANF funds. Withincertain guidelines, TANF funds can be used for a num-ber of services for which Title IV-E money cannot,such as in-home family services, parenting education,and family reunification services. TANF dollars are alsoan important resource for supporting kin caregivers. Insome states, kin can receive TANF grants to cover thecost of caring for children in their custody, regardlessof their own financial status. More than half of these“child-only” TANF grants are to relative caregivers.

At the same time, because TANF dollars are not dedi-cated to child welfare, their availability for child welfareservices could diminish during hard economic times,when the need for public assistance increases. Indeed,in light of the recent economic downturn, states have

begun to report declines in TANF funding for childwelfare services in 2002 and 2003.93

The diminishing amount of TANF funds available forchild welfare since 2000 underscores the need toaddress Title IV-E funding constraints. In fact, reform-ing the child welfare federal financing structure hasbeen a topic of concern for several years. To test inno-vation and encourage reform, in 1994 the federal gov-ernment approved waivers from Title IV-E fundingregulations in 10 states.94 In 1997, Congress expandedthe number of waivers to 10 per year for 5 years.Waivers are a useful way of determining whether newuses for federal monies can improve outcomes for chil-dren and families. Currently, 25 waivers have beengranted to 17 states to support such initiatives as sub-sidized guardianship, tribal access to Title IV-E money,substance-abuse treatment for caregivers, andenhanced training for child welfare workers.95 Reau-thorizing and expanding the number of waivers avail-able can continue to build a research base to inform therestructuring of federal financing schemes.

Other financing reform efforts are also under way. In2003, the Pew Foundation created a Commission onChildren in Foster Care charged with examining howto improve existing federal financing mechanisms toreduce the time to permanency.96 In addition, this year,the Bush administration has proposed legislation thatwould give states the option of receiving child welfarefunds as a block grant for a specified period of time.Block grants give states greater flexibility in how tospend federal dollars, but they cap the amount of fundsa state can receive. Other proposed reforms that mightincrease the flexibility and reach of Title IV-E moniesinclude giving states the option of delinking fromAFDC eligibility requirements, and offering Indiantribes the option of being directly eligible for Title IV-E money to ensure that federal dollars flow to all trib-al children.

Addressing the challenges of the child welfare systemrequires greater resources from dedicated fundingstreams. As Allen and Bissel note, greater investment inchildren and families in child welfare is urgently need-ed. Thus, while the heightened interest in reformingfederal financing is promising, altering federal fundingmechanisms cannot belie the fact that the child welfare



system is underfunded. That said, garnering additionalresources in the current fiscal climate is an uphill strug-gle. Finding creative ways to use available fundingstreams is perhaps the most realistic way for states toincrease the amount of federal dollars they can use toserve children in care.

RECOMMENDATION: Flexible Financing

The federal government should extend the flexibility and reach of feder-

al foster care funds by reauthorizing and expanding the number of

waivers available to the states and revising outdated eligibility require-

ments.

Coordinating Services and Integrating SystemsNavigating the complex web of agencies that make upthe child welfare system can be frustrating for birthfamilies, foster families, and social workers. Familiesinvolved in child welfare must interact with multipleservice delivery systems, each with its own paperworkrequirements, case plans, and eligibility requirements.Moreover, the lack of integration and coordinationbetween multiple systems undermines efforts to pro-vide continuity of care for children in foster care. Theneed for greater service coordination and systems inte-gration has become more critical as the number of fam-ilies in foster care contending with substance abuse ordomestic violence has grown, adding further complex-ity to the overlapping relationship between public assis-tance and child welfare programs.

Public AssistanceAs discussed above, a substantial amount of TANF dol-lars flow to the child welfare system. However, the linksbetween basic public assistance and child welfare arenot purely financial. Families dealing with poverty,poor education, inadequate access to health care, andsubstance abuse are more likely to be involved in bothpublic assistance and child welfare. More than half ofthe children who enter the child welfare system comefrom families eligible for welfare. In California, morethan one out of every four new public welfare cases hadsome child welfare involvement in the previous fiveyears.97 In Illinois, nearly 40% of children placed in fos-

ter care come from families who received welfare dur-ing the months their child was living in foster care.98

Through these “dual-system families,” the infrastruc-ture of family social supports provided by public assis-tance and child welfare are informally but inextricablylinked.99

Dual-system families often report feeling overwhelmedby the competing requirements from both systems. Forexample, work requirements may conflict with childwelfare court appearances and visitation schedules.Coordination between the two systems could help par-ents meet the requirements of both agencies. Closercollaboration also makes sense because many of theproblems dual-system families face affect both theirability to parent effectively and their ability to secureemployment.100 Collaboration between public assis-tance and child welfare programs opens up possibilitiesfor providing preventive services to families who are athigh risk of entry into the child welfare system. Finally,both child welfare and public assistance programs haveinstituted shortened timelines for meeting certainrequirements. Coordination of services would allowagencies to work together to assist families in meetingthese timelines.

In addition to making the system more navigable forfamilies, greater integration allows for greater informa-tion sharing across systems, which in turn would allowagencies to coordinate their efforts and to tailor servic-es to meet unique family needs. Systems integrationand information sharing with TANF, as well as otherpublic agencies and service providers, can lead to com-prehensive data systems that can track the service usageof children in care.101 This information could then beused to document the service usage of individual fosterchildren, improve continuity of care, and improve serv-ice planning.

Concerns about confidentiality, disclosure, and man-dated reporting are perhaps the greatest barriers to col-laboration. Such concerns should not be dismissed.The information collected about children and familiesinvolved with the child welfare system is extremely sen-sitive and, if widely shared, could be damaging. Addi-tionally, the flow of information from TANF to childwelfare agencies could result in more families beingreported to the child welfare system. To protect chil-

Volume 14, Number 1

dren and families from overly intrusive practices, infor-mation sharing across systems should not be imple-mented without clear-cut written policies detailingwhat information will be shared, with whom, andunder what conditions.

Nevertheless, many states are moving forward withcreating an infrastructure that is conducive to collabo-ration. At least 20 TANF agencies have documentedpolicies about how information will be shared acrosssystems, and 13 states have their TANF and child wel-fare agencies colocated. As a result, greater integration,coordination, and information sharing across theseagencies can facilitate more comprehensive and coordi-nated services to children and families. For example,Ohio has instituted regular meetings between publicassistance, child protection, legal staff, and other agen-cies.102 And at least one state, Oregon, is movingtoward consolidating child welfare and public assis-tance agencies.103

Substance Abuse and Domestic ViolenceThe links between substance abuse, family violence,and child maltreatment are startling. Because mostchild welfare agencies do not record this information,family problems with substance abuse and domesticviolence often are not identified.104 Nevertheless, stud-ies suggest that 40% to 80% of children in foster carecome from families with substance-abuse problems,and child maltreatment co-occurs in approximately30% to 60% of households where family violence hastaken place.105

Failing to identify and offer treatment and services tofamilies affected by substance abuse or domestic vio-lence can lead to children staying longer in foster care.For example, one study found that courts identified alack of appropriate services, specifically substance-abuse treatment, as a barrier to making prompt perma-nency decisions.106 Moreover, left unidentified anduntreated, chronic family problems such as substanceabuse and domestic violence are likely to reemergeafter a child is reunified, leading to reentry into the fos-ter care system.

Although there have been several attempts to pass fed-eral legislation addressing the links between substanceabuse, domestic violence, and child maltreatment,

none have passed.107 However, several states have beengranted waivers to test programs designed to addressthe co-occurrence of these problems. For example,Delaware’s waiver allows federal foster care funds to beused to bring substance-abuse treatment specialistsinto the child welfare agency to assure that families areprovided with appropriate substance-abuse treatmentwhen a child first enters care in the hope of reducingthe length of time children of substance abusing par-ents spend in foster care.108 The effectiveness of theseinitiatives is currently being evaluated; positive resultscould lead to more states providing integrated servicesto families.

RECOMMENDATION: Coordinating Services

State child welfare agencies should improve strategies to coordinate

service delivery to children and families, including the appropriate shar-

ing of information across programs and services.

Transforming How Children and Families Experience the SystemThe ultimate test of any effort to reform the child wel-fare system will be in how children and families experi-ence the system. A prevailing theme throughout thisjournal issue is the tendency of the child welfare systemto prescribe the same solutions for all children and fam-ilies. Children of different ages receive the same mix ofservices, despite their differing developmental needs.Birth families are given the same case plans regardlessof the specific challenges they may face. Kin caregiversare often treated in policy and practice like nonrelatedfoster parents, even though this group of caregivers isdifferent from other foster families and may requirespecialized supports. The one-size-fits-all mentality ofthe child welfare system hinders efforts to provide serv-ices that are tailored to children’s and families’ uniqueneeds.

Transforming the child welfare system from one thatemphasizes compliance, process, and procedure to onethat emphasizes flexibility and individualized treatmentfor children and families requires a reimagining ofgoals. The goals of a transformed child welfare system

22



would embrace a broader vision—a vision that recog-nizes the central role of protection, placement, andpermanency, but that also strives to improve the lifeexperiences of the children and families it touches.Making this transformation a reality starts with asignificant rethinking of the roles played by the courtsand caseworkers.

Rethinking the Role of the CourtsCourts play a central role in child welfare decision mak-ing, but most children and families regard them asforeboding and distant. Birth families often perceivethe courts as adversarial and punitive.109 Foster familiesreport feeling discounted, excluded, and unheard bythe courts.110 In focus groups with former foster youth,many reported that they did not know what to expectwhen they went to court, that they felt left out of thecourt process, and that the court did not take theiropinions seriously.111

Part of the reason the courts seem aloof and uncaringstems from the large number of child welfare cases andshortened decision-making timelines they face. Mostcourts simply lack the capacity to hear cases in a time-ly fashion, or to facilitate relationship building and con-tinuity among judges, children, families, andcaseworkers. Courts rely almost exclusively on stateand local funds for operating costs and thus havesignificant constraints on their ability to increase capac-ity. Congress recognized the need to improve courtperformance in 1993, when it made funds available tolocal jurisdictions for court improvements. As Allenand Bissell recount, these funds have been used toimprove how courts implement federal statutes andhandle foster care and adoption cases in all 50 statesand the District of Columbia.

More recently, the National Council of Juvenile andFamily Court Judges has seeded 25 model courtsthroughout the U.S. to implement comprehensivecourt improvements. Reforms instituted by thesemodel courts include ensuring clear and timely com-munication of court hearings, working with advisorygroups to address systemic issues, creating “familydrug courts” to assist birth families with substance-abuse problems and expedite reunification, and usingalternative dispute resolution mechanisms, such asmediation.

The one-judge, one-family approach is an example of amodel court initiative that holds promise for changinghow judges, caseworkers, families, and children interactin the child welfare system.112 Under this initiative, thesame judge follows a family’s case from the first decision toremove the child to the permanency decision. It is hopedthat the continuity established by following the casefrom start to finish will result in better decision making.

Rethinking the Role of CaseworkersThe success of foster care depends in many respects onthe quality of the relationship between children, fami-lies, and caseworkers. Caseworkers are the face of fos-ter care. They are involved at every level of decisionmaking, they link families with needed services, andthey can provide children with a sense of continuitythat is often lacking in their foster care experience. Yetfew caseworkers are able to play this supportive role.Most caseworkers carry large caseloads, labor undercumbersome paperwork demands, and, with minimaltraining and limited supervisory support, must makelife-altering decisions on behalf of children. As a result,children in foster care often report that they rarely seetheir social workers, and foster caregivers lament thelack of contact and support they receive.

Child welfare workers manage caseloads varying insize from 10 to more than 100 cases per worker,depending upon the type of agency. By comparison,professional child welfare organizations recommendcaseloads of between 12 and 18.113 Heavy caseloadslimit the amount of time and attention caseworkerscan give to children and families. To date, efforts todecrease caseloads have been largely unsuccessful dueto persistent staff shortages in most child welfareagencies. In 27 of the 32 CFSRs completed to date,staff deficiencies were seen as contributing to agen-cies’ inability to meet outcome measures.114

Child welfare casework is also a particularly stressfultype of social work. In a recent GAO study, a numberof caseworkers expressed concerns about the com-plexity of child welfare cases.115 Specifically, casework-ers reported that more families with drug and alcoholproblems and a growing number of children withspecial needs were entering the child welfare system.Some workers even expressed concerns for their ownsafety. One study found that more than 70% of front-


Volume 14, Number 1

line caseworkers had been victims of violence orthreatened with violence in the course of theirwork.116

The difficulties of assisting families with complexand diverse needs are exacerbated by large caseloadsand cumbersome paperwork demands. Theincreased emphasis on shortening time to perma-nency, compiling accurate data on children in care,and meeting accountability requirements have sub-stantially increased the paperwork and data-entrydemands and reduced the amount of time workerscan spend with children and families.

In addition, because child welfare is a particularly diffi-cult field, a chronic shortage of caseworkers worksagainst efforts to increase educational requirements.Fewer than 15% of child welfare agencies require case-workers to hold either a bachelor’s or master’s degree insocial work, despite evidence that caseworkers holdingthese degrees have higher job performance and lowerturnover rates.117 Moreover, caseworker salaries are oftenlow, and in some jurisdictions there is wide variation insalaries between public and private caseworkers.118 Thus,recruiting and retaining quality caseworkers is an ongo-ing challenge for most child welfare agencies.

Nevertheless, improving how children and families expe-rience foster care depends on the ability of child welfareagencies to recruit, train, and retain talented and dedi-cated caseworkers. The best-planned reform efforts can-not be implemented without a well-trained and qualifiedstaff. Further efforts to provide the right mix of recruit-ment incentives, quality training, supervisory support,and professional development opportunities arerequired to build a team of caseworkers capable of serv-ing the complex needs of children and families in fostercare.

Child welfare agencies have explored different avenuesfor increasing the number of qualified social workers onstaff, such as forming partnerships with local universitiesto provide training for current staff and to prepare socialwork students for a career in child welfare,119 and pro-viding opportunities for ongoing training and careerdevelopment. However, the federal government couldalso assist states in recruiting and retaining qualified staff.For example, the government could consider creating a

loan forgiveness program for social work students. Loanforgiveness programs are a useful means of attractingindividuals to enter critical professions that lack qualifiedstaff. Under such a program, students majoring in socialwork would be offered loans to support their academicwork. Upon graduation, students who went on toemployment in a child welfare agency for a specifiedperiod of time would have their loans forgiven. Severalsuccessful loan forgiveness programs are in operation.For example, to encourage health professionals to con-sider careers in such fields as clinical, pediatric, andhealth disparities research, the National Institute ofChild Health and Human Development loan repaymentprogram will repay loans associated with training costs,in exchange for a two-year commitment to work in theselected field of study.

The federal government could also make more fundsavailable to private agencies for staff training. ThroughTitle IV-E, the government provides matching funds forstaff training and development of up to 75% for publicworkers but only up to 50% for private workers.120 Asprivate workers make up a large portion of the child wel-fare workforce, the government should consider equal-izing the reimbursement rate to private agencies fortraining and development to aid in the recruitment andretention of these vitally important workers.

In sum, judges and caseworkers are responsible fordeciding the course of a child’s journey through childwelfare. However, large caseloads, shortened timelines,and other organizational challenges significantly limitthese professionals’ ability to build solid relationshipswith children and families that can improve decisionmaking and improve how children and families experi-ence foster care. Courts and child welfare agencies cando more to support judges and caseworkers and improvefront-line practices.

RECOMMENDATION: Transforming Frontline Practice

The courts and child welfare agencies should restructure their organi-

zations and adopt practices that support individualized planning and

build continuity into the relationships between judges, caseworkers,

children, and families in foster care.

24



ConclusionFor children and their families, the foster care experi-ence is inherently painful. In addition to the woundsinflicted by abuse and neglect, foster children must alsocontend with the emotionally wrenching experience ofbeing removed from their homes and placed in fostercare. For far too many children, foster care is not a timeof healing. Rather, despite the best intentions of thosewho work within the system, many children experiencefoster care as confusing, destabilizing, and at timesdamaging.

The work of healing children and families in foster carestarts with the child welfare system, but it does not endthere. Children in foster care are the nation’s children,and we all bear a collective responsibility to ensure theirhealthy development while in state care. We can and

should do more to return these children to wholeness,but it will require everyone who touches the lives ofchildren in foster care—friends, families, communities,caseworkers, courts, and policymakers—to claim sharedresponsibility for the quality of those lives. Reformingthe child welfare system requires all of these actors tobuild bonds and create a strong web of support forthese vulnerable children. Reform is not a destination—it is an ongoing process of organizational self-exam-ination, evaluation of practice, careful public oversight,and vigilant attention to outcomes. The route toreform is clear. It is our collective responsibility tochoose the path of renewal and ensure a more hopefuland brighter future for all children in foster care.

Sandra Bass, Ph.D.Margie K. Shields, M.P.A.

Richard E. Behrman, M.D.




1. Peter D. Hart Research Associates and Public Opinion Strategies.Results of a national survey of voter attitudes towards foster care.Washington, DC: Pew Commission on Children in Foster Care,May 7, 2003.

2. Horowitz, S. Judge didn’t see report before moving Brianna.Washington Post. January 15, 2000, at A1.

3. St. Petersburg Times. Newspaper finds children state declaredmissing. August 12, 2002, at 4B.

4. Polgreen, L., and Worth, R.F. New Jersey couple held in abuse;one son, 19, weighed 45 pounds. New York Times. October 27,2003, at A1.

5. About 60% of child maltreatment victims were found to be neg-lected by their primary caregiver. U.S. Department of Health andHuman Services, Administration on Children, Youth and Fami-lies. Child maltreatment 2001. Washington, DC: U.S. Govern-ment Printing Office, 2003. Available online at http://www.acf.hhs.gov/programs/cb/publications/cm01/outcover.htm.

6. See note 5, U.S. Department of Health and Human Services.

7. Therapeutic foster care is a family-based treatment program inwhich specially trained foster families provide care for childrenwith serious emotional and behavioral problems.

8. U.S. Department of Health and Human Services, Administrationfor Children and Families, Administration on Children, Youthand Families, Children’s Bureau. AFCARS, Report #8. Washing-ton, DC: U.S. Government Printing Office, March 2003. Avail-able online at http://www.acf.hhs.gov/programs/cb/publications/afcars/report8.htm.

9. Reasonable efforts are not required (but not prohibited) when acourt determines that a parent has committed murder, voluntarymanslaughter, or felony assault that results in serious bodilyinjury to his or her child; a parent has subjected the child toaggravated circumstances as defined in state law; or the parentalrights to a child’s sibling have been involuntarily terminated.

10. See note 8, U.S. Department of Health and Human Services.These children are sometimes referred to as “legal orphans.”

11. U.S. Department of Health and Human Services, Administrationfor Children and Families. Child welfare outcomes 2000: Annualreport to Congress. Washington, DC: U.S. Government PrintingOffice, 2003; see also the article by Wulczyn in this journal issue.

12. See note 8, U.S. Department of Health and Human Services; andthe article by Wulczyn.

13. The reasons for this decline are complex and largely unknown.One speculation is that the reduction may be a result of the com-bined effect of rules in the Adoption and Safe Families Act(ASFA) that shortened the amount of time birth parents have toreunify with their children and provided incentives to states foradoptions.

14. In some jurisdictions, court-appointed special advocates arereferred to as volunteer guardian ad litums.

15. National CASA Association. National Court Appointed SpecialAdvocate Association annual report 2002. Seattle, WA: NCASAA,2003. Available online at http://casanet.org/download/ncasa_publications/02-ncasaa-annual-report.pdf.

16. Nelson, K. The Child Welfare Response to Youth Violence andHomelessness in The Nineteenth Century. Child Welfare (Janu-

ary/February 1995):56–70; and Schene, P. Past, present, andfuture roles of child protective services. The Future of Children(Spring 1998) 8(1):23–38.


18. National Center for Youth Law. Foster care reform litigation dock-et 2000. Oakland, CA: NCYL, 2000. Available online athttp://www.youthlaw.org/fcrldocket2000.pdf.

19. Malm, K., Bess, R., Leos-Urbel, J., et al. Running to keep inplace: The continuing evolution of our nation’s child welfare system.Occasional paper no. 54. Washington, DC: Urban Institute,October 2001.

20. In New Jersey, for example, the state child welfare agency hadbeen under the leadership of three different directors in threeyears. See note 19, Malm, et al.

21. See the article by Stukes Chipungu and Bent-Goodley in thisjournal issue.

22. See the article by Jones Harden in this journal issue.

23. High-risk parent care is defined as children living with single par-ents with incomes 200% below the federal poverty level. See Kor-tenkamp, K., and Ehrle, J. Well-being of children involved with thechild welfare system: A national overview. Washington, DC: UrbanInstitute, January 2002, p. 2.

24. See note 23, Kortenkamp and Ehrle, p. 3.

25. See note 23, Kortenkamp and Ehrle, p. 3.

26. U.S. General Accounting Office. Foster care: Health needs ofmany children are unknown and unmet. HEHS-95-114.Washington, DC: GAO, May 26, 1995. Available online athttp://www.gao.gov/archive/1995/he95114.pdf.

27. See, for example, Magura, S., and Moses, B.S. Outcome measure-ment in child welfare. Child Welfare (1980) 59:595–606.

28. See note 27, Magura and Moses.

29. U.S. General Accounting Office. Most states are developingstatewide information systems, but the reliability of child welfaredata could be improved. GAO-03-809. Washington, DC: GAO,July 2003.

30. Many states have experienced significant delays due to difficultiessecuring matching funds, staffing shortages, and internal disagree-ments on design features. Importantly, 41 states reported that thelack of clear, documented guidelines from the Department ofHealth and Human Services was a major factor in the delays. Seenote 29, U.S. General Accounting Office.

31. Altshuler, S.J., and Gleeson, J.P. Completing the evaluation trian-gle for the next century: Measuring child well-being in family fos-ter care. Child Welfare (January/February 1999) 78(1):125–47.

32. See the article by Stukes Chipungu and Bent-Goodley.

33. Dicker, S., Gordon, E., and Knitzer, J. Improving the odds for thehealthy development of young children in foster care. Promoting theEmotional Well-Being of Children and Families Policy Paper No.2. New York: National Center for Children in Poverty, January2002.

34. Wulczyn, F., and Hislop, K.B. Babies in foster care. Zero to Three(April/May 2002) 22(5):14–15.

35. See note 34, Wulczyn and Hislop.

ENDNOTES



36. Perry, B.D. Childhood experience and the expressions of geneticpotential: What childhood neglect tells us about nature and nur-ture. Brain and Mind (2002) 3:79–100.

37. See note 33, Dicker, et al.

38. See the article by Jones Harden.

39. Gomby, D.S., Larner, M.B., Stevenson, C.S., et al. Long-termoutcomes of early childhood programs: Analysis and recommen-dations. The Future of Children (1995) 5(3):6–24.

40. Reynolds, A., and Robertson, D. “School-based early interven-tion and later child maltreatment in the Chicago LongitudinalStudy. Child Development (January–February 2003) 74(1):3–26.Available online at http://www.waisman.wisc.edu/cls/CD7412003.PDF. The sample for this study consisted of 1,408children who participated in the Chicago Child–Parent Centersprogram in 1985–1986. The comparison group consisted of 550children who participated in other preschool programs in theChicago area.

41. High-poverty neighborhoods are those in which 60% of the chil-dren live in low-income families. See note 40, Reynolds andRobertson.

42. The program is associated with the public school system, so mostpreschool teachers have B.A. degrees. Further, there may beselection bias in the study, as the families who choose to partici-pate may be more motivated and thus more likely to succeedthan those who did not participate.


44. See note 11, U.S. Department of Health and Human Services,pp. 13, 18.

45. Wertheimer, R. Youth who ‘age out’ of foster care: Troubledlives, troubling prospects. Publication #2002-59. Washington,DC: Child Trends, December 2002. Available online athttp://www.childtrends.org/PDF/FosterCareRB.pdf.

46. See the commentary by Pérez in this journal issue.

47. See the article by Massinga and Pecora in this journal issue.

48. See the article by Massinga and Pecora in this journal issue.

49. Foster Care Independence Act, Public Law 106-169, 113 U.S.Statutes at Large 1822 (1999), 42 U.S.C.A. § 677 note (2002).

50. See the article by Massinga and Pecora.

51. The term children of color refers to all nonwhite children.



54. Zambrana, R.E., and Capello, D. Promoting Latino child andfamily welfare: Strategies for strengthening the child welfare sys-tem. Children and Youth Services Review 25(10):755–80.


56. Roberts, D. Shattered bonds: The color of child welfare. New York:Basic Civitas Books, 2001.

57. Overall, about 41% of the children in foster care come from sin-gle-parent households, but this rate may be higher for children ofcolor. See note 23, Kortenkamp and Ehrle.

One small study in California found that nearly 80% of theAfrican American foster children in their sample lived in single-

parent households. See Harris, M.S., and Courtney, M.E. Theinteraction of race, ethnicity, and family structure with respect tothe timing of family reunification. Children and Youth ServicesReview (May–June 2003) 25(5/6):409–29.

Another study found that families of color involved with thechild welfare system were more likely than white families to beheaded by young single parents with either caregiver or child dis-abilities. See Courtney, M., Barth, R.P., Berrick, J.D., et al. Raceand child welfare services: Past research and future directions.Child Welfare (March–April 1996) 75(2):99–136.

58. Chasnoff, I.J., Landress, H.J., and Barrett, M.E. The prevalenceof illicit-drug or alcohol use during pregnancy and discrepanciesin mandatory reporting in Pinellas County, Florida. New Eng-land Journal of Medicine (April 26, 1990) 322:1202–06. The dif-ference in reporting rates may reflect differences in the type ofdrugs women abused: White women were more likely to test pos-itive for marijuana, whereas African American women were morelikely to test positive for alcohol and cocaine. However, theauthors also note that physician beliefs about the prevalence ofsubstance abuse among poor, urban minorities may lead them totest and report African American women more often than whitewomen.

59. See note 36, Perry.

60. Littell, J., and Schuerman, J. A synthesis of research on familypreservation and family reunification programs. Chicago: Westat,James Bell Associates, and the Chapin Hall Center for Childrenat the University of Chicago, May 1995.

61. A description of the Family to Family model is available online athttp://www.aecf.org/initiatives/familytofamily/.

62. National Council of Juvenile and Family Court Judges. Empow-ering families in child protection cases: An implementation evalu-ation of Hawaii’s Ohana Conferencing Program. TechnicalAssistance Bulletin (April 2003) 7(2).


64. Barbell, K., and Freundlich, M. Foster care today. Washington,DC: Casey Family Programs, 2001.

65. National Commission on Family Foster Care. A blueprint for fos-tering infants, children and youth in the 1990s. Washington, DC:Child Welfare League of America, 1991.

66. Lee, J.H., and Holland, T.P. Evaluating the effectiveness of fosterparent training. Research on Social Work Practice (1991)1:162–175.


68. See note 65, National Commission on Family Foster Care.

69. Kusserow, R. Using relatives for foster care. OEI-06-90-02390.Washington, DC: U.S. Department of Health and Human Ser-vices, Office of Inspector General, 1992.

70. Urban Institute. Children in kinship care. Washington, DC:Urban Institute, October 9, 2003. Available online athttp://www.urban.org/UploadedPDF/900661.pdf.

71. Andrews Scarcella, C., Ehrle, J., and Geen, R. Identifying andaddressing the needs of children in grandparent care. Washington,DC: Urban Institute, August 31, 2003. Available online athttp://www.urban.org/UploadedPDF/310842_B-55.pdf.

72. See note 71, Andrews Scarcella, et al.

Volume 14, Number 1

73. Additionally, 7% aged out of the system, 3% were transferred toanother system (typically the juvenile justice system), and 2% ranaway.




77. Taussig, H.N., Clyman, R.B., and Landsverk, J. Children whoreturn home from foster care: A 6-year prospective study ofbehavioral health outcomes in adolescence. Pediatrics (July2001) 108(1):E10.

78. The initial experiences with abuse and neglect are known to havea negative affect on child well-being. Evidence suggests that thefoster care experience can also be traumatic and lead to pooroutcomes. Reunifying a child with his or her birth family can bea tenuous and fragile process that can influence a child’s develop-ment. Further, children reunified with their birth parents mayreturn to high-risk neighborhoods with underperforming schoolsand other weak community institutions and supports, factors thatalso affect child outcomes.

79. Research indicates that children who are adopted when they areolder experience higher disruption rates than younger children.

80. See the article by Testa in this journal issue.

81. Festinger, T. After adoption: A study of placement stability andparents’ service needs. New York: Shirley M. Ehrenkranz Schoolof Social Work, New York University, 1996. Available online athttp://childrensrights.org/Policy/policy_resources_adoption_afteradoption.htm.

82. See note 81, Festinger; and Freundlich, M., and Wright, L. Post-permanency services. Washington, DC: Casey Family Programs,2003.

83. Schorr, A.L. The bleak prospect for public child welfare. SocialService Review (March 2000) 74(1):124–36.

84. Little Hoover Commission. Still in our hands: A review of effortsto reform foster care in California. Oakland: State of California,February, 2003.

85. Bess, R. The cost of protecting vulnerable children. Washington,DC: Urban Institute, November 2002. Available online athttp://www.urban.org/UploadedPDF/310586_FactPerspectives.pdf.

86. Other federal funding streams, such as Social Services BlockGrants (17%), Temporary Assistance for Needy Families (TANF)(15%), Medicaid (10%), and Title IV-B (5%), provided approxi-mately 47% of federal foster care dollars in that same year. Theremaining 4% comes from the Social Security SupplementalSecurity Income (SSI) program and Survivors Benefits and acompilation of other federal funding streams. (Numbers do notadd up to 100 because of rounding.) See Bess, R., Andrews, C.,Jantz, A., et al. The cost of protecting vulnerable children III:What factors affect states’ fiscal decisions? Assessing the New Fed-eralism, Occasional paper no. 61. Washington DC: Urban Insti-tute, December 18, 2002.

87. They may receive limited federal reimbursement from other fed-eral funding streams.

88. Geen, R. Improving child welfare agency performance throughfiscal reforms: An assessment of recent proposals. Paper prepared forthe Joint Center on Poverty Research Conference, Child Welfare

Services Research and Its Policy Implications. Washington, DC.March 20–23, 2003.

89. Some states have worked out voluntary payment agreementswith tribes that provide foster care services, and tribal children instate public systems may be eligible if they meet income require-ments.

90. See note 88, Geen.

91. See note 86, Bess, et al.

92. Billings, P., Moore, T.D., and McDonald, T.P. What do weknow about the relationship between public welfare and childwelfare? Children and Youth Services Review (2003)25(8):633–50.

93. See note 88, Geen.

94. Similar to waivers granted in the years before federal welfarereform, these waivers required that any changes to policy andpractice must be cost-neutral and that states evaluate the effectsof their initiatives. A description of the waiver initiative can befound at http://www.acf.hhs.gov/programs/cb/initiatives/cwwaiver.htm

95. U.S. Department of Health and Human Services, Administrationfor Children and Families, Children’s Bureau. Summary of IV-Echild welfare waiver demonstration. Washington, DC: U.S. Gov-ernment Printing Office, February 2003. Available online athttp://www.acf.hhs.gov/programs/cb/initiatives/cwwaiver/summary.htm.

96. The commission is also examining the role of the courts in childwelfare and will issue recommendations on how to improve thecourts in this capacity.

97. See note 92, Billings, et al.



100. Andrews, C., Bess, R., Jantz, A., et al. Collaboration betweenstate welfare and child welfare agencies. Washington, DC: UrbanInstitute: August 31, 2002. Available online athttp://www.urban.org/UploadedPDF/310563_A-54.pdf

101. Brown, R.A., Coates, A., and Debicki, A. Children’s servicestracking: Understanding multiple service use of at risk childrenthrough technology. Children and Youth Services Review (March2003) 25(3):225–49.


103. Sellers, J. Restructuring in Oregon. Policy and practice. Washington,DC: American Public Human Services Association, June 2002.

104. The reason for entry into foster care is often subsumed underthe catch-all category of “child neglect.”

105. See the articles by Allen and Bissell, and Stukes Chipungu andBent-Goodley in this journal issue.

106. U.S. General Accounting Office. Foster care: Recent legislationhelps states focus on finding permanent homes for children but long-standing barriers remain. GAO-02-585. Washington, DC: GAO,June 2002.

107. For example, The Child Protection and Alcohol Drug Partner-ship Act, which was introduced in the 106th, 107th, and 108thCongresses, would provide funds to state child protection andalcohol and drug treatment agencies to jointly address the needs

28



of children and families that come to the attention of the childwelfare system. The proposed legislation would allow funds to beused to increase comprehensive treatment approaches, improvesubstance abuse screening and assessment, expand aftercare, andenhance training.

108. A description of the Delaware waiver project can be found athttp://www.acf.hhs.gov/programs/cb/initiatives/cwwaiver/de1.htm.

109. See note 56, Roberts.


111. Knipe, J., and Warran, J. Foster youth share their ideas. Washing-ton, DC: Youth Work Resources, California Youth Connection,Child Welfare League of America, 1999.

112. Publication Development Committee, Victims of Child AbuseProject. Resource guidelines: Improving court practice in childabuse and neglect cases. Reno, NV: National Council of Juvenileand Family Court Judges, January 1995, pp. 18–19. Availableonline at http://www.pppncjfcj.org/pdf/Resource_guide/resguide.pdf.

113. U.S. General Accounting Office. HHS could play a greater rolein helping child welfare agencies recruit and retain staff. GAO-03-357. Washington, DC: GAO, March 2003. Available onlineat http://i-documentsolutions.net/news/GAO-03-357.pdf.

114. See note 113, U.S. General Accounting Office.




118. For example, in South Carolina the salary of public child welfarecaseworkers was nearly double that of private workers. See note113, U.S. General Accounting Office. Many child welfare socialworkers leave the field to pursue opportunities in other humanservices agencies that are less stressful and higher paying. Also,see note 19, Malm, et al.

119. Both California and Kentucky report that these partnerships havebeen beneficial in building a qualified pool of child welfare work-ers. See note 113, U.S. General Accounting Office.

120. See note 19, Malm, et al.


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