The Change is Not a Flash in the Pan

Tuesday, July 24, 2012Foster Family-Based Treatment Association Conference

Normer AdamsExecutive Director

Georgia Association of Homes and Services for Children

The changes occurring in foster care and group homecare are unprecedented. Fewer children are entering foster

care, even fewer are cared for in congregate care. Morefamilies are being supported by home and community

based services. This workshop will explore the decades ofpublic policy development that have lead to these changesin response to abuse and neglect. This workshop will be

invaluable to those who are considering what services willbe supported by the Federal and State governments.

The Change is Not a Flash in the Pan

• Change is mandated by:

– Federal and State Public Policy

– National Advocacy

– Evidence Based Practice

Personal Stories

• Early Medicine – George Washington died        from his cure.

In the Practice of Family Therapy – Eric Bern         Transactional Analysis        “How do you know that it works.”

Abel Ortiz - Georgia's Governors                                  Welfare Policy Director     "We will reduce foster care by 50%.  

Evidence Based Practice

– The Power of the Anecdote – DARE– Studies in Foster Care – Academy of  

      Pediatrics and Adolescent Medicine –       2008 – 50% better outcomes with       placement with kin.

– 2006 Chapin Hall Placement Stability      Study – Placement with Kin      more Stable

– 2002 - Georgia's DJJ Bootcamp       experiment

Movement to Home and Community

– Nursing Home Industry – • Most powerful of human service provider groups.• No growth in a decade• Home and Community Services

– Papua New Guinea • 3rd World of 3rd World• 16 out of 100 die in first year• Phone book description of family preservation and

       a  community based services

A Short History of Child Welfare

– English doctrine of parens patriae, which means ultimate parent or parent of the country, dominated early Colonial America policy.

– Super parent concept of the State

Hands Off Approach

– Charities did most of the benevolent work.– Development of “Orphans Homes”– Georgia had two of the Americas 1st

• New Ebenezer 1738• Bethesda for Boys in 1740

– Orphan trains to the West –          Apprenticeship and Reformation

Beginning of Foster Care • Interstate Compact on Placement of Children

• In 1887, Michigan passed the first law in the United States regulating the placement of children within the state. 1895, required out-of-state, child-placement agencies to post a bond for each child the agency brought into the state of Michigan.

• In 1899, Indiana, Illinois and Minnesota enacted similar but stricter laws which had  the effect of “prohibiting the placement of incorrigible, diseased, insane or criminal children” within their state boundaries.

• “Putting Up for Adoption”

• When the trains pulled into the stations, the caretakers would get the children cleaned up ready for inspection. The children would be put upon a stage to try to get the attention of potential parents. This became known as being "Put Up For Adoption."

Modern Era

– 1909 – Roosevelt's Whitehouse Conference on Children created the Children’s Bureau in 1912.

– to investigate and report "upon all matters pertaining to the welfare of children and child life among all classes of our people."

– 1921 - Sheppard-Towner Act also known as the Maternity and Infancy Act brought the children’s bureau to the states.

mprovements in Child Welfare

– Prior to this act, 16% children died in first year– After less that 1% child died

Social Welfare

– Government increased involvement in child welfare legistimized

• 1922 Prince vs Mass. Confirmed the State’s legitimacy in child welfare

• 1946 Aid to Dependent Children was added to the Security Act.

New Child Reporting Laws

– 1946 - Dr. Caffey Article on children’s trauma equals child abuse - Shaken Baby Syndrome

– 1962 - C. Henry Kempe, article The Battered Child Syndrome in the Journal of the American Medical Association first to identify set of indicators of child abuse

The Modern Era– 1935: Social Security Act, Aid to Dependent Children

• Tucked in the SSA was a provision authorizing the CB “to cooperate with state public welfare agencies in establishing, extending and strengthening, especially in predominately rural areas, child welfare services for the protection and care of homeless, dependent, neglected children and those in danger of becoming delinquent.”

– 1962 Amended: Provided Funding for Child Welfare

– By 1967 nearly all states had laws placing the responsibility for child protection in government's hands.

– 1973: Senator Walter Mondale wrote: “Nowhere in the Federal government could we find one official assigned full time to the prevention, identification and treatment of child abuse and neglect.” Lead to passage of the CAPTA.

Increased Federal Involvement

• Child Abuse Prevention and Treatment Act (CAPTA; Public Law 93-273; - Funding for investigation and prevention

Increased Federal Involvement

–  In 1980, Congress passed the Adoption Assistance and Child Welfare Act (Public Law 96-272; 42 U.S.C. 420). The act made federal funding for foster care dependent on certain reforms.

– IV-E became a household term

– Paid for 30% of all foster care

– mandated that a child be in an least restrictive environment (read family like and near their families.

Increased Federal Involvement

• Adoption and Safe Families Act of 1997– focus on States' capacity to create positive

outcomes for children and families

– Child and Family Services Reviews (CFSRs)

Adoption and Safe Families Act

– ensure conformity with Federal child welfare requirements;

– determine what is actually happening to children and families as they are engaged in child welfare services; and

– assist States to enhance their capacity to help children and families achieve positive outcomes.

(ASFA) of 1997 – Permanency

• Children have permanency and stability in their living situations.• The continuity of family relationships and connections is preserved for

         families.

– Safety• Children are, first and foremost, protected from abuse and neglect.• Children are safely maintained in their homes whenever possible and

         appropriate.

– Wellbeing. • Families have enhanced capacity to provide for their children's needs.• Children receive appropriate services to meet their educational needs.• Children receive adequate services to meet their physical and mental

          health needs.

ASFA Introduced Shorter Time Limits For Making Decisions About

Permanent Placements

– Permanency hearings to be held no later than 12 months after entering foster care.

– States must initiate termination of parental rights proceedings after the child has been in foster care 15 of the previous 22 months, except if not in the best interest of the child, or if the child is in the care of a relative.

ASFA Forever Families Sooner

– Required States to initiate court proceedings to free a child for adoption once that child had been waiting in foster care for at least 15 of the most recent 22 months, unless there is an exception.

– Allowed children to be freed for adoption more quickly in extreme cases.

ASFA Increased accountability

– Required States to increase documentation of child-specific efforts to move children into permanency.

– Required HHS to establish new outcome measures to monitor and improve State performance

ASFA LEAD TO the CHILD & FAMILY SERVICES REVIEW: RESULTS-ORIENTED APPROACH

• On January 25, 2000, the Federal Department of Health and Human Services issued regulations for ASFA establishing the Child and Family Services Review (CFSR).  The review covers child welfare services funded under Titles IV-B and IV-E of the Social Security Act including:

– Child Protective Services, – Foster Care, – Adoption, and – Family Preservation and Support Services.

•

Georgia received $9.4 million in IV-B and $79.4 million in IV-E in SFY 2007.

Fostering Connections Act of 2008

– Kinship guardianship assistance payments for children living in foster care with relatives (Sec. 101).

– Notice to relatives (Sec. 103). H.R. 6893 would require state agencies to exercise due diligence to identify and provide notice to all adult grandparents and other adult relatives of a child within 30 days after the child is removed from his or her home.

– Licensing standards for relatives waivers (Sec. 104). The Act clarifies that states may waive non-safety licensing standards.

– Expanding the Adoption Incentives Program (Sec. 401). The Act enhances incentives in current law to promote the adoption of children from foster care.

– Placing siblings together (Sec. 206).– Family Connection Grants (Sec. 102). H.R. 6893 authorizes a new grant program

in Subpart 1 of Title IV-B for activities designed to connect children in foster care (or at risk of entering foster care) with family. Funds can be used for: 1) kinship navigator programs; 2) intensive family-finding efforts; 3) family group decision-making meetings for children in the child welfare system, with special attention to children exposed to domestic violence; or 4) residential family substance abuse treatment programs.

– Transitional Care Funds - Continuing federal support for children in foster care after age 18 (Sec. 201).

National Advocacy GroupsThe Pew Commission 2003

– The nonpartisan Pew Commission on Children in Foster Care was launched on May 7, 2003.

– The panel was charged with developing practical, evidence-based recommendations related to federal financing and court oversight of child welfare to improve outcomes for children in foster care.

– Goals included the movement of children from foster care to safe, permanent families and to prevent unnecessary placements in foster care.

Casey Foundation

• Mission - All children need a safe, nurturing, family to protect and guide them - all children have a lifelong connection to a caring, supportive family.     

Goals and Mission -       – decreasing the number and rate of children entering foster

care; – increasing the rate and number of children connected to

stable and permanent families; – ensuring the welbeing of children by having their emotional

and physical needs met; and – reducing inappropriate disparities related to race, gender,

age, and ethnicity in the child welfare system.

Chapin Hall at the University of Chicago

• Sound policy is based on continuous knowledge building – evidence based practice.– Better policy emerges when researchers

engage with policymakers and practitioners in long-term collaborations - research to practice.

– A commitment to rigor, independence, and innovation is essential to our work – performance based contracting.

Casey Family Programs

– 2020 Strategy - By the year 2020, the nation will reduce the number of children in foster care by 50 percent and improve self-sufficiency

– Reduction and reinvestment - Casey believes that proactive service ultimately saves U.S. taxpayer money.  Eight Components of Change:

– Build political will – Develop leadership – Provide quality front-line supervision – Set reasonable caseloads – Engage community – Collaborate across systems – Enforce data-driven accountability – Allow time

Law Suits – Children's Rights– NJ, DC, OK, GA, and WI Lawsuits – Performance Outcomes – State's agreement focuses the outcomes on

performance measures.  These measures will filter down to private providers who provide services to children.  Providers will be asked to provide data to the State every six months.   

– Community Based Care – The settlement requires that children be served within 50 miles of their homes with certain exceptions.  

– Family Focused Care - This settlement moves children toward family based care.  Family based care is defined very narrowly to only include foster care and family placement.   

– Shorter Lengths of Stay – Fewer children will be in care for longer than 15 months under this agreement.  “Growing up in foster care” will be rare.  Resources to push children into permanency will increase the longer a child is in care.   

– Fewer Moves – The goal is to have less than 5% of foster children experience more than two moves. 

ASFA Performance Measures

• Child and Family Service Reviews with Program Improvement Plans (PIP)

– Safety– Permanency– Welbeing

Safety

– Children Safely kept in their homes– Removals Prevented– Prevention of Reabuse

Permanency

– Prevent Reentry– Stability of Placement– Adoption– Reunification– Preserve Connections with Family– Continuity of Family Relationships

• Proximity• Placement with Siblings• Parent and Siblings Visits• Relative Placement

Well-being

– Enhanced Capacity of Parents to Care for Children

– Education Needs provided– Mental Health needs met– Physical Health needs met

The Future - Now

– More Family Preservation– More Performance Based Contracting– More Family Centered Care– More Work with Children in their families– Less children in foster care– More community based care

Family Centered CareResults

In 2004, Georgia had 14,000 children in foster care. In 2011, Georgia had 7,200 children in foster care. 50% reduction.

     

Reductions in all measures

• Caseloads down by a third

• Reabuse down by 75%

• Foster care reentries down by 70%

• Number of children in group care down by a third

• Time in foster care down by a third

   

Family Centered Practicevs. Child Centered

• Family Centered– Family is client– Family is respected– Family knows best– Collaboration with

family– Family is decision

maker

• Child Centered– Child is client– Family is ignored– Agency knows best– Family is isolated– Therapist is decision

maker

Importance of Outcomes

– Prevention will be throughout the continuum of care.

– All contracts will be measured for outcomes.– Evidence based practices will be expected– Providers will partner with the State around

outcomes.– Data increasingly important

Steps toward the Future

• Is your program family focused versus child focused

• Are you implementing what you know that works - researched based practice?

• Are you developing programs that public policy are demanding?

• Is every program questioned about whether it can be done in the home of the client versus the "home" of the provider?

Steps toward the Future

• How is your agency working with the clients family?What about prevention, is it important?Does your staff know the three major goals of Federal policy and regulation?Are your programs outcomes in sync with those of your state and Federal Governments?

The Future - Now

– More Family Preservation– More Performance Based Contracting– More Family Centered Care– More Work with Children in their families– Less children in foster care– More community based care

Questions / Comments?

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