The Change is Not a Flash in the Pan

Tuesday, April 28, 2009 at 2:45 pm

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 changes

in response to abuse and neglect. This workshop will beinvaluable to those who are considering what services will

be 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 – “How do you know that it works.”

Evidence Base 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

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 first– New Ebenezer 1738– Bethesda for Boys in 1740

• Orphan trains to the West – Apprenticeship and Reformation

Modern Era

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

• 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.

Improvements 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 and Research driven policy– 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

– 1962 - C. Henry Kempe, article The Battered Child Syndrome in the Journal of the American Medical Association

– 1962, Children’s Bureau recommends child reporting laws. By 1967, 44 States had them.

– Reason for dramatic increase in number of abuse and neglect

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 of 1997

• 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.

Adoption and Safe Families Act 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.• Welbeing.

– 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.

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 (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.

• Continuing federal support for children in foster care after age 18 (Sec. 201).

The 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.     

Results -       • decreasing the number and rate of children entering foster

care; • increasing the rate and number of children connected to stable

and permanent families; • ensuring more children have 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 - collaboration.

• 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 – Kenny A• Performance Outcomes –Georgia’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. 

Performance Measures

Program Improvement Plan (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