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We know the problem. Abused and neglected children spend too long in temporary care. We know the solution: To find them a permanent home before they grow too much older. And finally we know the critical importance of a permanent home. Children left overly long in temporary care are far more likely as adults to become mentally ill, criminals or homeless, according to “Bonding in the Foster and Adopted Child” from James Kenny, Ph.D.
The Adoption and Safe Families Act has been federal law since 1997. ASFA set sensible deadlines based upon psychological research for the termination of parental rights. A contingency permanency plan was required for all children in temporary care if and when the initial plan ran into problems. Yet too often we simply fail to follow the law.
Seventeen years after ASFA, the Adoption and Foster Care Reporting System provides us with a report card. Despite the 12-15 month maximum set by ASFA, children still spend an average time of almost two years in foster care. Even worse, they wait in temporary care on average for an additional 13.1 months after parental rights have been terminated. And most disturbing of all, 23,439 foster children left the system in 2012 without a permanent home. They represent our failures. We know better. We can do better.
Three reasons stand out. The first is a lack of clarity about the desired outcome. While we may agree on the goal of permanence “within child time,” the system is vulnerable to becoming sidetracked by time-consuming policies and procedures. We fail to check regularly on progress. And we give the birth parents an often unlimited time to improve.
Even further, we have diluted the reality of a permanent home by relabeling certain situations as “Another Planned Permanent Living Arrangement.” We have talked of “permanent” legal guardianships when, in fact, legal guardianships are generally not lifelong and can be dissolved. Follow-up research shows that former foster children are more apt to require continuing parental support well into their adulthood. Emancipation to “Independent Living” has even been accepted as a permanency plan, an oxymoron if ever there was one. There are only two truly permanent outcomes — reunification or adoption.
The second reason for delay is a strong historical bias for the biological parents. Some case managers and judges believe that children belong with their biological parents, no matter how long it takes. Birth parents should be allowed as many chances as they need. ASFA supports this concern by specifying that reunification with the birth family is the initial goal. Biology, however, does not automatically confer elemental parenting abilities. For the child’s sake, there must be time limits. ASFA makes clear that the child’s right to a permanent home is paramount. If the birth parent cannot provide permanence within a reasonable time, then the child’s right to a safe and stable family takes precedence.
Finally, any change may be delayed by inertia. “We’ve always done it this way.” “Old ways are best.” “Hope springs eternal.” As any engineer will tell us, it takes a considerable amount of energy to get a stable object into motion. Inertia may be “justified” or excused by an ever-present bureaucracy. Lost in details and entangled with red tape, we allow ourselves to become diverted.
Time, however, is the enemy of the developing child. If, in our effort to “get it right,” we fail to proceed in a timely manner, we will most assuredly get it wrong. Motivational seminars and pep talks are not enough. To be more effective, both public and private agencies need to change their approach. We suggest that they consider applying the for-profit model used by successful businesses.
Thriving companies like Amazon, Honda, Verizon and many others will keep their eyes on the prize, increasing monetary profit. They do so by working hard to finalize sales quickly and they continue to provide good customer service. They work as a team, seek advice from all the players, and are serious about quality control.
If child welfare were run by a business, they would focus on the problem more directly: We have removed this child from his home. We need to get him back there as soon as we can or find him another one that is safe and permanent. Unfortunately, our foster care system currently directs more of its time and money to the intermediate activities. Seemingly endless efforts are spent on therapy for parent and child, conferencing, adhering to policies, waiting for the parent to do better, and other similar process issues while the child remains in temporary care. Long-term foster care rather than a safe home within child time is the result.
Delays do not improve our chances for success. Kids can’t wait. I believe that we can accomplish a safe home within the ASFA deadlines if we have the will. In business the all-out goal is profit. In child welfare it is permanence. Why not use the goal-focused approaches that have proven effective in the marketplace?
1. Clarify the outcome. Success for our vulnerable children in temporary care should be measured in how safely and timely we can find them a permanent home. Policies and procedures are meant to further this goal, not hinder nor delay it. The child’s rights are paramount. Reunify or find an adoptive home with the timelines prescribed by ASFA. Public and private foster care agencies need to be clear about this ultimate purpose in a way that infuses the entire system.
2. Start immediately. Give the birth parent an initial plan for reunification as soon as the child is taken. That allows the parent the opportunity to begin immediately to correct the situation. The necessary plan is usually obvious. Remedy the problems that led to removal. Drinking may need to be controlled. Housing may need to be cleaned and safe. If the child was physically or sexually abused, then appropriate steps to protect the child must be taken before the child can return. The plan can be altered as needed. But why delay the start to reflect about matters when the overall changes needed should be obvious?
3. Set timed deadlines as ASFA insists. To move things along, check compliance weekly. The child’s developmental clock is ticking. ASFA’s deadlines were formulated for the stability and protection of the growing child. Motivate birth parents by hurrying them along, but for the child’s sake, they cannot be allotted indefinite time. Continuing relapses into substance abuse are especially time-consuming and offer minimal hope for successful reunification.
4. Involve all the “players.” A good business encourages cooperation from all the important players. Management invites input from customers, suppliers and workers. This style is less true in the foster care system. Foster parents are often left out. They may be the only ones with 24/7 knowledge of the children in their care and may be one of the options for a permanent home. Yet they are frequently ignored when decisions must be made about schooling, medical treatment and placements. They are the only team members with no standing in court. Communication between caseworkers, birth parents and foster parents is important, especially in preparation for case conferences and court. Better child-centered choices could be made if all the key players worked as a team.
5. Recognize staff effectiveness. The best strategy for dealing with a specific problem is to focus primary attention, not on mistakes, but on the desired result. Criticism for shortcomings can provide a subtle reward for the very behaviors that need to be eliminated. “Pay” most attention to those staff activities that enhance and achieve permanence.
Supervisors need to be positive in recognizing case manager performance. Encourage the case manager to check weekly on the birth parent’s progress in following the case plan. Note the presence of a contingency plan for permanence in the file. Recognize when the case manager’s client is on track to meet the ASFA timelines. Publicly applaud each reunification and adoption.
Rewards come in many forms. Here are a few ideas adapted from thriving businesses. Use bulletin boards to display case manager progress toward permanency goals. Recognize a “case manager of the month.” Keep a scrapbook for each case manager with pictures of those children he or she helped to find a permanent home. A day off might be earned with a sufficient number of token points. Points could be considered toward promotion. A cooperative staff might treat the effective case manager with a lunch or dinner to celebrate each small success.
6. Provide quality control. Whenever we buy something on the Internet or stay at a hotel, we are asked to comment on our experience. The child welfare department can accomplish this rather easily in several ways. Learn what works and what does not from the clients and others involved in the system. Feedback from birth and foster parents, older children and other involved agencies should be welcomed. Both positive and negative comments should be reviewed, responded to, and kept in a file.
Supervisors can add to this effort with regular or monthly performance reports. Evaluations should be in writing and go in the case manager’s personnel file. Feedback is essential to improvement. Effective case managers will welcome the fact that their efforts evoke a response.
7. Get beyond the psychological cure. Foster care is an abnormal and disabling situation and needs to be addressed directly. The damage done by long-term temporary care is reflected in the significant increase in rates of adult mental illness, crime and homelessness among former foster children. To be effective in treating these children, our first focus must be on the situation itself: The temporary nature of foster care.
Like an emergency room, foster care provides a necessary remedy to a serious immediate problem. The ER is a valuable place to go in a crisis but certainly not the place to stay. Once the crisis has been handled, the true remedy is to change the situation that caused the problem and get back to normal.
In teaching therapists who treat foster children for “adjustment disorders,” the authors always stress that the primary therapeutic goal must be to find a permanent home for the child-patient. To help the child adjust to an untenable situation is like trying to fill a canteen with a hole in the bottom. You can try endlessly but it won’t work. Start by filling the hole. Or find a more serviceable canteen.
8. Redirect the funding. A good company will spend its money on those programs that are likely to enhance profitability. The foster care system might copy this strategy by going beyond its short-sighted focus on temporary care and adjustment therapies to fund additional interventions more directly related to permanence. The possibility of administrative changes to expand treatment funding to cover services focused on permanence are already being discussed with the Centers for Medicaid and Medicare by advocacy groups like the Foster Family-based Treatment Association. Examples include homemaker services and other in-home behavioral support for the birth parent; parent training for reunification; pre-placement planning; and home-finding.
Consider a fee-for-service model. Currently, many agencies are compensated by combining the additional and important services they provide by an accounting process called “bundling.” Although bundling is a simple way to reimburse agencies for the care and support they provide, it may inadvertently reward long-term foster care. Instead of paying agencies for the time a child spends in foster care, pay them with a fee for each specific service provided. If the reimbursement is adequate and based specifically on each intervention rather than on the days in care, such services might be more consistently provided and lead to better outcomes.
Why not provide a bonus for successful reunification or adoption to agencies? Make the bonus comparable to the cost of an additional six months spent in foster care. Agencies and welfare budgets should be compensated for success on a par with any future time that might otherwise be spent in foster care.
9. Provide continuing subsidies for adopted foster children. Foster-to-adopt parents are willing to take on a lifetime commitment. Paying per diem for foster care, however, and denying them a continuing daily subsidy for minors after adoption is counter-effective. The would-be permanent parents face a clear financial disincentive to adopt. Why would we want to punish parents willing to make a lifetime commitment by decreasing or withdrawing financial support for raising a minor child?
Case managers have sometimes tried to save the state money by discouraging foster-to-adopt parents from seeking post-adoption subsidies. They may fail to tell the prospective parents that they are entitled to a subsidy, or even worse, they may try to induce guilt by suggesting that the adults are adopting to get money rather than out of love for the child. No case manager should withhold funds which properly belong to the child, and no prospective parent should forego what is due to the child.
The North American Council on Adoptable Children provides detailed state-by-state information about post-adoption subsidies. Continuing financial incentives for adoption should be at least equal to the per diem for foster care. This is the type of systemic change that could significantly improve foster care outcomes.
Every child has the right to a permanent home. Despite good laws, foster children remain in care for an average of nearly two years. That represents a flawed system and is unacceptable. We can change the system by using successful strategies from the business world to focus more directly on the desired outcome of permanence.
ABOUT THE AUTHOR: Jim Kenny, Ph.D., MSW, is a retired psychologist with more than 50 years of clinical experience. He has doctoral degrees in psychology and anthropology and a master’s degree in social work. The author of 13 books on family and child care, Kenny is available as a consultant on attachment issues. His most recent books are “Attachment and Bonding in the Foster and Adopted Child” and “What Foster Parents Need to Know.” Check ACT’s website at adoptioninchildtime.org. More personally, he is the father of 12 biological and adopted children, and the foster parent of many more. He lives with his wife in downtown Indianapolis. His email address is firstname.lastname@example.org.
Mark Bontrager, MSW, JD, is the executive director of Aldea Children and Family Services in Napa, California. He has served in a variety of positions in the child welfare community from social worker to attorney. He currently serves on several boards, including Solano County Children’s Alliance Executive Committee and Napa County Child Abuse Prevention Council Steering Committee. He has written numerous article about foster care and the importance of permanency for children in foster care. He earned a bachelor’s degree in psychology from Goshen College, a master of social work degree from Indiana University School of Social Work and a doctor of jurisprudence from Indiana University School of Law.
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15 Dec 2018
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