Thursday, August 20, 2015

Barrus Report Proves It: Group Homes Are Right for Some Kids

On August 5, The Chronicle highlighted the recommendations of Eric Barrus, one of 12 former foster youths participating in the Foster Youth Internship Program of the Congressional Coalition on Adoption Institute. Barrus agrees with many experts that large group homes or institutions should not be used as long-term placements for foster youth. However, he proposes that small group homes run by families should be a preferred option for older, harder-to-place foster youth.
Barrus’s position is based on his personal experience. He was in foster care from age 16 through 19, and was initially placed in large group homes of up to 30 children where it was “next to impossible” to build the relationships with staff and peers that are important to healthy adolescent development. Finally, he was placed in an independent family group home in Montana called Open Gate Ranch. Eric thrived there, and was eventually adopted by the family that runs the home.
“The Ranch,” as it is affectionately known, is an independent family group home that houses up to eight boys at a time. Barrus stresses the family-like nature of the Ranch. “The parents live in the home 24/7, which creates a loving and accepting environment, where there are opportunities to develop trust, build relationships and be part of the family. They also…[make] every kid feel special by attending their extracurricular activities; …helping them attain a driver’s license; and celebrating birthdays, graduations, and other milestones.”
Residents of the home also enjoy weekly family nights, family vacations, theme park trips, and holiday celebrations, he wrote.
As a former foster care social worker, I know this is significantly more than I saw most foster parents do for their wards.
The Ranch is not alone in the provision of excellent family-based group care. In an earlier column, I described my visit to a Boys Town family group home in Washington, D.C. The dining room wall is covered with photos of former residents many of whom come back often to see the home’s “Teaching Parents,” who have been doing this for 20 years. Both the sparkling interior and the loving, dedicated full-time parents were in sharp contrast to many of the dark, dingy, loveless foster homes I have observed.
Group home opponents often cite research purportedly showing that foster care produces better outcomes than group care. But Dr. Bethany Lee, one of the nation’s leading experts on group care, questions the quality of this research. In an introduction to her own study, she notes several methodological problems with previous comparative studies between group care and foster care.
In their study, she and her co-author, Dr. Ronald Thompson, tried to minimize these limitations. Comparing youth who received foster care through Boys Town with youth who participated in Boys Town family-style group homes, they found that the youth in group care were more likely to be favorably discharged, more likely to return home and less likely to experience a subsequent formal placement than the foster care youth.
No differences were found in subsequent legal involvement or the likelihood of living in a homelike setting six months after discharge.
As Eric points out, family-style group homes are particularly needed in light of the foster parent shortages around the country, which can result in a prevalence of poor-quality foster homes. Agencies with a foster parent shortage are often reluctant to screen out or dismiss people who go into foster care for the money and provide nothing more than room and board. I described the results in an earlier column about bad foster homes.
Group home opponents often cite their expense, which is considerably greater than that of family foster care. Eric points out that some youth in foster care, especially older boys who have experienced trauma and failed in multiple family placements, simply cannot function in a foster home. The higher cost of group care for these youth might be a bargain if it enables the taxpayers to avoid future expenses on public assistance, homelessness, substance abuse, and incarceration.
Eric recommends that family group homes be made “a preferred placement option over non-family group home and institutional placements for “hard-to-place” teen boys.” He also suggests that “family group homes” should be considered a separate category between foster home care and group care.
Unfortunately, Sen. Orrin Hatch (R-Utah), the powerful chairman of the Senate Finance Committee, has expressed his intention to restrict funding for group homes. It’s not clear whether Senator Hatch recognizes the distinction between large institutional group homes and smaller, family-style homes. As The Chronicle suggests in the article about Eric’s recommendations, we need more research into the outcomes of different types of group homes for different types of youth before Congress places restrictions on their funding.

This column was published in the Chronicle of Social Change on August 13, 2015

Friday, August 7, 2015

Class Action Consequences: The Dangers of Measuring Quantity Instead of Quality

Child welfare systems in many states are under court monitoring or receivership. Courts became involved due to class action lawsuits, such as the one recently filed against New York City’s child welfare agency.
Obviously, these legal advocates are trying to help children caught up in these systems. However, as a social worker in the District of Columbia for five years, I was surprised to learn that court oversight often hindered my ability to help my clients.
Class action settlements often emphasize quantifiable performance, even when this is not meaningful. Moreover, some standards are poorly defined, requiring staff to waste time in unnecessary activities.
In the District of Columbia, the Child and Family Services Agency (CFSA) is operating under an Implementation and Exit Plan (IEP) approved by the court. The IEP contains 83 requirements (with associated “exit standards”) that CFSA must meet to “exit” court oversight. A few examples will illustrate the problems.
The IEP prescribes that each child in a new placement be visited four times in the first month. It seems reasonable to require more visits during the first month so that the social worker can assess how placement is going and intervene if necessary. But mindless implementation of that standard can result in absurdity.
I had a client who was temporarily placed with a new foster family because her foster parent needed heart surgery. As required, I visited my client four times in the first month in her temporary placement. The ailing foster parent made a slow recovery and my client ended up staying at the “temporary” home. When the placement was changed from “respite” to long-term, it was treated as a new placement, and I had to visit four times in that month as well!
The IEP requires that children in foster care receive a full medical evaluation within 30 days of placement. This sounds reasonable. What could be wrong with requiring a medical evaluation?
Let’s start with the fact that CFSA requires that this evaluation be provided by its own clinic. That clinic does not give immunizations, so if the child needs immunizations, she will have to receive another physical from a real clinic.
What happens if the child has already had a physical within the past year and documentation of this physical is obtained? No dice, unless that physical happened within the past month.
No big deal? Remember that the hard-working social worker or case aide is required to transport the child. Counting transportation there and back, this may take up half a day, typically more than the amount of time a social worker has to spend on each case per week. Meanwhile, the child might miss a half-day of school in order to obtain a physical that may be unnecessary or insufficient.
The IEP calls for the reduction of multiple placements for children in care. Of the youths served in foster care during a current year, 83 percent of them must have two or fewer placements.
As a result, CFSA staff are extremely reluctant to approve new placements even when in the child’s interest. I had one client who was not thriving. His foster parent provided no support or supervision, and he was alone much of the time.
When I tried to get him a new placement, I was told that he would have to stay in the home. It was more important to the agency to avoid a new placement that would hurt the numbers than it was to meet the needs of my client.
The IEP requires that all youth 18 or older have a “Youth Transition Plan” to prepare them for adulthood. A simple, useful format was replaced some time ago by a cumbersome template which contains about 20 separate Word documents.
Hysteria gripped my office when the deadline approached for documenting that all of our older teens had plans. Daily emails made it clear that this documentation was to be our top priority, ahead of things that had much more relevance to children’s lives.
Clients often were not interested in attending the team meeting that was supposed to be held to develop the plan. In one case, I had the entire team assemble three times, to be stood up by the client every time.
The existence of a written plan is much less important than other factors such as the quality of foster parenting, mental health care, and education that the client receives. But the existence of a plan is much easier to measure—and it is much easier to produce a plan than to improve the quality of services that the client receives.
I do not wish to leave readers with the idea that court supervision or performance standards are necessarily bad. If the standards are meaningful, they can be an effective method for improving child welfare systems. But meaningful standards are often ones that cannot be measured quantitatively.
The IEP contains some qualitative standards. Assessing performance on these standards requires qualitative review, which is expensive and hard to do well. Perhaps that is why agencies and courts seem to be addicted to meaningless, easy-to-measure standards that often hinder, not help, the provision of quality service.
This column was published by the Chronicle of Social Change on August 4, 2015.

The Shortcomings of Structured Decision Making

As recently reported in The Chronicle of Social Change, Los Angeles County and other jurisdictions have been developing a new tool to help assess the risk to children who have been referred to the child welfare system.
Los Angeles, like many other jurisdictions, is using an earlier generation of risk and safety assessment tools. But at least in my experience in the District of Columbia, few professionals have any faith in the utility of these tools.
I am referring to the so-called Structured Decision Making (SDM) model for child protection, produced by the National Council on Crime and Delinquency (NCCD). The model includes six different assessments conducted at different stages of a case.
According to NCCD, the model is in use in 33 jurisdictions in the United States and in a total of 48 jurisdictions worldwide. As recently as May of this year, Texas adopted the SDM assessments for investigations and is planning to adopt the remaining assessments for ongoing services in the fall.
SDM is based on checklists filled out by social workers based on their interviews and observations, as well as other data they might be able to obtain. Using this information, the computer uses “actuarial science” to generate a risk level or a recommended action.
Unfortunately, these SDM assessments rely on yes-or-no questions that do not capture many important factors. Speaking to The Chronicle‘s Holden Slattery, Los Angeles social workerRuby Guillen complained that the yes-no framework fails to distinguish between a mother experiencing depression after her husband’s death and a mother suffering from schizophrenia and refusing medication.
She added that the instrument also fails to incorporate important risk factors, including the risk posed by secondary caregivers such as a mother’s boyfriend—a major concern in child welfare.
The head of child welfare in Los Angeles, Philip Browning, expressed concern that, due to the manual nature of the process, workers could manipulate the process to provide the desired result. I know from personal experience that this is easy to do, especially since the checklists include poorly defined multiple-choice answers that leave workers no choice other than using their judgment.
Alternatively, the worker can simply override the system-generated result. However, I discovered that neither was necessary in the District of Columbia. In one case, I decided to leave the system-generated recommendation in place even though we had already decided to override it, just to see if anyone cared. Not surprisingly, nobody did.
So why are jurisdictions using these instruments if they are useless and ignored? In the District of Columbia, the SDM is so tightly integrated with the entire case management process within the electronic database that it might be costly to remove it. But if the costs in time spent by social workers were calculated, removing SDM would probably save money.
It is possible that in jurisdictions where social workers are not required to have a Master’s Degree or a license, the SDM provides some needed guidance in making decisions. But integration within the data system does not explain why the state system in Texas would be adopting the tool today.
Automated risk assessment algorithms (whether old or new) are supposed to improve upon the ability of the social worker to make child protection decisions. But the SDM risk assessments do not provide any such improvement in my experience. Whether a new generation of risk assessments can do better remains to be seen.
The risk modeling experiment conducted in Los Angeles used a wide variety of data including parents’ mental health and substance abuse history. Given privacy rules, I am not sure how the Department of Children and Family Services is going to get access to all this information.
Regardless of the answer to that question, I hope that those developing the new tools will field-test them extensively to make sure that they don’t suffer from the same problems as SDM.
But let’s not wait until new tools are adopted to throw out SDM and similar first-generation risk assessment tools, at least in jurisdictions where they are useless and ignored.
There is a real cost to having workers complete useless assessments, and it is measured in time: The time it takes workers to complete them; supervisors to review them (if they bother to); and trainers to train workers to use them.
Worst, perhaps, is the effect on worker morale of having to complete busywork when there is so much real work to be done.
This column was published in the Chronicle of Social Change on July 30, 2015.