Too Often, Parental Rights Trump Kids' Best Interest

It is National Adoption Month, and I’m remembering the four adoptions that I oversaw in my five years as a foster care social worker. These were among the happiest occasions in my child welfare career.

What could be better than seeing a child who had been abused or neglected permanently united with a family that had already proven their love and nurturance by fostering?

But I’m also remembering the adoptions that did not happen, despite the fact that they were clearly in the best interests of the children. Because the system too blindly favors biological parents, the interests of the children and their future prospects took a back seat.

“Tamara” came into care at the age of two when her mother was arrested for hitting and knocking her down at a CVS. After two years in foster care, Tamara was totally bonded to her foster family.

Despite months of individual and family therapy and parenting training, Tamara’s mother had not developed an attachment to her. She was unable to state anything she liked about Tamara, a lively, bubbly child.

In a court-ordered bonding study, knowing she was being observed, Tamara’s mother was unresponsive to Tamara’s attempts to get a reaction to her drawing. The parenting counselor who had worked with Tamara and her mother agreed with the bonding study: Tamara’s mother just was not attached to her.

Unfortunately, the judge did not agree. The government attorney and I were nearly in tears as we tried to explain the type of nurturing that children need for healthy development. All he saw was that Tamara’s mother had followed the court’s orders, such as participating in therapy and parenting training.

It did not matter that these services had not worked to make her a better parent. I had to return Tamara to her mother.

Then there was Davon. His extremely nurturing foster parents, a married couple with grown children, brought him up from the time that his mother abandoned him at the age of 3 months until past his second birthday.

In the foster home, Davon basked in an atmosphere of love, order and intellectual stimulation. But then, his mother named the real father, who had not known of Davon’s existence.

The 19-year-old father, jobless and a high school dropout, wanted to bring up his son. He had not abused or neglected Davon. Nevertheless, it was clear that Davon would do better with his foster parents. 

I left the job before I would have had the sad task of removing Davon from the only home he remembered. But I later heard from his attorney, who had opposed the move, that she had serious concerns about his emotional and intellectual development in the somewhat chaotic home to which he was transplanted.

I’ve been reading Meghan Walbert’s Foster Parent Diary in the New York Times. For seven months, she and her husband have fostered “Blue-Jay,” who came to their home at the age of three. Through her blog, we see a fearful child gradually settling in to the family.

We read about Blue-Jay’s anguish after his birth parents tell him on a visit that he is coming “home.” “I don’t want to live in a different house. I want to live in this house with this family,” he wails.

We see him becoming afraid of new places and new people, for fear that he will be taken away. How long this limbo will last is anybody’s guess.

The problem is, as Elizabeth Bartholet of Harvard Law School puts it, that the child welfare system puts parents’ rights ahead of the rights of the child. But laws are not the whole problem. District of Columbia law allows for a child to be adopted against a parent’s consent if it is in the child’s best interests. But courts will generally not waive a parent’s right to consent if the parent has complied with court orders or, as in the case of Davon’s father, was not guilty of abuse or neglect.

Federal law was changed in 1997 to require that the government move to terminate parental rights if a child has been in foster care 15 out of the most recent 22 months. But even after the government moves for termination, it can take a year or more before an adoption is finalized.

During that time parents can continue to press for reunification, a father can appear, or a relative can be found who is given priority because of the blood relationship. In the meantime, some children will become more bonded to foster and adoptive families, making the separation even more harmful.

Accumulating research findings show how important it is for a child to have a loving, consistent, responsive caregiver. Caregiver-child interactions shape the developing brain. Loving and appropriate responses to the child’s cries, gestures, and early speech are necessary for the child’s physical, mental and emotional health.

I hope that our increasing knowledge about early childhood brain development will eventually lead to a change in practice that puts the best interests of children at the heart of child welfare and allows for many more joyful adoption days in the future.

This column was published in the Chronicle of Social Change on November 23, 2015.

Short-Term Emergency Shelters Better than Uncertain Alternatives

Oklahoma is closing its emergency shelters for foster children pursuant to a settlement in a class action suit. As of October 20, the Oklahoma City shelter was down to one child, and the Tulsa shelter was to be closed by the end of the calendar year.

The Oklahoma shelters were supposed to serve as emergency intake facilities for children after they had been removed from their homes. But children were reportedly spending months at these shelters when foster homes could not be found for them. As part of a major class action suit, the state agreed to close these shelters.

The move to close Oklahoma’s emergency shelters is part of a general movement to eliminate institutional settings for foster children. Emergency shelters have gone out of style as research has suggested that institutions are bad for children.

In addition, states have reported that emergency shelters worsen their performance on the “placement stability” standard, which is one of the standards by which states are measured as part of the Child and Family Services Review (CFSR) process.

Now, in many jurisdictions like the District of Columbia, children are placed immediately into foster homes, even in the middle of the night. This approach is considered the best for children. But I have my doubts.

In my last job as a foster care social worker with a private agency in the District of Columbia, one of my duties was to be on-call overnight for a week at time. The main function of an on-call social worker was to receive emergency placement calls. In my last on-call week, I was woken up four times by calls between 2:00 and 4:00 a.m.

Here’s how it worked. I’d be woken by the call from the equally groggy on-call placement worker. I’d be told that a child or sibling group needed to be placed, given minimal information about them, and would then have to call all of our foster homes with vacancies. Depending on the age and sex of the children, there might be one possibility or as many as five or six.

Some of the foster parents did not answer their telephones in the middle of the night. The kids would go to the first one who did and who was willing to take them. Given the randomness of that process, my grogginess, and the very limited information provided about the children, the chance of placing the child with the best possible home was not great. Moreover, a sibling group could be split up if the one foster parent who could take them all did not answer the telephone.

I often thought, “How much better it would be if the kids could stay at an emergency shelter/assessment facility for one or two nights, while we contacted available foster parents and determined who might be the best match?” During that time, medical and mental health professionals could assess the children and determine whether they had special needs that should be taken into account. Special efforts could be made to place sibling groups together.

Emergency shelters or assessment centers should not be used as a long-term placement for children in foster care, as was was apparently happening in Oklahoma. But that can be addressed by limiting the amount of time that children can stay in such facilities rather than eliminating them.

Jurisdictions should consider the value of establishing or reinstating assessment centers where children can stay up to 72 hours while they are matched with an appropriate foster home. In order to encourage states to support foster care assessment centers, the federal government should change its measure of placement stability so that placements in emergency shelters and assessment centers are not included.

Children entering foster care need a proper assessment before they can be placed in the most appropriate home. This might be the best way to avoid future displacements as children who had been placed in poorly suited homes—or without their siblings—move to a better-matched home.

This column was published in the Chronicle of Social Change on November 3, 2015.

Real Experts Say Keep Group Homes Open

The anti-group home juggernaut continues to roll along. The Governor of California has signed legislation that aims to drastically reduce the number of foster children placed in group homes by turning them into short-term placements for up to 6 months.

On the federal level Senator Orrin Hatch, has announced his attention to work with other Senators to develop legislation reducing reliance on group homes for youth in foster care.

In last week’s column, I wrote about the folly of restricting group homes when family foster homes are in short supply. Today, I cite the real experts—young people who have thrived in group homes, often in contrast to their foster home experience.

Below are a few examples.

Sunday Koffron Taylor, a former foster child and current foster parent, is now the vice president of the Michigan Chapter of Foster Care Alumni of America. She questions the constant call that every child should be in a family:

The reality is that there are not enough qualified or willing foster homes for older children. I am the beneficiary of the group care system and I have noticed when talking to other foster care alumni that those of us who spent the majority of our time in group settings suffered far less mental and emotional abuse then our counterparts who are placed in foster homes. …Time would be more wisely spent improving group care, rather than attempting to coerce and cajole the unwilling and unprepared foster parent into accepting the care of children whose needs they are not equipped or willing to meet.

Eric Barrus, currently a student at Brigham Youth University, participated in the Congressional Coalition on Adoption Institute (CCAI)’s summer internship program. Eric bounced from home to home until he found stability and love at an independent family group home called Open Gate Ranch, which serves up to eight boys at one time.

The family running “The Ranch” have adopted six of their residents (including Eric) over the 20 years that they have operated the home. In his policy report for CCAI, Eric proposed that family-style group homes be placed in a different category from group homes operated by shift staff and be a preferred option for older boys in foster care.

Another former CCAI intern, Thomas McRae, Jr., entered foster care at the age of 11. He lived in 22 foster homes, suffering abuse, neglect, and multiple changes of school and neighborhood. He reacted with anger and aggression, leading to further disruption as foster parents refused to keep him.

After his last altercation with a foster parent, he ended up in a Boys Town family-style group home. He was supposed to stay only a few days, but his attorney fought for a longer placement, and he ended up there for 8 months. Of his house parents, Thomas states:

They were so inspiring, so motivating. They taught me what it means to have a mother and a father. They taught me patience and kindness. Had it not been for them, I would not be the man I am today.

Thomas is already a seasoned public speaker and will graduate from Cheyney University next spring with a degree in psychology.

These experiences illustrate that group homes not, in and of themselves a problem. As a sector of the child welfare continuum, however, it has come to be defined by its worst members. These are often larger and are known for their rigid “level” systems in which even the most basic “privileges” can be taken away.

The “foster home sector” could easily be viewed through the same lens, but it’s not. There are foster parents who have never been to their child’s school, never taken them to the doctor, and don’t buy them more than the minimal clothing. There are even abusive and neglectful foster parents. But nobody is talking about shutting down all foster homes, or limiting the amount of time a child can stay in a home.

Could the higher cost of group homes have something to do with this discrepancy? Group homes cost more than foster homes, although the ratio of costs varies by jurisdiction and type of home. But the higher cost of group homes might explain why some conservative legislators, like Sen. Charles Grassley (R-Iowa), are so keen on restricting group homes.

The child welfare field should take the advice of Sunday Taylor and improve group homes, rather than eliminating them or establishing arbitrary time limits. Improved standards and accountability for group homes can improve their quality.

And let’s do more research on the effectiveness of different types of group care compared to foster care for different populations. The one study that compares similar group and treatment foster homes following the same treatment model shows that family-style group homes produced better outcomes.

Let’s make sure we know what works before we make it any harder to place youth in homes that could mean the difference between a successful life and a future in prison or on the streets.

This column was published in the Chronicle of Social Change in October 28, 2015.

Curbing Congregate Care Plus Foster Care Shortage Equals Bad Policy

Rarely have I seen a greater disconnect between policy and reality than what is occurring in California’s foster care system.

On October 11, Governor Jerry Brown signed legislation that drastically reduces the number of children placed in group homes and the length of time they spend in such placements.

Four days later, the Los Angeles Daily News reported that there is an “urgent need” for foster parents in the San Fernando Valley. Yet nobody in the executive or legislative branch seems to be connecting these two facts. What is going on?

Under the new legislation, all group homes will be replaced by “Short Term Residential Treatment Centers.” These centers will be licensed only to provide short-term intensive treatment for children who are determined in need of such an intervention.

Stays at these centers will be limited to six months. Longer stays will have to be authorized by senior child welfare officials.

The new legislation is based on the increasing belief that “congregate care is detrimental to the development and well-being of youth in foster care.” Yet, as I wrotein an earlier column, the research behind this assertion is far from conclusive. Especially when it comes to older youth with more serious therapeutic needs, group care may be more appropriate. For larger sibling groups that cannot be accommodated in a single home, a group home may also be a preferable option.

A loving, caring family is of course the best option for many children. However, as I discussed in another column, many foster homes do not provide this type of nurturing environment. Some are neglectful or even abusive, and many are simply providing room and board.

There are also not enough foster homes, good, bad or in-between. So even if any foster home is better than any group home, most jurisdictions just don’t have enough foster homes.

The Daily News reported on October 15 that the Los Angeles County Department of Children and Family Services is holding a special event to recruit “urgently needed” foster parents. Because of the shortage of foster homes, there has been a surge in the number of children admitted to the County’s welcome centers, short-term shelters for children for whom there is no foster home available.

These centers are allowed to keep children for only 24 hours but the Los Angeles Timesreported that this rule was violated 800 times in the last year.

The underlying cause of the crisis is the collapse in the supply of foster homes in Los Angeles County. As reported by the Times, the number of beds in homes of foster parents who are unrelated to foster youth has dropped from 22,000 to 9,000 since the year 2000.

Social workers make up to 100 calls to place one child. What is going to happen when the closing of group homes creates an even greater demand for foster homes?

The supporters of the new California legislation understand that they will need to recruit more foster homes in order for the new regime to succeed. The new law will provide more money to recruit, retain and support foster families.

But unless this money will be enough to buy homes for foster parents in expensive areas like Los Angeles County, or to provide salaries so foster parents do not have to work outside the home, I doubt this effort will be successful.

The rush to close group homes during a foster parent shortage is not a California phenomenon. It is happening all over the country behind the child welfare establishment rallying cry, “Every child needs a family.” In the District of Columbia, children are being sent as many as 30 miles or an hour by car away from the District for lack of foster homes, while group home beds have been cut back.

When there are not enough foster homes, closing group homes does not make sense. Instead, we should create group homes that are as family-like and nurturing as possible. There are many group homes that already meet their residents’ needs for love and caring much more than many foster homes.

Next week, I will share the views of some of the real experts about group homes: young people who have lived in them.

This column was published in the Chronicle of Social Change on October 20, 2015.

A Rising Tide of Foster Care Entries

The federal government issued its new foster care data report on Sept. 18, and the news was startling. Foster care caseloads were up substantially for the first time in a decade. Between 2013 and 2014, the number of children in foster care increased from 400,989 to 415,129, which is an increase of 3.5 percent. This was the second consecutive increase in foster care caseloads.

The new data appear to confirm an end to the major decline in caseloads that occurred in the first decade of this century. The number of children in foster care fell from 567,000 in 1999 to 398,000 in 2011. The foster care caseloads declined slightly in 2012 and increased slightly in 2013, to 400,989. The 2014 figure suggests that we may be entering an era of increasing foster care caseloads.

Increased entries into foster care appeared to account for most of the increase in caseloads. The number entering foster care increased by almost 10,000 over the year. The number exiting foster care decreased, but by a much smaller amount.

The increase in foster care caseloads cannot be accounted for by expansion of some foster care systems to include youth between the ages of 18 and 21. The age distribution of children in foster care remained almost the same over the last year, as did the age at entry into foster care and exit from foster care.

The Department of Health and Human Services did not offer an explanation of this increase. However, several factors have been cited as explanations for increases at the state and local levels. Reports from many states suggest that the increased popularity of drugs like heroin and methamphetamine are resulting in more kids being removed from their families. For example, the number of children in foster care in Kansas has reached an all-time high, whichprofessionals attributed at least in part to the revival of heroin and methamphetamine.

Changes in child welfare policy may be responsible for caseload increases in some states. The number of children in foster care in Florida reached its highest level since 2008 this July. Among the reasons given are the use of a new method for assessing risks to a child’s safety, which is resulting in more removals. The state shifted to this system after a widely publicized series of child deaths. A similar dynamic is occurring in Oklahoma, where a spate of child deaths resulted in an increase in removals and foster care caseloads.

The number of youth in foster care has risen for two consecutive years, according to federal data collected from states

The Florida and Oklahoma situations illustrate the cyclical nature of child welfare practice. Child welfare systems have to balance the harm caused by removing children from their families with the risks incurred by leaving them in possibly dangerous situations. Many states have been reducing their caseloads for years. After years of erring on the side of keeping children at home, they may be reconsidering in light of evidence that they have gone too far.

There is a limit to how much a state can safely reduce its rate of child removals. I was a social worker in the District of Columbia between 2010 and 2014, when the caseload was cut in half. While this reduction was occurring, I heard from many attorneys working in the system that children were being kept in toxic homes for too long and were more troubled when they were finally removed.

Many professionals involved with the District’s child welfare system during the time of caseload reduction also expressed fear of a tragedy due to children being left in an unsafe home. One such event did occur. As I described in an earlier column, a child whose family had been the target of an investigation but who was not removed later disappeared and is presumed dead.

It is possible that increased investment in services to families will make possible a resumption in the decline in child removals without compromising child safety. Congress is considering a major change in child welfare funding so that services to prevent foster care placement could be funded at the same level as out-of-home care.

Perhaps if such a policy is implemented, it will usher in a new era of caseload decline, based on a foundation of adequate monitoring and services to families that have come to the attention of the system. Let us hope that it does not lead to financial pressure to keep kids at home even when they are not safe.

This column was published in the Chronicle of Social Change on October 5, 2015

Preventing Repeat Pregnancies Among System-Involved Moms

Last week, I wrote about the need to address teen pregnancy among youth in foster care. This week, I focus on repeat pregnancies among mothers who are already involved with the child welfare system. This includes mothers with children in foster care and those who are being supervised by the child welfare agency due to abuse or neglect.

Among the saddest news for me as a social worker in the District of Columbia’s foster care system was to hear that a mother whose child was in my caseload was pregnant again. There was the teenage mother, herself in foster care, who was not visiting her son consistently or complying with court orders. Still a teenager, she got pregnant again, perhaps in the hope of keeping this child.

There was the mother struggling against her addiction to crack cocaine. Her first three children were living with her own mother, but she could take no more. One or two were with the father. The sixth was with a foster parent who was trying to adopt him. And now she was pregnant with the seventh.

Some of these women continue to give birth and to have the children removed, over and over. I have witnessed mothers who were drug addicts, selling sex for drugs, and others who were trying to cement a relationship with a new man or replace the children who were taken away.

But we have no idea of what proportion of the caseload they account for because this data is not collected. The federal government does not even require the states to collect data on how many children each mother in the system has had. We have no idea how many mothers with a child in foster care get pregnant again or how many of these children end up in foster care as well.

This is a very sensitive subject. It would not be acceptable to most people if judges ordered mothers to use contraception and told them that another birth would reduce their chances of getting their children back. But there are meaningful steps that could be taken without depriving women of their rights to self-determination.

Mothers could be encouraged to use Long Acting Reversible Contraceptives (LARCs). As I wrote last week, many primary care clinics do not provide access to LARCs, and they should be made available at clinics that take Medicaid patients and uninsured patients and training provided to staff in how to insert them.

While a court couldn’t order mothers to use LARCs, it could offer a financial incentive to mothers who agree to have a LARC inserted. It could be a sizeable incentive, considering the cost that the birth of a child to most of these mothers saves in welfare, Medicaid, or foster care payments.

Perhaps many readers would object to this attempt to influence a woman’s reproductive decisions. But I’m guessing that those who are directly involved in caring for these children would agree with me.

One of my clients, a three-year old girl, was born to a drug-addicted mother who abandoned her at the District of Columbia’s family homeless shelter. The maternal grandmother was raising the first two children but was exhausted and ill, so her sister stepped up to the plate. She and her husband created a wonderful home for the little girl, but they were still hoping that mom would come back one day clean and sober so they could have the retirement they had dreamed of.

Then came the dreaded news that mom was pregnant again. A cousin in Texas agreed to take the next newborn. But she was also on her way to D.C., to track down mom in the streets and persuade her to get her tubes tied. There was nobody else to take another child, and this was not a family that allows its children to be taken in by strangers.

I don’t know if the cousin succeeded in her mission. But I hope she did.

This column was published in the Chronicle of Social Change on September 29, 2015.

Long-Term Contraception Has Great Potential to Help Foster Teens

When a teenager in foster care gets pregnant, the child welfare system has failed. The barriers to future education and employment for these young people are bad enough without the added burden of a baby. And of course, the risk of bad outcomes (including abuse, neglect and placement in foster care) are high for babies born to teen mothers.

Unfortunately, teenagers in foster care are much more likely to become pregnant than other teens. According to data compiled by the National Campaign to Prevent Teen and Unplanned Pregnancy, nearly half of teenage girls in foster care are pregnant by age 19, compared to 27 percent of all teenage girls. (Fatherhood data, sadly, is not available.)

It is not surprising that teens in foster care are more likely to get pregnant. Researchindicates that teens in foster care are about twice as likely to be sexually active as teens not in foster care. Girls in foster care are much less likely to use contraception than their peers who are not in care. Risky behavior by teens in care is probably related to their adverse childhood experiences  and the fact that they have fewer protective factors, like attachment to a caregiver.

Some teen pregnancies are intentional, and these may be more likely among young people in foster care. For some, a baby may provide the unconditional love and attachment that some teens in foster care have never experienced. For others, the opportunity to get an independent living apartment may be an incentive for pregnancy where such opportunities are available.

Even if they don’t want to get pregnant, teens are likely to conceive by accident if they don’t use effective methods of birth control. Methods that must be taken each day or used each time (like a condom) are not very reliable for teens. Because foster children move frequently, a method that requires repeat medical visits is not practical for them.

The availability of Long Acting Reversible Contraceptives (LARCs), such as an interuterine device (IUD) or a birth control implant, offers an opportunity to reduce pregnancy among teens in foster care. LARCs are safe and easy to use, and they last from five to ten years.

Unfortunately, LARCs are still not widely known or understood among teens, adults and even health care professionals. Problems with earlier versions of the IUD and contraceptive implant contribute to an impression that these methods are not safe. Teenagers and even clinicians continue to express concerns about LARCs, often based on myths and misconceptions.

Secondly, foster youth are not likely to be offered LARCs in most systems. Many foster care teens get their care at primary care clinics that take Medicaid. Research shows that primary care clinics are less likely to offer LARCs than are clinics focused on reproductive health care.

A few places are starting to see the value of long-term protection. The Colorado Initiative to Reduce Unintended Pregnancy made LARCs free and widely available. The initiative began in 2009; since then, the state’s birth rate among teens ages 15 to 19 has dropped from 37.7 per thousand to 25.4 per thousand.

When it comes to foster youth in particular, Los Angeles is setting an example for other jurisdictions.  As recently reported in the Chronicle, a new program there provides LARCs to foster youth and those at risk of entering into foster care in all of the “medical hubs” affiliated with the county’s Department of Health Services. Staff at these clinics are being trained in inserting the devices.

Jurisdictions should follow Los Angeles’ example and make LARC’s available to all teens in foster care. In addition, agencies should train foster parents, group home staff, and social workers to provide accurate information about the effectiveness of LARC’s and other birth control methods.

Contraception and education alone do not provide the solution to the problem of births to foster care teens. Research indicates that youth who received more monitoring by their caregivers were less likely to be sexually active, and more frequent use of contraception was likely among youth who reported feeling connected to their caregivers.

But as I have written in previous columns, many teens in foster care do not receive adequate attention or monitoring and do not have strong relationships with their caregivers. We need to find a way to replace these bad foster homes, be it with professional foster homes orfamily-style group homes.

Preventing pregnancy among teens in foster care should be a top priority for all child welfare systems. Teens in foster care need to complete their educations and defer childbearing until they are in a better position to support a child economically and emotionally. Unfortunately, Congress may be close to cutting resources for teen pregnancy prevention and family planning.

We can only hope that state leaders see the problems of teen pregnancy first-hand, and will be smart enough to ensure that prevention services to teens in foster care and other at-risk teens are increased, not decreased.

This column was published in the Chronicle of Social Change on September 22, 2015.