Senate Finance Hearing: Too Down on Group, Too Rosy on Foster Homes

On May 19 the Senate Finance Committee held a hearing entitled “No Place to Grow Up: How to Safely Reduce Reliance on Foster Care Group Homes.” The hearing was designed to demonstrate that too many foster kids are being placed in group homes for too long.This appears to be an issue on which there is agreement from both sides of the aisle, uniting liberal sensitivities against “restrictive settings” with conservative desires to save money.

As a former foster care social worker in the District of Columbia, I found that the hearing failed to draw some crucial distinctions. First, residential care is not a placement but an intervention. Nobody believes that young people should be placed in institutions instead of in families. However, some young people need more intensive treatment before they can thrive in a family foster home. Without such treatment, these children often bounce from home to home until they end up pregnant or in the juvenile justice system.

One of my young clients – I’ll call him Quentin for the sake of anonymity – was in a truck which his mother repeatedly drove over her abusive husband, killing him. Quentin went through a series of foster homes, being kicked out of each one until he was finally arrested for car theft at the age of 14 and placed in a juvenile justice facility.

Upon release, he was placed in one of his previous foster homes, and that lasted just three months. Quentin had been skipping school, stealing his foster parent’s liquor and belongings, and smoking marijuana in the home. A psychological evaluation recommended a therapeutic group home to provide the structure and supervision Quentin needed.

But D.C.’s child welfare agency refused to provide a group home placement. We placed Quentin with the only foster parent available: a single parent who treated him as a boarder. He almost totally stopped attending school and was failing by the time I left my job last January.

The hearing also failed to distinguish between high-quality and lower-quality group homes. Credible research shows that smaller, well-run group homes can be more effective than therapeutic foster care in improving outcomes for foster youth with therapeutic needs. Boys Town Family Homes, for example, are run by married couples (“Teaching Parents”) who live full time in the home and care for six to eight boys.

I visited a Boys Town Home in D.C. that was sunlit and immaculate, with a wall covered with photos of former residents. The “Teaching Parents” had raised their own children in the home and their two-year-old was currently basking in the attention of all his “big brothers.”

My experience was in the District of Columbia, where less than nine percent of foster children are in group homes, as compared to 18 percent of foster children nationwide. If the federal government imposes further restrictions on group homes, other states will be in the same position as the District, where children are being placed in inappropriate family settings. We risk ending up like Australia, which eliminated over half of its residential placements, resulting in the migration of many children to the homeless and juvenile justice systems and a foster care crisis due to the loss of foster parents.

This month’s hearing also failed to differentiate between good and bad foster homes, with witnesses insisting that a family is always better than an institution. Senator Grassley said that children need to be in families so that someone will tuck them in at night. He never met “Ms. V,” a long-time foster parent who worked from 3 pm to 11 pm. She certainly was not available for tucking in “Renee,” a 14-year-old who was severely damaged by 10 years in foster care and repeated rejections by foster and potential adoptive parents.

Ms. V was supposedly a “therapeutic” foster parent and received extra training and compensation in exchange for caring for more troubled young people. But most of the “therapeutic” parents with whom I worked were no different from other foster parents. They provided nothing more than room and board, and had no contact with kids’ schools, therapists, or families. Ms. V refused to attend a meeting at school for Renee, who was failing, telling me, “I would if I cared but I don’t care.”

I am not advocating for group homes as a replacement for inadequate foster homes. But some young people need residential care as a short-term intervention. And for foster youth who can be placed with a family, we need to find loving, caring foster parents who can meet their therapeutic needs. This may require increasing compensation and training for foster parents dealing with older and more troubled youth. The Administrationhas indicated its support for this approach, and I plan to discuss possible program models in a future post.

This column first appeared in the Chronicle of Social Change on May 27, 2015.

Great Foster Parents I Have Known

In honor of Foster Care Month, I'd like to share the stories of some of the great foster parents I knew in my five years as a social worker in the District of Columbia foster care system.

Mr. and Mrs. C had grown children and grandchildren but lots of energy and love to spare. They took in three-month-old baby S when his mother abandoned him in a bout of rage. Mrs. C was retired and stayed home full-time with the baby, playing with him, talking to him, and loving him. Ms. C. brought S to every well-baby appointment even though some foster parents left this to social workers or other agency staff. When they brought S to visit his mother at the agency, Ms. C thanked her for letting them take care of S until she would be able to take him back. (Sadly, S's mother did not get him back, but he did end up going to his father.)

Ms. T was a single parent of a boy but wanted at least one girl in the household. She took in two sisters after the younger one was abused by her previous foster parent. Ms. T worked from home one day a week, allowing her to take the girls to medical appointments or see their teachers. Every weekend, she drove the children to visit their mother and picked them up at the end of the weekend. After the girls were reunified with their mother, Ms. T would often take them for the weekend at their request or their mother's. She continued to give them gifts and sometimes money when requested. Ms. T has now adopted a second set of girls whom she fostered.

Mr. and Mrs. F took in a ten-year-old girl and her four-year-old brother. Ms. F. worked part-time so that she could spend most of her time being a foster parent. She drove the children daily to their previous school so that they did not have to put up with a long van ride. When the older child was in fifth grade, the F's researched and visited charter schools in order to find a more challenging placement. They were able to get her into one of the most highly thought-of charter schools in the District .

Two siblings, K and M, were placed together in the home of a couple, but they soon expelled K due to her disrespectful behavior. Luckily, K ended up in the home of Ms. W, who saw the wounded child behind the defiance and let her know that there was nothing she could do to get herself kicked out. K's behavior improved in response. Ms. W was so anxious for K and M to see each other that she hosted sleepovers as often as M's foster parent would allow, picking M up and dropping him off. She also picked up their mother from her nursing home so that they could see her as well.

These great foster parents shared two important things—motivation and time. They all became foster parents because they wanted children in their lives and to make a difference in the lives of children. Secondly, they all had the time to devote to their foster children. Two of these foster families consisted of two-parent families in which one parent worked part-time or not at all. The two single mothers worked, but both had jobs with flexibility that allowed them to do things for their children on weekdays.

In five years of work in DC's foster care system, families like the C's, the F's, Ms. T. and Ms. W have been a minority of foster parents I've met, particularly among the foster parents caring for older, more troubled youth. I wrote in an earlier post and column for Youth Today about some foster parents who are providing nothing but room and board—if that. How can we attract more foster parents like the C's, the F's, Ms. T. and Ms. W? If we paid foster parents a salary, this would open up a new supply of potential foster parents—people who want to have a career helping our most vulnerable youth. This would of course increase costs greatly unless we asked foster parents to take more children. Until recently, one private agency in the District of Columbia contractepaid foster parents as employees to care for four children each. Such a model might merit a closer look. Or we might even want to redefine foster care to include agency-owned homes for 6-8 children such as those provided by Boys Town. These are considered group homes, but they actually have a greater resemblance to foster homes—operated by loving, dedicated married couples who have the time to provide the parenting their charges need.

Foster Parent Licensing for Relatives:An Unnecessary Barrier to Permanency

One of my happiest days as social worker in the District of Columbia's foster care system was the day I was able to place an 18-year-old client with her older brother under the District's emergency kinship licensing process, which allows a foster child to be placed with kin through an expedited “emergency licensing” process. My client's brother now had six months (which could be extended to nine) to obtain his permanent foster parent license. During that time, he had to complete extensive paperwork and take a 30-hour foster parent training class –meaning six hours per week for five weeks. And this turned out to be a big obstacle. The class he was offered was from 6:00 to 9:00 at night. My client's brother could not make it at that time because he was often needed to pick up his own two children from school and supervise them until their mother came home from work. As I frantically searched for a foster parent class, I began to wonder why he needed 30 hours of training in order to care for his 18-year-old sister.

This was not the first case where foster parent training requirements posed a barrier to placing clients with family. In another case, a ten-year-old who had been mostly brought up by grandparents in Tennessee was unable to be returned to them because they were unwilling to undergo 30 hours of training. Of course one might question their commitment to the children if they were unwilling to take the time to attend training, but the fact remains that they brought her up for most of her life and she wanted to be with them.

I had another client, aged 14, who had been in and out of the foster care system for ten years. He had been ejected from one foster home and was in another where he got no attention or emotional support. His older half-sister, with whom he was very close, was willing to take him. But her application was denied because she lived in Maryland, and Maryland required that their be a separate bedroom for my client. He was not allowed to sleep on a sofabed in the living room and I was told that the license would not be granted even if he slept in the bedroom and his sister slept on the sofabed. In this case, if the sister had lived in the District, the license could have been granted. She was willing to seek out a bigger apartment but was locked into her lease for 18 months. So my client remained in his grim, neglectful foster home.

Situations like those described above would not occur in all states. The District of Columbia and 19 states require relative caregivers to become licensed as foster parents, according to the Child Welfare Information Gateway. The other states do not require relative caregivers to be licensed, although they may have to meet similar standards, as in California.

The District and other states that require licensing for relative caregivers should consider eliminating licensing for relatives or establishing a more liberal set of requirements for relatives. There should be some standards, whether for a license or for a parallel process as in California. Relatives need to have their criminal and child abuse records checked and need to be assessed for their ability to care for a child. Their residences need to be assessed for safety. But additional requirements that are not necessary for health, safety and good care should be eliminated for relative caregivers.

All over the nation, there is a big push to keep children out of foster care with strangers and place them with relatives. This policy stems from the knowledge that it is best for children to be with family and also from the increasing shortage of qualified foster parents. Unnecessary requirements should not interfere with the interest of the state in placing children with their families.

This column was published at youthtoday.com on May 4, 2015.

Many Barriers to Providing "Normal" Activities for Foster Children

One of the most frustrating things about working as a social worker in the District of Columbia's foster care system was being unable to ensure that my clients were able to do the normal things that other young people get to do—like visiting friends and participating in extracurricular activities. When a foster parent asked if a child could visit a friend, I had to say this was not allowed unless all the adults in the friend's family took time off from work to get fingerprinted, paid for the fingerprints, and filled out a long child abuse clearance form. The whole process cost them up to $60 (depending on where they lived) and it would be at least a month before the clearances were approved.

More frustration ensued when foster children wanted to participate in extracurricular activities. Federal law requires that children in foster care be kept in the same school when they are placed in foster care or change foster homes, except if it is not in their best interests. As a result, many of my clients were not attending local schools and had to use private transportation services. This made it hard for my clients to engage in extracurricular activities because these providers usually require that the child be picked up at the same time every day and drivers are often not available for pickups that occur after school dismissal time.

Another problem was the refusal of many foster parents to transport their foster children to and from friends, activities and games. Most of my clients, like more than half of DC foster care youth, live in the Maryland suburbs, since there are not enough foster homes in the District of Columbia. While suburban parents know that transporting children to activities is part of their job, the same is not often true of foster parents, especially when the child attends school in the District or across the county. The foster parent of one of my clients had never been to her school the year that the child lived with her. My client was never able to participate in an evening performance or go to a school dance because her foster parent would not bring her. And of course, even if another parent had offered to bring her, that would not have been allowed unless that parent received police and child abuse clearances.

A new movement over the past two years has called for “normalcy” for foster children. Basically, the concept means that foster children should be able to engage in the same normal activities as their peers. Following the lead of several states, Congress recently passed a law that requires states to develop a standard for what is reasonable and prudent in allowing foster care children to engage in “extracurricular, enrichment, cultural and social activities.”

As a former foster care social worker, I wholly support the effort to bring normalcy to foster children. Being in foster care is abnormal enough. Denying foster youth the activities that will help them build relationships and skills and relieve stress is truly adding insult to injury. Unfortunately, implementing the law is less simple than it appears to people who are unfamiliar with the nuts and bolts of foster care.

In order to make sure that children in foster care can have normal social lives, states will have to address the valid concern about who is liable in the unlikely event that a foster child is exposed to some type of maltreatment at a friend's home. Florida's normalcy law, which was the model for the new federal law, provides that a foster parent is not liable for harm caused to a foster child during an activity deemed reasonable in accordance with the “reasonable and prudent” standard. Without such a provision, many foster parents will not be willing to allow visits and sleepovers.

In terms of extracurricular activities, the fix is more difficult. More emphasis may have to be placed on keeping a child in the same school district when he or she moves to a different foster home. Children's attorneys who have aggressively pushed for their clients to stay in the same school may have to consider whether this is truly in the child's best interest when it prevents them from participating in extracurricular activities. States and local jurisdictions have to be willing to say goodbye to foster parents who are not willing to inconvenience themselves to enrich the lives of their charges.  

This column was published in Youth Today on April 22, 2014

A Tale of Two Families

Last week, the nation was once again focused on a Montgomery County, Maryland story that first came to national attention on December 20 of last year when a ten-year-old boy and six-year-old girl were picked up by police while walking home by themselves from a playground about a mile from their home. The police contacted Montgomery County Child Protective Services (CPS), which interviewed the children at school, visited the family at home, and threatened the children would be removed unless the parents signed a “safety plan” promising that they would not be left alone until the case was resolved.

The children's parents explained that they believed in “free range parenting,” allowing their children to take gradual steps toward independence consistent with their age and ability. Eventually, CPS took the middle route between substantiating the neglect and ruling it out, making a finding that left open the possibility that neglect took place. But on April 12, the children were once again in the clutches of CPS when police picked them up in a park and brought them to CPS headquarters after a dog walker called 911. They were not reunited with their parents for five-and-a-half hours (without any food), and their parents did not know where they were for the first three hours. The family is reportedly planning to sue CPS.

The extreme attention paid to the Meitiv family stands in ironic contrast to another story that transfixed the Washington area last year. On March 19, 2014, police began searching for eight-year-old Relisha Rudd, who had lived with her family at the District's large family homeless shelter. Relisha had not been at school since February 26 but no report had been made because her family had lied to the school about her absence, stating that she was sick and under care by a “Dr. Tatum.” Tatum turned out to be a janitor at the shelter. His wife's body was found on March 20 with a bullet in the head; he was found dead of an apparently self-inflicted gunshot wound on March 31. Relisha has never been found.

An investigation by the Washington Post found that DC's Child and Family Services Agency (CFSA) had sustained three complaints of abuse or neglect involving this family. The last complaint was only two to three months before Relisha disappeared. Due to the family's right to confidentiality, the agency has declined to release any details about the conclusions of their investigation, whether any type of monitoring or services were provided or whether the family had an open case when Relisha disappeared.

The juxtaposition of these two episodes illustrates the fundamental conflict in child welfare between doing too little and doing too much. In one case, children who were being allowed to develop independent living skills in a safe and loving home were traumatized by Child Protective Services. In another case, child in a family that was clearly struggling, whose brother was found to be abused not three months earlier, was allowed to disappear from a government-funded homeless shelter with no action taken until she was gone for three weeks.

What can be done to prevent more children to be unnecessarily traumatized or fall through the cracks? Somehow, we need to inject a little bit of common sense into child welfare practice. The Washington Post reported that there were many signs that all was not well in Relisha's family, in addition to the three prior reports of abuse or neglect. School staff “described her arriving with filthy clothes, dirty hair and an empty stomach, and they said she often didn't want to leave.” On the other hand, the Meitiv children seem to display the independent spirit and self-confidence that comes from a loving home. Social workers and police need to be trained and allowed to distinguish the children who need help and those for whom their intervention will only a source of trauma.

More Information Needed on CFSA's Handling of Relisha Rudd Case

A recent flurry of articles and media reports commemorated the one-year anniversary of the disappearance of Relisha Rudd from the homeless shelter at DC General Hospital. However, many questions remain about Relisha and her family's contacts with the Child and Family Services Agency (CFSA), the agency responsible for protecting abused and neglected children in the District of Columbia. Despite some very interesting information published by the Washington Post almost a year ago, nobody has answered directly the question of whether the family was under agency supervision when Relisha disappeared. The agency seems to be hiding behind the smokescreen of confidentiality, but that should not prevent the City Council from demanding the full answers in closed session.

In an article published last April 5, the Washington Post reported that “confidential files read to The Washington Post show that the agency sustained complaints at least three times involving Young [Relisha's mother]'s children.” The last complaint occurred in November 2013, when the family was in the shelter. This was only a few months before Relisha disappeared. One of Relisha's brothers had been thrown to the ground and slapped until his lip bled, according to the report read to the Post. A social worker noted lack of supervision and abuse.The Post goes on to report that the police got involved and received conflicting accounts about who hit the boy, and no charges were filed. But the the story did not note that there is an important distinction between the police filing charges and CFSA substantiating the allegation, which is the trigger that is needed for the children to be removed or for the family to receive agency supervision.

The Post stated that the children remained with their mother, and that “only after Relisha went missing were her three brothers placed in foster care.” But as CFSA Director Brenda Donald pointed out in a letter to the Post, “The fact that CFSA does not remove a child as a result of a substantiated abuse or neglect allegation does not mean that we do not provide any services.” That quote confirms something that was unclear from the Post's language that “the agency sustained complaints.” It seems clear that the agency substantiated (or confirmed) one or all of the neglect allegations against the family. And with the above statement, Ms. Donald is strongly suggested that the agency did provide services to Relisha's family.

Unfortunately, the Washington Post reporters did not follow up by asking the right question. Given that the an allegation was substantiated but the children were not removed from the home, they should have asked if a case was opened on the family. Opening a case is the only vehicle for the agency to deliver services, as well as continue monitoring the family. Ms. Donald's response suggests strongly that a case was opened. The fact that there was an open case is further supported by the heavily redacted version of the District Government's Review of Interactions With RR and Her Immediate Family and District Government Agencies, published on September 2, 2014, and available on the internet.¹ That report states that

The family was receiving services from multiple social service, ______, education and health agencies and community providers. At the time of RR's disappearance, ___ 's [presumably Relisha's parents'] compliance with ____ and other services was inconsistent; however, the known family circumstances did not satisfy the legal threshhold for removal of the children.

It is very likely that the first and third blank originally read “child welfare” and that the family was a subject of an open case. My conclusion is based on logic as well as on the two recommendations that the District drew from this redacted statement. The second recommendation, in particular, states that CFSA and the Office of Attorney General should establish a policy dictating “when it is appropriate to involve the DC Superior Court in providing judicial oversight on in-home child welfare services when a family is not making adequate progress despite the offer of services.” Usually, when CFSA does not remove a child but opens an in-home case, it does not involve the court, but there has been discussion of the need to involve the court more often in such cases. Therefore, from this recommendation, it seems obvious that a case was opened but the family was not responsive.

So given what we know, it is highly plausible that CFSA opened a case on Relisha's family, probably after the November 2014 allegation was substantiated. If that was true, then the CFSA social worker would have had to say that the the problems had been resolved and the children was safe in order to justify closing the case. Thus, a critical question is whether the case was still open when Relisha disappeared, or whether it had been closed. And here the redacted document provides some hints as well. The report states that: "At the time of RR's disappearance, both _________ [probably CFSA and the Department of Mental Health] were providing services to the family; however, there was no recent assesssment of RR's parents' capacity or of the family's overall functioning.”

Based on that statement, it is reasonable to assume that a case was still open on the family. That means a social worker should have been visiting the family twice a month. That worker should have been checking on Relisha's school attendance and and the parents' compliance with whatever services the agency was requiring in order to close the case, which probably included mental health services. Most importantly, the worker should have been seeing Relisha at least twice a month. Police began to search for Relisha on March 19 and found that she had been with Tatum since February 26, but nobody had reported her missing. What was the social worker responsible for the case doing all this time? (If the family did not have an open case, then the question becomes why not, given that the social worker reported lack of supervision and abuse.)

It is crucial to know exactly what happened so that more disasters can be avoided. In its recommendations, CFSA stresses the adoption of new assessment tools for children and families, a standardized safety plan, and training for workers on “effective visitation.” I'm skeptical of these kinds of quick fixes, which are often an attempt to avoid hiring more social workers and giving them enough time with their clients. If social workers are overwhelmed by too many cases and required busywork, then they simply cannot assess for safety correctly, no matter how many “tools” and “plans” they are forced to complete,. Indeed, such tools may worsen the situation as the time needed to fill them out can come at the expense of critically needed time with the family.

Some information about the quality of CFSA's in-home casework is provided by the most recent report of the Center for the Study of Social Policy (CSSP), the court-appointed monitor for CFSA.² In its report, CSSP reported on a detailed review of 20 in-home cases between January and June 2014. Of these 20 cases, only five (or 25%) were rated as “acceptable” on “Implementing Supports and Services.”

I filed a Freedom of Information Act (FOIA) Request requesting information about how CFSA is dealing with families with substantiated abuse or neglect allegations where the child is not removed. In FY2014, CFSA's Acting Director testified that 877 allegations of abuse or neglect were substantiated. I asked how many of those allegations resulted in removals of one or more children and how many resulted in the opening of an in-home case. I also asked what happened to those in-home cases. How many eventually resulted in a removal? How many closed? Of those that closed, how long were they open? CFSA denied my request because FOIA “does not require an agency to create documents that do not exist and ...does not require an agency to answer questions.” The fact that CFSA does not even collect this data, or at least report it in this form, is very troubling.

The City Council should request the systemwide information that was denied to me. The Council should also demand the following information about Relisha's case:.

1. A list of all the reports that were filed about Relisha Rudd's family over the years.
2. A list of all allegations that were substantiated.
3. When was the most recent case opened?. Was it closed? If not, what services were being provided?
4. When was Relisha most recently seen on a visit to her family? According to agency files, did the worker ask about Relisha's whereabouts and what was he or she told?

CFSA has been touting the success of its initiative to “narrow the front door” or take fewer children into foster care. The acting director reported proudly in his recent testimony to the council that 62% of the children it serves are at home, as compared to only 51% at the end of FY 2010. That is good news indeed, as long as the children who are at home are receiving the monitoring and services that they need to be safe. And Relisha certainly was not.

Notes

1. Office of the Deputy Mayor for Education. Office of the Deputy Mayor for Health and Human Services. Summarized Findings and Recommendations: Review of Interactions with RR and Her Immediate Family and District Government Agencies. September 2, 2014. Accessed March 4, 2015 from http://dme.dc.gov/sites/default/files/dc/sites/dme/publication/attachments/RR%20Report%20FINAL%209%202%2014_Redacted.pdf
2. Center for the Study of Social Policy. LaShawn vs. Gray Progress Report for the Period January 1 to June 30, 2014, page 84. Accessed March 26, 2015 from http://www.cssp.org/publications/child-welfare/class-action-reform/2014/LaShawn-A-v.-Gray-Progress-Report-Jan-June-2014.pdf

If not Trauma Systems Therapy, then What?

In my last post, I questioned the DC Child and Family Services Agency (CFSA)'s selection of Trauma Systems therapy (TST) as a means for implementing trauma-informed practice in child welfare. I stated that this model was more appropriate for a mental health agency than for a child welfare agency as the practices it prescribes are more appropriate for therapists than for child welfare social workers. Today, I'll discuss how I would incorporate the new information about trauma into child welfare practice.

First, what is this new information about trauma? In the last few years, brain researchers have learned that trauma has long-lasting effects on the brain. In a threatening situation, the lower-level systems of the brain, led by the amygdyla, function to ensure that we survive by fighting, fleeing, or freezing. The problem is that in a child who has been repeatedly traumatized, these systems become engaged when there is no real danger. When confronted with something that reminds them of a traumatic experience, even though no danger is present, traumatized children respond by becoming emotionally or behaviorally dysregulated.¹

Trauma systems therapy, as described by its developers, is an intervention that tries to help children and their families regulate their emotions, as well as to try to decrease traumatic reminders in the social environment.² The major components of the intervention involve sessions between the therapist and the child and family. The nature and quantity of these sessions change according to the phase of treatment, but it starts out at two to three sessions per week. That is why I deem this an inappropriate modality for child welfare social workers, who are case managers, not therapists, and are already overworked.

OK, so if Trauma Systems Therapy is inappropriate for the child welfare system, then what if anything needs to change to incorporate new knowledge about trauma into child welfare practice? Clearly, some important things need to be done, if they have not been done already.

First, social workers and foster parents need to be trained in the effects of trauma on children's emotions and behavior. Social workers had already received trauma training before the adoption of TST and it was incorporated into the TST training as well. Foster parents were also trained as part of the TST roll-out. From now on, training in trauma and its effects and available treatments should be incorporated into the pre-service and in-service training received by social workers and foster parents.

Secondly, CFSA's clients are now being routinely assessed for trauma when they enter care. Any child who has been found to have experience trauma needs to be referred for trauma-informed mental health treatment. Luckily, the Department of Mental Health (DMH) has already adopted several evidence-based (unlike TST) methods of therapy, including Trauma Focused Cognitive Behavioral Therapy, for clients who have undergone trauma. Unfortunately, due to poor pay and working conditions, many DMH therapists are not well qualified to administer such therapies and those who are often leave their jobs to go into private practice or work for better pay and conditions. Because of this, CFSA and private foster care agencies already contract with private providers such as JMD Counseling and the Capital Region Children's Center. I believe that these providers also incorporate trauma into their practice.

Perhaps most important, treatment cannot be confined to the time that the client spends with the therapist. In TST, the caregiver is a crucial part of the treatment and this is true in any model of trauma-informed care, or any effective therapy. For example, in TST, the caregivers learn how to help the child manage emotions and also how to decrease traumatic reminders in the home environment. Compare this to most of CFSA's foster homes, including most of its “therapeutic foster homes,” where the foster parent never meets or talks to the therapist or attends treatment planning meetings. At a minimum, foster parents of all children who have problems of emotional or behavioral dysregulation need to work together with the therapist and the entire treatment team. Ideally, all of these children would be in truly therapeutic homes, where there would be at least weekly communication between the foster parent and the social worker and the foster parent would be responsible for carrying out the treatment plan.

CFSA's investment in Trauma Systems therapy was not a total waste. Social workers and foster parents were trained in trauma and its effect on emotions and behavior. A trauma assessment has been developed and implemented. But CFSA needs to recognize that its social workers are not therapists and should not be duplicating the work of therapists. And most importantly, CFSA needs to recognize that it is impossible for a system to become “trauma-informed” when many children are being cared for by foster parents who do not participate in their treatment. There is no shortcut or substitute for truly therapeutic foster homes.

Notes

1. See Glenn N. Saxe, B. Heidi Ellis, and Julie B. Kaplow, Collaborative Treatment of Traumatized Children and Teens. New York: The Guilford Press, 2007,
2. See Saxe, Ellis, and Kaplow.