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. 

Trauma Systems Therapy: Good Idea, Wrong Model, Poor Implementation

New information about trauma and its effect on the brain has led the federal government and child welfare systems around the country to launch initiatives aimed at incorporating this knowledge into child welfare practice. In 2012, the District of Columbia won a $3.2 million five-year grant from the federal government to “make trauma-informed treatment the foundation of serving children and youth in the District's child welfare system.”1  This is a worthy goal. However, there are reasons for concern about the model chosen and the way the model was implemented.

The Child and Family Services Agency (CFSA) selected the Trauma Systems Therapy (TST) model, which it describes on its website as “an evidence-based approach shown to dramatically speed and improve healing of child victims of abuse and neglect without relying on medication, hospitalization or prolonged counseling.2 Unfortunately, this glowing account seems somewhat exaggerated. The California Evidence-based Clearinghouse on Child Welfare, the only clearinghouse of evidence-based practices in child welfare, reviewed TST but found that it “lacks the necessary research evidence to be given a scientific rating” as to whether it is supported by research or even promising.3

The lack of strong research evidence to support TST does not mean it is not a good choice as a model for CFSA; it simply raises the questions of whether the agency examined the research evidence before adopting TST and whether the agency was aware that it placed misleading language on its website. More concerning to anyone who has looked at this model is whether it is an appropriate choice for a child welfare agency.  

TST is a model of treatment for traumatized children and their families that was developed by Glenn Saxe and his team at Boston University Hospital and described in their 338-page manual, which CFSA bought and distributed to all of its social workers.4 Starting from page one, the manual makes clear that it is intended for mental health workers, stating, “If you are like most mental health clinicians in the United States, you work out of your office or a mental health clinic.” Later in the book, when the treatment is actually described, it becomes clear that true to its name, TST is a type of therapy, in which the clinician must see the family and the child at least weekly, and more like several times per week when the treatment starts.

TST is not appropriate for child welfare social workers because child welfare social workers are not therapists, are not trained to be therapists, and do not have the time to be therapists. No child welfare social worker has the time to spend about an hour with our clients at least once a week. Child welfare social workers are case managers. They have their hands full monitoring the children's well-being, making sure they get needed medical appointments, helping their parents secure the services they need to get their children back, preparing court reports and reams of required documentation, responding to crises, and dealing with constant audits, and more.  It is hard enough for social workers to squeeze in their required two visits a month, let alone see their clients four times a month as any serious therapist must do. Our clients need real therapists, as well as foster parents or birth parents (depending on where the child lives) who will work with the therapists and make their homes a healing environment for the children. Most of our clients receive their therapy from providers working with the Department of Mental Health, which has adopted several trauma-based therapeutic modalities.

So why did CFSA adopt TST? One reason may be that CFSA was already working with the Kansas-based consulting firm KVC, which has bought into TST bigtime. KVC has a long and tangled relationship with CFSA. KVC's Executive Vice President has also been CFSA's Deputy Director. Actually, she appears to have held both positions at the same time as a “shared executive” under a contract between CFSA and KVC.5  According to KVC's own website, their official's contractual position at CFSA "led to an additional contract for implementation of Trauma Systems Therapy (TST), a significant element of KVC's model.”6 The fact that a KVC employee used her contractual position at CFSA to promote another contract with her employer raises some concern about conflict of interest—and about whether CFSA made the best choice in adopting TST.

Even if we put aside all concerns about whether TST was an appropriate model for CFSA, the way it was implemented raises many questions. An extensive and elaborate training regimen began in May of 2013. All case-carrying social workers and supervisors were expected to read the manual and then participate in four 90-minute “webinars.” After completing the webinars, staff were required to participate in two full days of in-person training. After completing the training, staff were expected to observe or participate in twelve one-hour calls, called Trauma Team Meetings, in which they would learn to apply TST principles and tools to specific cases. Five cohorts of staff underwent this process, starting in May 2013 and finishing up in the summer of 2014. But staff had still not been told to use any of the forms or tools, which were still being modified for CFSA use.

A new set of trainings was rolled out in the fall of 2014. In October 2014, social workers, supervisors, and others were required to participate in a two-hour training which focused on a new trauma assessment tool that would be rolled out in December. In December 2014, all caseworkers and social workers were required to participate in an additional two-hour training. In this training, staff were presented with a new version of four different TST tools, which had been modified since we had received the earlier versions. But we were still not told to start using them. Moreover, we were told that it had been decided that not all clients would receive TST. According an email from  CFSA's Trauma Grant Specialist, CFSA began implementing its trauma assessment for new entries on December 1, 2014. That practice will be expanded to all youth in care starting on April 1. And by early summer, “trauma-informed practice will be fully implemented into case management and decision making.” I am intrigued by the fact that  “TST” was not mentioned in this email.

So over two years into the five-year grant period, and almost two years after the first cohort began its training, implementation of the TST model has barely begun. Moreover, it is not clear that the “trauma informed practice” that will be implemented will have much to do with the model in which we were trained. There is nothing wrong with taking two years to develop a trauma informed practice model that works for the child welfare system in the District of Columbia. But in that case, the District should not have started by training its staff in a model that had not yet been adapted for their use.

I have raised two sets of questions in this post. The first focuses on whether TST was an appropriate method to incorporate new information about trauma into child welfare practice. The second set of questions focuses on the implementation of TST. More than two years into the five-year-grant period,  staff have spent many hours in training. But aside from the new assessment, no changes to current practice have yet been incorporated. It remains to be seen whether CFSA's version of Trauma Systems Therapy bears much resemblance to the model that it originally adopted—and whether it will be the last straw for already-overwhelmed social workers.

1. See http://cfsa.dc.gov/page/trauma-informed-practice
2. http://cfsa.dc.gov/node/892012
3. See http://www.cebc4cw.org/program/trauma-systems-therapy-tst/
4. Saxe, Glenn N., Ellis, B. Heidi, Kaplow, Julie B., Collaborative Treatment of Traumatized Children and Teens. New York: The Guilford Press, 2007.
5. See http://www.kvc.org/services/consulting/
6. See http://www.kvc.org/services/consulting/

More Group Homes Needed for More Troubled Youths

In my last blog post, I suggested that the District needs to get rid of its poorly performing foster homes and that it should consider placing some of its older and more troubled teens in family-style group homes instead of foster homes. Many people will respond negatively to this suggestion. The prevailing wisdom today is that foster homes are better than group homes for almost all children. However, this common wisdom is based on a misinterpretation of available research, which is quite limited.

While it is commonly argued that evidence shows foster care to have better outcomes than group care, this conclusion is based on a few studies comparing group homes with a specialized model of foster care called Multidimensional Treatment Foster Care (MTFC). In the foster homes studied, parents were expected to implement an individualized behavior management system to reinforce clients’ strengths and provide consequences for problem behaviors. Foster parents were supervised during weekly group meetings and daily telephone calls. School performance was monitored daily with a daily school card signed by the teachers. Clients participated in therapy weekly with therapists who were employed by the program and had training and supervision in the same behavioral techniques used by the foster parents. Children’s behavior was tracked daily and used to adjust treatment in the foster home..1 The District of Columbia does not have MTFC or any other similarly intense Treatment Foster Care model. The District has two types of foster care, “traditional” and “therapeutic.” “Therapeutic foster care,” designed to serve more difficult clients, provides a higher reimbursement rate to foster parents but does not require anything of beyond additional training. The therapeutic homes that I have seen in my five years of practice are indistinguishable from traditional homes except in the nature of the children. Many of the non-nurturing foster homes that I described in my last post are so-called “therapeutic foster homes.”

Even the conclusion that MTFC is more effective than group care is open to question. Dr. Bethany Lee of the University of Maryland School of Social Work is one of the nation's leading experts on group care. She points out that there are several methodological problems with the existing comparative studies between group care and foster care, including poor response rates, small sample sizes, and the lumping together of different types of group homes. In her own study, she and her co-author, Dr. Ronald Thompson, attempted to minimize these limitations. Comparing youth who received treatment foster care through BoysTown 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.2

It is important to note that Boys Town group homes differ from the traditional group home, which is staffed by shift workers. In the Boys Town Family Home Program, six to eight boys or girls live with a married couple in a single-family home. The home functions like a family, where every child attends school, participates in extracurricular activities, and take part in daily chores and family activities. This type of family-style group home looks more like a foster home than like a shift-style group home, as I learned when I visited a Boys Town group home in Washington, DC. The “Teaching Parents” who run the home with the help of two Assistant Teaching Parents who work in the afternoon and evening, have a wall full of pictures of young men who have graduated from the home and who often come back for visits. All of their children have grown up in the home, which is bright, sparkling and immaculate—especially compared to some of the dark, dingy foster homes where some of our children are placed. Based on extensive research documenting positive impacts, the Family Home Model was found to be a promising practice in an exhaustive review of the research  by the California Evidence-based Clearinghouse for Child Welfare (www.cebc4cw.org/).

As Boys Town researchers point out in an excellent publication available on their website, “Many organizations like Boys Town acknowledge and agree that at-risk youth should be served in their own homes or in foster care whenever possible, and have already made a shift to that approach....But even with that shift, we still known that these less-restrictive approaches cannot meet the needs of all youth, particularly those with serious behavioral and emotional problems.” Anyone who has worked with these youth, as I have, and seen them expelled from home after home, knows how true that statement is. It is not without cost to let children bounce from home to home. Placement disruptions cause trauma, may require a change of school, and lead to further emotional and behavioral problems. Eventually these youth may end up in a residential treatment center or in the criminal justice system--or even homeless. (See www.boystown.org/quality-care for more information about the reasons why group care is the best option for some youth.)

Incredibly, Boys Town operates only one Family Home under contract with CFSA. The other three homes on Boys Town's DC campus serve clients of the Department of Youth Rehabilitation Services (DYRS). CFSA reported to the DC Council on February that only 4% of its youth, or 42 in total, are in a group care setting. This compares to 57 in 2013, and more in prior years. CFSA terminated two group home contracts last year. Of course every child should be in the least restrictive setting capable of meeting his/her needs, but I think CFSA and other agencies around the country are hurting children by denying them the higher level of care that they need. And I can't help feeling that saving money is part of the motivation behind this misguided policy.

Yes, quality residential care costs money. But not providing the level of services needed by our most troubled youth costs even more. A study published in 2008 found that saving a 14-year-old high risk juvenile from a life of crime will save taxpayers between $2.6 and $5.3 million in costs due to crime, drug abuse, and lost productivity.

What about treatment foster care programs like MTFC? Some advocates might argue for investing in that approach rather than in group homes. I think that some of the children who are now struggling in so-called therapeutic foster homes could benefit from true therapeutic or treatment foster care, which provides the same type of  structure and supervision that is provided by Boys Town group homes. However, it is not reasonable to expect that many of our current foster parents, most of whom work full-time, would be able to take on this demanding job, or that many new foster parents could be recruited. Although there is no national data on the number of children in intensive treatment foster care programs such is MTFC, most programs seem to be small. One of the best-known programs is operated by Anu Family Services in Wisconsin and Minnesota. Anu states on its website that it received 800 referrals last year and were able to find homes for less than 60 children. Probably the only way to expand treatment foster care to all the children who need it would be to pay the foster parents for full-time work. That would make treatment foster care more expensive than family-style group care, since we would be paying people full-time to care for only one or two children. In my view, a family-style group home such as those operated by Boys Town provides all the benefits of treatment foster care in a more efficient manner. And it is more amenable to expansion since being a Teaching Parent is a full-time job that appeals to people who love and care about children but want to do it as a full-time job.

Notes

1. Chamberlain, Patricia and Reid, John, Comparison of Two Community Alternatives to Incarceration for Chronic Juvenile Offenders. Journal of Consulting and Clinical Psychology 1998. Vol. 66, NO. 4, 624-633.

2. Lee, Bethany R. and Thompson, Ron, Comparing Outcomes for Youth in Treatment Foster Care and Family-Style Group Care. Child Youth Services Review, 2008: 30(7): 746-757.

3. Thompson, Ronald, Huefner, Johnathan, Daly, Daniel, and Davis, Jerry, Why Quality Residential Care is Good for America’s At-Risk Kids: A Boys Town Initiative, available from http://www.boystown.org/documents/quality-care/why-quality-care.pdf.

4. Cohen, Mark A. and Piquero, Alex R, New Evidence on the Monetary Value of Saving a High Risk Youth. Journal of Quantitative Criminology (2009) 25: 25-49.

Some Foster Homes Must Be Closed

DC's Child and Family Services Agency (CFSA) has recently been touting its new emphasis on the well- being of the children under its care. Interim Director Davidson boasted in his testimony before the DC Council on February 18, 2005, that the District continues “to increase emphasis on the well-being of those we serve.” As evidence, he cites the fact that 96% of children in the system got a health screening before entering foster care and that 85% of children ages 0 to 5 got a developmental screening upon entering care. This is a strange and limited concept of well-being. Unfortunately, this system which claims to focus on well-being has shown a remarkable lack of interest at the quality of parenting that the District provides to its wards.

Some of the most selfless and heroic people I have ever met are foster parents. These foster parents treat children as their own. They take them to the therapist weekly and to all medical appointments. They attend back to school night and parent conferences at school. They see themselves as part of the child's treatment team and they would not dream of having someone else take the child to the therapist or psychiatrist. They get to know the children's birth parents and often take the children to visit them. Perhaps most importantly, they understand the traumas that their foster children have experienced and that their difficult behaviors are a response to these traumas. Therefore, they respond to these behaviors appropriately without condemning or rejecting the child.

Unfortunately there are too many foster parents who, far from treating children as their own, refuse to visit their foster children's schools, pick them up when they are sick, or take them on to the doctor or therapist. They refuse to meet the birth parents or bring the children to visit them. Just to give you some examples, one foster parent I worked with had never (in a whole year) been to the school of one of her foster children for a meeting, back to school night, or to see her in a performance. The child was never able to attend an evening activity (such as a dance) at her school because the foster parent would not take her. The foster parent even refused to go to the school to pick up the child when she was throwing up. She did not want to miss work and was afraid to drive into the District from Maryland. This foster parent also told the social worker, in front of the child, that she wanted the child removed from her home after a year because she was too much work. Another foster parent refused to go to a meeting I was trying to schedule with the child’s teacher and therapist in order to improve the child’s school performance. She said, and I quote, “If I cared, I would go, but I don’t care.”A third foster parent knew that her two foster children were getting on a public bus to get to school. But she had no idea what bus they were taking, where their schools were, or that the 15-year-old was letting the 6-year-old get off the bus and find her way to school on her own.

The impact on children of this type of neglect is hard to overestimate. It is bad enough for these young people to have their status as foster children constantly on display by having paid staff show up at school to take them to the doctor, having nobody attend performances that they are in, or not even be able to attend these performances or evening activities because their foster parents won't take them. Just think of having a social worker or aide take a child to therapy. What is the use of a 45 minute session once a week if the foster parent does not communicate with the therapist? More important is the lack of the emotional support that these young people so desperately need. And the rejection that these children often suffer from foster parents who criticize their behavior or demand that a child be removed as soon as he or she talks back or misbehaves.

Anyone who has been a foster care social worker, at least in the District of Columbia, knows that some people foster for the money. Depending on the age of the child and the level of their needs, payment ranges from $991.20 for a child under 12 with no special needs to $1505.98 for a child aged 12 or over with multiple handicaps. Foster parents are expected to spend all of their stipends meeting the expenses of caring for their children and there are guidelines indicating how much they should spend on clothing, transportation, personal allowances and other expenses. However, while the best foster parents often spend more than their stipends, some foster parents siphon off some money for their own personal expenses. Children in the homes of these foster parents may only have one school uniform or the foster parent make require them to pay for necessities out of their personal allowance, which is not allowed. Many young people have weekend visits with their birth parents as they are getting closer to reunification. In most of these cases, the foster parents pocket the subsidy for those weekends and even longer periods while the parents must struggle to pay for their visiting children. A foster parent who spends the bare minimum on the foster child can definitely siphon off money to pay her personal expenses and many do.

Let me say again that I have known several fabulous foster parents, most of whom use their entire subsidies and even their own money for the children. These foster parents are not motivated by money. Most of them are providing foster care because they want a child or children in their lives. Usually the love of children is combined with the desire to help children and influence their lives. Unfortunately, we don't have enough of these great foster parents. That's why we don't fire the bad ones.

The District’s partially privatized foster care system, in which many foster homes are provided by private agencies, also contributes to the failure to fire bad foster parents. The private agencies are competing with each other because the District has been closing about two of them every year. Private agencies are reluctant to give up foster parents, no matter how bad, because they get black marks for CFSA for being unable to find a home when CFSA asks. In one private agency where I worked, social workers were asked to rate foster parents before they could be re-licensed. The form even asked if the foster parent should be licensed again. But even when I said no and backed it up with disturbing accounts such as those mentioned above, the licensing staff proceeded with re-licensing the foster parent.

What can be done? We must close down bad foster homes and replace them with better options. This cannot be done immediately as there would be no place to put the children. So here is my suggestion. CFSA should use the annual foster parent licensing process to make sure that all foster parents are aware of and committed to the requirements of the job. All new foster parents need to be given a full explanation of what they are expected to do, and they should sign a written list of duties. All current foster parents identified by social workers as doing less than an “A” job should be brought in for a meeting when their licenses are due to be renewed. Like new foster parents, they must be told the requirements of the job and they must commit in writing to fulfilling them. If they cannot do so, their licenses should not be renewed. Of course, there are foster parents who are simply not suited to the job because they lack the empathy and concern for the children that are necessary. Social workers know who these foster parents are. Their licenses should not be renewed.

Implementing my suggestion will result in a loss of foster parents. In order to fill the gap this will cause, we either need to decrease demand for foster parents, increase supply, or use another sort of residential option. A decrease in demand is unlikely this year because the foster care caseload has decreased drastically in the past few years due to demographic changes and CFSA's policy of keeping children at home if at all possible. Because the District has already decreased its foster care caseload so much, it is anticipating only a very small decrease this year.

A second strategy to fill the gap between supply and demand is to focus on increasing the supply of foster parents. One approach would be to recruit among different groups of people that have not traditionally served as foster parents. This is a good idea but it is unlikely that all of the bad foster parents could be replaced by a change in recruiting strategy. Therefore, the District will have to look to other residential options such as family style group homes (such as those currently operated by Boys Town) for some of the older, more troubled youth who tend not to thrive in family foster homes. I will discuss this in my next blog post.