Book Review:
Careful examination of kids and foster care

Take Me Home: Protecting America’s Vulnerable Children and Families

by Jill Duerr Berrick, Oxford University Press, 2009.

 

Jill Berrick is a distinguished scholar who was a co-author of The Tender Years, one of the most important books on child welfare published in the 1990s. In recent years, Berrick has published articles on re-entry into care and concurrent planning, among other subjects.

 

Take Me Home is an interesting and important book about permanent planning for children in foster care and unlicensed kinship care and about the foster care system itself.  Nevertheless, this book is an incomplete treatment of  complex subjects, especially the chapter on reunification which (surprisingly) lacks an in-depth analysis of post-reunification services, re-entry into care, reunification criteria, promising programs for substance abuse or co-occurring disorders or more unusual approaches to reunification such as shared family care and intentional communities. These are puzzling omissions for an author who clearly wants a renewed child welfare investment in reunification services and improvements in the foster care system.

 

In her introductory chapters, Berrick argues there is thin evidence that prevention programs or family preservation services either prevent child maltreatment or foster placements; and she is concerned that widespread support for poorly researched or ineffective family support programs is draining away valuable resources from children in foster care needing permanent nurturing families. Berrick asserts that “The fundamental mission of child welfare is downstream (i.e., after entry into out of home care), where children must be served, where the child welfare system accepts its greatest responsibility,…” and “ … the dollars spent on ineffective prevention services should be redirected to the children already under the supervision of child welfare agencies and the courts.”

 

These are not likely to be popular views with child advocates, most of whom want an increased public investment in prevention and early intervention programs; but even more to the point, the funding for prevention / early intervention is currently only a small fraction of foster care funding. Even if the paltry public investment in prevention were redirected to reunification services and foster care, the increased funding would not amount to much in most states, including Washington State. The actual trade off since the passage of AFSA (which Berrick only briefly touches on) has been between increased public investment in adoption and, to a lesser extent, subsidized guardianship vs. reunification. It is difficult to understand why Berrick’s commitment to better funded and more effective programs for birth parents did not result in an analysis of AFSA’s unbalanced public policy favoring permanency outcomes other than reunification.

 

The greatest strength of Berrick’s book is six case studies of parents who lost custody of children due mostly to substance abuse and neglect and then (sometimes after years) regained custody of some of their children. These are powerful candid stories of addiction, chronic family violence and criminal histories told in the voices of parents with no apologetics for bad behavior and no punches pulled. These stories have the potential to challenge any policy framework. Berrick is

 

skilled in adding narrative which fills out the stories without reducing their emotional impact. In these stories, young children were severely neglected by hopeless, helpless parents addicted to drugs until child welfare agencies made out of home placements, usually initially with relatives. The relatives entrusted with care of the children were themselves troubled and often drug abusers as well. Much of the care these children received from both relatives and non-relatives was substandard at best.  Relatives often returned young children to the custody of substance abusing parents for weeks at a time without the knowledge or permission of child welfare caseworkers. When children were placed in non-relative care, they were often moved from home to home and /or physically abused. Some of the mothers continued to have children who were removed one by one by child welfare agencies from the mother’s care. After substantial periods of time and numerous reunification plans, some of the parents reported making a mysterious transformative commitment to recovery and gradually regained custody of some or all of their children. 

 

Child welfare agencies / staff, relative and non-relative caregivers frequently do not appear in these stories in a flattering light. Some of the parents are deeply angry regarding the treatment they received from caseworkers and their own family members; but they do not minimize the fact or extent of their addiction and neglect, and most are grateful for being coercively pushed into treatment programs. In these stories, “the path to reunification suggests a lonely experience that speaks largely to issues of compliance and less to changes in real-life circumstances,” Berrick states.  The children in these stories were poorly protected and served in out of home care; and permanent planning did not occur for them in a timely way. A few ended up with birth fathers, but most experienced several transient placements with kin and non-kin foster parents, as well as birth mothers. If these stories are widely representative of the experience of children in out of home care (let’s hope they’re not), child welfare systems are in worse condition than even vocal critics maintain.

 

Berrick is at her most eloquent in commenting on the experience of one of these mothers: “When Tracy ( one of the mothers in the stories) was working to reunify with Asia, Raymond, Amber and Tyson, she needed to learn how to engage in positive parenting experiences, she needed a coach to help her learn techniques for managing her children’s now challenging behaviors; she needed support in responding to their needs in their new dyadic, intimate, day to day relationship. Tracy also needed concrete help establishing a home for her children. She needed an apartment in a new community, away from the familiar triggers she associated with the drug use of her past. She needed furniture, phone service, kitchen paraphernalia, bedding, clothes—Tracy needed all of these and had none. She needed an enriched child care program for her youngest and after school programs for the others. She needed reliable transportation…. She needed another bed, sheets and blankets. What Tracy needed was income to clothe and feed a very large family. What she got was another generic parenting class.” As a cogent indictment of common reunification practice, this passage can hardly be improved on.

 

Berrick proposes a framework for reunification practice in which families whose prospects for reunification appear remote 6 months after their child’s placement would be given two caseworkers, one to work with the parents, the other to work with the child and the foster family or relative caregiver who will become the permanent family for the child if reunification within a reasonable period of time is not possible. Berrick explains that “ The two-worker model has the effect of shining a bright light on the child’s need for permanency and pushing reunification workers to make honest assessments about parents’ actual changed behavior, rather than their hoped for change.” Berrick believes that “a single social worker can not see children’s need for permanency clearly when juxtaposed with parents’ emotional wells of pain; thus decision making at critical junctures may be impaired.” Berrick recommends that permanency decisions be made at 12 months after out of home placement, both to better meet the needs of children for permanent families and also to limit the emotional uncertainty of alternative families caring for children in a concurrent planning framework. Unfortunately, Berrick does not go on to describe a set of reunification services which could be offered parents during the critical 6 month period before Courts make final permanency decisions. The lack of reunification services tailored to the needs of parents and children is a recurrent theme in the parents’ stories in Take Me Home. Intensified case management absent better services and resources is likely to result in more termination actions rather than more reunifications.

 

Apart from the parents’ stories mentioned above, the strongest feature of Take Me Home is Berrick’s chapter on foster care, one of the best informed indictments of the foster care system published in recent years and all the more powerful because Berrick is a strong advocate of renewed efforts to reform foster care. Berrick begins her discussion with reference to the acute and chronic shortages of foster homes and to the high drop out rates among foster parents; some 40% of newly licensed foster parents give up their license within the first year of service, according to Berrick. Foster care systems that exist with chronic shortages can usually not match children with families based on children’s needs and family strengths; and shortages lead to overcrowding in available homes. Foster parents are inadequately compensated in most states. Berrick comments on evidence from the National Study of Child and Adolescent Well Being (NSCAW) that one fifth of foster parents have annual incomes under $25,000 per year and 40% have incomes under $35,000 per year. These are not families that have the resources to compensate for inadequate agency financial support of foster placements or unlicensed kinship placements.

 

Berrick cites surveys of young adults with histories of foster care in which 25-40% of respondents claim that they were harshly punished by a foster parent. Of even greater concern, Berrick discusses John Orme’s and Cheryl Beuhler’s summary of foster care studies which found that 15-20% of foster parents “have problems in their home environment, family functioning, and parenting;” and a study done by the Urban Institute that found that a quarter of children surveyed were living with kin and non-kin foster parents who were “highly aggravated.” NSCAW has found that foster parents were “providing marginally adequate environments” for children, and in one of the more distressing research findings in recent years, Barth, et al, assert, based on evidence gathered in NSCAW, that “about one fifth of the (foster) children were rated as experiencing both low responsiveness and high punitiveness,” in other words emotionally unresponsive harsh parenting. Berrick comments that “Combined, these studies point in a similar direction: a significant minority-probably somewhere around one fifth of foster homes-are not appropriate settings for seriously vulnerable children.”

 

Berrick’s view is that “support for foster parents is woefully inadequate;” payment rates are “unfathomably low” , respite care is often unavailable, “social workers are unresponsive and unsupportive during times of crisis,” and foster parents may be given little assistance in finding essential services for children. Many foster parents have deeply felt grievances with how they are treated or mistreated by the public child welfare agency, with the bureaucracy, caseworkers’ unavailability or indifference, low reimbursement rates and lack of emotional and concrete support.

 

Given this litany of concerns and grievances, it is easy to understand the perspective of policy makers, practitioners and advocates who want child welfare systems to be less dependent on foster care and their reluctance to invest limited resources in a deeply flawed system. However, Berrick is surely right that the need for good foster homes is unlikely to wither away due to prevention programs, family preservation services and kinship care. Currently, about a quarter of children in out of home care live with relatives; some jurisdictions have occasionally achieved kinship care rates of 50%; but it would be very surprising if, nationally, the percentage of children in kinship care were to double in the next decade. Furthermore, the same concerns which tempt some practitioner and advocates to give up on improving non-kin foster care equally apply to kinship care providers: inadequate resources and agency support, high rates of “aggravation” and irritability, a fifth of kinship families providing non-nurturing care by the NSCAW criteria. Furthermore, Berrick believes that child welfare agencies often promote “extended family relationships to such an extent that it (the child welfare system) ignores children’s health and well being and makes a mockery of the government’s role as an intermediary in vulnerable children’s lives.”  The difficulties child welfare agencies have in providing high quality and safe foster care would not vanish if out of home care were to be totally provided by relatives.

 

Furthermore, there is no reason to despair of improving a system in which the lack of support, compensation and resources is so glaring. Berrick sensibly recommends increased investments in training, innovative ways of compensating foster parents, and use of evidence based therapeutic foster care models. Berrick asserts that “Child welfare reform which squarely tackles the issue of quality foster care can make irrelevant many of the smaller reforms underway.” She adds “ … (foster care) can offer children a therapeutic environment in which to recover from trauma and a richly stimulating setting in which to catch up on previously lost opportunities.” Surely, Berrick is right that the policy goal must be to transform foster care into a largely therapeutic experience while also making new investments in improved reunification services.

 

Berrick has written a courageous book which is likely to upset even groups which share her policy goals such as foster parent associations; advocates of prevention programs are certain to differ with her summaries of child welfare research.  Berrick is in disagreement with mainstream thinking about prevention, kinship care and child welfare priorities. She is unduly pessimistic in my view regarding the lack of knowledge to guide child welfare practice due, I believe, to her implicit view ( widely shared among researchers)  that knowledge is the body of consistent findings produced by randomized controlled trials (RCTs). While RCTS are invaluable sources of understanding (especially of best practices), they are only one among several ways of developing effective ways of achieving results. Berrick uses qualitative interviews with parents to great advantage in Take Me Home; this is a source of valuable information and guidance for practice which can be used far more extensively than is currently the case.   

 

In her final chapter, Berrick demonstrates her scholarly talents in summarizing several inconsistent recent studies regarding foster care outcomes. “Taken together, she writes, “the findings from these studies paint a murky picture. For cases considered “marginal” children may do better at home, without the disruption and uncertainty that follow a foster placement. For children who require protective care away from their parents, … outcomes may be better in foster care than remaining at home.” While the jury is still out on the comparative developmental advantages of children’s placement in foster care vs. remaining in troubled birth families, it has become increasingly evident that some groups of children are distinctly not thriving in foster care, especially behaviorally troubled school age children with highly unstable placement histories (one recent Australian study refers to conduct disordered youth as “wretched in care” and “effectively homeless”) and youth aging out of the foster care system. There is also some preliminary troubling evidence from NSCAW that infants may not be improving on standard developmental measures while in foster care. Berrick believes that the quality of foster care is highly uneven and that “many caregivers are providing high-quality services in spite of the system, and a significant number of caregivers are providing low-quality services because of the system.”  

 

Berrick insists that efforts to improve foster care and kinship care must not be abandoned. “… some system of state-supported foster care must exist”; and it is of the utmost importance to the integrity of child welfare practice that foster care not only does no harm but begins to restore children’s normal development in the vast majority of cases in which children are placed for months or years.  Take Me Home leaves no doubt that this country’s foster care system must be dramatically improved or every effort must be made to safely reduce its use.

 

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