U.S. Foster Care Systems: Three Crossroads
(Originally published November 2021)
U.S. foster care systems are beleaguered, under widespread attack from child and parent advocates, and in disarray due to acute and chronic shortages of foster homes, especially homes for behaviorally troubled children. During the past few years in many states, including Washington, Oregon and Idaho, foster youth have been placed in increasing numbers in hotels ($2000 per night) or offices, and in Washington even maintained overnight in cars, sometimes while caseworkers drove them hundreds of miles to facilities a youth refused to enter! A recent King 5 (Seattle) news story revealed that youth were sometimes made as uncomfortable as possible in cars by turning on the air conditioning and/or opening the windows to create an incentive for the youth to accept a placement she/he was resisting. This story was confirmed by the 2021 Office of the Family and Children’s Ombuds report.
In Washington, children of all ages have been moved from foster home to foster home every 24 hours, without the foster families so much as feeding the children dinner or breakfast! Investigative journalists have ignored stories regarding 24 placements which sometimes cost $300-600 per night/ per child; and this has become business as usual. It is also commonplace to place children for months or years out of county due (again) to foster home shortages. This practice hardly raises an eyebrow among child advocates and is rarely mentioned in news stories.
These practices, especially hotel placements, have become more common in recent years in the Pacific Northwest. According to the recent Ombuds report, hotel placements in Washington increased from 125 days in 2015 to 2500 days in 2021, despite periodic news stories drawing attention to these placements and recurrent proactive utterances from elected officials and DCYF leadership promising to stop the practice. DCYF has yet to even propose a serious plan to stop hotel placements which, as of November 1, are prohibited by a federal court order.
Family First regulations have created additional obstacles to the use of residential care which, intentionally or unintentionally, has been undermined by this federal legislation. Given the direction of federal policy, what sensible person or organization would invest more resources in residential care (aka congregate care)? It is likely that existing residential care programs will gradually close their doors, which is probably the intent of the law, a development which will only intensify the impact of foster care shortages in most states. It seems that the view of influential child advocates, including foundations, is that hotel placements, office placements and 24-hour placements are an acceptable cost of dismantling residential care programs and lobbies (still powerful in some states – though not in Washington)
Under these circumstances, one might imagine that child welfare leaders would be actively discussing and (hopefully) testing alternatives to residential care such as therapeutic foster care and/or professional foster care, to alleviate the current crisis and to begin the creation of a therapeutic foster care system. However, this is not the case in Washington for one main reason: a few key legislators are adamantly opposed to professional foster care which conflicts with their personal values ( i.e., “foster parents should not be paid a salary to take care of vulnerable children”); and which has the potential to create large new funding demands from DCYF. In Washington, DCYF has included 15 federally funded therapeutic beds in its plan to end hotel placements when a realistic “ask” would be 10 times that number, as well as 25 mental health CLIP beds reserved for dependent youth.
These token gestures to address the state’s foster care crisis ignore conditions that have been endemic in foster care systems for decades, i.e., multiple placements, overuse and misuse of psychotropic medications, and lack of adequate mental health services for children and youth with serious behavior problems, as well as lack of adequate resources for severely physically disabled children.
Some child advocates believe that a combination of increased use of kinship care, along with new family support services developed through Family First will create viable alternatives to residential care. This is wishful thinking at best, and disingenuous for advocates and scholars who should know better. Kinship families are no more able to cope with the challenges presented by behaviorally troubled or physically disabled children than non-kin families. Furthermore, the idea that there are tested, evidence-based placement prevention programs ready to be taken to scale is false. Most programs listed on authoritative evidence-based websites are not evidence based for placement prevention, and the ones that are (e.g., Family Preservation Services) have a narrow scope and application. Evidence-based rhetoric cannot fill the gap in placement resources, though there are several promising programs that should be piloted and implemented in stages. Meanwhile, nationally, there are currently more than 400,000 children in foster care, half of whom have serious behavior problems and a quarter of whom (arguably) need a professional level of care.
What is most striking about the current moment is the lack of discussion among policymakers and child welfare leaders regarding how the needs of these children and youth can best be met, given the decrease in residential care that is the direct result (and probably goal) of public policy. Whether this lack of discussion and innovation is the result of denial or wishful thinking, child welfare ideology, or an “all-in” bet on the potential of Family First to fund effective placement prevention programs is unclear and may involve all three to varying degrees. Regardless of the motives(s), it is a dereliction of duty to foster youth and to foster parents who deserve better from public agencies and political leaders than stubborn denial and indifference to egregious systemic mistreatment of foster youth.
The history of foster care
Catherine Rymph is an historian at the University of Missouri. Her Raising Government Children: A History of Foster Care and the American Welfare State (2017) is the best book on foster care published in the U.S. since Jill Berrick’s, Take Me Home (2009). Raising Government Children is mis-titled. As Rymph makes clear, governments had a minor role in the creation of U.S. foster care systems, which from 1860 through the 1930’s was mostly the creation of philanthropists and private agencies, e.g., through orphan trains, boarding homes, “free” homes and work homes. Governments were a late arrival on the scene, and did what governments do, i.e., create bureaucratic rules and standards and regulate providers.
Even in the modern era, it is false that foster care is about “raising government children.” This is what permanent planning laws were designed to stop, largely (but not completely) successfully. Currently, about 85% of foster children exit to permanent plans (reunification, adoption, guardianship). Most states have permanent planning failure rates, i.e., aging out of care or exits to ‘other’, in the 10-20% range.
Rymph’s history reminds that “foster care” is an abstraction. Foster care systems of different eras have embodied different values, depended on different legal arrangements, and had different missions and goals. Orphan trains were a response to thousands of destitute children of European immigrants living on the streets of large Eastern cities. These children were often transported by train hundreds, or even thousands, of miles to farm families who provided homes in return for labor. Orphan trains flourished in an era that took the need for child labor as a given, and which believed that moving children out of crime ridden cities, in which they often survived through petty theft, to families where they would develop a strong work ethic would build character, while also protecting the community. Orphan trains vanished during the progressive era when child labor came to be viewed as a violation of children’s rights.
Foster care evolved into paying low-income women ‘board rates’ for the care of poor children whose parents were unable to care for them temporarily due to illness, a death in the family, incarceration, work schedules, severe poverty, alcoholism, etc. These placements were initially arranged through the agreement of families or by private agencies; and gradually came to include legally dependent children in greater numbers. Foster care in the early and mid-20th century also included “free” homes in which children and youth were expected to assist in the care of invalids or the elderly; and “work” homes in which a youth received room and board for work in a business or on a farm.
Foster care evolved out of arrangements that were modern forms of indenture, in part because it was taken for granted that foster care had to have benefits for all parties, i.e., parents, foster parents and communities as well as children. Nevertheless, foster families received meagre financial support from private agencies and governments that were uncomfortable with the idea of paying foster parents for the care of children. According to Rymph, foster care during the 20th century was stigmatized: it was low paid women’s work grudgingly funded to accommodate the needs of destitute children who lacked a functional family, at least temporarily. Rymph asserts that foster parents have always subsidized the cost of children’s care; and were always a source of discomfort to child welfare agencies and policymakers concerned about their financial motives, lack of training and erratic quality of care.
Some child welfare experts and private agency directors began advocating for the development of professional foster care in the mid- 20th century as a means of breaking the connection between poverty and foster care, with the aspirational goal of transforming foster care into a therapeutic service.
Rymph asserts that U.S. foster care systems have always been in crisis, i.e., never enough homes or skilled caregivers, inadequate reimbursement, with ambiguous legal standing and unclear roles for foster parents. Nevertheless, foster care did not become indelibly associated with the coercive removal of maltreated children until the past 35-40 years. I worked as a caseworker, supervisor, and manger in Washington State’s child welfare system during the 1980’s and 1990’s when at least 20-30% of foster children were in foster care due to developmental disabilities, behavior problems or family conflict; many through voluntary agreements with parents or “c” dependencies without a finding of child maltreatment.
Both federal and state policies persistently sought (initially) to reduce and then to severely limit voluntary placement of children, and placements for reasons other than abuse or neglect. Foster care has become mostly a response to child maltreatment, with the use of legal structure required by federal law. Since 1995 and following the passage of the Adoption and Safe Families Act, the number of adoptions out of foster care has increased from 20-25,000 per year to more than 60,000 per year, almost tripling adoptions in 25 years. Adoptions have recently increased to 26% of exits from foster care, while reunifications have decreased to less than 50% of exits for the first time.
Foster parents have been encouraged to keep their distance from children’s parents, often referred to as “perpetrators.” Approximately 30-40% of prospective foster parents seek a foster home license to adopt a child, while only about 25% of foster parents become licensed to care for a wide range of children on a temporary basis. As a result, foster care is front and center in an emotional, increasingly ugly, debate about social and racial justice in child welfare. Foster care has come to represent a key part of punitive, coercive policies and practices which collectively amount to a policing of the parenting of low-income families, who are disproportionately racial minorities. Some child and parent advocates would rather destroy child welfare systems, regardless of the effects of child maltreatment (which some minimize as mostly “just neglect”), rather than support practices that embody this type of social injustice.
U.S. foster care systems have arrived at three crossroads:
– use of legal structure vs. increased use of voluntary agreements,
- separation of foster parents from parents vs. partnerships with parents,
- a preference for adoption vs. a preference for safe reunification, and
- an alternative to parental care vs. support for parental care.
2) There have always been some foster parents who developed ositive, supportive relationships with the parent(s) of a foster child, and who learned how to do this safely and for the benefit of children. These practices, commonly referred to Family Connections in Washington State, should be strongly encouraged and supported, but not mandated. Family Connections practices will increase and flourish when they are valued and rewarded by child welfare agencies. Mandates will alienate a percentage of foster parents and lead to a loss of foster parents, a loss which child welfare agencies can ill afford. The reshaping of parent/foster parent relationships from separation/conflicting interests to partnerships can only occur gradually as child welfare values shift, not through ill-conceived policy mandates. Federal and state law should encourage voluntary placements in some circumstances rather than insisting on legal structure and existing ASFA timelines, especially for school age children and youth. Child welfare systems cannot become less coercive if federal and state law continue to require legal structure for all children in foster care longer than a few days or weeks. In addition, ASFA should be revised to create the same incentives for safe reunifications as for adoptions, including two years of financial support for parents following reunification from court ordered placements equal to adoption support payments.
3) Investment/commitment – currently, federal law and unstated child welfare policy in many states is a deliberate attempt to undermine residential care without creating viable alternatives. The unwillingness to make new investments in the repair of old cars and houses, long- term intimate relationships and institutions reflects a decision to allow these entities to fall apart, and start anew with new products, relationships, or social interventions. The refusal to invest in foster care improvements such as foster parent liaisons, respite care, on-demand psychiatric consultation, certification programs, and a more adequate basic rate reflects the idea that child welfare systems should be investing in improved family support services rather than foster care improvements. This is a foolish, unnecessary either/or. Policymakers face a stark choice: make significant new investments in foster care; or allow these systems to fall apart with disastrous consequences for years to come.
Foster has depended on a volunteer business model, a proven failure for behaviorally troubled children and severely disabled children. Foster care can never become a therapeutic intervention using this model. There are only two realistic alternatives to foster care reform that helps (rather than causing additional harm to) a large percentage of behaviorally troubled youth: a large investment in therapeutic foster care models and/or a commitment to professionalizing 10-20% of licensed homes.
Hopefully, child advocates who reject these alternatives will articulate their preferred alternatives in concrete terms. It’s not enough to refer to “community-based care” or “evidence based placement prevention,” absent specifics.
U.S. foster care systems have arrived at the current crisis via three roads:
(1) association with coercive child welfare policies and practices
(2) disinvestment in residential care and refusal to make new investments in family foster care, and
(3) dependence on a failed volunteer business model.
Three roads in, but only two roads out:
(a) increased use of foster care for family support, both prior to and following reunification, and
(b) transforming foster care into a therapeutic intervention for behaviorally troubled and severely physically disabled children and youth, which can only be done through development of professional therapeutic foster parents.
In next month’s Sounding Board, I will describe a therapeutic foster care program in Washington State, and will discuss the elements required to develop a cadre of professional foster parents and the supports they will require.
Berrick, J., Take Me Home: Protecting America’s Vulnerable Children and Families
(2009), Oxford University Press, New York City.
Dowd, P., Office of the Family and Children’s Ombuds' Annual Report, 2021, Seattle, Washington.
Rymph, C., Raising Government Children: A History of Foster Care and the American Welfare State (2017), University of North Carolina Press.