Providing Poverty Related Services in Child Welfare:
Guidelines and New Developments
(Originally published September 2023)
By Dee Wilson and Toni Sebastian
Last month’s Sounding Board discussed the utilization of poverty related services to transform child welfare and improve the reputation of child welfare systems among advocates and low-income families. We recommended that states’ neglect statutes be revised to mandate that public child welfare agencies assist families in accessing poverty-related services as needed or, in the absence of available economic services, fund essential services or resources for families with open child welfare cases.
Subsequent to sending out this commentary, a DCYF child - welfare staff member in Washington State sent us a copy of a recent policy memo requiring the provision of poverty related services. This policy, dated July 1, 2023, requires caseworkers to:
“Provide concrete goods for children, youth, parents, guardians, relatives, and suitable person that are in-home, placed in out-of-home care, or to remove barriers for a trial home visit,” when
a) “The goods or services meet the identified need to assist with or maintain safety, well-being, stability or placement.”
b) “Not use concrete goods and services a) that may be paid through a DCYF services contract; b) as an ongoing means of support, or
c) for licensed foster parents that are not relatives or suitable persons.”
The policy memo requires supervisory approval for expenditures exceeding $500 but not more than $1000; area administrator approval for expenditures between $1001- $2000 and regional administrator approval for Amounts exceeding $2000. The policy memo does not
set a limit on total expenditures per family or youth, limit the provision of services to one time only, or clearly define the meaning of “ongoing means of support.”
This is an exemplary policy which may become a model for other child welfare systems. For this reason, it is important to clarify the different ways poverty-related services can be utilized to strengthen families, including kinship families and foster youth aging out of care, while setting reasonable limits on their use, and to identify challenging issues child welfare agencies will face as they place a greater emphasis on the economic well-being of families.
Caseworkers often encounter poor or severely poor families on initial visits following a CPS report. Families may be on the verge of eviction, or without electricity, running water or toilets that work; or lack adequate food for the last week of the month, or adequate winter clothing and diapers, or access to medical or dental services despite urgent needs, or money for transportation or childcare to enable a family member to maintain employment. It is of the utmost importance that CPS caseworkers have quick and easy access to needed funds for emergency services without lengthy bureaucratic delays in an approval process.
This is easier said than done when quick action is needed to prevent loss of housing or locate emergency housing for homeless families, or find funding for expensive dental work. Of course, there will be limits on expenditures for a specific family, subject to an exception to policy process, but the limit should not be $1000 or even $2000 over a period of weeks or months. Provision of emergency services and resources is a humane response to need, and is also an expression of concern for the well-being of families reported for alleged maltreatment. This is an ethical imperative rather than a placement prevention strategy.
Nevertheless, concrete services delivered in a timely way may occasionally prevent foster placements.
Imagine a CPS caseworker interviewing parents about myriad neglect concerns in a home without electricity or working plumbing, when a parent has no money for food, diapers or transportation, while ignoring these conditions needs. What would a parent and school age children think about a caseworker who ignores their urgent concrete needs while discussing allegations in a CPS report?
The range of concrete services
Child welfare caseworkers frequently encounter low income parents and kinship caregivers who need assistance with:
· home repairs
· trash removal
· utility bills
· purchase of cribs and playpens
· diapers and other necessities for infants
· seasonal clothing such as coats, hats, gloves
· school supplies
· dental or eye care; glasses
· car repairs, bus or rail passes
There are many situations that require concrete services on an interim basis (1-6 months):
1. As a bridge to establishing eligibility for public benefits, e.g., TANF, SSI, food or housing vouchers.
2. As part of a treatment plan that includes an evidence- based parenting program, or other mental health services. It is not sensible
or humane to refer depressed parents whose families are food insecure, lack housing, or have urgent medical or dental needs to
physicians or psychiatrists who can prescribe anti-depressants or to therapists, while ignoring a family’s concrete needs.
A recent Scottish study of 5,217 children from birth to adolescence found that “persistent poverty has a particularly strong association with decreasing parental mental health over time.” And: “the findings here strongly suggest a major key to tackling poor mental health in parents and children is to tackle poverty and to prevent long periods of living in poverty.” (Treanor, et al, 2023) There should be an initial public policy emphasis on eliminating severe poverty, i.e., annual incomes less than 50% of the federal poverty standard, which is slightly less than $20,000 for a two-person family, just under $25,000 for a three-person family and $30,000 for a family of four. In practice, some severely poor families need interim financial assistance of at least $500 -$1,200 dollars per month until they become eligible for other types of financial assistance.
A recent JAMA article re the Food Is Medicine (FIM) movement comments: “The food is medicine movement has grown dramatically in the past few years. Interest is largely driven by a desire to address the persistent and expensive problem of poor health arising from poor nutrition … and is a leading cause of mortality. … FIM generally refers to food and nutrition programs … tied to the provision of health care and intended to prevent diet related diseases. … FIM approaches increase fruit and vegetable consumption and decrease body
mass index, glycated hemoglobin level and total health care spending … The Biden-Harris administration has approved Section 115 demonstration (Medicaid) waivers for five states,” including Washington. These waivers “allow eligible high-risk patients to redeem electronic debit “prescriptions” for fruits and vegetables.” (Bleich, et al 2023) In some FIM projects, participants are eligible for six months.
There is nothing stopping the federal government from authorizing FIM programs to reduce food insecurity for severely poor families, or state child welfare systems from funding FIM programs for poor families with in-home service plans. Eighteen hundred dollars for food over a 6-month period would make a big difference in families with monthly incomes of less than $1,200 per month.
The contention that concrete services of this type, including interim income support payments of $1,000 per month to a modest percentage of severely poor families would be prohibitively expensive is false. Cost of income support in child welfare does not stop adoption support payments to affluent families up to an adopted child’s 18th birthday, a policy rarely questioned by policymakers because there is widespread political support for adoption. Hotel placements in Washington cost an average of $2,000 per night, and in past years the state’s child welfare system sometimes placed youth out of state at a cost of $12,000-$20,000 per month, or more. Some mental health services or substance abuse treatment programs cost hundreds of dollars per month, at least. Enhanced concrete services to low-income families are viewed as prohibitively expensive only when they violate the social values of key policymakers or opinion leaders.
There are some situations that call for income support payments for 1-2 years:
Unlicensed kinship care families caring for a sibling group receive less financial assistance through TANF than foster families caring for two or three siblings. Kinship families, on average, have lower incomes than non-kin foster families. The DCYF policy discussed above allows the provision of concrete services to support kinship care to prevent sibling separation as well as for other reasons, e.g., to pay for home repairs needed to care for a foster child or sibling group.
Youth, 18-21, aging out of foster care will often need income support for at least 1-2 years to achieve self- sufficiency. A few states (e.g., California) have developed or are considering income support programs for youth aging out of foster care without a permanent plan. Some of these youth can and do return to a parent or relative, but this is not always possible. No society capable of enlightened self-interest or with an ounce of compassion would allow older youth who lack a supportive family or job skills, and sometimes lacking a high school degree, to exit foster care without a home and economic support. To do so invites the development of criminality, sexual exploitation, and episodic homelessness.
Parents who are reunified with a legally dependent child should receive the same income support as adoptive parents for two years because a) many of these parents are severely poor and economic resources affect both the timing and course of reunification; and b) to balance Adoption and Safe Family Act (ASFA) support for adoption with equivalent support for safe and stable reunification. Even in the absence of revisions to ASFA, state and county child welfare systems can do much with concrete service dollars and childcare to support reunification. (See Jill Berrick’s, Take Me Home).
Should housing authorities and housing case managers be given performance targets to ensure a dependable rate of exits from scarce housing resources? If child welfare families and older youth who receive housing rarely exit these
Policy issues in utilization of housing services
The lack of adequate housing (or sometimes any housing) has been a major obstacle to reunification. Child welfare agencies usually have had little, if any, ability to provide or facilitate access to affordable housing due to lack of funding for this purpose and the long waiting list for federal section 8 housing vouchers and other subsidized housing. The inability to assist low- income families in finding affordable housing has begun to dramatically change in Washington State.
According to information received from DCYF staff and advocates well informed regarding newly authorized housing services for child welfare involved families and youth:
The state legislature recently authorized $9 million dollars for the biennium to fund housing case management services and some concrete services for 2,200 families or youth with open child welfare cases to leverage an estimated $63 million dollars of housing through local housing authorities. One million dollars of this funding has been given to the Juvenile Rehabilitation Administration, leaving $8 million dollars for child welfare families and youth. DCYF is in the process of implementing this legislation, though there have been pilot programs operating in Region 4 (with local funding) and Region 6 (with state funding) for the past few years. Because enabling legislation in Washington includes the authority to provide federal vouchers, and those vouchers require ongoing supportive services, families and youth can maintain housing supports after their child welfare case is closed. One of the functions of housing case managers is to assist families and youth with finding other sources of housing supports; and to date this has occurred in current programs in King County and Region 6. The number of child welfare families authorized to enter housing monthly and families exiting housing services into a maintenance phase has been approximately equal to date, we were told. The federal government requires states to maintain foster youths’ eligibility for 36 months, though many of these youth exit the program to other housing resources earlier.
Policymakers and child welfare managers in other states who embark on similar housing programs will be faced with a number of policy choices regarding how to best utilize a valuable and scarce resource:
Should housing resources be solely devoted to facilitating reunification or prevention of foster placement, as in Washington, or used for other purposes, e.g., in response to domestic violence or youth homelessness or for prevention?
If enabling legislation requires that housing services be used to facilitate reunification or to prevent foster placement with legal structure (as in Washington), the application of this guideline may still be open to question. Randomized controlled trials of Family Preservation Services (FPS) in past decades revealed that “risk of imminent placement” has no clear meaning in federal or state law, and may be defined by caseworkers and program managers arbitrarily in order to narrow or expand eligibility for services.
Should the provision of housing services be conditional on parents’ good faith participation in treatment plans, or be left to the discretion of housing managers? Every human services agency that serves adults with substance abuse and chronic mental health disorders must grapple with these issues. Child welfare is no exception.
Should housing authorities and housing case managers be given performance targets to ensure a dependable rate of exits from scarce housing resources? If child welfare families and older youth who receive housing rarely exit these services, the supply of housing for other families and youth may be quickly exhausted.
Poverty Aware programs in social service departments in Israel
The impact of changes in policies and programs is greatly influenced by the commitment of direct services staff who implement programs. As child welfare agencies increase their investments in poverty related services, it is important that caseworkers and supervisors embrace the potential of these services to help families reduce the risk of child maltreatment.
One of the most interesting initiatives in the delivery of poverty related services, the Poverty-Aware Paradigm has occurred since 2015 in nine programs that operate in half of the public social service departments in Israel. A recently published review of 25 evaluation studies (Timor-Shlevin, et al, 2023) indicates that PAP programs were designed for “Families living in persistent extreme poverty and branded as uncooperative” in traditional service delivery efforts and families “not coping with mental illness, delinquency or addiction,” including neglecting families.
The review found that “all the studies demonstrated strong indications of improvements in the relationships between service users and social workers.” And “A common experience reported in many of the studies was the service users’ feeling that the social workers were not only interested in their children’s situation but also in the well-being of their parents.” A randomized controlled trial found that families in a PAP program “began to receive more help from other professionals than families in the control group. … Caseworkers trained to support low-income parents found to be uncooperative with services in past contact with social service agencies were better at 'creating a beneficial working relationship with people living in poverty.'”
It is possible to combine strong commitment to assisting low- income families in their struggles with severe poverty and a commitment to child protection. A commitment to “standing by” poor families does not have to include denial or minimization of child maltreatment, but it is a challenge to train newly hired caseworkers to see families as they are, warts and all, and support parents in their struggles with poverty, substance abuse and mental illness to the maximum possible extent, without compromising child safety.
Bleich, S., Dupuis, R. & Seligman, H., “Food is Medicine Movement - Key Actions Inside and Outside the Government,” JAMA Health Forum, 4 (8), August 10, 2023.
Timor- Shlevin, S., Saar -Heiman, Y. & Krumer-Nevo, M., “Poverty- Aware Programs in Social Service Departments in Israel: A Rapid Evidence Review of Outcomes for Service Users and Social Work Practice,” International Journal of Environmental Research and Public Health, 20, 889, 2023.
Treanor, M. & Troncoso, P., “The Indivisibility of Parenting and Child Mental Health,” Journal of Adolescent Health, 73, 2023, published online.
See past Sounding Board commentaries