DEE WILSON CONSULTING
Special Report: Substance Abuse and Child Welfare:
Reflections on Child Welfare History 1985-2024
(Originally published March 2024)
This month’s Sounding Board will begin a series of commentaries on substance misuse and child welfare that will include 1) reflections on U.S. child welfare responses over the past four decades to the co-occurrence of substance use disorders and child maltreatment; 2) safety assessment and safety planning in this context; 3) promising family support programs; 4) use of Plans of Safe Care when hospitals identify prenatal substance abuse; and 5) reunification practices and the Adoption and Safe Families Act (ASFA). Every part of this discussion is controversial.
Currently, it is very difficult to have civil disagreements about child welfare reform among child welfare professionals, child and parent advocates, stakeholders (including judges) and policymakers, many of whom support abolishing child welfare and view opponents as defenders of structural racism. The good intentions of persons with opposing views are no longer assumed in child welfare debates. Nevertheless, my hope is to provide a useful discussion regarding a subject of the utmost importance for child welfare reform, or for efforts to completely “re-envision” the U.S. child welfare system from mandatory reporting laws to ASFA timelines and goals.
Reflections on child welfare history: 1985-2024
Beginning about forty years ago (mid-1980s), U.S. child welfare systems were overwhelmed by a crack cocaine epidemic that developed into a methamphetamine epidemic in the Western United States. The U.S. foster care population doubled to 567,000 children in care on any one day during a period of 13-14 years. In some jurisdictions, the rate of infant placements increased 50%-100% within a few years. There were periods during the 1990s when New York City, Los Angeles County and Illinois had 40-50,000 children in care. Currently, New York City has approximately 7,800 children in foster care; Los Angeles County’s foster care population is about 30,000, while Illinois has close to 20,000 children in foster care. The U.S. foster care population in FY 2021 was 391,000, a number which included 14,500 youth, 18-21, an age group ineligible for foster care during the late 1980s and 1990s. When youth, 18-21, are removed from the count of children in foster care, there were approximately 190,000 fewer children, 0-17, in care in FY 2021 compared to FY 1999; and it is likely there has been a further reduction in the U.S. foster care population since 2021 despite the current opioid epidemic.
The huge increase in foster care greatly exacerbated endemic workload problems in public agencies, inundated juvenile court systems, led to acute and chronic foster home shortages, and left most states and large cities struggling to expand inadequate substance abuse assessment and treatment resources. By the mid-1990s, most child welfare leaders understood that the number of children in foster care had to be greatly reduced, both because many thousands of young children were languishing in foster care without permanent families, and to bring agencies’ limited resources (both staffing levels and services) into line with demands on their systems. To reduce foster care, public agencies needed to both reduce entries-into-care and greatly increase exits to permanent families.
The federal Administration for Children and Families (ACF) begun to fund Family Preservation Services (FPS) during the 1990’s. Within a few years, these programs became a source of scholarly controversy after a few randomized trials failed to find much, if any, effect on foster care entries. The scholarly debate over FPS research was heated and sometimes ill tempered, but paled in comparison to current debates over the abolition movement and related issues. In retrospect, it appears obvious that crisis-oriented FPS services were not well designed for families with chronically relapsing conditions such as substance abuse and mood disorders, or for chronically maltreating families. These programs had minimal effects on aggregate foster care entries in Washington or nationally, although they were often useful in responding to parent-child conflict and to family emergencies.
One of the goals of 2018 Family First Prevention Services Act was to expand the use of evidence-based programs for families with substance misuse and mental health challenges in order to reduce the need for foster care. However, Family First has had minimal effect on family support services in most states, due in part to the legislation’s strict regulations, and also because federal IV-E requires state matching funds. The large decline in foster care in Washington State since 2018 has not been due to improved family support services for the most troubled families in the state’s child welfare system.
The decline in foster care during the past 24 years has been the result of two main factors: 1) a large decline in entries into care, i.e., from 299,000 in FY 1998 to 216,000 in FY 2021, a period in which referrals of child abuse and neglect increased by about a third nationally and, 2) a large increase in exits from care driven mostly by increased adoptions and guardianships. The increase in adoptions began prior to the passage of ASFA in 1997 and then increased rapidly for a few years after the law’s passage. U.S. adoptions out of foster care more than doubled between 1995 and 2000, before leveling out at slightly more than 50,000 adoptions per year for several years. In FY 2017, adoptions peaked at 66,000 and have since declined to 53,546 in FY 2021, similar to the annual number of adoptions in the early 2000s. In addition, almost 15,800 children exited to guardianship in FY 2021 vs. about 5900 children in FY 1998.
Racial disproportionality and ASFA
The doubling of the U.S. foster care population between 1985-99 had a large and lasting impact on low-income Black families. In FY 1998, 43% of children in foster care were Black-Non-Hispanic vs. 22% in FY 2021, without counting mixed race children. Thirty percent of children who entered foster care during FY 1998 were Black compared to 20% of entries in FY 2021. Many of these children were infants or toddlers when they entered foster care and were less likely than White children to be reunified with parents. They had longer lengths of stay in foster care and were at greater risk of exiting foster care without a permanent plan. These children were also at risk of unstable placement histories associated with child behavior problems and long lengths of stay in foster care. For many behaviorally troubled school age youth, lengthy stays in foster care were not (and are not now) either safe or stable.
ASFA, with its single-minded commitment to completing permanent plans for children within strict time frames, exacerbated these trends. However, it is not true that ASFA was a malicious strategy to permanently separate Black children from their families. When ASFA became law in 1997 there were already hundreds of thousands of children in foster care, almost a third of whom had been in care for longer than 3 years. Some studies of parents mandated by juvenile courts to complete substance abuse treatment found that no more than a quarter successfully completed a treatment program. Since the 1990s, many states have found ways to more than double the percentage of parents involved in dependency actions who enter drug/alcohol treatment, but these approaches to parent engagement were not widely available in the late 1990’s. It was apparent to child advocates and policymakers that hundreds of thousands of children in foster care were unlikely to ever be reunified with their parents and urgently needed a permanent family.
Initially, there was widespread support for ASFA among child advocates, child welfare leaders, practitioners and policymakers. The goal of moving foster children to permanent homes had great appeal. The number of children in foster care steadily declined from 1999 to 2012 as public agencies made dedicated efforts to complete permanent plans for foster children, in accordance with ASFA timelines. Since the early 2000s, child welfare agencies in many states have made foster care reduction the centerpiece of their reform initiatives. For many years, most child welfare leaders (including top managers) implicitly assumed or explicitly declared that their child welfare systems could not be effectively reformed without a large reduction in foster care. Many agencies increased their investment in timely adoption, in large part through federal financial incentives for increased adoptions over a baseline.
The part of ASFA most vulnerable to charges of structural racism is not timelines for completing permanent plans; rather, it is the provision of financial adoption incentives to states intended to increase adoptions, but failing to provide similar incentives for stable and safe reunifications. Furthermore, this policy was not changed after the effects on the permanent separation of Black and Native American families became well understood. This is a clear public policy preference for adoption over reunification, despite a large body of research demonstrating the potential for safely increasing reunification rates through family treatment drug courts, Safe Baby courts, parent mentors, housing services and other family supports.
It is true that some premature and/or risky reunifications have led to child maltreatment deaths. Basing reunification decisions (primarily) on parental compliance with court ordered treatment plans may endanger children’s lives. It is also true that neither the federal government or most states have made investments in improving reunification programs and practice comparable to investments in adoption incentives and adoption support payments. End result: highly elevated rates of termination of parental rights (TPR) among Native American and Black families and among families with public insurance. A 2021 study of TPR rates for more than 519,000 children born in California in 1999 found a TPR rate of 1.1% for the entire cohort, but a 3.2% rate for Black children and a 3.8% rate for Native American children vs. a 1.3% rate for White children. (Communication with Emily Putnam Hornstein, 2021). Children born to mothers with public insurance were six times more likely to have had a TPR by age 18 than children born to mothers with private insurance (Putnam-Hornstein, et al 2021). These are shocking differences in the rate of permanent family separation, and help to explain the emotionally charged nature of the current debate regarding the future of child welfare.
The child welfare response to the opioid epidemic
The number of children in foster care in the U.S. declined steadily from FY 1999 to FY 2012, eventually falling to approximately 381,000 children, 0-17, and an additional 17,000 youth, 18-21. U.S. foster care began to modestly increase in FY 2013 and continued to grow through FY 2017 when 441,000 children were in foster care, according to AFCARS statistics. This increase was almost certainly the result of the gradually accelerating opioid epidemic that has led in recent years to more than 100,000 overdose deaths annually.
In Washington, the number of drug overdose fatalities and near fatalities among children has greatly increased since 2018, according to reports from the Family and Childrens Ombuds Office, while the number of children in foster care has declined by at least a third to less than 6000 children in care on any one day.
How is it possible for a state to reduce its foster care population by a third or more, with the largest reduction among infants, during the same time period when drug overdose fatalities and near-fatalities among children hugely increased? The answer is the influence on decision makers in both DCYF and the juvenile courts of the Keeping Families Together Act (KFTA) following the law’s passage in 2021, even prior to implementation on July 1, 2023. Policymakers in the legislature and Governor’s Office, influenced by vocal child and parent advocates, and hearing little opposition, narrowed the grounds for involuntary child removal to “risk of imminent physical harm,” while raising the bar for showing that an immediate threat to child safety exists. DCYF supported the passage of KFTA.
The DCYF data unit issued a report during the fall of 2023 which asserted: “(KFTA) did not increase the availability of community-based resources that support child safety … Since it’s passage, the availability of these resources are declining.” The report also asserted that “The vast majority of critical incidents (incidents in which a child is injured or dies) are cases with no indicated safety threat at the time of assessment.” In effect, the DCYF report asserted that the KFTA standard for child removal could not possibly have protected young children who died or were seriously injured by opioid overdoses.
Once again, Washington’s child welfare system has become the "canary in the coal mine" for ideologically driven policy changes that ignored safety threats to children (especially children, 0-3) in the social environment. Compare what has occurred in Washington’s implementation of KFTA with what could have (and should have) occurred: the legislature and Governor’s Office could have taken savings from the reduction in foster care and reinvested those savings in safety- oriented programs and services such as Pregnant and Parenting Women’s residential treatment programs, crisis nurseries, respite care, therapeutic child care, while developing an agency and private agency infrastructure to support in-home safety planning. Instead, KFTA was passed without additional family support resources and in the midst of a workforce crisis that has left many inexperienced overwhelmed caseworkers making life and death decisions in child protection cases.
It is impossible to understand the KFTA debacle in Washington and similar developments in child welfare agencies across the U.S. without understanding the past four decades of U.S child welfare history. The response from 1985-99 to the crack cocaine epidemic was to double the number of children in foster care, with devastating consequences on low-income families (especially Black and Native American families), public agencies, courts and foster care systems. The current response to the opioid overdose crisis has been to reduce foster care placements, without adding essential family support and safety-oriented services, influenced by persistent attacks on foster care and appeals to social justice values. The perspective of influential progressive voices seems to be that foster care is potentially more harmful to children than risk of death or near-death and less harmful than growing up with chronic maltreatment. Despite claims to the contrary, this is not a sound research-based argument.
Summary
In my view, U.S. child welfare systems should not – and cannot – repeat the near total reliance on involuntary child removal, foster care and permanent family separation that occurred during the 1990s and continues to a lesser extent to this day. However, denying, ignoring or minimizing the harms of child maltreatment and engaging in drastic experiments with children’s lives, while making little or no effort to greatly improve family support services, in-home safety planning and treatment resources for parents with co-occurring substance abuse and mental health disorders is unconscionable. In addition, foster care systems need to be strengthened -- rather than allowed to fall apart -- through investments in professional foster care for behaviorally troubled youth, and by repurposing the use of foster care to support parents with respite care, coaching and emotional support.
Next month’s Sounding Board will discuss safety assessment and in-home safety planning for families allegedly engaged in substance abuse with open CPS cases.
References
“AFCARS Report #29,” Children’s Bureau Express, Administration for Children and Families, Vol. 24, No. 1, Feb. 2023.
“AFCARS Report: Final Estimate for FY 1998 through FY 2002 (12),” Administration for Children and Families, 2006; available online.
“Child Fatalities and Near Fatalities in Washington State,” Office of the family and Children’s Ombuds, September 2023.
Johnston, W.R.,” Historical Trends on adoption in the United States, plus statistics on child population and welfare,” last updated, November 2022, available online.
“Keeping Families Together Act,” DCYF External Webinar, October 16, 2023, Washington State Department of Children, Youth and Families, Olympia, Washington; available online.
Putnam-Hornstein, E., Ahn, E., Prindle, J., Magruder, J., Webster, D. & Wildeman, C., “Cumulative Rates of Child Protection Involvement and Terminations of Parental Rights in a California Birth Cohort,” 2021 American Journal of Public Health, p. 1-7.
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©Dee Wilson