Alternatives To Foster Care
(Originally published September 2016)
After recent news stories, court findings and research articles regarding the acute and chronic shortages of foster homes and the widespread abuse and neglect of some groups of foster children and youth that have occurred in numerous foster care systems,
it's difficult to disagree with Richard Wexler's contention that foster care reform must include its reduced use. Overcrowded and under-resourced foster care systems inevitably compromise children's safety and development. Furthermore, it has become increasingly apparent that foster care is especially hazardous for school age behaviorally troubled children and youth who remain in care for lengthy periods of time. The loss of confidence in residential care among child welfare practitioners and advocates and scholars began a couple of decades ago due to cost, revelations of widespread physical and sexual abuse of residents in some of these programs and limited evidence of therapeutic benefits for youth with lengthy stays in large facilities. A similar loss of confidence in family foster care is steadily increasing due to the stories of foster care alumni discussed in recent Sounding Boards, and because of the inability of most states' child welfare systems to recruit and retain more foster homes in the midst of an opiate epidemic.
What is Foster Care?
Foster care involves more than the care of children by licensed foster parents or placement of children with unlicensed relatives or in staffed residential care facilities. Foster care also includes the legal framework for these placements, i.e., usually dependency actions and, eventually, dispositional orders of courts following findings that children have been abused or neglected by birth parents or other caregivers. Foster Care also includes the social context in which children are placed out-of-home and the goals of these placements. In the United States, the early development of foster care was associated with orphan trains which transported children from large Eastern cities to farming communities where these children provided low cost labor. Foster care was a response to the destitution of immigrant families in large Eastern cities and to the inadequacy of orphanages and other institutional settings for the care of children. Arguably, orphan trains ended after 1920 not because of the widespread abuse and exploitation of children and youth in foster families, or because some of these youth left their foster families and became a burden on states and local communities, or because the Catholic church opposed the placement of children from Catholic homes with Protestant foster parents, but because social attitudes toward child labor changed dramatically. The use of foster children for farm labor, once an accepted practice, became increasingly unacceptable.
For at least three decades following the creation of modern child welfare system in the 1960s and early 1970s, foster care was frequently used in Washington for youth with oppositional behavior when parents had lost the ability to control these youth. Professionals in the communities where I worked in child welfare usually assumed that adolescents with serious behavior problems from “dysfunctional” families were better off in residential care. In these cases, community protection was often viewed outside child welfare agencies as an important child welfare function. In addition, foster care systems not so long ago used to care for large numbers of disabled children whose parents made desperate pleas for help from child welfare agencies and often refused to take “no” for an answer. For decades, Washington State's child welfare system included a large Family Reconciliation Services (FRS) program that made use of Crisis Residential Centers (CRCs) for brief placements when parents and youth, mostly teenagers, were in conflict. As recently as a decade ago, one-fifth or more of children in foster care in the U.S. were placed due to behavior problems or for reasons other than abuse or neglect. These practices continue today in many states but much less frequently than was once the case. Washington State's FRS program, for example, is a shadow of its former self. Most states can no longer afford to place large numbers of youth with behavior problems, and have made persistent efforts to reduce the use of residential care. Furthermore, when the policymakers' need to control costs lines up with scholars' and advocates' doubts regarding the benefits of some types and uses of foster care, dramatic changes in child welfare practices may rapidly occur. Increasingly, foster care in the U.S. is viewed solely as a (hopefully) safe haven for abused and neglected children and as a conduit to adoption or guardianship when children cannot be safely reunified with birth parents within legally defined time frames. This is (to put it mildly) an idiosyncratic version of foster care discordant in important respects with child welfare practices in many other developed countries. There are other ways of operating foster care systems despite the notable absence of discussion (even among scholars) of what they might be.
Alternatives to Foster Care
Alternatives to foster care include in-home safety plans or services that reduce safety threats, for example crisis oriented family preservation services or respite care on demand. It is also possible to change caregiving arrangements so that substance abusing parents enter residential treatment programs that allow mothers to retain custody of young children. In some countries in Northern Europe, parents and their children may be placed together in shared family care with resource families, an idea that has never caught on in the U.S.. The legal framework for foster care could change so that an increased percentage of foster care placements occur through voluntary agreements with parents rather than court structure, a practice that would make foster care less threatening to birth parents and reduce the length of stay in many cases. The uses of foster care could be altered so that a group of professional foster parents coach and otherwise support birth parents, rather than being utilized as substitute caregivers for abused and neglected children. In a few states, therapeutic communities have been developed to support adoptive parents, including relatives of children who adopt sibling groups or youth with challenging behaviors. Programs that safely reduce entries-into- care, or increase rates of safe and stable reunifications, adoptions and guardianships should be developed and tested. It is also possible to make large investments in substance abuse prevention and in other prevention programs that would reduce the need for out-of-home care. Arguably, one of the main causes of the large reduction in foster care from 2000-2012 was the decline of substance abuse among low income populations. The ongoing opiate epidemic has placed great pressure on foster care systems around the country and led to practices such as placements of youth in hotels or moving children from home to home every 24 hours causing further damage to the reputation of foster care systems.
The federal government made a large investment (by child welfare standards) in family preservation services during the 1990s, and federal funding of family preservation services continues to this day. The many research studies of family preservation programs which occurred for more than a decade following the initial federal investment in family preservation led to a bad tempered debate among child welfare scholars regarding the effectiveness of these programs. The short version of this controversy is that several randomized controlled trials of family preservation programs did not confirm the early positive findings of studies which did not use control groups or used other less rigorous research designs. Some family preservation programs were found to have small effects (if any) on numbers of children placed in out-of-home care, primarily because children in control groups alleged to be at imminent risk of placement were placed out of the home infrequently. “Imminent risk of placement” was revealed to be a phony eligibility criterion easily “gamed” by child welfare staff needing services for families with open cases in resource poor agencies.
Whatever the merits of the scholarly debate regarding family preservation services, many policymakers at the state and federal level eventually concluded that use of these services endangered children and prevented a small percentage of placements. Nevertheless, scholarly discussion of family preservation services research has continued during the past decade with less emotionality (a good thing) and more cogency. Several years ago, the Washington State Institute for Public Policy (WSIPP), after its review of the research, concluded that family preservation services delivered in fidelity to the original Homebuilder model were effective in reducing placements while programs that changed the model in various ways were ineffective. I have a different view which is that the crisis oriented design of the programs made their use suitable for some types of cases but not others. Specifically, crisis oriented programs worked best for parent-child conflicts and for physical abuse cases of school age children involving excessive discipline. Crisis oriented short term services are insufficient for families with chronically relapsing conditions, or for chronically neglecting families or for types of physical abuse other than excessive punishment, for example escalating cycles of injury, battered child syndrome or child torture. In past years, some scholars zeroed in on the types of ongoing family support services needed for substance abusing families, or families with chronic mental health conditions, but most did not. Too often, the scholarly debate ended up being about the quality of research rather than about the best use and limitations of specific programs.
Expanded funding for family preservation services, as currently designed, is a poor idea. Instead, what is needed is the incremental creation of a range of family support services with a developmental focus on the needs of three groups of children, infants and other preschool children, 0-5, 6-11 year olds and adolescents, 12-17. To decrease entries into care and increase safe reunifications for infants and toddlers whose parents have chronically relapsing conditions, communities need day treatment programs with comprehensive family supports, parent mentors and resource families who can care for children as needed and provide coaching and emotional support to birth parents. In Washington State, a large percentage of children in foster care come from destitute single parent families. These overburdened parents must have the support of functional extended families or non-kin resource families for young children to be safe living in the parent's home. Parents with young children need access to evidenced based parenting programs and to concrete poverty related services, especially housing services and income support programs, as well as to drug/alcohol and/or mental health treatment. Washington State has made a good start in developing the services needed for substance abusing parents through its Parent Child Assistance Program (PCAP). Oregon's Relief Nurseries provide a model for day treatment programs for infants that could be developed in Washington State. Seattle's Childhaven is an example of a day treatment program for 2-5 year olds that could once again be made available around the state.
Children, 6-11, who enter foster care with serious behavior problems are at risk for long lengths of stay and of being moved from home to home without being reunited with birth parents or finding another permanent family. Birth parents are often ambivalent about being reunified with out of control children who flaunt their authority. In recent Sounding Boards, I have discussed the creation of a cadre of professional foster parents to care for these children, and to provide coaching and support to birth parents. In addition, school based mental health programs are needed for children on a trajectory for educational failure and anti-social behavior. Crisis intervention mental health services are also useful for this group of children and their families. Educators, caseworkers, advocates and mental health experts should imagine and develop opportunities for pro-social activities and skill development that will bring positive social recognition to these children. Many of the parents in these families have substance abuse and/or mental health problems and domestic violence incidents that periodically put families in turmoil. Neverthless, child welfare agencies and courts have often been too quick to terminate parental rights in these cases when there was no family available to adopt a behavioral troubled child. Child welfare involvement has often harmed more than helped these children.
Washington State's Family Reconciliation Program (FRS) was once an effective program for parent-child conflicts involving adolescents. This program which utilized staffed residential centers (CRCs) for brief placements often defused conflicts that could have led to abuse and lengthy stays in care. To its credit, Washington State has invested in educational advocates managed by Treehouse, a private agency in Seattle, to work with and advocate for adolescents struggling to stay in school.
Unfortunately, several hundred adolescents per year have aged out of foster care in Washington State during recent years. Every effort should be made to reduce this number, either through specilized adoption programs, or by reuniting older youth with birth parents with whom they have lost touch, even in many instances when there has been a termination of parental rights. Troubled adolecents badly need support systems even when they appear to be undermining them at every turn.
Other Alternatives to Foster Care
The next Sounding Board will discuss kinship systems, in-home safety planning and prevention programs that can reduce the need for foster care. Under any plausible scenario, foster care will remain a vital resource for child welfare systems in the U.S.. Neverthless, it is time to reduce the dependence of child protection systems on foster care that is in short supply and often carries with it major risks to children's safety, health and development.
Barth, Richard, “Long Term In-Home Services,” Chapter 13 in When Drug Addicts Have Children, edited by Besharov, D. and Hanson, K., Child Welfare League of America and the American Enterprise Institute, 1994.
O'Connor, Stephen, Orphan Trains: The Story of Charles Loring Brace and The Children He Saved and Failed, Houghton Mifflin Publishers, 2001.