Can Foster Care Be Prevented?
(Originally published October 2016)
During the past thirty years, increases and decreases in the number of children in foster care in the U.S. has occurred in multi-year cycles. The number of children in foster care doubled between 1986-99 in response to a substance abuse epidemic (mainly use of cocaine and methamphetamine) and possibly increased rates of parental incarceration resulting from the War on Drugs. From 2000-2012, the number of children in foster care declined from 568,000 at one point in time to about 381,000 children, 0-17, a decline of almost a third. This surprisingly large decline of children in foster care occurred because (a) substance abuse in low income populations markedly declined in some large cities and states, in part because communities mobilized to resist substance misuse and deployed therapeutic resources to help substance abusing parents; (b) social learning regarding the dangerous effects of addiction to drugs with the potential to destroy health and well being; and (c) the efforts of child welfare agencies, foundations and the federal government to reduce the use of foster care through reduced entries-into-care and increased exits from care.
The number of children/youth in foster care has steadily increased since 2013 to approximately 415,000 (0-17), an increase of almost 10%, with no end in sight. Furthermore, a number of states have extended foster care eligibility to age 21 prior to or following changes in federal law authorizing use of IV-E funds for young adults (18-21) leading to an increase in the number of young people in foster care, further increasing the country's foster care population. A nationwide opiate epidemic has increased entries into care by 20-25,000 children per year.
For the past three decades, numbers of entries into foster care has been heavily influenced by social conditions, especially the rates of substance misuse among low income populations. Exits from care to permanent plans have been more dependent on child welfare practices and on the actions of juvenile courts. However, child welfare agencies overwhelmed by increases of children entering foster care are usually forced to take some caseworkers and other staff assigned to foster care units and reassign them to CPS units. As a result, when entries into care increase rapidly, exits from foster care tend to decline due to the smaller number of caseworkers assigned to units engaged in permanent planning. Juvenile courts, child welfare agency attorneys and public defenders face similar workload issues, thus reducing court time and attention available to legally dependent children.
Increases in foster care in the mid-1980s and in 2013 began about four years after the end of severe recessions, arguably because of despair regarding economic conditions among groups which concluded that losses suffered during the economic downturn will not be made whole, and that communities and the society at large has lost interest and concern in their living conditions and economic prospects. Arguably, it is not poverty, per se, that leads to increases in substance abuse and the neglect and abuse of young children, but economic hopelessness. Substance abuse is likely to increase in any situation in which drugs are cheap and widely available when vulnerable populations have lost hope in their future prospects. In the September 2014 Sounding Board, I referred to the delayed effect of severe recessions on drug misuse and child welfare as the Post Recession Blues.
Combating Substance Abuse and Economic Hopelessness
Communities and states can mobilize to combat a substance abuse epidemic and its deleterious effects on children and families through collaboration between and among law enforcement agencies, drug and alcohol treatment agencies, child welfare and various family support systems, including churches. These collaborations usually require a few years to have effects on the size of foster care populations. State legislatures can fund programs that combine advocacy, emotional and concrete support for struggling parents, housing and outreach to homeless families such as Oregon's OnTrack or Washington's PCAP. There are many examples of community and state agencies coming together to close down methamphetamine factories or other drug operations while increasing therapeutic resources for parents in recovery from substance misuse and addiction. Community and state leaders usually have more difficulty creating sustainable economic opportunities in neighborhoods and communities on the wrong side of the 'Have/Have Not' divide. Nevertheless, there are a wide range of possibilities for increasing both educational and economic opportunities for low income children and families, but it is more difficult to achieve fully mobilized communities which are politically divided on behalf of these goals. For this reason, community mobilization is often limited to areas of agreement among concerned citizens such as protecting children from abuse and neglect, combating substance abuse and community violence and, in a few states (including some Red states), providing high quality early childhood education to all pre-school children.
Limiting the length and impact of a substance abuse epidemic will eventually reduce pressures on foster care systems, at least for a few years, until subsequent economic downturns and social policies drive home the message of Haves to Have Nots: “You and your family's welfare does not concern us; on the other hand we will place your children in foster care if you seriously mistreat them.”
Can Triple P Reduce Foster Care?
More than a decade ago, researchers at the University of South Carolina conducted a study in which Triple P, a parenting intervention with multiple “levels” developed in Australia, was implemented in nine randomly selected medium sized rural and semi-urban counties in South Carolina. Rates of substantiated child maltreatment, child injuries and entries into foster care in Triple P counties were compared with rates in nine control group counties. Triple P counties had much lower rates of substantiated child maltreatment and entries into care (a third lower) than control counties. Following publication of the results of this study, several authorities on evidenced based practices designated Triple P as an evidence based practice for the reduction of child maltreatment. However, in 2014 a researcher at Cambridge University published a careful analysis of the South Carolina Triple P study which found methodological flaws and discrepant descriptions of the study's research methods in publications or presentations of the research in 2007 and 2009, as well as uncertainty regarding even the years in which the study was conducted. This critical analysis also pointed out that substantiated child maltreatment increased (rather than decreased) in counties chosen for Triple P implementation at about the same rate as in most South Carolina's counties during the study period; and that claims that Tripe P “reduced” substantiated maltreatment was based on a comparison with a large atypical increase of substantiations in control group counties.
There are a few lessons which can be taken from this controversy: (1) it is premature to arrive at judgments regarding evidenced based practices based on a single study, (2) it is foolish to depend on the judgments of experts regarding which programs are or are not evidenced based without reading the research oneself, (3) given the potential importance of the Triple P South Carolina study, it is imperative that this study be replicated and evaluated by a new group of researchers who have no investment in the program's success or failure. Premature conclusions regarding the effectiveness of programs may lead to skepticism regarding the evidentiary claims of prevention advocates and possible misuse of scarce public and private resources.
Narrowing the Use of Foster Care
During the past decade, there has been a reduction in the placement of children and youth in foster care for reasons other than abuse or neglect. The acute and chronic shortages of foster homes in most states has forced public child welfare agencies to prioritize the use of scarce foster care and residential care resources for children who have been abused or neglected. Furthermore, the loss of confidence in residential care has led to a determined effort to reduce its use, resulting in fewer resources for behaviorally troubled youth who have not been recently abused or neglected. This is a trend likely to continue until foster care systems are able to (1) recruit and retain a much larger number of foster parents, (b) consistently stabilize behaviorally troubled children in care, (c) stop the overuse and misuse of psychotropic drugs with children with diagnosed mental health conditions, and (d) reduce caseloads in foster care units so that caseworkers can develop relationships with children and youth necessary to assure their safety in foster care. Caseworkers who lack a therapeutic resource in which they have confidence should not be placing behaviorally troubled children in foster care, absent an immediate safety concern.
Child welfare agencies should also be developing alternatives to out-of-home placement for groups of abused and neglected children who benefit the least from foster care. Currently, school age children and youth, 6-17, with behavior problems may be at risk in foster care, especially in states with severe shortages of foster homes, a higher than average percentage of children in residential care, inadequate children's mental health systems and a lack of caseworkers or advocates able to maintain close and frequent contact with foster children/ youth. Child welfare staff should not assume that this age group of children will be physically or emotionally safe in foster care, much less that their developmental needs will be met. State child welfare and mental health systems can invest in school based day treatment programs for children with mental health conditions, develop foster parent/birth parent partnerships in which foster parents coach birth parents, and provide respite care and other concrete supports.
Policymakers don't seem to understand that foster care is a de-facto child mental health system due to the large percentage of foster children with mental health conditions. Currently, there is a lack of caregivers with mental health expertise and a lack of sufficient supports for foster parents who have behaviorally troubled children in their home. Furthermore, it is often difficult to reunite children and youth with birth parents who lack the skills and resources to cope with challenging child behaviors, even when parents have made excellent progress in substance abuse treatment programs or in mental health treatment. Child welfare systems need increased mental health expertise at all levels (beginning with foster parents) as well as mental health services and supports which can be utilized by both foster parents and birth parents. These services and supports include respite care on demand, timely access to consultation from psychologists or therapists, crisis intervention services and the availability of trauma-informed programs and practices for children susceptible to “meltdowns.” The same service packages that will improve foster care will also allow for its reduced use through quicker safe and stable reunification, guardianship and adoptions.
Some of the strongest recent evidence for the benefits of foster care is from studies of youth (18-21) who voluntarily extended their stays in care to pursue higher education or vocational training. Foster care is a better option (by far) for young people aging out of care than homelessness or becoming trapped in low wage jobs without the resources and support to attend college or a vocational training program. Foster care reductions, per se, should not be the primary goal of child welfare systems; in some instances, such as for youth aging out-of-care, the use of foster care should increase, not decrease.
In-Home Safety Planning
Currently, the weakest part of child protection in the U.S. is in-home safety planning. For decades, child protection programs organized CPS decision making around a dichotomy: place children out of the home or don't place. To this day, in-home safety planning does not receive the attention in CPS programs it deserves, and agencies' policy frameworks for safety planning are often highly questionable. Furthermore, child welfare scholars have invested enormous amounts of time and effort in research of risk assessment tools but have had little or no interest in safety assessment tools or in safety planning frameworks and outcomes. As a result, there has been little or no recent research to guide in-home safety planning. There is an urgent need for the federal and state governments to invest in studies of in-home safety planning for various groups of children and families, e.g., infants and toddlers, school age behaviorally troubled children comparable to the federal government's investment in research of treatment outcomes for maltreating families in the 1970s. In the meantime, CPS caseworkers must depend on practice wisdom developed by experts who often disagree among themselves regarding the fundamentals of effective safety plans. One piece of practice wisdom seems certain: the conscientious implementation of safety plans is more important than what is written on a form in a case record. Effective in-home safety plans take considerable time and attention to detail. Overwhelmed caseworkers have difficulty following up on these plans to the degree required to make them effective. If CPS programs want to safely reduce the use of foster care, they must dramatically improve in-home safety planning and safety services, for example child care, respite care, safety network facilitators, crisis intervention services and poverty related services. In the absence of these improvements, many practitioners are likely to conclude that whatever the safety concerns associated with foster care, these risks are far less than leaving children in seriously abusive or neglectful birth families. It will be difficult to achieve large reductions in the number of children in foster care under these circumstances.
Eisner, M., “The South Carolina Triple P System Population Trial to Prevent Child Maltreatment: Seven Reasons to be Skeptical about the Study Results,” University of Cambridge, Institute of Criminology, Violence Research Center, May 25, 2014; available at
Turney, K. and Wildeman, C., Mental and Physical Health of Children in Foster Care,”
Pediatrics, vol.158, no.5, November, 2016.