Is Foster Care Safe?
(Originally published June 2016)
During the fall of 2015, a federal judge in Corpus Christi, Texas declared the Texas foster care system to be unconstitutional due to its failure to provide children reasonable protection from harm. Judge Janice Graham Jack mentioned the “deliberate indifference” of state officials to the plight of foster children in the state's care 43 times in a 260 page opinion. She opined that children in foster care “almost uniformly leave state custody more damaged than when they entered...” Several of the plaintiffs in the class action lawsuit brought by Children's Rights who were placed in foster care by age 5 or younger had been repeatedly raped both by other children and by caregivers. For example, according to a story in the Dallas Observer “At 5, the girl identified as S.A. entered the Texas foster care system. Within months, she reported being raped by an older child. At 18, after aging out of the system, she walked into traffic and was hit by a car. At last report, she was living in a homeless shelter.” K.S., a plaintiff, was placed in foster care at age 5. “He told the court he was raped by both caregivers and other children. He was unable to report the abuse because the abusive caregiver was generally present when S. was on the phone with the caseworker. K. S. also felt that no one would believe him or do anything about the abuse even if he managed to report it.”
In a blistering editorial in the Dallas Observer, Jim Schuze commented that the federal court found “rapes and beatings of children were common and pervasive, the norm...” Schutze suggested that the newly appointed head of the public child welfare agency in Texas, a former Texas Ranger, should “throw a whole bunch of people including most of the Texas state legislature, the governor and lieutenant governor into prison for running a state sponsored rape factory.”
These are harsh words (to put it mildly) that raise the question of whether other states' foster care systems function similarly or very differently than the description of Texas' foster care system contained in the federal court opinion. Texas state officials have been unwilling to enter into a settlement agreement with Children's Rights, the advocacy group that filed the lawsuit, in part because they strongly object to Judge Jack's characterization of foster children in Texas as “the children that even God has forgotten,” as well as objecting to federal interference in the state's affairs. Nevertheless, there is plenty of cause for concern regarding the safety of foster children based both on first hand accounts of youth aging out of care in other states and on a recently published study of self reported abuse/neglect by young adults included in the Midwest Youth Study.
In Foster Shock, a documentary film recently shown at the Palm Beach International Film Festival, a dozen or so young adults who spent years being shunted among foster homes and group care facilities in Florida's privatized foster care system reported being sexually abused by both other youth, foster parents and residential care staff, living in facilities in which sex trafficking involving residents was common, being denied food or given inadequate amounts of food, being forced to take large doses of psychotropic medications to control their behavior, losing all contact with siblings and being detained for days in psychiatric facilities for punishment, in effect imprisoned in chaotic and violent group homes that profited from depriving them of necessities, without advocates or concerned adults to turn to for protection. These young adults describe conditions they viewed as endemic in the foster homes and facilities in which they resided, not with the righteous anger one might expect but with an anguished puzzlement that foster care providers could actually use children for profit without concern for their safety or well being. As in Texas (according to the federal court opinion), caseworkers entrusted with the protection of these children were missing in action, possibly because caseworkers did not have enough of a relationship with children on their large caseloads to take their complaints seriously or see past a plethora of mental health diagnoses to a struggling child.
A Retrospective Study
Some readers may be inclined to dismiss or minimize the messages of Foster Shock as stories of a few children that may not be representative of the experiences of other foster children in Florida. These readers and other skeptics resistant to the idea that foster care systems can be systematically dangerous to children’s health and safety should consider the findings of a recently published study of 386 young people in Illinois included in the Midwest Youth Study of youth aging out of care in several Midwestern states. In this study (2016), Judy Havlicek and Mark Courtney compared the rates of reported and investigated allegations of abuse and neglect in out-of-home care to youths’ self reports at age 19 of maltreatment they experienced in foster care and residential care. About one-fifth of these young adults had been the subjects of investigations of child maltreatment while they were in out-of-home care and almost 5% of them were named as victims in substantiated reports. However, almost 46% of these youth reported being abused or neglected while in foster care:
Neglected (including “had to go without needed things,” “ignored a serious injury or illness,” “missed school to care for children or do chores,” “failed to provide regular meals, or "failed to wash or groom”) - 39.6%
Physically Abused - 29.5%
Sexually Abused - 15%
Of the youth who reported maltreatment, more than 40% reported experiencing at least two types of maltreatment, for example, neglect and physical abuse; and 12.8% reported being neglected, physically abused and sexually abused. More than half (57%) of these youth reported experiencing multiple types of maltreatment by caregivers prior to placement in out- of-home care; half of the youth entered foster care prior to age 10. Havlicek and Courtney comment that, “Together they (youths’ self reports and investigations) reveal alarming rates of maltreatment prior to and during out-of-home care and large disparities between official investigations and self reports of maltreatment.” These authors maintain scholarly detachment in delivering some extremely bad news, i.e., that rates of abuse and neglect in foster care (including group care) in Illinois during the past two decades may have been as large as half the rate of maltreatment in birth families from which children were removed. Furthermore, more than two-fifths of the youth who reported maltreatment in the Illinois foster care system described patterns of chronic maltreatment, i.e., combinations of neglect and abuse commonly found in chronically referring families with multiple CPS reports. This study also suggests that child neglect is surprisingly common in foster care, an alarming finding that deserves more scholarly attention than it has received.
Conditions that Compromise Child Safety in Foster Care
It’s possible that foster care systems in Florida, Illinois and Texas are unusually dangerous for children. However, several of the conditions that have contributed to compromised child safety in these states are widespread across the country:
Most child welfare systems function with acute and chronic shortages of foster homes, especially shortages of homes for emotionally troubled children and teenagers. The chronic shortage of homes leads to risky practices such as placing children wherever there is an opening regardless of the fit between a child’s needs and the strengths of foster parents, overcrowding homes, placing physically aggressive or sexually acting out children in homes or facilities with younger or weaker children unable to protect themselves, having children sleep in child welfare offices or in hotel rooms, moving children from home to home every 24 hours and ignoring children’s needs unless they are severe or immediate. The shortage of foster homes also leads to increased use of group care which in Florida, Texas, Illinois and Washington (and other states) has included facilities where maltreatment of youth was widespread. My guess is that almost every veteran caseworker has had the experience of dropping off children and youth at homes or facilities with poor track records of caring for children and youth or in appalling conditions due to the lack of other options.
Agencies in which caseworkers are routinely assigned unreasonably heavy caseloads do not require their staff to have frequent contact with children in foster care or group care. These agencies often have difficulty enforcing a policy requiring monthly health and safety visits, most of which occur in the child’s foster home. Caseworkers who have infrequent contact with children and youth are unlikely to have close trusting relationships with them, and may have heard lots of information from caregivers regarding a child’s behavior problems, lying and stealing, etc. Foster youth often feel that they lack a single advocate or helping person who will listen to them.
The misuse (especially overuse) of psychotropic medications is a nationwide practice which should be viewed as an urgent child safety concern. National Study of Child and Adolescent Well Being (NSCAW) data indicates that almost 30% of children in non-relative foster care and one third of youth in residential treatment centers were taking a psychotropic medication at the time of NSCAW I & II sampling, and 13% were taking three or more medications on a regular basis, with the highest rates of usage in the 6-11 year old age group. These medications frequently have poorly understood inadequately researched effects on health and mental health. Any estimate of a rate of maltreatment in out-of-home care that does not take into account the misuse of psychotropic meds is almost certainly an underestimate. The Texas federal court opinion and Foster Shock suggest that the willingness of foster parents and group home staff to force children and youth to use of powerful mood altering drugs with uncertain side effects is experienced by many youth as an invasive abuse of power. In Foster Shock, young people with lengthy histories of foster care assert that refusal to take psychotropic medications often resulted in use of restraints, i.e., being strapped to a bed. Furthermore, an elevated rate of use of psychotropic medications is one way foster care may be more dangerous to children than living in abusive or neglectful birth families.
In many states, children’s mental health services are grossly inadequate to meet the needs of foster children and children with open child welfare cases. NSCAW data indicates that most children with identified mental health conditions did not receive mental health services. The overuse of psychotropic medications with youth in foster care is likely directly related to the lack of better alternatives, including a range of evidenced based programs and high quality foster parent training.
How to Create Safer Foster Care Systems
1. Smaller is safer. Foster care recruitment initiatives typically have limited, if any, effects, in part because parents in families in which both adults are employed are too stretched for time and emotional energy to willingly accept responsibility for a foster child. A large percentage of foster parents (at least a third) become licensed as a means to adoption, or because of an interest in caring for a specific child. There is not a large pool of adults interested in caring for children unrelated to them, much less emotionally troubled children and youth. For these reasons, child welfare systems must reduce the number of children in foster care to eliminate the acute and chronic shortage of licensed homes. Shortages of homes extended over months or years will inevitably lead to questionable practices that endanger children and harm their development as well.
2. Child welfare systems need to steadily develop alternatives to foster care. The numbers of children in foster care cannot be safely reduced without a range of alternatives to foster care. Federal and state investments in family preservation services have been flawed attempts to do the right thing despite the inadequacies of these programs. It is important to learn from the mistakes of family preservation programs, e.g., their use of crisis oriented short- term services provided only when out-of-home placement is imminent. Family support programs should be available for neglecting families well before young children are in danger. In addition, there needs to be a steady determined effort to improve in-home safety planning, arguably the weakest element of child protection programs.
3. Every child needs an advocate. Until and unless workloads in child welfare are reduced, every child residing in foster care longer than a few days or weeks needs an advocate with the time to develop a close relationship with the child. CASA programs should be funded to make this possible.
4. The use of residential care should be strictly limited. It is very difficult to protect children and youth living in residential care programs with several other youth who may be bullies or sexually aggressive, and to ensure that staff do not engage in abusive practices to control youths’ oppositional behavior. As a rule, not more than 5-10% of a state’s foster care population should be placed in residential care facilities. Child welfare agencies need full time staff whose job it is to closely monitor the safety and well being of youth in these facilities.
5. Panels of physicians and mental health experts should review use of psychotropic medications with an emphasis on scrutiny of prescriptions of multiple medications for a single youth. The reckless use of psychotropic meds to control the behavior of emotionally troubled children and youth is an outrage that must stop. Currently, this widespread practice is not even viewed as child maltreatment in child welfare agencies or by scholars, though its potential to do serious harm far exceeds many of the maltreating behaviors described by Havlicek and Courtney (see above).
In "The Foster Care Recruitment and Retention Crisis," I discuss a positive vision for foster care as a therapeutic system providing tangible benefits for almost all children entering care. This is a system that some policymakers and advocates may believe already exists. Unfortunately, they are mistaken.
Foster Shock, Muer Inc. in association with Greendoor East, retrieved at http://vimeo.com/13941763, 2016.
Havlicek, J. & Courtney, M., “Maltreatment histories of aging out foster youth: a comparison of official investigated reports and self reports of maltreatment prior to and during out-of-home care,” Child Abuse and Neglect, vol. 52, February 2016, pp. 110-122.
Shutze, J., “Horrors of Texas Foster Care Are Not Materially Unlike Better Known Atrocities,” Dallas Observer, April 18, 2016.
Stambaugh, L., Leslie, L., Ringeisen, H., Smith, K. & Hodgkin, D., “Psychotropic Medication Use by Children in Child Welfare,” OPRE Report, #2012-33, Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, 2012.