Mary Bissell

Is America Serious About Mental Health?

Cecille Isidro — Thu, 19 Apr 2007 20:10:00 -0400

The Virginia Tech massacre raises questions that may never be answered. Even in the insolubility of this week's events, however, one thing is clear: Cho Seung-Hui was a very sick young man.

No one deserves an explanation to the questions this tragedy raises more than the victims and their families. One question we all should be asking: Is America serious about the mental health of its young people?

America's young people face a mental health crisis. According to the Foundation for Child Development's 2007 Child Well-Being Index, the emotional and spiritual well being of young people has fallen nearly 7% since 2002.

College counseling center directors report an increase in students with severe psychological problems. According to the 2005 National College Health Assessment, more than 62% of student respondents reported feeling "overwhelmed" at some point during the year. Nearly a third reported feeling "so depressed it was difficult to function" and more than 5% reported they "seriously considered suicide."

The pressures of growing up, fitting in and getting ahead leave many students in need of mental health support that many are not getting. For some, the stigma of mental illness is enough to avoid treatment altogether. Those students who seek counseling often face understaffed clinics and insufficient health insurance coverage.

To address the mental health needs of young people, we need adequate funding for mental health services. We need health providers and parents who monitor children's mental health as regularly as their temperatures. We must make sure that young people feel comfortable making an appointment with a psychologist. We should convene education, health, mental health, family and youth experts to identify communication strategies that build bridges between the education and mental health systems.

Would even the best mental health care have prevented the tragedy in Blacksburg? No one will ever know. It should, however, cause us to work to improve our nation's mental health system for our young people.

The 2007 Child Well-Being Index

Communications — Tue, 17 Apr 2007 07:00:00 -0400

A New America Event
04/17/2007 - 10:00am

The annual release of the Child Well-Being Index (CWI) provides a research-based look at the status of children in the United States over 30 years. The CWI is commissioned by the Foundation for Child Development and provides policymakers and the public with a tool to monitor the well-being of children nationwide.

The data cut through the headlines and conventional wisdom to offer a multi-faceted portrait of the quality of life of our children. The index addresses questions such as… more

Fighting Meth, Healing Families

Cecille Isidro — Wed, 03 Jan 2007 21:43:00 -0500

Nationwide, methamphetamine, or “meth,” is devastating children, families, and the child welfare agencies that serve them. Adding to the crisis is the widespread misconception that meth addiction is untreatable. This myth not only hurts children and families, but makes it even more difficult for child welfare agencies to secure the government resources and community supports necessary to address it.

In collaboration with law enforcement, business, and the media, however, child welfare agencies are learning more than ever about new partnerships, tools, and programs that are working to protect families against meth.

1. Media Campaigns

In recent years, several states have developed effective public education campaigns to warn against the risks of meth use. These campaigns are built on the premise that, in a media-saturated world, one message is not enough when it comes to preventing substance abuse.

When software billionaire Timothy Siebel learned about the devastating effects of meth on Montana’s communities, he put his money to work to create a comprehensive advertising and community action project to reduce meth use in the state. In 2005, the Montana Meth Project began targeting 12- to 17-year-olds, with graphic, disturbing TV commercials, radio ads, billboards, and posters to warn against meth use.

The campaign worked. A March 2006 survey of more than 1,460 respondents found shifts in attitudes about the perceived “benefits” and risks of meth by as much as 30% over a period of only eight months, including a significant increase in communication between parents and teens.

Recovery Coaches

Since 2000, the Illinois Department of Children and Family Services (DCFS) has operated a successful federal waiver demonstration project to provide enhanced alcohol and other drug abuse services to child welfare-involved families. The demonstration allows DCFS to waive current restrictions to use federal foster care funds more flexibly to address the needs of this population.

The waiver builds on an existing partnership with the state’s Department of Alcohol and Substance Abuse that has resulted in expedited assessment and priority treatment admission for child welfare families. The courts also played a key role in this collaboration through the Juvenile Court Assessment Project, which provides onsite substance abuse assessment services at the juvenile court.

A cornerstone of the project is “recovery coaches,” who help parents obtain treatment services and negotiate departmental and judicial requirements associated with recovery and permanency planning. Coaches work in collaboration with the child welfare worker, treatment providers, and extended family members to bridge service gaps. Specialized outreach and intensive case management are provided at all stages of the treatment, reunification, and recovery processes.

Based on a comprehensive evaluation, the first five years of the demonstration project have shown that children whose parents participate in this model are more likely to return home -- and return home more quickly -- than are children whose parents did not have access to these services. In addition, families in the program were less likely to have subsequent child abuse and neglect reports or to have additional children born exposed to drugs.

2. Expanding Permanency Options

With adequate supports, good substance abuse treatment services, and strong collaboration between multiple systems, parents can successfully kick meth habits and keep their families together.

But even the best possible interventions do not work for everyone. To help those children who cannot return home to live safely with their parents, child welfare agencies and the courts are redoubling efforts to ensure permanency through adoption and guardianship. In particular, subsidized guardianship is an increasingly valuable permanency tool when adoption or reunification with parents is not viable. This option is especially popular for children who are being cared for by grandparents and other relatives.

Subsidized guardianship programs, now available in at least 37 states and the District of Columbia, provide ongoing financial support to allow children to leave the foster care system to live with a permanent family that has agreed to provide them a safe, loving home. Subsidized guardianship is a particularly important permanency option for many older youth who do not want to be adopted. Subsidized guardianship is also a useful option for grandfamilies -- grandparents and other relative caregivers -- who do not want to disrupt family relationships by terminating parental rights, and for Native American and other populations for whom termination of parental rights is contrary to cultural norms.

An estimated 20,000 children in the foster care could leave the system if a permanency option like federally supported guardianship were available. If subsidized guardianship were widely available in all states, many of these children would be able to exit foster care to the permanent care of loving relatives and other foster families.

3. Interagency Collaborations

Because meth affects children in many different ways, partnerships are critical to ensure that all involved agencies -- from child welfare to law enforcement -- are addressing individual needs effectively.

One particularly effective model gaining influence nationwide is Drug Endangered Children (DEC) partnerships. DEC partnerships are designed to coordinate the activities and responsibilities of all agencies that may be involved as first responders at a drug scene or in a meth-related crisis intervention, including law enforcement personnel, child protection workers, emergency room personnel, prosecutors, and fire and hazmat crews.

To support the more than 25 states and regions that have established DEC teams, a National DEC Training Program has educated more than 5,500 professionals from multiple disciplines in 20 different states. Building on the success of these collaborations, the National Alliance for Drug Endangered Children has also been established to provide technical assistance and support for the state networks of professionals involved in substance abuse issues.

As part of the reauthorization of the Patriot Act, Congress recently authorized $20 million dollars in grants to the states to expand and establish new programs to provide comprehensive, coordinated services to drug-endangered children living in homes where meth and other controlled substances are made and used.

In addition to law enforcement partnerships, more child welfare agencies are also turning to broader collaboration with the substance abuse treatment community and drug courts. The National Center for Substance Abuse and Child Welfare (NCSACW), funded by the U.S. Substance Abuse and Mental Health Services Administration, was created specifically to help foster greater collaboration among these agencies.

Extra Support for Grandfamilies

Janet Parker was looking forward to retiring with her husband when she started noticing things weren't quite right with her niece. She looked tired and would disappear for long periods of time. When her niece became pregnant, the family became even more concerned. When the baby, Brian, was born, his mother disappeared for two weeks and eventually ended up in jail for possession of meth.

Janet and her husband decided they had no choice but to take the baby in. "I had this little guy just laying in my lap, and it turned my world upside down," she explains. "I was footloose and fancy-free, and then all of a sudden I had this new baby."

After her niece disappeared, Janet and her husband talked about getting child protective services involved so Brian's mother wouldn't come and take the baby. But they were afraid. "I think I feel what a lot of relatives do," Janet says. "My primary concern was that if I got the child welfare system involved, they might take him away from us, and we didn't want to risk it."

Instead, they decided to go to court and get full custody of Brian, but not before they got help from the Kinship Adoption Resource and Education (KARE) Family Center, a private support organization for grandfamilies in Tucson, Arizona, where Janet had worked as a volunteer. Through the KARE Center, Janet was able to access a range of services, from support groups and one-on-one counseling to a guardianship clinic that helped her navigate the court process.

"This was an emotional experience for me," she remembers. "Knowing there were others who had been through what I had been through really helped." In response to Janet's and other caregivers' experiences, the KARE Center is now offering a series of lectures on "Meth in Tucson" which introduces families to local law enforcement officials, clinicians, and other service providers with expertise in combating meth. "When I volunteer to answer questions from other relative caregivers, I'd say at least 60% of the calls I get are meth-related," Janet says. "It's a huge problem."

NCSACW’s technical assistance resources and online trainings provide agencies the basic structure for successful collaborations, including a framework for shared values and principles, interagency protocols for working together, substance abuse expertise for child welfare agencies and family courts, information on developing strong and early assessment processes, and other resources.

4. New Supports for Grandfamilies

Grandfamilies have become lifelines for millions of children who cannot live with their parents due to meth and other substance abuse. As the child welfare system’s reliance on grandfamilies continues to grow, a number of new programs and resources have become available to address the unique issues they face.

To help grandfamilies break the cycle of substance abuse in their lives, the Children of Alcoholics Foundation has created a comprehensive guide and series of fact sheets, Ties That Bind, to help support relative caregivers dealing with parental substance abuse issues. The curriculum helps grandfamilies learn strategies for accessing child welfare services, ways to deal with changing family relationships, and managing children who have been affected by meth and other drugs.

Other programs are exploring new ways to help grandfamilies and other foster parents better address the developmental needs of children who have been affected by meth -- especially young children who can benefit most from special early intervention programs.

The Therapeutic Preschool Model, developed by a coalition of national child development professionals for the Green County Behavioral Health Services in Muskogee, Oklahoma, provides one-on-one support for young children who have been exposed to parental meth use. In addition to a range of developmental services, teachers also work directly with grandparent caregivers and foster parents who are caring for children who have been removed from their homes.

The needs of grandfamilies are also being incorporated into foster and adoptive trainings. As a former police officer and the current coordinator of the Cerro Gordo County Community Drug Court, Mike McGuire of Mason City, Iowa, has been watching the devastating effects of meth on communities across his state. Based on his extensive experience with children and families affected by meth, Mike now offers a series of peer trainings for foster and adoptive parents and grandfamilies who are raising children in the child welfare system. The trainings include general drug awareness, as well as classes on promoting positive relationships with birthfamilies and system professionals to increase positive outcomes for children.

“Relative caregivers caring for children in foster care have many of the same issues as other foster and adoptive parents,” McGuire say, “but one subject that tends to be ignored is the impact of meth on the entire family system. Wherever meth is present, we’ve just seen an explosion of relatives raising children.”

5. Enhancing Treatment Options

Comprehensive, readily accessible treatment programs are communities’ best hope have for breaking the cycle of alcohol and drug dependence and helping families stay together. One of the most promising treatment models is comprehensive family treatment, which provides services for both parents and their children.

A 2003 evaluation of 24 residential family-based treatment programs showed successful outcomes for mothers and their children, including 60% of mothers who remained clean and sober six months after discharge. The study also showed that 44% of children returned to their mothers from foster care.

Annie's Story: Treatment Keeps Families Together

Annie Zander had been using for more than 12 years when her son, Jory, tested positive at birth for meth and marijuana. The Oregon Department of Human Services took custody of Jory and placed him in foster care while Annie attended substance abuse treatment and parenting classes. She got him back when he was about 5 months old, continued out-patient treatment, and graduated from treatment four months later.

But Annie hadn't kicked her addiction. "I hadn't been clean any of that time," she says. I was just going through the motions and acting like I was clean."

Annie was soon arrested for possession. She went to jail, and Jory went to foster care. Sentenced to 18 months, Annie was told she didn't have to serve her sentence if she completed two months of in-patient and one year of out-patient treatment. When she had been clean for six months, she was accepted into a transitional housing program for women and children. She received shelter, parenting supports, and case management to help her form a more healthy relationship with Jory.

Annie has been clean and sober for five years. She now works with a parenting program in Portland, where she mentors other women who are trying to keep their children, but she's particularly worried about the scarcity of similar programs for others. "We've done a good job at taking Sudafed off the shelves, but we need to do better at dealing with the sheer numbers of people who need treatment."

In addition to the benefits to women and children, comprehensive family treatment programs also are a cost-saving alternative to foster care. In New York State, for example, effective family treatment costs $25,000 per family, compared with the $30,000 average cost to support one child in the foster care system and the $30,000 cost of incarcerating a mother in a state or federal prison.

Most important, comprehensive substance abuse treatment increases parents’ willingness to begin treatment in the first place. “In the family treatment program, I knew my wife and children were safe and healing,” says Darren Noble, an Ohio father in recovery from a meth addiction. “That really eased my mind so I could focus on my treatment.”

6. Family Drug Courts

The nation’s dependency courts are also responsible for ensuring children are safe and families can access the child welfare services they need. As many of these courts are finding, treatment works, but only if those who need it have the right support and motivation to try it in the first place.

Family drug courts have been widely lauded as a key ingredient to motivating families to enter and stay in treatment. These special courts handle substance-abusing offenders through comprehensive supervision, frequent drug testing, and immediate sanction and incentives to participate in substance abuse treatment. Drug courts bring all the players -- judges, lawyers, substance abuse treatment professionals, and child protection agencies -- into the process, forcing parents to confront meth use and other substance abuse-related issues.

One of the oldest and most effective drug treatment programs is the Sacramento County Family Drug Court in California. Over the past decade, the program has instituted a number of innovations that have substantially improved outcomes for thousands of children and families involved in the child welfare system.

At the very first detention hearing to determine a child’s placement in the child welfare system, parents are referred to the STARS program (Specialized Treatment and Recovery Services), directly across the street from the courthouse, where they receive a comprehensive evaluation for appropriate services and a treatment plan. In addition to intensive counseling and other comprehensive treatment components, parents in the program are assigned role models, individual certified addiction specialists who are also in recovery.

The American University’s Drug Court Clearinghouse reports that more than 400,000 offenders have participated in drug court programs like the one in Sacramento since they were created in 1989. A 1997 Government Accountability Office report estimated 71% of offenders participating in drug treatment courts had either successfully completed or remained actively involved in their programs. A 2001 Columbia University study found that drug courts continue to provide “the most comprehensive and effective control of the drug-using offender’s criminality and drug usage while under the court’s supervision.”

7. Targeted Community Supports in Indian Country

Children, families, and tribes in the Native American community have been hit particularly hard by the meth crisis. Nationally, American Indians and Alaska Natives use meth at two to three times the rate of whites, with the highest rate of use among people ages 15-44.

The devastating effects of meth on the American Indian community is compounded by the fact that native children are already disproportionately represented in the child welfare system. In fact, Indian children are placed in foster care at two to three times of other children nationally. In some states, Native American children represent as much as 50%-60% of the children in state care.

To ensure infants and young children and their relative caregivers receive the full range of early intervention services, the Tribal Social Services Division of the Confederated Salish and Kootenai Tribes of the Flathead Nation in Montana has developed a comprehensive Developmental Assessment Clinic for children who have tested positive for meth and other drugs at birth. Of these children, 70%-80% are placed in foster care with relatives and then referred to the clinic, where they receive physical therapy, speech and language, medical, and dental screenings.

Although many of these families would also benefit from in-home support services, funding isn’t available. “We need to learn how to remove, not just individual children, but whole families from the drug environment,” explains Arlene Templer, the tribes’ Social Services Division Manager. “We have the expertise to give children, parents, and relative caregivers the services they need, but we don’t have the money.”

New Hope, New Directions

Meth is not the first nor the last child welfare crisis. Policy changes at the federal, state, and local levels must be flexible and broad enough to address a range of current and unforeseen issues. At the same time, meth’s particular brand of devastation, especially on certain states and communities, is a potent reminder of the urgent need to continue testing, modifying, and replicating effective practices and new solutions to this entrenched problem.

In addition to promising strategies, the best weapon may be our nation’s inherent capacity to support change when it’s most needed. “We need to believe that change is possible,” explains an adoptive father of 8-year-old twins whose birthmother recently entered substance abuse treatment. “If we lose hope, we might all as well pack it in.”

Congress Approves Grants for Meth Abuse

Legislation enacted last fall will provide $40 million in grant funding for regional partnerships that address permanency outcomes for children affected by meth.

The Child and Family Services Improvement Act, S. 3525, which reauthorizes the Promoting Safe and Stable Families Program, establishes a series of grants to regional partnerships designed to address the safety, permanence, and well-being of children who are in, or at risk of placement in, out-of-home care as a result of meth or other substance abuse.

Competitive grants of $500,000 to $1 million will be available to address methamphetamine or other substance abuse as it affects the child welfare system. Grants will be from at least two to five fiscal years.

Applicants will have to demonstrate that meth or some other substance abuse has had a substantial effect on the number of out-of-home placements for children or the number of children who are at risk of placement, how they expect the funds to help address this impact, and how the integration of services and interagency collaboration will help achieve these goals.

Regional partnerships that address methamphetamines, have limited resources to address the needs of children affected, and lack the capacity for or access to comprehensive family treatment services will receive priority consideration.

Grant recipients will be able to use the funds for a variety of activities, including family-based, comprehensive, long-term drug treatment; early intervention and prevention; child and family counseling; mental health services; parenting-skills training; and replication of successful models for proven family-based, comprehensive, long-term substance abuse treatment.

Mary Bissell

Operations — Wed, 19 Apr 2006 17:40:00 -0400

Former Fellow

Mary Bissell is an attorney and an expert on a variety of policy issues affecting children and families, particularly child welfare issues. She formerly worked as an attorney and lobbyist at the Children’s Defense Fund and as a legislative assistant in the office of Sen. John D. Rockefeller IV (D-WV).… more

Fostering Progress

Cecille Isidro — Thu, 01 Dec 2005 00:00:00 -0500

What prevents the U.S. child welfare system from doing all it can to protect children and support families? Complex social problems? Insufficient funding? Staff turnover? The truth is, the inability to address these barriers is rooted in a much larger problem--a chronic lack of public will. Despite its best efforts, child welfare faces daunting challenges in making policymakers and the public understand and commit to fixing the system.

Child welfare agencies and service providers rarely have the time, expertise, or capital to invest in strategic communications that promote their successes. And media coverage rarely moves beyond crisis-driven headlines to a more meaningful discussion of the programs and policies necessary to stop a crisis before it occurs. The unfortunate result is that the public understands little about foster care--and the information it does have is often based on anecdotes or stereotypes.

To build support for child welfare innovations, the public first needs accurate information. The following test is designed to help you educate the opinion leaders in your community to distinguish foster care fact from fiction.

Most abused or neglected children end up in foster care. FALSE.

In 2002, more than 3 million children were reported to child welfare agencies for abuse and neglect. About 900,000 of these children were confirmed as victims of abuse and neglect, but only one-fifth were actually placed in foster care, the last resort when they can no longer remain safely with their parents.

In fact, most cases of abuse or neglect aren't serious enough for children to be taken from their families. Instead, child welfare agencies should provide supportive services to stabilize the family. Although child welfare agencies provided these preventive services to more than 1.7 million children in 2002, about 40% of child victims of abuse and neglect received no services at all.

Most children are in foster care because of physical abuse. FALSE.

Nearly 58% of children in foster care have been removed from their families for neglect (for example, their parents have left them unsupervised at home or failed to take care of their basic needs). About 19% of all children who are maltreated are physically abused, 10% are sexually abused, and 7% psychologically abused. The remaining 6% of maltreated children experience educational or medical neglect, cases in which a parent fails to ensure that a child goes to school or receives proper medical care.

Foster parents rarely end up adopting the children in their care. FALSE.

Of the children adopted in 2002, 61% were adopted by their foster parents. Family members adopted another 24%. "Like all parents, foster parents form strong emotional attachments to the children in their care," says Courteney Holden of Voices for Adoption. "Foster parents and children often become forever families by choosing adoption."

There is a national shortage of foster parents. TRUE.

With the onset of the crack cocaine epidemic, the number of children in foster care doubled between 1986 and 1996, while the number of available foster care homes declined. "This trend is expected to continue as an increasing number of foster parents adopt children in their care," says Karen Jorgenson of the National Foster Parent Association. "We now need 130,000 more foster homes to meet the demand."

Grandparents and other relatives can't become foster parents. FALSE.

Increasingly, child welfare agencies are relying on placements with caring relatives for abused and neglected children. Grandparents and other relatives currently provide care for nearly one-third of all children in foster care. "Sometimes, children move through the child welfare system without anyone realizing that the solutions to their care lie right there with the children's families' networks," says CWLA President and CEO Shay Bilchik. "Grandparents and other relatives should be the first line of defense."

Most children stay in foster care for a long time. FALSE.

Even a week is an endless amount of time to a child, but most abused and neglected children do not spend their entire childhoods in foster care. Of the children who left foster care in 2002, 19% spent less than a month in foster care, and 51% spent less than a year in care.

Unfortunately, however, more than one-fourth of children in foster care have been there for at least two years, and 17% of children have been in foster care for five years or more. Equally distressing, an estimated 10% of maltreated children who go home to their parents return to foster care within the year.

Most children in foster care move around a lot. FALSE.

Although media accounts often focus on the experiences of children with multiple foster care placements, 84% of children who have been in foster care for a year or less have had two or fewer placements (and the first placement often is an emergency shelter). Child welfare agencies have far to go, however, to minimize placement disruptions. "Each additional move after the trauma of children's separation from their families only adds to their sense of loss, confusion, and uncertainty," says consultant Madelyn Freundlich, formerly of Children's Rights Inc.

All children in foster care get federal support. FALSE.

A child's eligibility for federal foster care funds is based on whether the child enters care from a low-income family rather than on the child's individual needs. More than 40% of children in foster care are not eligible for federal foster care support. According to Rutledge Hutson of the Children's Defense Fund, "The federal government should have a role in responding to the needs of all children who have been abused or neglected, not just those from very poor families."

In most cases, siblings in foster care are placed together. TRUE.

About 60% of children in foster care are placed together with some or all of their siblings, but it still doesn't happen often enough, according to April Curtis, an Illinois advocate for foster youth. "Agencies also need to do more to help siblings maintain close relationships when they can't be placed together," Curtis notes. "Many states only allow siblings two one-hour visits per month. That adds up to only one day per year."

Foster parents are in it for the money. FALSE.

"There's a difference between doing it for the money and needing money to do it," says Margie Chalofsky of Washington, DC's Foster and Adoptive Parent Advocacy Center. "The real question is whether that foster parent is a good parent and the child is well-placed in their home." Foster parents point out that foster care stipends rarely cover even children's basic expenses. Nationally, the average monthly foster care payment for a 9-year-old child is $420. The average middle-class family spends about $780 on a child of the same age, according to the U.S. Department of Agriculture.

Child maltreatment is higher in African American families. FALSE.

There is no difference in the incidence of child maltreatment based on race. African American children, however, are significantly overrepresented in foster care, comprising 15% of the U.S. child population, but 41% of the foster care population. "The child welfare system needs to better understand exactly why children of color are disproportionately represented in foster care before we can improve these children's lives," says Ralph Bayard of Casey Family Programs in Seattle.

Abuse by foster parents is rare. TRUE.

Whether perpetuated by birthparents, foster parents, or any other adults, child abuse is wrong. Well-publicized tragedies of children abused in foster care, however, often distort public perceptions of the benefits that foster families provide to children who have experienced abuse and neglect before entering foster care. Of children who experienced abuse or neglect in 2002, 81% were abused by their parents, but less than 1% reported abuse by their foster families.

Foster parents are not permitted to contact a child's birthparents. FALSE.

In addition to caring for a child, foster parents can play an important role in helping birthparents enhance their parenting skills and improve their relationships with their children. "Foster parents are often needed as mentors to birth families," explains Chiemi Davis of Casey Family Programs. "More and more frequently, they are becoming key members of a team that can include social workers, relatives, and, of course, the youth."

Child welfare workers earn about the same as public school teachers. FALSE.

The average starting salary of a child welfare worker is $22,000, one-third less than the average beginning salary of public school teachers. Given the difficult working conditions and poor compensation, it's no surprise that 22% of child welfare workers leave their jobs every year. The average tenure of a child welfare worker is less than two years.

Child welfare workers have higher caseloads than they should. TRUE.

Nationally, average caseloads for child welfare workers are double the accepted standards for good social work practice. In some jurisdictions, caseloads are three to four times the accepted standard.

Most children have bad experiences in foster care. FALSE.

"The most negative part of foster care is usually not where you're placed, it's how other people judge you," says Letitia Silva, a senior at the University of Pennsylvania who spent time in foster care. "Too often, people treat children in foster care like they did something wrong."

Although every child's foster care experience is different, it's not always bad. According to the National Survey of Child and Adolescent Well-Being, the first comprehensive study of children in the child welfare system, more than 85% of children in foster care reported they like the people they are living with, feel like part of their foster family, and believe their foster parents care about them.

The U.S. foster care system faces persistent challenges, but real improvements are impossible unless new policies are grounded in a better public understanding of the realities facing child welfare workers, foster families, and children. Until the public can understand the daily challenges of the child welfare system, we will not have policies that allow children and families at risk to reach their full potential.

Dedicated, Overworked, Underfunded

Cecille Isidro — Mon, 05 Sep 2005 00:00:00 -0400

Before it became a celebration of summer's end, Labor Day was a symbol of reform--a time, said labor activist Samuel Gompers, to discuss rights and wrongs and make the worker 'stronger for it.' In the true spirit of the holiday, Americans who care about children and families should first resolve to improve the imperiled state of the nation's child-welfare workers.

Sensational cases of child abuse and neglect have kept the spotlight on the failures of state child-welfare agencies and the thousands of workers responsible for protecting children. These caseworkers, often the first responders in a family violence situation, must determine whether abuse or neglect has occurred, assess its severity and make sure the child is safe -- often within minutes of meeting the family.

Modest Salaries

In addition to serious emotional stress, caseworkers generally carry a caseload anywhere from two to three times the recommended levels. Most end up spending 50 to 80 percent of their time on paperwork--precious hours that would be better spent in direct contact with children and families.

Although mission-driven workers don't go into social services for the money, the Bureau of Labor Statistics reports that child-protection work remains one of the five worst paying professional jobs in the country with an average starting salary of only $22,000.

The work is also dangerous. Seventy percent of frontline caseworkers reported they had either been threatened with violence or been a crime victim. The double whammy of high stress and low pay makes it exceedingly difficult for child-welfare agencies to recruit and retain talented social workers with the experience needed to handle complex cases. Annual turnover rates for caseworkers can run as high as 50 percent, and most workers leave child-protection work for good after two years.

The lack of proper training is also a chronic problem. Currently, one-third of child-welfare workers have a social work degree or sufficient pre-service training to help them sort through complicated issues of substance abuse, domestic violence, mental illness and poverty. And instead of incentives for good performance, workers are often rewarded with larger caseloads and increased supervisory responsibilities.

Even in this state of emergency, there is good news--concrete solutions to ensure that child-welfare workers are armed with the tools they need to keep children safe.

* The federal government can start by developing minimum caseload, training and other appropriate requirements and conditioning federal child-welfare funding -- more than $20 billion per year -- on states' implementation of these standards.

* Federal child-welfare financing must also be overhauled to give states more flexibility and increased funding to give caseworkers, supervisors and child-welfare administrators the training they need to improve the lives of children and families.

* In exchange for necessary increases in federal and state child-welfare investments, state agencies must demonstrate significantly better outcomes for children and families. For example, accountability standards on workforce-related issues should play a significant role in Child and Family Service Reviews, comprehensive federal evaluations of state child-welfare agencies, to ensure adequate caseloads, training procedures and hiring and retention practices.

Financial, Moral Support

In the end, wrote Marc Parent, a former social worker in New York City, 'children don't fall through the cracks. They slip through human hands.' If the American public is truly serious about preventing abuse and neglect and helping children lead better lives, child-welfare caseworkers and administrators must be given the financial and moral support they need to succeed.

A version of this article also appeared in The Seattle Post-Intelligencer

Relative Care Creates Powerful Bonds for Children

adminn — Mon, 01 Aug 2005 00:00:00 -0400

So boy, don't you turn back.
Don't you set down on the steps
‘Cause you finds it's kinder hard.
Don't you fall now --
For I'se still goin', honey,
I'se still climbin',
And life for me ain't been no crystal stair.
--"Mother to Son," Langston Hughes

Family, with all its strengths and complexities, is a cornerstone of American culture. For generations, grandparents and other relatives have stepped forward to raise children whose parents cannot. And while family members still provide a vital safety net for children at-risk, the obstacles facing these families are more formidable than ever. "Fifty years ago, the entire family and the community we're expected to join together and do their part to help," explains one Washington, DC grandmother raising three ngrandchildren. "These days there is no one else to help. No one wants the responsibility. No one wants the heartache."

Substance abuse, incarceration, domestic violence, physical and mental illness, teen pregnancy and other serious problems have resulted in more than 6 million children who currently live in grandparent-headed households. According to the most recent U.S. Census, 2.4 million grandparents report they are responsible for their grandchildren's basic needs. Increasingly, great-grandparents, aunts, uncles, cousins and siblings are also taking on the role of substitute parents—either through family agreements or under the supervision of state child welfare agencies and courts.

The Changing Face of Relative Care in America

Inside and outside the foster care system, life is not easy for children raised by grandparents and other relatives. Without court-sanctioned legal custody or guardianship, family members find it difficult to access even the most basic benefits and services. "If children are living with relatives informally, their caregivers are often unable to enroll their grandchildren in school, obtain medical care and make all the other day-to-day decisions parents take for granted," says Sherry Neal, Director of the Grandparent/Relative Caregiver Project at Atlanta's Legal Aid Society.

The emotional stress of raising a child is also hard on caregivers, especially for older, disabled or poor caregivers who may have serious health problems of their own. Children raised by grandparents and other caregivers are more likely to have a range of special needs including complications from low birth weight, ADHD and other developmental and behavioral issues that result from parental substance abuse. These problems can be exacerbated by the parents themselves, who often move in and out of their children's lives unpredictably and with little accountability.

Even caregivers who are caring for children under the "watchful" eye of the child welfare system are often at a disadvantage. "In our experience, relatives are offered and receive fewer services than non-kin caregivers," says Legal Aid's Neal. "A lot of times, the agency views relatives as a way to prevent children from coming into the system in the first place, so they rarely provide the services necessary to truly support the placement." In many cases, the lack of services to relatives when a child first comes into care can also result in additional complications for court personnel. "One reason that so many CASA programs are pressed into serving children who appear before the court in guardianship and domestic custody cases is because a lot of these cases should have been adjudicated as abuse and neglect in the first place," explains Janet Ward, National CASA program specialist for the Midwest region, "Instead, they are coming into the family court in droves."

The Myth that Hurts Children and Families

According to many relative caregivers, the most painful barrier they encounter is not the lack of services and financial supports. It is the antiquated notion that the "apple doesn't fall far from the tree"—the misguided assumption among some social workers, lawyers and judges that if the child's parent aren't able to raise the child, the rest of the family must be equally dysfunctional. Experts who work most closely with caregivers and the children they are raising contend that shattering this myth is the first step in getting these families the community understanding and support they need most. "I've lost count of how many times I have seen grandparents beat themselves up over what they did wrong. A grandmother can have three other adult children who turned out great, but she still thinks it's her fault," says Carol Boyer, Director of Generations Together, a Delaware support program. "Every parent knows that sometimes there are influences beyond even their control."

Caregivers say that these common misperceptions are not only hurtful to them, they unfairly brand the child they are raising. "We say that the apple may not fall far from the tree, but we're not responsible for how far it rolls," says Brigitte Castellano, Executive Director of the National Committee of Grandparents for Children's Rights, a national advocacy organization. "Not only are we advocating for the child, but we also have to fight the prejudice against us."

Relative Care as a Source of Stable Placements for Children

Despite its critics, most agency leaders and expert practitioners agree that an appropriate placement with caring relatives can often provide a loving, familiar and stable setting for a child at-risk. "Grandparents are usually the first line of defense from abuse and neglect," says the National Committee's Castellano. "When a parent can no longer care for their children, why should those children lose their entire family?" Placing a child with caring family members also has other advantages for the child, such as helping to preserve a child's racial and ethnic identity, and sometimes their ability to stay in a familiar and supportive neighborhood. "Grandparents and other relatives are also more likely to keep siblings together," adds Kikora Dorsey of Casey Family Programs in Seattle, a fundamental consideration that is often overlooked when agency placements are made.

The most important reason to place the child with qualified relatives, however, is also the most obvious: they already know and love the child. "Grandparents know the history of the child and the family," says Boyer, "They know the child personally and intimately. And the child knows them." Preserving family connections is especially important in cases involving older children. Explains Karen Worthington, Director of the Barton Law & Policy Clinic at Emory University School of Law, "the adolescent years are the time when many children most need that sense of belonging. Family members can often provide that support in ways others may not be able to." Casey Family Program's Dorsey agrees. "Raising adolescents in a changing world can be challenging for anybody, but especially so for grandparents and other relatives who may not be prepared to deal with a teenager. It's even more complicated if the child has special needs and these needs have not been met as the child grows."

Children, Caregivers and the Courts

While grandparents and other relatives may be certain of their love and commitment to a child, they are much less sure of their relationship with child welfare agencies and the courts. Even when children are placed with relatives through a child welfare agency, caregivers' roles in subsequent dependency proceedings are poorly defined. While federal law now requires that foster parents and relatives caring for a child in foster care must be given notice of and an opportunity to be heard in any hearings or reviews involving the child, some courts interpret this provision narrowly or overlook it altogether. "In many states, there is no uniform procedure for gathering information from caregivers," explains Cecilia Fiermonte, an attorney with the American Bar Association's Center for Children and the Law. "Judges might put a written report in the file, but not consider it as evidence. They may not ask the caregivers if they have anything to say, so the relatives end up missing their opportunity to speak at all."

There are additional complications when a caregiver tries to navigate the judicial system without counsel. "Generally, caregivers are clueless about the court system and what rights they may have," explains Carol Boyer. "They don't understand why parents' interests are represented by an attorney and they're not given counsel even though they are the ones raising the child." Caregivers who decide that they might be better off hiring their own lawyers often find themselves in a legal Catch-22, earning too much to qualify for the limited number of free legal services and too little to afford the high costs of a private attorney.

In addition to feeling "pitted" against the parents of the children in adversarial court proceedings, relatives often report feeling unfairly judged by agency representatives and court personnel. Sometimes dismissed as ‘intrusive' or ‘meddlesome,' grandparents are afraid that if they speak up in court, the agency or judge might retaliate against them and take away the child. The situation can be worse for relatives who become involved in an abuse and neglect case late because they had not even been told that the child had been placed in foster care. "Often kin are out of the loop or waiting on the sidelines hoping that the child's parents will get their acts together," says Barbara Kates, director of Family Connections, a grandparent outreach organization in Bangor, Maine. "Just because relatives don't participate in the court process immediately doesn't mean they are not committed to the child. Sometimes they just don't know where or how to start."

Relative Caregivers as a Resource for CASA Volunteers

Although some courts may still be struggling to define the appropriate role of extended family members in abuse and neglect proceedings, grandparents and other relatives can still be an invaluable resource for CASA volunteers helping a judge to determine what is best for a child. First and foremost, relative caregivers can be a source of helpful information. "It's important for CASA volunteers to recognize family members as vital allies in the process of developing a permanent placement for the child," says Atlanta Legal Aid's Sherry Neal. "Even when a family placement doesn't turn out to be the best one, relatives can still give the court important information on the child's background, medical history—even her likes and dislikes. They might also be able to recommend alternative placements with family friends and help to maintain important family connections for children regardless of where they end up."

The information and insight family members can provide are especially important for CASA volunteers who have been tasked with especially difficult cases. "Because there are often more cases than volunteers, we sometimes get the cases that need the most attention," says Jennifer Miller, a child welfare policy expert and CASA volunteer in Providence, Rhode Island. "For kids living in shelters or group homes, children dealing with seriously addicted parents, or those in large sibling groups, we need to be asking how relatives can help—even if they are not a possible placement." Miller also points out that volunteers can also play a key role in assuring that children are placed and remain in safe and stable homes. "Family is vital, but we have to stop the practice of assuming that kids are automatically O.K. just because they are with grandparents or other relatives. The advantage of being a CASA (volunteer) is that we get to look at each case on an individual basis."

CASA Volunteers as Liaisons for Children and Families

Just as family members can deepen a CASA volunteer's understanding of a child's needs, volunteers can find new ways to support children as a "front-line" resource for caregiver families. When a child first enters the system, they can help overworked agency staff to identify and build strong relationships with grandparents and other relatives who might be willing able to provide temporary care for the child or ongoing emotional support to the child or the parents. By visiting frequently with their clients and their caregivers, CASA volunteers can also develop a relationship of trust and, where appropriate, act as liaison with agency personnel to ensure that children are getting the full range of foster care services and supports.

In addition to providing family members with information on available public benefits and support groups, CASA volunteers can also help relative caregivers learn to manage and monitor children's safe, consistent visitation with their birth parents. In situations where a child can be safely reunified with his or her birth parents, CASA volunteers can encourage relative caregivers to play a positive role in the child's return home. In cases where a child is unable to return home, CASA volunteers can help social workers and court personnel move the permanency process forward through adoption or guardianship. Finally, volunteers can help to ensure that grandparents and other relatives have an opportunity to share their perspectives on the child with the court and agency personnel in dependency hearings and related reviews.

In seeking out the information that only grandparents and other relatives can provide and by supporting caregivers who are raising almost one-third of the children in foster care, CASA volunteers can be an invaluable resource for agency and court decision makers and, most importantly, for the children they represent. "While caregivers carry the past, they can also help envision a better future for children. They are the bridge that many children stand on," says Carol Boyer. "If we really want to help kids, we need to do a better job of recognizing that."

Not Ready to Go It Alone

Cecille Isidro — Sun, 15 May 2005 00:00:00 -0400

In the basement of D.C. Superior Court, Magistrate Judge Juliet McKenna sits next to Tiffany, a 19-year-old ward of the foster-care system.

"How about H&M?" McKenna asks. "It's a hip store and easy to get to."

Tiffany's lawyer, social worker, "life skills" coach and an attorney representing D.C. Child and Family Services are at the table while McKenna goes over the list of stores accepting city clothing vouchers.

Given the challenges facing the District's child welfare system, clothes may seem an unorthodox subject for the court, but for Tiffany, who lives in a world that often overlooks such practicalities, the discussion is long overdue.

During the past seven years Tiffany has been in 12 foster-care placements, in a psychiatric hospital for six months and in a group home with "too many personalities and too many rules." For the past year Tiffany has lived on her own under city supervision in what is known as an alternative planned permanent living arrangement.

Yet Tiffany's situation is anything but permanent. Each year about 100 of the 673 young people in the District's independent living program "age out" of foster care at age 21. While some take advantage of agency services and some of college, too many find themselves without the money, job skills or family connections to succeed. While many young Americans are living at home longer -- 56 percent of men and 43 percent of women between the ages 18 and 24 live with their parents -- former foster youth have no such safety net.

A new program designed to ease the transition between foster care and adulthood is the D.C. family court's Benchmark Permanency Program. " 'What do you want to do with your life?' takes on new meaning when you're going to be on your own in a few years," explains McKenna, the program's founder.

With the help of social workers, lawyers and community organizations, Benchmark hearings are guided by a signed agreement between the court and the young people that lays out the steps needed to maximize foster care services. The court also asks the young people to involve a trusted adult.

But sometimes, McKenna admits, a good mentor is hard to find. In a city packed with talented politicians, professionals and world-class thinkers, how is this possible?

Well, D.C. Child and Family Services needs to do a better job of facilitating mentoring opportunities. That means providing training and supervision to mentors and making sure that young people are paired with responsible adults who will stick with them. It also means better coordination with Benchmark and other projects that reach these young people.

Just as parents don't stop being parents when a child turns 21, the agency should consider providing affordable health care, especially mental health treatment, to young people in the first five years after they leave foster care. Although expanding these services would require more funding, the investment would help create stable and employed young people.

Until the city pays more attention to the needs of these young people, it will continue to emancipate them from foster care only to leave them trapped in lives of limited possibilities.

Parental Grandparents

Cecille Isidro — Sun, 03 Apr 2005 00:00:00 -0500

David and Carolyn Wells raised their children, sent them to college and saved up for retirement. But this hardworking Knoxville couple never imagined having to raise their grandchildren. They knew their son and daughter-in-law were struggling. And they worried that their granddaughters weren't getting proper care. When the child welfare agency threatened to step in, however, there was only one choice. At 51, they became parents once again.

"It was a nightmare at first," explains Carolyn, now 62. "Both children had special needs that hadn't received appropriate attention." Their older granddaughter was profoundly deaf. Doctors predicted that the baby, diagnosed with failure to thrive, would someday be institutionalized. Between the constant care, endless doctor visits and two full-time jobs, there was "just sheer exhaustion," recalls Wells. Worse yet, there was nowhere to turn for help.

Help came later in the form of the Grandparents as Parents Program, a comprehensive support program at the Knoxville Community Action Committee's Office on Aging. One of the first efforts in the state specifically designed to address the needs of grandparents and other relative caregivers, GAPP's model program provides support groups, recreational activities and a variety of other vital outreach services to help kinship care for families across Knox County.

But additional supports are still needed to help GAPP and similar programs reach out to grandparents and other relatives raising children whose parents are battling substance abuse, incarceration, mental illness, domestic violence and other serious problems. More than 61,000 Tennessee grandparents currently report that they are responsible for the grandchildren living with them -- 1,289 in Knoxville alone.

In 42 percent of these households, there are no parents present to help with child-rearing responsibilities or to contribute to the family's income -- a particularly serious problem for those disabled and retired grandparents living on a fixed income and the one-fifth of Tennessee grandparent caregivers who live under the poverty line.

While the majority of families served by GAPP are not formally connected to the child welfare system -- often grandparents intervene before the state becomes involved -- the lack of comprehensive services for Tennessee kinship families is due, in large part, to the chronically inflexible national foster care financing system, which provides Tennessee with more than $155 million per year in federal aid but places significant restrictions on how the money can be used.

For example, the state can use Title IV-E dollars, the main source of federal child welfare support, mainly to fund room and board for children in foster care. Under current law, however, it cannot use the funds to prevent children from coming into care in the first place by providing preventive services: affordable child care, legal counsel or the other programs that GAPP provides.

"The truth is that grandparents who step in before the state has to are saving taxpayers millions of dollars," says Harry Rehagen, 66, pastor of St. Andrew's United Methodist Church in Knoxville. While Rehagen and his wife, Joyce, have since adopted their two young grandsons, the start-up costs of taking them in were high. In addition to $2,500 in legal fees just to get temporary guardianship of the boys, the working couple spent down much of their retirement savings just to cover the cost of child care and mental-health counseling.

"We love these children so much that we couldn't conceive of putting them in state care," Rehagen explains, "but at the same time we were struggling to do what was needed to keep them with us."

Despite current federal funding incentives, there is new hope for grandparent caregivers.

Recently, the Pew Commission on Children in Foster Care, a national panel of child welfare experts, laid out a series of promising reforms to improve the way the federal government funds child welfare and related prevention services. In particular, the commission recommended that states be permitted to use the federal money they don't spend on foster care to reinvest in other programs that help keep children out of foster care.

Such services could support child-care stipends, pay for mental-health counseling or even help to establish a kinship navigator program, a statewide resource and referral system that would help families find accurate information on a range of available government resources and local support groups.

In addition to aiding grandparent caregivers raising children outside of the child welfare system, the proposed reforms would also help the more than 1,600 Tennessee children who have been formally placed with grandparents and other relatives through foster care. In many of these cases, licensed foster relatives may be willing to assume permanent responsibility for the children in their care but are hesitant to adopt because it requires the termination of parental rights. Under the Pew proposal, the state would be able to use federal funding to pay for subsidized guardianship, an arrangement in which relatives obtain legal guardianship of the children in their care and receive ongoing financial assistance.

Until additional federal and state support is available to help these caregivers, Tennessee's grandparents and other relatives must continue to choose between keeping their families together and accessing essential services.

"You gotta do what you gotta do to get help for your grandchildren," says Mechanicsville's Roslind White, who is raising two grandchildren. "But it's a shame these kids have to suffer just because their parents couldn't take care of them."

Proper Sin Tax?

Cecille Isidro — Mon, 22 Nov 2004 00:00:00 -0500

It wouldn't be the holiday shopping season without schmaltzy commercials, mall Santas, and Halo 2, the most hotly anticipated video game in American entertainment history. Expected to gross $80 million, this "shoot-'em-up" sensation may not change the world, but it could help put the compassion back into conservatism with a financial boost for chronically under-funded domestic policy programs.

The Bush administration has talked a good game about supporting federal programs designed to keep kids safe from abuse and neglect, drugs, gun violence, and crime. With a war to fight and an economy to revive, however, investing in America's children has predictably taken a back seat to other front-page issues, allowing the administration to sidestep a crucial postelection question: How is it going to pay for all this stuff?

It can start by requiring an industry that profits from violence to help prevent it. A modest excise tax on the sale of violent video games could fund an array of new supports for children. And -- even better -- such a tax could help fully fund existing programs such as Head Start and successful initiatives to help prevent child abuse and neglect.

This wouldn't be the first time that politicians have used so-called "sin taxes" to fill budget gaps, especially in rough economic times. After all, corrective taxes already generate millions of dollars a year by targeting such all-American vices as cigarettes, liquor, and guns. Despite the occasional grumble, the public generally tolerates these taxes as the price it must pay for using potentially harmful products. And targeted industries have come to regard these taxes as an inevitable cost of doing business.

With so much violent media fare, why single out video games? Despite growing evidence of the psychological harm of these games, few would claim that they are the sole cause of family or community violence. But in a nation where 92 percent of children grow up playing them regularly, violent video games aid and abet a popular culture that champions even the most extreme brutality through games like the "Grand Theft Auto" series, self-described studies in "hedonism and violence" that encourage players to kill prostitutes and hijack cars.

If graphic content isn't enough to convince squeamish politicians of the undeniable sin tax potential of these games, recent events have pointed to a more compelling link between the virtual world and real-life violence. Last year in Ohio, a teenager obsessed with "Grand Theft Auto" stole his friend's car and then bludgeoned her to death with a bedpost. Teenaged sniper Lee Malvo and the Columbine High School killers used highly realistic first-person shooter games as virtual training grounds for their murder sprees.

How will we know video-game violence when we see it? Conveniently, most video-game makers already comply with a voluntary ratings system that includes descriptors for violence. By making these ratings mandatory, the government could impose a 3 percent federal tax on every violent video game sold. This would not eliminate or even discourage violence, but just 3 cents on every dollar of sales in the $10 billion a year domestic video-game industry could provide the government with millions of additional dollars a year to support American children.

Some critics will argue that a sin tax on video games impedes freedom of speech. But a modest tax would not dictate the content of video games, nor would it ban -- even significantly reduce -- sales. And while free market enthusiasts excoriate this proposal as an improper use of economic coercion, sin taxes have never claimed to be the brainchild of high-minded economic theory. They are the imprecise but nonetheless lucrative tools of political expediency.

Now that the campaign rhetoric is over, it's time to get real: Violent video games aren't going away and neither is the real world violence that plagues the nation's children.

While the Bush administration may be reluctant to have its "moral values" discussion with the politically formidable entertainment industry, it seems only fair that at-risk children share in the profits as well as the pitfalls of the boundless American imagination.