1. When Does Foster Care Do More Harm Than Good?
Washington State CASA Conference
Spokane, Washington
November 2, 2018
Dee Wilson

2. ‘Foster Care’ is an abstraction
There are a large number of foster care systems in the U.S. and around the world. Foster care systems differ in rates of residential care and kinship care, ages of children/youth entering foster care, and in the uses of foster care. Generalizations about foster care outcomes should be viewed with these differences in mind.

3. Length of Stay in Foster Care
A significant percentage of children/youth entering foster care return to a parent’s home within a few days, weeks or months. In Washington State, in 2016,approximately 25% of those entering foster care exited in 60 days or less. “Short stayers” have different experiences, on average, than children with long lengths of stay.

4. Foster Home Shortages
Washington State’s foster care system is shaped by acute and chronic shortages of foster homes. Many state child welfare systems have a ratio of licensed foster homes to number of children in care worse than Washington’s. DCYF has about 5,000 licensed foster homes for about 9300 children/youth. The DCYF kinship care rate is about 50%, a large increase from years ago.

5. Effects of Foster Home Shortages
Foster home shortages increase placement instability at both entry into care and during placement moves. Foster home shortages have led to frequent use of hotel placements, especially in King County, at a cost of more than $2,000 per day for many behaviorally troubled youth. DCYF also uses 24 hour placements for all ages, combined with babysitting of young children, in these placements in DCYF offices during the day. A lack of BRS capacity has led to the placement of youth (on any given day) in costly out-of-state residential facilities. It is next to impossible to closely monitor these safety and well being of youth placed in out-of-state facilities.

6. The Expectations of Foster Care Should Increase with Length of Stay.
Foster care should always be safe and humane for children during all lengths of stay. Children who remain in care for longer than a week should be assessed for medical and dental needs and for developmental status, and be referred for needed services. For children in lengths of stay of at least 6 months, foster care should (a) promote positive development and (b) ameliorate mental health conditions that impede normal development.

7. Foster Care Systems Can Be Dissected
Approximately half of children entering foster care are 0-5 at time of initial placement; about half are school age, 6-17, at entry into care. About half of children entering out of home care have behavior problems, about half do not. School age children are much more likely than younger children to have behavior problems when they enter foster care.

8. Age of Child Affects Permanent Plans
Nationally, approximately 50% of foster children are reunified with a birth parent. However, infants are more likely to be adopted than reunified.
Adoption rates decrease dramatically for school age children.
Adolescents, at entry into care, are at significant risk of exiting foster care/residential care to “other”, e.g., to a juvenile justice institution, psychiatric facility, run away, or aging out of care.

9. Children’s Behavioral Problems Affect Length of Stay and Permanency Outcomes
Children’s behavior problems increase the difficulty of stabilizing a child/ youth in care. A study based on a sample from the National Study of Child and Adolescent Well Being (NSCAW) found that children’s behavior problems became worse with every change in placement. A recent survey found that youth in BRS placements averaged 6.5 placements prior to their first BRS placement. Number of placements is less important than the number of unplanned placement changes.

10. Placement Instability Affects Length of Stay and Rates of Exits to Permanency
Children and youth who are quickly stabilized in foster care are much more likely to be reunified, adopted or placed in guardianship than children/youth who bounce from home to home.

11. Permanent Planning Casualty Rate
Every child welfare system has permanent planning casualties, i.e., children who lose their birthparents and siblings without finding another permanent family. The longer a child is in placement, the more likely he/she will lose touch with the birth family. Behaviorally troubled children are at risk of losing family connections due to (a) age (b) behavior problems that become worse due, in part, to experiences in foster care and (c) placement volatility

12. Behaviorally Troubled Children/Youth May Not Be Safe in Foster Care
During recent years, several sources of information have raised doubts regarding the safety of foster children/youth: ● Stories of older teens and young adults following their exit from care; ● Class action lawsuits, e.g., in Texas; ● Tort actions alleging grievous ongoing abuse resulting in large settlements; there have been several large settlements in Washington; ● Studies of foster care alumni, for example in Chapin Hall’s Midwest Youth Study; ● News stories re abuse in residential care, for example, in Illinois; and ● Deaths of school age children in adoptive homes, including more than a dozen child deaths or near deaths in Washington since 2005.

13. Rates of Child Maltreatment in Foster Care
A 2016 study of older youth and young adults who were part of the Midwest Youth Study found that 47% of foster care alumni reported that they had been maltreated in foster care or residential care. 30% reported experiencing more than one type of child maltreatment; 13% reported being physically abused, neglected and/or sexually abused while in care. The study found a prevalence rate of child maltreatment almost 8 times higher than the prevalence rate computed from agency records.

14. The Truth May Be Worse Than Studies Indicate
Foster youth may be physically or sexually abused by other youth in the foster home or residential facility. Unless caregivers were negligent, these incidents would not be counted in agency statistics or many academic studies.

15. Misuse of Psychotropic Medication
Many school age children and youth are given one or more psychotropic medications. Some of these medications have powerful, poorly researched side effects. A recent OIG study of use of psychotropic meds in 5 states (not including Washington) found that foster youth were often being given these medications without a treatment plan or careful monitoring of side effects.

16. A List of Questions
A list of questions can be asked about every child placed in foster care for longer than 6 months:
Has the child been stabilized in care?
How many unplanned placement changes has the child experienced?
Is the child placed in the county where the parents reside?
Have there been credible allegations of child maltreatment by foster parents, residential care staff or other children?
Does the child/youth feel safe and wanted?
Is the child/youth on one or more psychotropic meds? If so, is use of medication part of a treatment plan and are side effects being carefully monitored?
Is the child in regular contact with birth parents and siblings?
Is it likely the child will exit to a permanent plan in the near future?
Is there anyone for whom the child is special?

17. List of Questions (cont.)
7. Have the child/youth’s special needs been assessed and, if so, are needed services being provided? 8. Is steady progress toward a permanent plan occurring? 9. Is there anyone for whom this child/youth is special?

18. Foster Care Outcomes
Studies based on NSCAW samples indicate that behaviorally on target children benefit developmentally from foster care the most, while behaviorally troubled children benefit the least, at least from a developmental perspective. CHILDREN WHO NEED FOSTER CARE THE LEAST, BENEFIT THE MOST. CHILDREN WHO NEED FOSTER CARE THE MOST, BENEFIT THE LEAST.

19. Foster Care Alumni Struggle in Young Adulthood
Youth aging out of foster care have highly elevated rates of incarceration, substance abuse, mental health conditions, suicide attempts, homelessness and severe poverty compared to other low income young adults. Foster care experiences may not be the main cause of these outcomes; nevertheless, foster care and residential care do not appear to be therapeutic for older foster youth, considered in the aggregate.

20. Foster Care Experiences of Children and Youth Vary Enormously
Older youth aging out of foster care vary greatly in their perspective on their foster care experiences. In a recent Chapin Hall survey of 21 year old’s who aged out of foster care in California, 2/3 of the study’s large sample responded that they felt lucky to have been placed in foster care; 55% expressed satisfaction with the quality of care they had experienced. About one quarter of those surveyed were unhappy or very unhappy with the quality of care they had received, while 15% regretted that they had been placed in foster care.

21. Court Reviews Should Consider Children’s Experiences in Foster Care
Judges, Commissioners and CASA’s should consider what has happened to children in foster care and residential care when deciding on next steps.
When children and youth have been in foster care for 6 months or longer, and have not been stabilized in care, decision makers should ask the question, “Is foster care for this child doing more harm than good?”

22. Foster Care Must Be Improved
Foster care is not a lost cause; attempts to improve foster care should not be abandoned.
The current deficiencies of the state’s foster care system are the direct result of public policy, including large budget cuts during the Great Recession, persistent efforts to undermine BRS programs through inadequate rates, the elimination of receiving homes and a stubborn refusal to reconsider the failed volunteer foster care business model.

23. BRS Programs Must be Rebuilt
DCYF has asked for an increase in BRS rates in its budget; however DCYF has also stated an intent to limit BRS placements to 6% of the foster care population. This cap cannot work without an investment in volunteer foster parents.

24. A Cadre of Professional Foster Parents Should Be Developed
The state should seek to professionalize 20% of licensed foster homes through a certification program. Professional foster parents may either be salaried and given standard benefits and/or be paid elevated rates for every child placed in their home. An array of supports should be developed to support professional foster parents.

25. Alternatives to Foster Care
Crisis intervention mental health services should be available to birth families.
School based day treatment programs for behaviorally troubled children should be made widely available.
A cadre of foster parents should be trained to be resource families to birth parents.
Relief Nurseries on the Oregon model should be funded through public/private partnerships.
Therapeutic child care programs for children 2-5, should be funded across the state.

26. DCYF Must Establish and Live by Workload Standards
DCYF units should be staffed according to reasonable workload standards, and these standards should utilize both averages and lids.

27. In Conclusion…
A research entity outside of DCYF should be funded to conduct a survey of school age foster children/youth every 2-3 years to assess what these children/youth think about the quality of care they are receiving.

28. Sources
Abramo, Allegra, “Foster Kids Trapped As WA System Collapses,” Investigate West, September 21, 2018 Behavioral and Health Treatment Needs and Outcomes Among Medicaid Children in Washington State, Research and Data Analysis, DSHS, Olympia, WA (available online) Courtney, M., Okpych, N., Park, K., Harty, J., Feng, H., Torres-Garcia, A. & Sayed, S., Findings from the California Youth Transitions to Adulthood Study: Comparisons of Youth to Age 21, Chapin Hall, 2018 English, D., “Data Mapping and Analysis of Selected Children’s Administration Data,” July 2018, available upon request from DCYF. Havlicek, J, & Courtney, M., “Maltreatment histories of aging out foster youth: a comparison of officially investigated reports and self reports of maltreatment prior to and during out-of-home care,” Child Abuse and Neglect, Vol. 52, Feb 2016.

29. Survey of Foster Children/Youth
A research entity outside of DCYS should be funded to conduct a survey of school age children and youth every 2-3 years to assess what these children/ youth think about the quality of care they have received. Every school age child in foster care at the time of the survey should be asked directly “Do you feel safe in your foster home?” “Do you feel wanted by your foster parents?” ‘Has anyone harmed you since you’ve been in foster care?” The results of the survey should be released as required by state law.