the Invest in "Kids" Act
United States House of Representatives
Subcommittee on Income Security
and Family Support
Testimony of James Purcell, CEO, Council of Family and Child Caring Agencies-New York State Child Welfare League of America
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February 27, 2008
Chairman McDermott, Representative Weller and distinguished members of the Subcommittee, my name is Jim Purcell, I am the CEO of the Council of Family and Child Caring Agencies in New York state. I am also a member of the Child Welfare League of America (CWLA) and am pleased to be here today on behalf of both organizations.
The Child Welfare League of America includes hundreds of state and local direct service organizations including both public and private, and faith-based agencies. CWLA members provide a range of child welfare services from prevention to placement services including adoptions, foster care, kinship placements, and services provided in a residential setting. CWLA's vision is that every child will grow up in a safe, loving, and stable family and that we will lead the nation in building public will to realize this vision.
The New York State Council of Family and Child Caring Agencies is the primary statewide membership organization for child welfare services providers, representing over 110 not-for-profit agencies that contract with the New York City and the county departments of social services to provide foster care, preventive services, adoption, and aftercare services as well as education for children on our facility campuses. These agencies serve 80% of all children and families in the state's child welfare system, and nearly all of New York City's children at risk.
Thank you for inviting me to testify in regard to the legislation that is now before this subcommittee, HR. 5466, the Invest in "KIDS" Act. The Child Welfare League of America, as well as the New York State Council, express our strong support for this legislation and we thank Chairman McDermott for both his introduction of this measure and his desire to enact some significant reforms in child welfare.
I am pleased to be here today, the same week that CWLA is holding its annual National Conference. We are especially grateful to be here along with Representative Chaka Fattah and Subcommittee member Representative Jon Porter, cosponsors of an important bill that will re-establish a White House Conference on Children and Youth. A conference that we see as serving as a tool to implement the reforms we hope this subcommittee will be able to help guide to passage in this Congress.
We have an important responsibility and obligation to the children we are focusing on during this hearing. In fact the children in care are there in part because of the laws we have written and that makes it incumbent upon us to make sure they get the very best care. Throughout the last several years CWLA has called for or endorsed a number of bills to improve the nation's child welfare system. HR 5466, includes a number of the proposals that have been introduced in the last several congresses and have had the support of both Democrats and Republicans. I highlight a few key provisions included in this bill and currently before Congress in other legislation:
Over the past two years this Subcommittee has dedicated much of its attention toward an examination of the complexity of the nation's child welfare system. We appreciate this effort.
- Reforming the current eligibility requirements under Title IV-E foster care and adoption assistance. Current eligibility is restricted to those children removed from a home that would have qualified for the now non-existent AFDC program as it existed on July 16, 1996. This makes no sense to anyone. There is no rationale for the federal government to provide support for some abused and neglected children, but not for others.
- Extending federal funding to support kinship and guardianship placements as a form of permanency as supported by Congress through the 1997 passage of the Adoption and Safe Families Act. (ASFA) and extending federal funding to children in Indian country.
- Enhancing flexibility in the use of Title IV-E federal funds so that key services can be funded to prevent placement into foster care or that can move children out of foster care more quickly.
- Supporting efforts and strategies to strengthen the child welfare workforce including access to current federal training funds by private agencies.
What is needed now is to move beyond past debates that were frequently limited to a discussion of numbers, the 506,000 children in foster care placements at the end of the federal fiscal year 2005 and the approximate $7 billion in federal funds spent on the foster care and adoption assistance under the Title IV-E entitlement. We need to address the reality that 800,000 children spend at least some time in foster care each year. A reality that 3.3 million reports of abuse and neglect were made in 2005 and that 899,000 children were substantiated as abused or neglected in that same year. We need to address the approximate 40 percent of those children who do not receive follow up services, and the fact that more than 24,000 youth leave foster care simply because they become too "old" or "aged-out" of the system.
Key Components of a Sucessful Child Welfare System
Studies have demonstrated the effectiveness or promise of several approaches to prevention of child maltreatment. Programs such as home visiting have produced evidence that positively impacted a variety of outcomes for children and families, including prevention of abuse and neglect. Similarly, high quality pre-kindergarten programs such as the Chicago Child Parent Centers and Head Start, that include parental involvement and supports, have also demonstrated effectiveness.
Independent studies have found that the financial savings achieved by the most effective of these approaches far exceeds their costs. Rigorous cost-benefit analyses conducted by the Washington State Institute for Public Policy showed cost savings for several pre-kindergarten, family support, and home visitation programs as well as for Parent-Child Interaction Therapy, a center-based intervention that provides direct coaching to parents as they interact with their young children.
In New York City our preventive services programs have contributed mightily to reduce the use of foster care by more than half in the past seven years-declining by 53.3% from 2001 to 2005. Today more than twice as many children receive Preventive Services than Foster Care-with 16,985 children in foster care and 38,768 remaining at home while their families receive Preventive Services.
Early intervention services play a vital role for children and families who may already be in trouble. These interventions may include services such as child care, housing, job training, and substance abuse services. These are the kind of non-traditional child welfare services that can enable families to stay together safely to the fullest extent possible.
To better target the needs of families a number of child protective service systems (CPS) utilize differential response. This approach allows CPS to respond differently to accepted reports of child abuse and neglect. Family preservation services are additional programs which may incorporate several of these services in an effort to prevent the removal of a child.
Preventive Services programs work with families whose children are at risk of foster care placement, and clearly would have been placed in foster care in the past. These families often suffer from mental illness, substance abuse and alcohol addiction, domestic violence and other abusive behaviors, as well as economic, housing, educational, and social deprivations. Preventive services caseworkers counsel the families to identify their needs and work to connect them with the specific services that will address their problems. While they are working with the parents, they are monitoring the safety of their children and ensuring that the children receive the child care, educational, medical, emotional, and other resources necessary to remedy the neglect or abuse that they have suffered
Impact of Legislation
While we have made progress in my state we can do more. We are encouraged by the potential impact of HR 5466 on funding for these services. First it proposes to open Title IV-E in a measured way and tie this to goals of reducing the length of stay, reducing the number in care, and improving the well-being of children in care. It is also important that a state be allowed to identify outcomes that can measure results. It is a challenge to design a federal program that can encompass all the prevention services that may be needed. These services will vary by location and community. A new funding source that allows states to target that funding in a way that is tied to outcomes is an important part of a reform effort. We are also supportive of efforts that build on the Child and Family Review Process (CFSR's) and its accompanying program improvement plan (PIP).
Reunification is the first permanency option states consider for children entering care. We know that of the 280,660 children exiting out-of-home care in 2005, sixty-four percent were reunited with their parents or other family members.
Successful reunification requires skilled workers, readily available supportive and treatment resources, clear expectations and service plans, and excellent collaboration across involved agencies. Reunification also requires culturally appropriate support and treatment services for families and the critical need for after care or post-permanency services to ensure that safety and permanency are maintained following reunification.
Children in foster care have greater health, emotional and developmental challenges. Children in care may come into that care having been traumatized by violence, or have been affected by having many of their basic needs neglected for some time, including failure to note and treat chronic medical, dental, developmental, and mental health issues. In addition separation from parents and in some cases from siblings, frequent changes in placements and caregivers, and a sense of instability and uncertainty about the future can undermine children's physical, emotional, and developmental well-being.
Studies have documented that children and youth in out-of home care experience higher rates of physical and emotional problems and that significant percentages of children in care have chronic medical conditions, developmental delays, and mental health problems. One study, for example, found that approximately 60% of children in care had a chronic medical condition, and one-quarter had three or more chronic health problems. Studies further suggest that up to 60% of preschoolers in out-of-home care have developmental delays. One study found that children younger than 6 in out-of-home care had higher rates of respiratory illnesses (27%), skin problems (21%), anemia (10%), and poor vision (9%) than the general population of young children. In relation to mental health problems, it is estimated that between 54% and 80% of children in out-of-home care meet clinical criteria for behavioral problems or psychiatric diagnosis.
The Impact of Legislation
This legislation provides an important step through child welfare planning requiring states to better coordinate health planning and services for children in care including health screenings, the collection of health records and information, the oversight of medications and how they are used, and steps that will be taken to maintain a continuity of care. There is a much bigger challenge today for states. The Administration has issued a series of Medicaid regulations that undercut the very purpose and effectiveness of the Medicaid program. Later today at 1:30 p.m. in room 332 of the Russell Senate Office Building CWLA will be cosponsoring a Capitol Hill briefing on one of these new rules that threatens case management services for vulnerable populations including children in the child welfare system.
There can be no question that the children placed into foster care bring with them a complex set of unmet needs. Many of these children have been physically or even sexually abused. Virtually all of them have suffered the effects of poverty and chronic neglect of their basic needs. They are far more likely than similar children to suffer form chronic diseases, to have developmental delays, to be in dire need of dental care, and to suffer from the effects of parental substance abuse, mental health needs, and domestic violence. They need substantial levels of mental health services, notably to address the chronic impacts of trauma they have experienced.
Many states use case management services under the Medicaid program for children in foster care. Case Management and Targeted Case Management services are a state option under Medicaid and assist beneficiaries on a state-wide or targeted basis in accessing much needed medical, social, educational or other services. Taking into account the vulnerability and complex needs of children in foster care-including health needs, at least thirty-eight states employ the Medicaid TCM option to ensure that children in foster care receive a comprehensive approach and greater coordination of care. The immediate and long-term impact of TCM services is overwhelmingly positive and cost-effective, as children in foster care that receive TCM services are more likely than non-recipients to receive physician services, prescription drugs, dental services, rehabilitative services, inpatient services, and clinic services.
Through Section 6052 of the Deficit Reduction Act (P.L. 109-171), Congress clarified the scope of the case management/TCM benefit, excluding from the definition the direct delivery of certain underlying medical, educational, or social services, all the while prominently iterating that many case management services remain allowable, legitimate Medicaid expenses.
The Center for Medicare and Medicaid Services (CMS) issued an interim final regulation seeking to interpret the DRA that goes beyond the DRA's statutory provisions on numerous fronts. For instance, the regulation vaguely disallows Medicaid reimbursement for case management/TCM services that are deemed "integral to" the administration of another non-medical program, such as child welfare and child protective services. Why would the federal government exempt for its medical and mental health funding the most vulnerable children who most need those services, just because they are in foster care? The regulation's preamble states that this exclusion could extend to case management services furnished by contractors to State child welfare and CPS agencies, even if they are otherwise qualified Medicaid providers. This dissection obliterates the goal and need for systems to work together towards the well-being of children in care and seems directly contradictory to the very purpose of case management and TCM. The regulation also contains several provisions that would negatively impact other vulnerable populations.
CWLA sincerely hopes that CMS will heed the public's and Congressional members' concerns and at a bare minimum, temporarily stop the regulation from going into effect to ensure that Congressional intent is upheld. Legislation has been introduced in both the Senate and House that would impose a moratorium on all administrative action surrounding the regulation until April 1, 2009. Representative Keith Ellison (D-MN) introduced the House bill (H.R. 5173) and Senators Norm Coleman (R-MN) and Amy Klobuchar (D-MN) led the Senate bill S. 2578. Such a moratorium was recently added to the Senate's Indian Health bill (S. 1200) by voice vote. Action must be taken quickly as the rule is to take effect on March 3, 2008.
Research demonstrates the importance of children being nurtured in a stable family environment, confirming the need to move those who must enter foster care into permanent living situations as quickly as possible. Recent studies suggest that, when children must leave their families, well-supported kinship placements have the potential to provide more stable and normalizing environments than unrelated family care .
Kinship care is a situation in which an adult family member, such as a grandparent, aunt, uncle, or other relative, provides a caring home for a child who is not able to live with his or her parents. The practice is not new, but it is growing partly because repeated studies and CWLA Best Practice Guidelines have revealed the value of placing children with a relative when appropriate. The financial difficulties many relatives experience potentially threaten the use of this practice.
Subsidized guardianship is another important permanency option for relatives who care for children. In 2005, the U.S. Department of Health and Human Services (HHS) released findings and evaluations of the seven state waiver demonstration programs that allow federal Title IV-E Foster Care and Adoption Assistance funding to support guardianship programs. These findings reflect that non-relative guardianship is a viable and effective option for child welfare workers to consider. The major findings include: the availability of assisted guardianship as a permanency option may decrease the length of out-of-home placements; combined data from two states reveals that less than 5% of the children in guardianship placements return to foster care; children in guardianship placements fare as well as those in other permanency settings on several measures of well-being, including school performance, engagement in risky behaviors, and access to community resources; and the use of guardianship placements shows statistically significant signs of positive outcomes, with more exits from foster care resulting in reunification or adoption.
Adoption has long been a vital service for children who need families, bringing children whose birth parents cannot or will not be able to provide for them together with nurturing adults who seek to build or add to their families. Although only 2 to 3% of the U.S. population is adopted, adoption touches the lives of many people. In 1938, the Child Welfare League of America published the first professional standards to guide adoption agencies. Over the past decades, families choosing to adopt have become increasingly diverse. A growing number of foster families, families of color, older individuals and families with children, two-parent working families, single parents (both male and female), gay and lesbian couples, families with modest incomes, individuals with physical disabilities, and families of all education levels, religious persuasions, and from all parts of the country now adopt. These individuals and families have one important thing in common: they are willing and able to make a lifelong commitment to protect and nurture a child not born to them, by providing a safe and loving family for that child. Historically, most of the federal adoption support has been targeted toward promoting adoptions. As adoptive families increase in number and as time passes, however, there is a corresponding, increased need to address some of the challenges that may surface in later years for these families through post-adoption services. The most common post-adoption services are subsidies. The other services which should also be available include support groups, crisis intervention, child and family advocacy, adoption searches, case management, family therapy, mental health treatment, respite care, and targeted case management. Some adoption agencies also provide chemical abuse treatment, day treatment, and intensive in-home supervision, indicating a strong commitment to making adoption placements work.
The Impact of Legislation
There are several provisions in this bill that CWLA believes will enhance these various permanency options. First and foremost the bill would mean that all children in foster care and special needs adoptions would be covered by federal funding. The current eligibility tied to an eligibility standard last written in 1996 makes no sense. Secondly we believe that this nation has a compelling interest in the future of all children in foster not just the 45 percent now covered by federal funding. We would advise that as the legislation develops and states trade off some of their federal matching funds in exchange for covering all children we pay special attention that no state comes out with a formula that might provide substantially less per child simply because of the old AFDC standard. CWLA is prepared to work with the Congress in this regard.
We are also strongly in favor of the provisions of this bill that would extend federal Title IV-E funds to kinship and guardianship placements. We would remind the subcommittee that the Government Accountability Office has recommended that one of the key ways to help address the issue of disproportionality or the overrepresentation of certain populations in the nation's child welfare system is by adding a kinship provision to Title IV-E.
Adoption Incentives/Adoption Tax Credits
We support the efforts to make the adoption tax credit more available to lower income families and those families adopting from the foster care system. Many of the 51,000 adoptions from the foster care system annually are by poor families who have opened their homes to provide loving and permanent families. We need to be doing much more in this regard and need to pay particular attention to post adoption services as these adoptions continue to increase.
In regard to the adoption incentive fund we would suggest a new formula that is not set on a specific base year but is perhaps averaged out over a two year period. Most states have seen their number of adoptions jump in the first years of this incentive fund. A baseline that recognizes slight increases would be more appropriate.
In addition to the provisions that encourage adoption of older children there must be increased technical assistance to programs that can target this population. We suggest that when funds are appropriated for the incentive fund, if states do not draw down all available federal funding, the funds be held by HHS instead of allowing these dollars to lapse back to the federal treasury. These dollars could be designated perhaps for technical assistance or to advance these adoptions.
We are also encouraged that the bill's proposal to expand the incentive to guardianship placements is an important provision. The challenge may be in collecting the data and how to accurately measure permanent placements in these settings.
Youth Leaving Foster Care
In 2005 over 24,000 young people exit the foster care system due to age, a number that seems to be increasing. Young people transitioning out of foster care are significantly impacted by the instability that accompanies long periods of out of home placement. Youth in the foster care system are often confronted with emotional, behavioral, developmental, and health challenges. The life events of these young people place them at an increased risk for experiencing adversity. In the midst of elevated rates of homelessness, poor educational outcomes, low wages, unemployment, long-term dependency on public assistance, incarceration and health issues, young people "aging out" of the foster care system are also experiencing pregnancies and early parenthood. Confronting and overcoming these challenges is more difficult without support networks or familial connections and impedes their transition into adulthood.
Providers of child welfare services want every young person aging out of foster care to have the pathways to success that we all want for our own children-a college education or preparation for meaningful employment and permanent connections to a caring and supportive family or individual. Young people in foster care are encouraged to stay in school and their progress is monitored. This can be very challenging. Many of the teens coming into foster care are under-educated, with long histories of school absences. Studies have shown that many are not likely to get their GED until they reach the age of 20. Foster care agencies focus much attention on helping teens in their care address their school problems, hiring tutors and paying for extra instruction. Education is a strong factor in the plan developed with youth when they enter care. But much time and personal attention are required to compensate for the lack of consistent schooling in the past.
Having seen too many examples of youth leaving foster care without benefiting from the preparation available to them, some agencies have developed innovative ways to work with youth.
Impact of Legislation
- developing incentives to encourage youth to attend skills sessions,
- hiring a former foster youth to engage the teens currently in care,
- Presenting youth with contracts to be signed by the youth and the agency,
- Creating their own transitional housing programs,
- Collaborating with housing programs to ensure that youth leaving foster care have a place to live, and
- Keeping youth connected to the agency so that they have a place to return to for help.
We are supporting other bills that would extend Title IV-E funding beyond age 18 and we are pleased that this legislation does the same. We believe it is important that the child welfare system recognize that our society has changed. Young people regularly return home in their early and late twenties after college. As our families change, we need to recognize that leaving the foster care system at age 18 not fully prepared should never happen. First we should make every effort to prevent a child from staying in care that long and make every effort to reunify these young people where possible or help them find a loving family. If that is not possible then we must step up our efforts through legislation such as this. It is also important that states provide the needed transitional supports and oversight for these young people.
Children and youth in foster care encounter numerous barriers to school success. In addition to the abuse and neglect initially bringing them to the attention of the child welfare system they must deal with the emotional consequences of being removed from their homes and communities, separation from siblings, sometimes being moved from home to home, and having the child welfare agency and court system involved in all aspects of their lives.
Schools should represent stability for foster children during times of transition and instability, but due to poor coordination and communication between schools and child welfare agencies, this often does always happen. Federal law falls short in assuring school stability and access to supportive services for children in care. Too often there is as much movement among schools as there is in living arrangements. When children change schools, education records frequently do not follow in a timely fashion. Indeed, youth in foster care in some states have been reported to move through an average of nine different schools during their tenure in foster care. These children and youth are commonly out of school for weeks or months and fall behind academically, cognitively, and socially. They often need to repeat courses and are unable to access the support services that could improve education outcomes.
Impact of the Legislation
CWLA supports the directive in the bill that states do a better job assuring that if a child is placed into foster care they will be allowed to stay in that same school even if they move. It is also vital to assure that if it is in the best interest of the child to enter a new school they be given immediate enrollment and not be delayed due to the slow or inadequate transition of school and health records.
We also encourage members to weight in during the reauthorization of No Child Left Behind (NCLB) law. CWLA has joined together with a number of other groups including some of the advocates for homeless children and families to amend and to increase funding for the McKinney-Vento Homeless Children's program to clarify current law to assure that foster children are covered by the same protections for homeless children.
Tribal child welfare services operate in a unique context shaped by laws, jurisdictional issues, cultural factors, financial constraints and a federal trust relationship that is unlike any other experienced by states or the territories. Most federal funds that could address the needs of children from tribes that come into contact with the child welfare system are not provided directly to tribal governments. Tribes receive a limited set-aside of funds from Title IV-B Part 1 and 2, Child Welfare Services, and the Promoting Safe and Stable Families program respectively. Under Title IV-B Part 1, over half of the tribal grants are less than $10,000, and under Part 2, most of the tribal grants are under $40,000. Under the Child Abuse Prevention and Treatment Act (CAPTA), tribes compete for a very small portion of funding with organizations serving migrant populations. The greatest inequity however is that the most basic funding under Title IV-E foster care and adoption assistance may never reach children in Indian country. This is an inequity that must be addressed.
Impact of the Legislation
CWLA supports the provisions of this bill that would extend access to Title IV-E funds to tribal governments and consortia. Members of both parties and both houses including members of this subcommittee have supported this through separate legislation. Currently these bills include S 1956 and HR 4688. This too is an issue of cultural competence and an important part of our need to addresses the issue of overrepresentation of certain children in the child welfare system.
Child Welfare Workforce
Successful outcomes for children and families in child welfare depend heavily on the quality of services received, and in turn, on the ability of the workforce delivering them. Yet, child welfare agencies across the country are facing a workforce crisis on many fronts. Attracting, training, and retaining qualified staff at all levels has become increasingly challenging. Staff shortages and high turnover rates have grown with the increasingly rigorous demands of the work, low to modest compensation, and competition with other more attractive options in the job market. Child welfare workers must be prepared to handle caseloads typically well beyond recommended national guidelines. Every day they work with children and families with complex problems and often in situations that may jeopardize their safety.
A report from the U.S. Government Accountability Office found that states failed to meet some of the outcome measures in the Child and Family Service Reviews, due at least in part, to workforce deficiencies. Areas where measures were not met due to workforce issues included: timely investigation of abuse complaints, efforts to reduce the risk of harm to the child, the ability to maintain stable foster care placements, establishing permanency goals for the child in a timely manner, involvement of children and families in case planning, and adequately monitoring child safety and well-being.
New York State conducted an extensive study in 2006 to identify "reasonable" caseload sizes. One example was the finding that foster care workers should have no more than 12 children on their caseload. In New York City our average caseloads approach 20 children, with many being considerably higher. An analysis of the data from the study shows that with a caseload of about 20 a worker has an average of 60 minutes a month of face to face time with that child and/or their family. That is far too little if we really want to expedite the services needed by the family and discharge children to safe homes as quickly a possible.
The need for training for both new staff and on-going training for current staff is a critical part of the workforce issue. States must be able to ensure worker competencies through the provision of comprehensive, rigorous, competency based training programs. We believe that an important part of this strategy is to allow states that contract their services to private agencies to be able to use federal IV-E training dollars to train this important part of the workforce.
In this challenging economy where many of our citizens and leaders fear jobs going overseas, it might be a useful national strategy for this country to invest in human service jobs from child welfare workers, to nurses, to long term care workers to child care workers and many others. Many of these career paths require greater experience, greater demand and are locally based.
The Impact of the Legislation
We strongly endorse the provisions of this bill that would provide funding for applying states to address what is a shortage in child welfare workforce. This is an area too often overlooked. When we ask for greater and more detailed data collection as ACF is currently doing; when we ask for monthly caseworker visits as mandated by this subcommittee; and when we need to recruit more foster and adoptive families-all of this comes down to the need for more workers and better trained workers. Keeping families together, reunifying children with families placing children in adoptive and kinship families and providing these children and families with the needed services is labor intensive.
We strongly support the provisions of this bill that would allow private agencies access to Title IV-E training funds. This is a longtime item on the CWLA agenda and we appreciate the efforts of both the Chairman and the Ranking Member Representative Jerry Weller's longtime support for this provision. Where private, usually not-for-profit agencies are caring for the public's children why deny them access to the training deemed necessary for all workers?
CWLA appreciates the opportunity to offer our comments to the Subcommittee in regard to child welfare reforms. We commend the Subcommittee and its members for taking up the issue of child welfare. If in the remaining days of this session it is not possible to address a comprehensive effort then we feel it is very important that Congress take at least some critical steps. In addition to the reauthorization of the adoption incentive fund we urge you to address our top priorities of kinship care, access to Title IV-E funding for tribal governments, and expanded assistance to youth beyond age eighteen. Of course we also hope all members will do all they can to see that H.R. 5461, the bill to re-establish a White House Conference on Children and Youth, is passed in this Congress.
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