CWLA Testimony Submitted to the Senate Finance Subcommittee on Health Care for the Hearing on the Health Care Needs of Children in the Foster Care System
October 13, 1999
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The Child Welfare League of America (CWLA) welcomes this opportunity to submit testimony on S. 1327, the Foster Care Independence Act. We commend the efforts of the bill's bipartisan sponsors for taking steps to address the needs of young people transitioning from foster care to independence.
CWLA is an association of more than one thousand public and private non-profit community based agencies that serve more than three million children, youth, and families each year all across the United States. Virtually all of CWLA's member agencies provide foster care and other services to teens who can not live safely at home with their families or who are homeless. Over 500 of our members provide specialized independent living and other transitional support to young people who will not be returning to a family and who will be on their own once they leave care.
History of the Federal Independent Living Program
In the early 1980's, older adolescents in foster care and young adults who had been discharged from foster care became a source of great concern to professionals in human services and to society at large. Many young people released from foster care were returning to the care of the state as adults, either through the welfare or criminal justice systems, or as residents in shelters for the homeless (Stone, 1987). At the same time, studies such as the one conducted by Westat in 1986 showed that about half of the children in foster care nationally were age 12 or older, and that many of these teenagers would exit foster care as adults who must live on their own (Westat, 1988; Stone, 1987). Public agencies recognized the need to make fundamental changes in their programs and services for these older children, particularly in the areas of education, employment, life-skills, and decision-making.
These concerns culminated in the passage of legislation creating a federal Independent Living Program in 1986. In 1987, funds were allocated and program implementation began in all 50 states. In some states, federal funds supplemented state funds that were already being directed to the provision of independent living services to older teens in foster care. Maryland, for example, had recognized the need for independent living services for teens and begun implementing a state funded program in 1985.
The Independent Living Program was amended in 1990 to extend eligibility for independent living services to age 21 at state option. This extension recognizes that young people in foster care often face difficulty in making an abrupt transition out of care at age 18, and that services are more effective on a longer continuum. In 1993, the Program was permanently authorized and funded at $70 million. These funds are distributed to states by formula, and must be matched dollar for dollar over the original amount allocated to the state in 1986. Federal Independent Living Program funds may be used to provide counseling, educational assistance, life-skills training, and vocational support to youth in care. Funds are also directed to state and local independent living staff positions, staff training, foster parent training, and youth participation activities such as annual youth independent living conferences.
The Federal Independent Living Program does not require states to provide specific services (other than an initial life-skills assessment), and allows for great flexibility in program design. States are required to have a state plan for independent living services, an individual independent living plan for each youth participating in the program, and cooperative and collaborative efforts among agencies. Other than these basic requirements, states have tremendous flexibility in designing and delivering independent living services. Many states' independent living programs vary widely across counties and cities as well. Programs in each state vary according to how social services are administered, i.e., centrally, through a state department of social services, or locally, through a county administered system. The presence of state Independent Living Coordinators and state-wide Independent Living Advisory Committees facilitates the sharing of program strategies and fosters consistency in program implementation. A number of national organizations, including CWLA, the National Resource Center for Youth Development, the National Independent Living Association, and the Daniel Memorial Institute, provide resources, information, training, and other support to independent living programs nationwide.
Federal funds can not currently be used to provide room and board to youth participating in the independent living program; residential services or other housing assistance must be provided through other funding sources. For example, in many states, residential placements and subsidized independent living services are paid for through Title IV-E foster care maintenance funds or other state funds.
Independent Living Services for Youth in Foster Care
Learning to live independently is a lifelong process. For most children, the early stages of this process take place as part of growing up in a family. In the family setting, children receive continuous economic and emotional support from nurturing parents as they make the transitions from childhood to adolescence and from adolescence to adulthood. For many children, however, this family support is unavailable-for a few weeks, months, years, or for their entire childhood. At times when parental care and protection are unavailable, local government agencies become the community's designated agent in loco parentis.
An eventual transition to self-sufficient adulthood is a major goal for all children in foster care, whether they will return to a family, be adopted, or live independently. Historically, however, independent living services have only been available to those older adolescents (ages 16 and up) in foster care who are approaching the statutory age of release from state custody. Philosophically, independent living should be seen as a desired developmental goal for all children. Child welfare agencies acting in the role of parents have the responsibility to ensure that the children in their care receive the supports and opportunities they need to achieve this goal. This is particularly true for children and youth in out-of-home care settings, who face the many challenges of growing up without traditional family supports.
- Currently, teens represent approximately 30% to 40% of the more than 530,000 children in foster care nationally (Petit et al., 1999).
- Each year, 25,000 of these older youths "age out" of foster care and must make the transition to self-sufficiency. Only about one in four of these young people will return home permanently.
- In 1998, over 80,000 young people in out-of-home care participated in independent living programs.
Additionally, there are three areas of practice critical to effective implementation of independent living services:
- A flexible continuum of living arrangement options. Youth should have access to the placement(s) which best suit their level of developmental readiness. Young people should be able to move from a more structured to a less structured setting, and be able to return temporarily to a more structured setting if necessary.
- A continuum of case management. Effective case management should include assessment, training, resource development, advocacy, and re-evaluation. Successful case management includes young people actively and consistently involved in the decisions that affect them.
- A positive youth development approach. Programs employing this approach place value on young people regardless of their situations, and emphasize their strengths and potential, rather than their problems and deficits. This approach emphasizes program services that will contribute to young peoples' healthy development, support them in building on their own strengths, and enable them to contribute to programs and communities. This does not mean that the serious issues and service needs of young people should be ignored. It does mean that focusing on development and promoting competence will most effectively address existing problems, prevent potential problems, and support young people in their current and future roles as contributing members of the community.
Independent Living Services and Programs
Services and programs provided through federally and state-funded independent living programs represent one part of the continuum of services and opportunities available to young people in foster care. Independent Living program services may include:
Most states offer all of the basic services that the federal Independent Living Initiative supports: education and/or employment assistance; training in daily living skills; individual and group counseling; integration and coordination of services; outreach; and a written individual transitional living plan for each participant. The availability of these services varies widely among the states, as does eligibility for participation in IL programs. Independent living services, by law, must be available to all youth in foster care at age 16. Some states, such as New York, Maryland and Missouri, have chosen to use state funds to provide independent living services for youth as young as 13 or 14. Eligibility to receive services ends at 6 months after emancipation, which occurs between ages 18 and 21, depending on the state. It is important to note that the majority of states are reaching only 50% of the youth eligible to receive independent living services.
- Centralized state-wide activities, resources, information, and program planning available through the federally funded independent living program, and implemented by the state Independent Living Coordinator and, if in place, the state Independent Living Advisory Board;
- Assessment, life skills activities, training, support and case management related to preparation for independent living provided by individual case workers and independent living coordinators at the local or county level;
- Residential services, including foster homes, stipend boarding arrangements, supervised independent living apartments, residential group care, and apartment-based independent living programs. These programs may also include counseling, educational/vocational assistance, case management, life skills training, socialization, and community resource development.
Completion of a high school education, and participation in higher education, are some of the strongest indicators of future ability to achieve and maintain self-sufficiency after discharge from Social Services' custody (Cook, Fleishman, & Grimes, 1991). Youth who receive support from the state (their legal "parent") up to age 21 and who participate in post-secondary education programs may be more likely to obtain living-wage employment, less likely to become pregnant as teenagers, less likely to become involved in the criminal justice system, and less likely to become homeless or join the welfare rolls after discharge.
CWLA Standards for Independent Living Services emphasize the importance of housing services in assisting youth aging out of care. In a 1998 survey of CWLA member agencies providing services and supports to youth who have emancipated from the foster care system, 67% reported housing as the most needed service (Nixon, 1998, p. 16). Not surprisingly, 57% of the agencies surveyed reported that housing was also the most difficult service to provide to youth leaving foster care (p.17). Although many public and private social service and foster care agencies have demonstrated great flexibility and creativity in assisting youth in care find the most appropriate housing option meeting their needs, the inaccessibility of affordable housing limits opportunities for young people to successfully transition to independence. Human services professionals and young people themselves agree that an apartment-living program provides the best preparation for independence.
What do Young People in Foster Care Need?
This discussion can be clearly articulated within the framework of existing child welfare reform efforts set forth in the Adoption and Safe Families Act. That law focuses on child safety, permanence, and well-being.
In the majority of states, emancipation of a foster youth is not determined by readiness, but happens by statute at 18 or upon attainment of a high school diploma or GED. Research demonstrates that young people who emancipate from the foster care system experience great risk in terms of emotional, economic, and physical safety (See Attachment 1 at the bottom of this page). They are more likely to become homeless, to leave school without a diploma or GED, to experience early parenthood, and to be victims of violence than their mainstream peers. Like all youth in their age bracket, they are more likely to be unemployed or underemployed, with the additional burden of less educational achievement and opportunity. Young people report that the transition to independence and expected self-sufficiency is often very rapid, sometimes unplanned for and unexpected, and results in their feeling "dumped".
To strengthen the system of support that contributes to the safety of young people emancipating from the foster care system, we must:
- Increase early and consistent access to independent living preparation, especially opportunities for realistic practice of employment and life skills.
- Ensure the active involvement of young people in the individual planning and decision making processes that will lead to successful emancipation.
- Increase access to emergency shelter, transitional housing, and longer-term affordable housing options.
- Ensure that no youth is discharged to homelessness.
- Provide support and concrete assistance, including health care, basic necessities, and formal aftercare services through age 21.
Young people need appropriate information about the strengths and limitations of all permanency options, including adoption, legal guardianship, and other permanent living arrangements, as well as emancipation. Though many foster teens are adopted each year, emancipation to independence is the reality for many others. Long lasting, supportive, and strong connections to family members, friends, and other adults are critical to young people's healthy development while they are in foster care and to their success in adult life. Young people report that relationships with people who care about them and are there for them consistently make all the difference in the world when they are on their own.
To strengthen the system of support that contributes to permanence for young people emancipating from the foster care system, we must:
- Provide more information about permanency options and support in making decisions related to permanency to young people, families, foster/kinship caregivers, prospective adoptive parents, and service providers.
- Encourage discussions of permanence both inside and outside of the legal context so that child welfare staff can help emancipating youth build the networks of support they need to make successful transitions.
- Ensure early and continuing access to supportive adults, including biological family members, identified family/kin, mentors, former service providers, and other community members who can be part of a long-term network of support.
Personal and social functioning, health, education and employment are all critical areas of well-being for young people as they move toward adulthood. The experiences that result in children and youth being placed in foster care, as well as the actual experience of foster care, can create barriers to achieving well-being in any or all of these areas. Coordinated efforts on the part of policymakers, public officials, caregivers, service providers, educators, community members, and youth themselves are critical to the positive development of young people making the transition to productive interdependence. Young people who have left the foster care system say that disruptions in education due to changing placements, inadequate preparation for the workplace, lack of access to physical and mental health care, and the immediate struggle for day-to-day survival after leaving care make planning for a good future very, very difficult.
To ensure the current and future well-being of transitioning foster youth, we must:
- Provide a continuum of support and preparation for adulthood that begins when a child or youth enters foster care and continues through the post-emancipation period.
- Stabilize foster care placements to ensure educational continuity and achievement.
- Increase youth involvement in the planning and delivery of services to transitioning youth at the local, state, and national levels.
- Create national and local networks of foster youths and former foster youths that will enhance overall levels of support and participation.
- Provide opportunities for organizations serving older youth to network with each other, communicate strategies, and coordinate service delivery.
- Facilitate greater coordination among and between national and local education, housing, health, employment, and assistance programs to better serve this population.
- Ensure accountability through data collection on 6-24 month outcomes for youth leaving foster care, technical assistance to the states, and evaluation of independent living services.
Why is there a Special Need for Health Care Services for these Youth?
The extent of the health care problems facing abused and neglected children and youth in foster care is truly alarming (Schor 1982; Hochstadt et al., 1987; Simms, 1989; Halfon, 1992). Most children enter foster care in a poor state of health, and most enter with developmental, behavioral, and emotional disturbances. Even when compared with other children of the same socioeconomic background, children in foster care suffer much higher rates of serious chronic physical disabilities, birth defects, developmental delays, and emotional problems (American Academy of Pediatrics, 1994). A GAO study found that, "As a group, they [children in foster care] are sicker than homeless children and children living in the poorest sections of the inner city." Chronic medical problems affect 30-40% of children and youth in the child welfare system. Often these chronic conditions have been untreated or only partially treated (Schor, 1988).
Adolescents in foster care experience higher risk for continuing medical problems, which are exacerbated by multiple placements, lack of continuity of intervention and record-keeping, and declining emphasis on preventive measures (e.g., immunization) as they enter adolescence. In addition, adolescents in foster care report feeling low levels of trust in adults and the service system, which may prevent their accessing health care and other services.
During the time immediately following statutory discharge from the foster care system (usually at age 18), former foster youth experience tremendous problems both in terms of their health status and in their ability to access health services. Because health coverage ends at the time of emancipation, young people lose both routine preventive care and the care they have needed to treat chronic medical conditions. As many as 25% of youth leaving foster care experience homelessness during the year following emancipation (Cook, 1991). In a national study of youth accessing services from urban health clinics, 41% of homeless youth served had a history of placement in foster care (National Coalition for the Homeless, 1998).
Securing and maintaining employment are critical factors in accessing health insurance for all adults. Youth who are forced to leave foster care at 18 are often still in high school, and most are still in entry-level employment, if they have been able to secure employment at all. Research suggests that about half of the youth leaving care are employed at the time of discharge (Mech, 1994). Furthermore, since only 35-45% of teenagers in foster care are able to graduate from high school, their employment prospects are particularly discouraging. Clearly, the realities of educational underachievement and difficulties with securing and maintaining employment place these youth at a significant disadvantage for achieving self-sufficiency and meeting their health needs.
Like most young people their age, youth leaving foster care can not achieve immediate economic independence. They carry the additional burdens of the long-term effects of severe abuse and neglect, and of not having access to family members who might provide for some of their needs. This vulnerable population of young people needs sustained support from the child welfare system to ensure that their long-term health needs are met during the transition to adulthood. Most importantly, they deserve the opportunity to achieve their potential as healthy adults and productive citizens.
The Foster Care Independence Act of 1999
The federal government plays an important role in ensuring that young people exiting foster care make a successful transition to adulthood. Congress passed the bipartisan Adoption and Safe Families Act in 1997 to ensure that more children in foster care would have safe and permanent homes. While most children and youths in foster care can eventually return to their biological families, many can not. ASFA makes it easier for many children to move more quickly into permanent adoptive homes or other permanent living arrangements. Adoption, however, is not always possible for many older children in foster care. Congress should now address our obligation to these youths. We should do all that we can to help these youths achieve self-sufficiency. The Foster Care Independence Act, S. 1327, addresses many of the issues. We support this bill and urge Congress to pass the bill this year. This legislation will increase resources, enhance accountability, and increase the chances for a safe, healthy future for America's foster youth.
American Academy of Pediatrics (AAP), Committee on Early Childhood, Adoption, and Dependent Care. (1994, February). Health care of children in foster care. Pediatrics 93 (2), 1-4.
Burrell, K. & Perez-Ferreiro, V. (1995). A National Review of Management of the Federally Funded Independent Living Program. Boston, MA: Harvard UP. (Malcolm Wiener Center for Social Policy, John F. Kennedy School of Government).
Child Welfare League of America. (1989). CWLA standards for independent living services. Washington, DC: Author.
Cook, R. (1991). A national evaluation of Title IV-E foster care independent living programs for youth: Phase 2. Rockville, MD: Westat, Inc. (Contract No. OHDS 105-87-1608, U.S. Department of Health and Human Services).
Cook, R., & Ansell, D. I. (1986). Independent living services for youth in substitute care. Prepared for the Administration for Children, Youth, and Families, U.S. Department of Health and Human Services. Rockville, MD: Westat, Inc., Contract OHOS 105-84-1814.
Cook, R., Fleishman, E., & Grimes, V. (1991). A national evaluation of Title IV-E foster care independent living programs for youth, Phase 2. (Final Report for Contract No. 105-87-1608). Rockville, MD: Westat, Inc.
Halfon, N., Berkowitz, G., & Klee, L. (1992a) Children in foster care in California: An examination of Medicaid reimbursed health services utilization. Pediatrics 89, 1230-1237.
Hochstadt, N., Jaudes, P., Zimo, D., & Schachter, J. (1987). The medical and psychosocial needs of children entering foster care. Child Abuse and Neglect 11, 3-62.
Mech, E. (1994). Foster youth in transition: Research perspectives on preparation for independent living. Child Welfare, LXXIII (5), 603-623.
National Coalition for the Homeless (1998). Breaking the Foster Care-Homelessness Connection [On-line]. Available: http://nch.ari.nte/sn/1998/setp/foster.html.
Nixon, R. (1998). Improving economic opportunity for youth formerly served by the foster care system: Identifying the support network's strengths and needs: Final Report. Washington, DC: Child Welfare League of America.
Petit, M.R., Curtis, P.A., Woodruff, K., Arnold, L., Feagans, L., & Ang. J. (1999). Child abuse and neglect: A look at the states. Washington, DC: Child Welfare League of America.
Schor, E.L. (1982). The foster care system and the health status of foster children. Pediatrics 69 (5), 521-528.
Schor, E.L. (1988). Foster care. The Pediatric Clinics of North America 35 (6), 1241-1252.
Simms, M.D. (1989). The foster care clinic: A community program to identify treatment needs of children in foster care. Journal of Developmental and Behavioral Pediatrics 10, 121-128.
Stone, H. (1987). Ready, set, go: An agency guide to independent living. Washington, DC: Child Welfare League of America.
Summary of Outcomes for Youth Formerly Served By the Foster Care System
Child Welfare League of America 1999
This study documents the experiences of youth who emancipated from foster care.
30% reported having no housing or having to move every week.
At follow-up, 45% of 21 year olds had completed high school
75% were working, with an average income of $10,000.
31% of youth had been arrested while 26% had served jail time.
40% reported a pregnancy since discharge, most were unplanned.
Almost 40% received AFDC or general assistance funds.
The study examined the impact of independent living services on enhancing the ability of foster youth to be self-sufficient, 2.5 to 4 years post-discharge.
25% reported at least one night of homelessness.
54% had completed high school.
38% maintained employment for one year.
No data reported.
60% of the women had given birth.
40% were a cost to the community.
Alexander & Huberty (1993)
The study was conducted with a sample of former foster youth from The Villages in Indiana, with an average age of 22 years
The average number of moves during the last five years was 7.4.
27% had some college or vocational training.
49% were employed, compared with 67% of 18-24 year olds in the general population.
Almost 42% had been arrested
No data reported.
14% received assistance in the form of food stamps, general assistance, and/or AFDC.
Courtney & Piliavin (1998)
The study looked at foster youth transitions to adulthood, 12 to 18 months post-discharge.
12% reported living on the street or in a shelter since discharge.
At 12 to 18 months post-discharge, 55% had completed high school.
50% were employed, & the average weekly wage ranged from $31 to $450.
18% experienced post-discharge incarceration
No data reported.
32% received public assistance.
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