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Child Welfare Journal of Policy, Practice and Program

Special Issue: Family Foster Care in the Next Century

Introduction

Although family foster care, designed to provide temporary protection and nurturing for children experiencing maltreatment, has been a critical service for millions of children in the United States, the increased attention given to this service in the last two decades has focused more on its limited ability to achieve its intended outcomes than on its successes. This has resulted in a questioning and devaluing of family foster care as well as predictions of drastic reductions in its use. The reality, however, has been quite different. Though the use of the service has shifted, reflecting social and political events, family foster care remains an important child welfare service.

Reaffirming its commitment to family foster care, the Child Welfare League of America's National Advisory Committee on Family Foster Care recommended that a special issue of Child Welfare be published on the subject. Aware that recent history has shown out-of-home care reacting to rather than anticipating change, the Committee decided to focus the special issue on family foster care in the next century. This issue would thus provide the opportunity for the field's best practitioners, researchers, and managers to share their knowledge as well as their expectations, concerns, and hopes for family foster care.

Acting on the Committee's recommendation, a call for abstracts was issued in the fall of 1997, with overwhelming results: three times the number of abstracts usually submitted for a special issue were received. Both the range of content addressed and the quality of the abstracts received were impressive, making selection of the 11 articles included in this issue difficult. The need to consider balance and coverage of specific topics necessitated the exclusion of many fine papers.

Immediately after CWLA issued the call for abstracts, Congress enacted major federal legislation impacting family foster care -- the Adoption and Safe Families Act of 1997 (P.L. 105-89) -- reminding us of the importance of legislation as it reflects social trends and political thinking and shapes practice. A review of that act, as well as other major child welfare legislation, provides an important contextual element for this volume.

In 1980, in response to the "drifting" of children in care, Congress passed the Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272), a key factor in shaping the current status of family foster care. The legislation responded to concerns that placement in out-of-home care was being used when other services were more appropriate, that children were remaining in care for excessive periods of time, and that children were simply being forgotten once they entered out-of-home care. The goal of the act was to reduce reliance on out-of-home care and encourage the use of preventive and reunification services; it also mandated that agencies engage in permanency planning efforts.

By 1984, P.L. 96-272 was showing some success in reducing the number of children in care and the length of time spent in care. From the mid-1980s to the late 1990s, however, a dramatic 74% increase in the number of children in out-of-home care occurred [Petit & Curtis 1997]; the length of time children remained in care and their rate of reentry into care also rose. Concurrently, the out-of-home care system found itself facing new challenges: the overrepresentation of children of color; an influx of infants and preschoolers; children with increasingly severe emotional/behavioral problems; the pervasiveness of substance abuse and its impact on families; the growing number of children infected/affected by HIV/AIDS; and the discharge of many youths from care who lacked jobs, homes, and connections to a family.*

Once again, the out-of-home care system found itself straining to deal with the sheer number of children in the system and with the complex issues that had brought them there. Concern grew that many children were coming into care needlessly and that many more could go home or achieve permanency with another family if more family-centered, intensive services were available. Congress again took action, creating the Family Preservation and Family Support program as part of the Omnibus Budget Reconciliation Act of 1993. This program reiterated the principles of P.L. 96-272 but added funding for a variety of services, including intensive family preservation services (intended to keep families together) and services to reunify families with children in care.

Despite the mandates and funding of the Family Preservation and Family Support program, the child welfare system continued to struggle to provide the level of services needed for children to achieve timely permanence, the number of children in out-of-home care continued to increase in most states, and a significant percentage of children experienced increased stays in care. Large caseloads, inexperienced and untrained staff, and high turnover rates of workers and foster parents made it difficult for children and families to obtain the help they needed. In response, in late 1997, Congress passed the Adoption and Safe Families Act (ASFA); President Clinton signed it into law on November 17, 1997. The new legislation reauthorized the Family Preservation and Family Support program, renamed it the Promoting Safe and Stable Families program, and modified and clarified a wide range of policies established under the Adoption Assistance and Child Welfare Act of 1980, including: modifying the "reasonable efforts" states must make to preserve or reunite families by providing examples of circumstances in which states are not required to make efforts to keep children with their parents for safety reasons.

establishing (for the first time in federal law) timelines and conditions for filing termination of parental rights petitions. States must file on behalf of any child, regardless of age, who has been in care for 15 of the most recent 22 months.

setting new timeframes for permanency hearings at 12 months rather than 18 months. At a permanency hearing, there must be a determination of whether and when a child will be returned home, placed for adoption, or referred for legal guardianship or another planned permanent living arrangement.

encouraging adoptions by requiring states to make reasonable efforts and to document child-specific efforts to place a child for adoption, and by providing "bonuses" for the adoption of children with special needs previously in care.

continuing and expanding the Promoting Safe and Stable Families program to include funding for time-limited reunification and adoption promotion and support services.
To comply with the law, public and private agencies must initiate significant program and practice changes in the coming years. The articles in this special issue provide guidance on improving permanency outcomes and child well-being, the cornerstones of ASFA.

Responding to the Need for Change

As social and political trends and new legislation evolve to reshape child welfare, policymakers and service providers continue to offer innovative policy and practice options, as demonstrated through the number and variety of submissions received in response to Child Welfare's call for abstracts. Areas of concern included the following: Meeting the needs of special populations. Abstracts addressed children who are seriously emotionally disturbed (SED), medically fragile infants, infants and toddlers entering care, adolescents aging out of care, and youths who are lesbian, gay, transgender, bisexual, or presenting other sexual identity issues.

Recruiting and retaining high-quality family foster caregivers. Abstracts addressed strategies for recruitment that involve various sectors of the community; determining exceptional versus abusive homes; specialized training to increase the competence of parents fostering prenatally substance exposed infants; planned and emergency respite care; using foster caregivers as resources for children and their families, particularly in relation to treatment for SED; professional, salaried inner-city foster parents; and a redefinition of foster parents as extended family who continue to have involvement with children after reunification.

Kinship care. Abstracts addressed both informal and formal kinship care; regulatory procedures-monitoring, compliance, and ongoing risk assessment-and their effect on family life; the dual role as family member and foster parent; and supports for kinship parents. Recognizing the importance of kinship care, CWLA published a special issue of Child Welfare on the subject in September 1996.

Mandates for expedited permanency. Abstracts addressed the expanding infant and preschooler population in care; arrangements for early assessment and intervention by interdisciplinary teams; public-private collaboration to provide mandated health/mental health screening; and concurrent planning, especially for substance-affected infants or other children at high risk of foster care drift. To expedite reunification, abstracts discussed increased services to biological families; providing for child safety while rehabilitating parents; arranging biological family contact according to such factors as the child's emotional readiness and developmental stage; and providing immediate foster care placement rather than temporary shelter.

Family supportive, community-based care. Both current philosophy and new legislation are impelling us toward identifying new models of intervention that respect, preserve, and strengthen family-child ties and that reflect the significance and power of communities as resources to families. Abstracts described programs for transitional housing for homeless women and their children; parenting apprenticeships; shared family care; placing foster children within their home neighborhoods and using foster parents as resources for biological parents; and therapeutic communities.

Service delivery and funding arrangements. Abstracts dealt with collaboration in service delivery, particularly in relation to community-based services for SED children and early intervention for infants and preschoolers; the use of contractual services; managed care, particularly in relation to meeting the health and mental health needs of SED and medically fragile children; increasing flexibility and finding alternatives to rigidly defined service boundaries and categorical funding; and increased funding.

Cultural issues. As the cultural mosaic of America is changing, so must the cultural sensitivity and responsiveness of child welfare services. Abstracts focused on African American children and youths and the service implications of culture-related responses to abuse; the need for and obstacles to recruiting Asian foster parents; and American Indian family issues.

Outcomes and accountability. Outcomes and accountability were subthemes in most of the abstracts submitted, and the call for more sophisticated and informative evaluation and appropriate measures recurred. One difficult and provocative issue raised was defining and documenting accountability when responsibility for services is broadly dispersed throughout a community. Other abstracts reviewed measures of child well-being, reported on the use of children's voices in program evaluation, and provided a variety of perspectives on using data to understand and improve policy and services.

Preview of Articles Selected for Inclusion

To give adequate attention to all the important issues facing family foster care would have required several volumes. The central theme of the articles included in this issue is outcomes accountability, certainly a current driving force in child welfare as well as in other public and private services fields. With new data systems, new funding arrangements, and new calls for evidence that interventions are effective, the importance of outcome accountability can be expected to increase in the next century. The articles are organized into three categories-using data for planning, enhancing outcomes through new models, and promoting child well-being.

Using Data for Planning in Family Foster Care


The Administration on Children, Youth, and Families' Program Instruction [ACYF 1998] regarding the Adoption and Safe Families Act of 1997 (ASFA) underscores the legislation's intent regarding results and addresses the appropriate use of statewide data for planning. Marie Jamieson and Jami M. Bodonyi, in "Data-Driven Child Welfare Policy and Practice in the Next Century," describe how Washington State's Families for Kids used two data systems-the Washington State Children's Administration Case and Management Information System and the Washington State Social Service Payment System-to identify children legally free for adoption and to track their movement through out-of-home care. In so doing, they identified gaps in the information available through these systems and discovered obstacles to permanence. The authors described how data were interpreted and findings carried back to the field to provide a framework for problem solving and continuous improvement of practice to enhance permanency planning.

In "Measuring Performance in Child Welfare: Secondary Effects of Success," Charles L. Usher, Judith B. Wildfire, and Deborah A. Gibbs report selected results from evaluations of two reform initiatives-Family to Family and Families for Kids-in three states (Alabama, North Carolina, and Ohio) and offer lessons for the development of outcome measurement. Although the evaluations produced positive findings in terms of the children's movement through the out-of-home care system, these successes also had secondary effects, including changes in the population of children entering care and increased staff awareness and understanding of trends in and the need to monitor and use data to shape service responses.

Leslie Wilson and James Conroy's article, "Satisfaction of Children in Out-of-Home Care," serves as a reminder that no system of accountability is complete without the voice of the customer-in this case, the children who have experienced the out-of-home care system. The authors report on four years' data collected through interviews in which children discuss their satisfaction with both their physical environments during placement and their foster families. Results supported the children's ability to assess their own needs and to provide valid information that can be used to improve the out-of-home care system.

Enhancing Outcomes Through New Models of Family Foster Care


Demographic data provide a picture of the population of children who will need family foster care in the next century. Linda Katz, in "Concurrent Planning: Benefits and Pitfalls," describes a model that promotes timely permanence for one significant subgroup of this population-young, chronically neglected children. Katz's article explains the model's history and theoretical underpinnings, target population, core components, common concerns about and pitfalls in implementation, possible outcomes, and evaluation results. The author suggests that the model be viewed as only one approach to enhancing outcomes for some children in care and cautions us not to see concurrent planning, as she has defined it, as the sole and best way to improve outcomes.

Although family foster care provides for the safety of children, the children still experience the emotional and psychological distress caused by the separation from their families. In "Shared Family Care: Providing Services to Parents and Children Placed Together in Out-of-Home Care," Richard P. Barth and Amy Price suggest that a shared family care model can not only eliminate separation trauma but may also expedite permanence and decrease the recurrence of child abuse and neglect and additional placements. They present key elements of the emerging model of shared family care, describe several programs, and discuss how, despite the relatively high cost of shared family care, outcomes (shorter and fewer placements) can result in fiscal savings. Financing such programs and evaluating the results are also addressed.

The proliferation of specialized family foster care programs to meet the needs of children with developmental, behavioral, emotional, or medical needs will most likely continue in the next century. Do these programs provide stable, family-focused, community-based care and achieve permanence for children? In "Professional Foster Care: A Future Worth Pursuing?," Mark F. Testa and Nancy Rolock report on their study of outcomes achieved by professional and specialized family foster care program models in Illinois. Using five criteria, the authors compare the specialized programs' results with the results from the agency's kinship care and nonrelative foster care programs. The findings have implications for child welfare administrators' allocation of limited resources among kinship care, nonrelative foster care, and specialized family foster care programs.

Promoting Child Well-Being in Family Foster Care


The Adoption and Safe Families Act of 1997 "establishes unequivocally that the national goals for children in the child welfare system are safety, permanency, and well-being [ACYF 1998: 2]. Thus, as states continue to struggle with improving the traditional outcomes of safety and permanency, they must also begin to address the less familiar outcome of child well-being. Currently, clear definitions of child well-being are lacking, as are appropriate, accessible interventions and measures of success.

In "Completing the Evaluation Triangle for the Next Century: Measuring Child 'Well-Being' in Family Foster Care," Sandra J. Altshuler and James P. Gleeson, noting the absence of systematic measures of child well-being in our administrative databases, review the literature regarding how child well-being has been conceptualized and measured. Domains that have been assessed include resilience, coping, and overall functioning; physical health; mental health, including cognitive functioning, developmental delays, behavioral disturbances, and emotional or psychosocial adjustment; and school performance. The authors also discuss the challenge of selecting common measures for incorporation into administrative databases for ongoing monitoring and evaluation.

Considering the large number of very young children now entering family foster care, "Starting Young: Improving the Health and Developmental Outcomes of Infants and Toddlers in the Child Welfare System," describes a collaborative, multidisciplinary, developmental approach to meeting the needs of children in two domains of child well-being-health and developmental needs. Authors Judith Silver, Paul DiLorenzo, Margaret Zukoski, Patricia E. Ross, Barbara J. Amster, and Diane Schlegel discuss the high rates of medical conditions, developmental delays, and mental health problems among children entering care, along with inadequate care related to these conditions. The intervention program on which the authors report is intended to improve health and developmental outcomes of infants in the child welfare system by identifying problems, facilitating access to evaluation and services, establishing interagency linkages and coordination, and training child welfare workers and medical students for better identification of conditions and service provision.

In "Delivering Health and Mental Health Care Services to Children in Family Foster Care after Welfare and Health Care Reform," Mark D. Simms, Madelyn Freundlich, Ellen S. Battistelli, and Neal D. Kaufman discuss the extensive health and mental health needs of children in family foster care and how reform efforts may impact the health care system's ability to meet those needs. The authors identify major changes brought about by welfare reform, Medicaid managed care, and other health care reforms. Questions are raised about whether reform efforts will address and remove current obstacles to services or add new ones. The connections among children's well-being, access to quality health and mental health care services, and achievement of permanence are discussed, as are the essential features of an effective health care system able to meet the needs of children in care.

Parental drug abuse (particularly maternal use during gestation) is the biggest threat to the well-being of children entering care today and in the next century. Theresa McNichol, in "The Impact of Drug-Exposed Children on Family Foster Care," reports on her study of infants exposed to drugs during gestation and identifies the challenges these young children present and ways the family foster care system can meet them. A series of recommendations is presented on providing quality care; monitoring progress; advocating for and obtaining services for the children and their families; training staff, kinship care providers, foster parents, and biological parents; building relationships with biological families; and assessing intervention effectiveness.

Research by McNichol and others has shown that substance-exposed infants have special caregiving needs. Foster parents, as the primary caregivers, need to know how to meet these needs. In "Evaluation of a Training Program for Foster Parents of Infants with Prenatal Substance Effects," Caroline L. Burry provides information about the effectiveness of a competency-based training program designed to develop the specific skills needed by foster parents to care for infants exposed to drugs prenatally.

* In 1986 Congress amended the federal foster care program to create the Independent Living Services program, a relatively small program designed to provide services and supports to enhance independent living skills of youths who had not been reunified or adopted and who would remain in care until they "aged out."

Acknowledgments

This special issue would not have been possible without the support of the following individuals, who gave of their time and expertise and served as peer reviewers: Lou M. Beasley, Ph.D., Director, Partners in a Planned Community, School of Social Work, Clark Atlanta University, Atlanta, Georgia; Mark Courtney, Ph.D., Associate Professor, School of Social Work, University of Wisconsin-Madison; Anthony Maluccio, D.S.W., Professor, Graduate School of Social Work, Boston College, Boston, Massachusetts; Ruth W. Massinga, Chief Executive Officer, The Casey Family Program, Seattle, Washington; and Jake Terpstra, M.S.W., Foster Care Specialist, U.S. Children's Bureau (retired), Grand Rapids, Michigan. Their extensive knowledge and expertise helped us immeasurably as we selected and edited the papers that comprise this issue and its projections for family foster care in the next century.
Kathy Barbell
Child Welfare League of America
Washington, DC
Lois Wright
Assistant Dean
College of Social Work
University of South Carolina
Columbia, South Carolina
References

Administration on Children, Youth, and Families. (1998). Memo containing program instruction regarding the Adoption and Safe Families Act of 1997. Washington, DC: Author

Petit, M. R., & Curtis, P. A. (1997). Child abuse and neglect: A look at the states-The 1997 CWLA stat book. Washington, DC: Child Welfare League of America.

To order a copy of the January/February 1999 special edition of CHILD WELFARE, call 800-407-6273.


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