Children's Voice Mar/Apr 2006

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When Children Need a Home in a Hurry

What's the best approach to emergency care for abused and neglected children?

By Jennifer Michael

When a state takes a child under its protective wing, it's rarely a planned event. Child welfare workers don't have the luxury of finding the right foster family ahead of time and giving that family several weeks to decorate a bedroom for the child, purchase clothing and toys, and get school paperwork in order.

When a child must be removed from his home due to abuse and neglect, he is usually removed immediately, no matter the time of day. A social worker takes his hand, comforts him, and leads him to safety and security. Unfortunately, the worker also leads him into temporary limbo.

The type of emergency care a commu-nity provides to a child immediately after he or she is taken into state custody, and before a long-term foster family is located, is ultimately a matter of geography. A child living in Louisville, Kentucky, may enter a 24-hour emergency shelter. There, she'll move into living quarters with other children who are facing similar situations. A variety of staff will attend to her health, counseling, education, and other needs for as little as one night or as long as 30 days.

In Contra Costa County, California, a child goes immediately to one of three receiving centers. Two operate in renovated office buildings, the third in a renovated home. At the receiving center, he can nap, eat, and take a warm bath. Staff perform a quick assessment of his needs and, within 24 hours of his arrival, place him in an emergency foster home--a placement that can last a few days, a few weeks, or a few months.

Meanwhile, a child in Lucas County, Ohio, initially goes to the Lucas County Children Services office--also open 24 hours--where she can bathe and receive clothing and medical services while staff immediately work to find an emergency family foster home for her within a matter of hours. Further assessment of the child is done onsite, in the emergency foster home.

These are just a few examples of how communities nationwide deal with children who need emergency care. Debate over the most appropriate type of emergency care is ongoing. Some communities, such as Lucas County, have decided to move away from emergency group shelter care altogether, while shelter proponents say they can provide greater stability and another care option, particularly for older youth, in addition to emergency foster home care.

CWLA's position is that to appropriately serve children, communities must establish an array of placement options that are sensitive to the trauma the child has endured and that meets their safety, health, treatment, and education needs.

"Emergency care should be part of a full array of treatment and placement options that begins with family supports for children who can remain safely at home and includes kinship care, family and therapeutic foster care, and residential treatment," says CWLA President and CEO Shay Bilchik. "It must also integrate community-based support networks for children placed in family settings or residential facilities."

Jake Terpstra, a former foster care and licensing specialist for the U.S. Children's Bureau, notes a growing emphasis on deinstitutionalizing emergency care for children and adopting a system that focuses greater attention on emergency family foster care. The primary drivers, Terpstra says, include cost--emergency shelter care costs about $150 and up, per day, per child. Costs for emergency foster care are below $50 per day, per child. Awareness is also growing that most children can be better served in families, he adds.

The idea of going strictly one way or the other makes Terpstra uneasy. "It's extremes that cause so many problems," he says. "They solve one problem, but create another one, which is often worse, and then nothing gets solved."

Ideally, Terpstra says, communities of about 100,000 people or fewer should rely primarily on emergency family foster care. In larger cities, he believes emergency shelter care is a necessity, in addition to emergency family foster care, due to greater numbers of children, with a greater variety of needs, demanding care. Both emergency shelter and family foster care would operate as one coordinated program, overseen by the same administrator, and would incorporate child and family assessment services.

But everyone's ideal is different, as evidenced by the varying approaches to emergency care nationwide. Children's Voice asked agencies in Louisville and in Contra Costa and Lucas Counties to provide greater detail about their emergency care programs and how they meet their communities' needs. Sure enough, officials in each location expressed differing viewpoints on how best to help children during the critical period immediately after they've been removed from their home. All agreed, however, on the same long-term goal--to eventually find permanent, loving homes for children.

Louisville

Home of the Innocents is Kentucky's largest emergency placement center. Annually, 800-1,000 children and youth, birth to age 17, are admitted to the 24-hour, 45-bed emergency shelter located in the community of some 700,000 people. Roughly half the young people arrive through an emergency custody order, and the average stay is about three weeks. Approximately 60 staff and 225 regular volunteers work with the children, including onsite supervisors and clinical staff.

The number one goal at Home of the Innocents, explains President and CEO Gordon Brown, is to get every child and youth the agency serves into a permanent, nurturing home, whether with a foster family, an adoptive family, or a biological family. But just as important as permanency, he says, is stability. "So many times, our kids lack stability, and they keep moving around, going to different homes, to different agencies, being referred to hospitals, and they never get to settle in and have a childhood and friends...and they hit the age of 18 totally dysfunctional."

In doing its part to counter this trend, Home of the Innocents functions like a hospital emergency room, with a team of staff working to treat a child's trauma and normalize her life before she moves on to the next appropriate setting.

Judith Bloor, Senior Vice President of the Childkind Center at Home of the Innocents, can't imagine a child being removed from his home in the middle of the night and, while traumatized and sleepy, being handed over to a new family. "That would be like somebody taking my hand and walking me out the front door and saying 'Here, meet your new husband, have a nice life,'" she says. "I can't even fathom that because we wouldn't possibly do that to an adult."

Home of the Innocents' emergency shelter "allows us to treat that trauma, just like an ER, and it also allows us to offer a comprehensive assessment so that if the system uses it wisely, we can make a better placement."

Director of Residential Services Larry Owens often reads about children "languishing in residential care," but he insists that's not the case for the children at Home of the Innocents. Some children do stay for an extended period of time, but not due to problems with the shelter. "What that means," Owens explains, "is they need more treatment and more intensive care to help them transition to a more permanent location. In a way, it speaks to why we are needed more than ever before."

For longer-term residents, the shelter provides clothing and school uniforms. If a child was attending a local school before arriving, Home of the Innocents has an agreement with the school system for buses to transport the child to her home school. Home of the Innocents also allows families to visit the shelter, if approved by child protective services; visits are supervised and documented. The children participate in supervised field trips and local cultural events, and they also display artwork in a gallery at the Home of the Innocents.

"When children are here at the home, they live as good as any middle-class kid in America," Brown says. "We take great pride in the fact that we are striving very hard...to give them a normal experience."

Brown says his shelter can be a necessity for kids who are hard to place in homes. "We get some kids who are so badly damaged by what they've been through that they're extremely unattractive for foster placement...[They] benefit greatly by our services and by being here a little bit longer. But even with them, the ultimate goal is, as quickly as possible, without forcing it and without rushing it, seeing them into a foster home or with their biological family, if that's possible."

Even though children at Home of the Innocents present a variety of emotional and behavioral issues, Brown says his facility is safe. Home of the Innocents has passed numerous state surveys and inspections, and the inspections are ongoing. His staff is also trained in therapeutic holding techniques to address out-of-control behavior--training that foster parents may not routinely take.

Home of the Innocents does not advocate for shelter care as the only emergency care option, staff emphasize, but as part of a continuum of care.

"We have a model that works very well, and we'd be more than happy to share [information] with anyone who wanted to do it," Brown says. "But my belief is that one size does not fit all; we should have a wide array of services   available."

Contra Costa County

Receiving centers, a relatively new phenomenon, are described differently in some areas of the country. In general, they are short-term programs that provide assessment, crisis intervention, stabilization, and placement or other post-discharge planning after a child has been removed from his home.

These centers, Brown claims, keep children in a "suspended state" in a cold, office-like atmosphere, and "force" systems to make placements for children other than emergency shelters.

But Danna Fabella, Director of the Children and Family Services Bureau of the Contra Costa County Employment and Human Services Department, says her community created receiving centers in response to emergency foster parents' concerns about children arriving at their homes uncleanly and without having been assessed for major health issues. They felt a disconnect between the child welfare agency and those caring for the children.

"We thought about it and came up with the concept of a receiving center being a less-than-24-hour facility to do just those immediate assessments, to settle a child, and to make a better match for the child in the emergency foster care system," Fabella explains. "It's not a stand-alone entity. It's a receiving center that's the hub of an emergency care system."

Fabella continues, "Built around our receiving care system is work with our mental health partners. We have an emergency care mental health team that provides assessments for children, as well as mobile response teams, so that if something happens and the foster parents need mental health help, we have the ability to provide services in the home."

Today, Fabella says, the county's ability to retain foster parents is high because the receiving centers are making better placements, and foster parents know whom to contact if they have problems. Recruiting new parents, however, is a never-ending process in the county of about 1 million people. Contra Costa runs a particularly large campaign geared toward finding homes for harder-to-place sibling groups and teens.

Receiving center staff work to place children in the least-restrictive form of care. They do so by first seeking placement with an immediate relative. If that isn't possible, they search for a licensed foster home. If a foster home can't be found, then a child is placed in one of the county's four group homes. Children with high-end mental health needs or behavioral issues may also be placed in the group homes; each has six beds.

Fabella says her receiving centers are far from cold and office-like. Local civic groups have painted murals, and toys and interactive games line the shelves. "It's very child-friendly," she says. "We've made a point of making sure that happens."

Contra Costa County developed its receiving center system in 1997. Before that, children were either placed in emergency family foster homes or a privately run emergency shelter that at one time accommodated at least 100 beds. "Older children were just staying in our shelter care and not moving, and, in fact, got pretty used to institutional care and didn't want to go to foster homes," Fabella recalls. "They would refuse, and they would run back."

As a former supervisor and manager of shelter care systems, Fabella isn't a proponent of group shelter care. "I think a child should be in that setting only when their needs are such that they need that setting."

Fabella cites the example of staff shift work in shelters, which she claims can lead to a lack of continuity of care, particularly for young children, she says. Medications sometimes get confused from shift to shift, and shifts often change in the middle of the night, so that one group of staff puts the children to bed, and another wakes them up. Staff are often young and inexperienced and turn over quickly.

"In every group home I've been a part of, or known of, or used, so much depends on the administrator in that building and the staff delivering those services," she explains. "You can have a good institution for a while, and then as soon as the manager or the director or some of the key clinical staff leave, you have a very shaky facility taking some very difficult children. I have seen that pattern for the last 26 years in my experience in child welfare. I've seen good programs turn into not-so-good programs in a matter of a few years."

Fabella admits, however, that receiving centers are not without their flaws, including the short amount of time staff have to assess a child. She says she does not want to convince true believers of group home care that receiving centers are better, but she does believe it is an option communities should consider before they build shelters for kids.

If a community decides to focus on providing emergency shelters, Fabella suggests that an outside board regularly review the programs and make site visits, that children have options for moving from group homes to regular care, that collaborative relationships between the shelters and local mental health and health partners be established, and that data documenting children coming to and leaving the shelter be closely examined. If a community decides to open a receiving center, she recommends they have good training in place for emergency foster families and that they contract with a wide array of community partners.

Lucas County

Lucas County Children Services operates similarly to Contra Costa County, except it moves a child as quickly as possible from its office--where the child comes initially after being removed from her home--into an emergency foster home, and then conducts site visits and observes and assesses the child's needs while she is in the foster home.

"All those things we can do in a family-based setting," says Executive Director Dean Sparks. "How are you going to see how a child can interact in a family setting if you don't have them in one?"

Lucas County, an urban and suburban community that includes Toledo, closed its emergency shelter in the 1980s. Since then, Sparks says, the county has focused solely on emergency foster families who are ready "at a moment's notice" to provide care for children in need.

"Our community made a commitment to not use emergency shelter care," Sparks explains. "We certainly believe families can better watch over some of these kids and perhaps stabilize them more quickly when they come out of an abusive situation. I think it's worked well for our community in probably 98% of the cases."

Sparks doesn't favor emergency shelter care for younger children, or even older children. He believes youth in shelter care learn negative behaviors from other children and gravitate toward these children rather than working with staff.

Lucas County works with a local mental health center that has developed a system of therapeutic foster homes, in addition to the foster homes already working with Children Services. The agency operates regular business hours, but staff are available 24 hours a day if a child needs placement in the middle of the night. The children do not sleep at the office, but they can take a bath, wash their clothes, and be seen by nursing staff.

"There is never a time when we leave a shift and there is a child sitting here with no place to stay," he says.

More Study Needed

Even though they are quick to point out the pros and cons of emergency shelter care and emergency foster care, Brown, Fabella, and Sparks each contends that every community's needs are unique. A particular approach may work in one community and not in another for a variety of reasons, including population size and availability of community resources. For example, Home of the Innocents has operated in Louisville for 125 years, and local child welfare workers are thankful for the facility, Brown says. But Fabella and Sparks say the shelters in their communities had too many problems, ultimately leading to the decision to focus on family-based emergency care instead.

Little research has been done offering a critical assessment of the advantages and disadvantages of emergency shelter care versus family-based emergency care. But, says Jake Terpstra, with many communities using emergency shelter care, and many others seeking alternatives, such research is clearly needed. Terpstra is one of the few who has studied the issue. In the mid-1980s, he wrote one of the first analytic papers, published by CWLA, on the role of emergency shelters. But Terpstra says he can understand why researchers avoid the subject.

"It's not a sexy subject," he says. "I don't think researchers understand it, so they avoid it. It would be hard to measure outcomes if you don't have some pretty clear ideas of what is a good and bad outcome."

Jennifer Michael is Managing Editor of Children's Voice.

Photos courtesy of the Children and Family Services Bureau of Contra Costa County, California.


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