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 3. 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. 4
Home visitation programs refers to different model programs that provide in-home visits to targeted vulnerable or new families. Home visitation programs-either stand-alone programs or center-based programs-serve at least 400,000 children annually between the ages of 0 and 5. 5 Eligible families may receive services as early as the prenatal stage. A child’s early years are the most critical for optimal development and provide the foundation necessary for success in school and life. Therefore, home visiting services have the potential of making a tremendous impact on the life of a child and his or her family. Nurses, professionals, or other trained members of the community conduct home visits on a weekly, bimonthly, or monthly basis. Program goals could include an increase in positive parenting practices, an improvement in the health of the entire family, an increase in the family’s ability to be self-sufficient, or enhanced school readiness for the children.
Quality early childhood home visitation programs lead to several positive outcomes for children and families, including a reduction in child maltreatment. Annual data indicates that approximately 40% of the 899,000 children who have been substantiated as abused and neglected, but not removed from the home, never receive follow-up services. 6 More widely available and implemented home visitation services could help address this drastic shortcoming.
Home visitation services stabilize at-risk families. Research shows that families who receive at least 15 home visits have less perceived stress and maternal depression, while also expressing higher levels of paternal competence. 7 Home visitation programs may also reduce the disproportionality or overrepresentation of children and families of color, while improving outcomes for these families.
Family Support Services
Family Support Services (FSS) were developed to respond to the concerns, interests, and needs of families within a community. Family Support Services are targeted to families with difficulties and concerns related to the proper functioning of the family and care of the children. The focus of the program is on prevention. The services address the need to improve the well-being of a child, family functioning, and the parent’s ability to provide for the family, before they are in crisis. Family support programs work with outside community organizations such as schools and child welfare agencies. The aim is to provide temporary relief to families and to teach them how to better nurture their children. Involvement in these services is voluntary. Types of services include a broad spectrum of community-based activities promoting the safety and well-being of children and families such as structured activities involving parents and children, respite care services for parents and caregivers, parenting skills training, and information and referral services. Programs may also include services outside the traditional scope of child welfare, such as health care, education, and employment.
Early intervention services play a vital role for children and families who may already be in trouble. Early intervention services 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 to the fullest extent possible.
To better target the needs of families a number of child protective service systems (CPS) utilize differential response which 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.
Community-based child protection programs have demonstrated that many families can be helped before there is a need for protective intervention with the family. Often, the family can identify what is needed, be connected to resources and supports, and contact with the formal child welfare system can be averted. Often, after a formal report has been made, a child can be maintained safely at home with sufficient supports, clear expectations, and monitoring.
Differential response is a developing approach being implemented by a number of states which allows child protective services (CPS) systems to respond differently to accepted reports of child abuse and neglect, based on the circumstances.
Several states are implementing these models that are sometimes referred to as multiple track or alternate response. According to CWLA Best Practices Guidelines: Child Maltreatment in Foster Care (2003), “these approaches recognize the variety in nature of reports and that one approach does not meet the needs of every case.” 14 This approach may allow some CPS systems to provide services to a family without a formal complaint of abuse and neglect.
Substance abuse treatment
Alcohol and other drug problems devastate the lives of hundreds of thousands of children and their families each year. A major factor in child abuse and neglect, substance abuse is a factor in one to two-thirds of cases of children with substantiated reports of abuse and neglect and in two-thirds of cases of children in foster care. 8 Furthermore, children whose parents use drugs or alcohol are three times more likely to be abused, and four times more likely to suffer from neglect. 9 In addition, children from families with substance abuse problems tend to come to the attention of child welfare agencies younger than other children, are more likely than other children to be placed in out-of-home care, and once in out-of-home care, are likely to remain there longer. 10
Many recent studies demonstrate that most substance abuse is a treatable public health issue with cost-effective solutions, and that treatment is effective for families involved with the child welfare system. Treatment has been shown to reduce alcohol and drug use and lower health care costs, as well as to increase family functioning. 11
Too often, a lack of substance abuse treatment capacity poses a significant barrier to success. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH), approximately 23.2 million Americans needed services for an alcohol or drug problem in 2005, but only 3.9 million actually received treatment. This is consistent with a 1997 CWLA study that found that child welfare agencies could provide drug abuse treatment to less than one-third of parents who needed it. 12 The supply of treatment services for women and children is especially inadequate. 13
The significant rise in the number of children entering out-of-home care due to parental drug use over the last two decades represents one of the most serious policy challenges with the latest example being the spread in the use of methamphetamines. The overall shortening of timelines and movement to make quicker permanency decisions in out-of-home care cases required by the Adoption and Safe Families Act (ASFA) of 1997 has increased the sense of urgency and further emphasized the pressing need within the child welfare system to develop adequate capacities to address parental substance abuse issues. Good assessment, early intervention, and comprehensive treatment are key to determining when and if a child can safely stay at home or be reunited with his or her family.
Family Preservation Services
Family Preservation Services (FPS) are comprehensive, short-term, intensive services for families delivered primarily in the home and designed to prevent the unnecessary out-of-home placement of children or to promote family reunification. The services are intended to protect a child in a home where allegations of child abuse or neglect have occurred, prevent subsequent abuse or neglect, prevent placement of a child, or reduce the stay for a child in out-of-home care. Families in need of family preservation services are usually referred by public welfare agencies. Services are provided within 24 hours of referral and the family’s involvement is voluntary. These services respond to families on a 24-hour basis, including services such as family therapy, budgeting, nutrition, and parenting skills.
Reunification is the first permanency option states consider for children entering care. Yet, in many ways, it is the most challenging option to achieve. We know that of the 280, 660, children exiting out-of-home care in 2004, sixty-four percent were reunited with their parents or other family members. 15
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’s experiences in out-of-home care can significantly affect their health and well-being. 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. Children often hold strong attachments to their birthparents even when they are in out-of-home care for long period periods of time and parent-child separation can result in children experiencing escalating emotional and behavioral problems. 16 The negative emotional effects on children when they experience frequent changes in placements and caregivers have been well-documented. Children who enter foster care with few apparent health issues may, over time, develop physical, emotional, and behavioral problems that were not evident at the time they entered out-of-home care. 17
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, 18 developmental delays, 19 and mental health problems. 20 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. 21
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. In one study, researchers found that between 40% and 60% of children in out-of-home care had at least one psychiatric disorder and that this population of children used both inpatient and outpatient mental health services at a rate 15 to 20 times higher than the general pediatric population. 22
Successful reunification requires access to health care for both the child and family and this includes access to mental health services. It also requires dedicated, fully training and adequately supported caseworkers who can address the range of issues and needs of that foster child.
Research demonstrates the importance of children’s 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 (Webster, Barth, Needell, 2000). 23
When it is not possible for a child to return to their families of origin, alternatives such as adoption or subsidized guardianship can offer long term stability. Cost analyses of child welfare services have linked kinship care and subsidized guardianship to cost savings. One study found the cost of effecting an adoption for children in foster care to range from $6,000 to $28,539, or an average of $19,141, suggesting that this permanency alternative has the potential to achieve a substantial savings over long term foster care. 24 Findings concerning the stability of adoptions are also encouraging; overall, disruptions occur in 10% to 16% of adoptions, while rates may be higher for some placements such as those of much older youth or in families lacking prior experience in foster care or adoption. The rate of adoption dissolutions after the adoption is finalized is very low. 25
Post-permanency services are critical to ensuring the option selected as a child’s permanent placement is an enduring one. These services would support reunification, prevent children from reentering foster care, and maintain permanence for children who are adopted and those in guardian-ship arrangements. Subsidies should be available to all resource families, including guardian and adoptive families. An aftercare workforce should offer ongoing support to prevent dissolution, 26 including linking families to community-based networks of family supports developed for at-risk families. In addition to post-permanency services for adoptive and kinship families we also need to assist youth preparing to age out of the child welfare system by providing them with the resources and support networks necessary to make a successful transition into adulthood.
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 andCWLA 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 and merit of this practice, however.
Kinship placements for children in the child welfare system have increased in recent years. The U.S. Children’s Bureau gives three major reasons for this growth: the number of non-relative foster parents has not kept up with need, child welfare agencies view the kinship option more positively, and courts have placed a higher value on the rights of relatives to act as foster parents. 27
Subsidized guardianship is another important permanency option for relatives who care for children. The number of states implementing guardianship programs reflects growing national interest in the use of guardianship as an alternative permanency option for some children in foster care, particularly for children who are placed with relatives, who cannot be safely reunified with birth parents, and who cannot, or do not, wish to be adopted. 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 initial 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. 28
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 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.
Funding for these important services has been drawn from a mix of federal, state, local and private funds. In a 2006 survey of CWLA member agencies involved with adoption, over a third of respondents reported using contract money through the state or county child welfare agency to support these services. Other government funding includes Temporary Assistance for Needy Families (TANF), adoption incentive grants, adoption opportunities grants, Medicaid, and state mental health funding. For the rest of the agencies, funding appears to be challenging, with many using funding sources other than public agency contracts or funds to pay for their post-adoption services. A few agencies receive small grants from foundations to pay for programs. Some agencies charge families for post-adoption services, using a sliding scale based on family income. Over two-thirds of agencies surveyed support these services independently because they either have no outside funding, or the funding does not cover the total cost of services. 29
Youth Leaving Foster Care
Every year, it is estimated that 20,000-25,000 30 young people exit the foster care system. 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 without support networks or familial connections make it challenging for these young people to successfully transition into adulthood.
Lack of Affordable Housing & Homelessness Young people aging out of the foster care system need economic security and affordable, safe and stable housing. The 2000 Census reported that nearly 4 million people between the ages of 25 and 34 live with their parents due to economic realities – jobs are scarce and housing is expensive. This phenomenon has been has been identified as “adultolescence”, an extended period of adolescence during which it is has become common and expected for young people to live with their parents. Unfortunately, foster youth do not always have the option of turning to their families for financial support. Former foster youth are often prematurely confronted with the harsh reality of the gap between the wages they earn and the cost of housing. As a result, young people aging out of the foster care system are becoming homeless at disconcerting rates.
Former foster youth are experiencing homelessness anywhere from 12% to 36%. 31 It has been reported that as many as three in ten of the nation’s homeless adults report foster care history. Homeless parents who report a history of foster care are almost twice as likely to have their own children placed in out-of-home care as homeless people who never experienced foster care. Youth transitioning out of the foster care system are facing critical housing needs upon discharge. This is a particularly critical issue for young people with mental health needs. These youth frequently face service gaps while waiting to transition from the foster care system to the adult services system, sometimes resulting in periods of homelessness.
In order to successfully transition into adulthood, youth need to be appropriately prepared to exit the foster care system. It is imperative that youth work in partnership with their caseworker to create an effective discharge plan. An effective discharge plan focuses on the development of independent living skills, including securing housing, developing a financial plan, obtaining and maintaining employment, continuing education, and creating social networks and connections. In an effort to close the gaps that allow so many youth to fall through the cracks, it is necessary to have cross-system dialogue, collaboration on and coordination. These exchanges will allow systems to educate each other in order to integrate programs and improve services for young people aging out of the foster care system. Creating connections, developing effective discharge plans and integrating services will prevent the intersection of foster care with homelessness, health issues, incarceration, unemployment, pregnancy and early parenthood. Instead, these partnerships along with a solid discharge plan, will allow these resilient youth to become thriving, productive, and contributing members of society.
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, being bounced 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. Schools need a better understanding of the unique situations and experiences of children in foster care and child welfare agencies need to focus more on the educational needs and outcomes of the children and youth they are serving. The reauthorization of No Child Left Behind (NCLB) provides an opportunity to do both and to better address the needs of children and youth in foster care.