Struggling to achieve its mission, but wanting to expand it: CWM’s 2022 Performance Oversight Testimony on CFSA

Good morning! Thank you for the opportunity to testify today. My name is Marie Cohen and I write the blogs Child Welfare Monitor and Child Welfare Monitor DC. After my first career as a policy analyst and researcher, I became a social worker and served in the District’s child welfare system until 2015. Soon after leaving that job, I began writing these blogs to share some of the insights I had gained from my time in the field, and I’ve been amazed to see both of my blogs acquiring readers and influence beyond my wildest dreams. I take a child-centered approach, placing the safety and wellbeing of the child above all other considerations. I also take a particular interest in translating academic research for a lay audience and exposing misinterpretations of research by those trying to support their point of view. In my testimony today, I’ll start by talking about CFSA’s performance in child protective services, then continue with in-home services and then foster care. In conclusion, I’ll explain why I fear that CFSA is losing interest in these core services in its desire to become a “child and family well-being agency” and why I hope that the Council will encourage a renewed focus on CFSA’s primary mission.

My testimony draws from several sources. First, I have used recent CFSA reports including the FY 2021 Needs Assessment and the performance oversight responses recently submitted to the Committee, as well as the CFSA Data Dashboard. I also share some insights from my service on the Child Fatality Review Committee and as a mentor through BEST Kids for almost seven years. Finally, I draw from the national research and policy trends I that I review for my blog.

CFSA has had some successes in the past year. The agency has returned to a mostly normal service posture after the pandemic-induced transition to virtual services. It has found a creative way to claim federal funds for case management and improved one service for families with substance abuse by bringing it in-house. The agency is increasing the number of professional foster parents, though not by enough so far, and the menu of therapeutic services available to foster youths and their parents through a contract with MBI. It has used federal funds to add four new staff members to work with schools and families to reduce school absences due to educational neglect. But CFSA is still falling short on meeting its primary missions of keeping District children safe and providing a physically and emotionally safe haven for those children who must be removed from their homes.

Child Protective Services: CFSA’s primary mission of protecting children has suffered as the agency has continued to emphasize narrowing the front door.

CFSA often boasts about the drop in the foster care rolls, which have fallen from over 1500 on September 30, 2012 to only 614 on September 30, 2021, crediting its policy pillar of “Narrowing the Front Door.” But a drop in foster care numbers is not in itself a positive outcome unless it has been achieved without compromising the safety of children. The choice of “Narrowing the Front Door” rather than “Keeping Children Safe” as the first pillar is not accidental: the goal has become reducing foster care regardless of the impact on child safety. Moreover, CFSA is no longer serving more children in their homes as they place fewer children in foster care; the number of children receiving in-home services has also fallen since 2019, with the total number of children served decreasing from 1994 at the end of FY 2020 to 1904 at the end of FY 2021.

My service on the Child Fatality Review Committee (on which I am thankful to have been joined by Chairperson Nadeau), has revealed many occasions in which CFSA missed chances to protect some of our most at-risk children. I have reviewed death after death of children from families that were the subject of multiple reports to the CFSA hotline dating back many years. Yet these allegations were repeatedly screened out or not substantiated by the agency. CFSA needs to assess the operations of its hotline and investigations, which have both been criticized by the Court Monitor in the past, to make sure that its desire to narrow the front door is not outweighing the concern for child safety. But there is also something the Council can do. I have noticed that many children who later died were at some point assessed to be at high risk but were left after an investigation with no support or monitoring by CFSA. When I ask why, I am reminded that CFSA cannot open a case if abuse or neglect was not substantiated, no matter how risky the situation appears to be. So whether we can protect a child depends on whether harm has already occurred, not whether it is likely to occur. But not all jurisdictions require substantiation in order to open a case for in-home services or foster care. In Washington State, an allegation does not need to be substantiated for an agency to file a neglect petition in court; the purpose of filing a petition is to “prevent harm” and there is no need to prove that harm already occurred. In Michigan and Minnesota, a case can be opened or a child removed because of “threatened harm,” which can be substantiated as a type of maltreatment. I hope the Council will consider changing DC law to make it possible for CFSA to protect at-risk children before it is too late, even without a substantiated allegation.

In-home services: Services provided through CFSA’s Prevention Services Plan are reaching few people and wasting funds, at the same time as CFSA is failing to provide families with needed behavioral health and other services.

The Family First Prevention Services Act allows CFSA to spend Title IV-E funds for evidence-based family preservation or reunification services to prevent entry or re-entry to foster care. However, only evidence-based practices (EBP) that are approved by the Children’s Bureau’s Prevention Services Clearinghouse can receive federal reimbursement. Currently, the only services receiving Title IV-E funding from HHS are Motivational Interviewing, which is part of CFSA’s case management model, and a home visiting program called Parents as Teachers (PAT) that is run by the Health Department. The other services included in CFSA’s Prevention Plan are funded by Medicaid or other local sources.  

CFSA deserves credit for realizing that one practice that is reimbursable under Family First, motivational interviewing, could be incorporated into case management, thus allowing CFSA to collect matching funds for case management for all families receiving services in their homes. This was a creative way to claiming federal funds despite the flaws of the Family First Act, under which has not brought about the promised bonanza of federal resources for family preservation services.  I also applaud the agency for improving the performance of Project Connect since they brought the program in-house. Project Connect provides intensive home-based services to families with an in-home case who are addressing substance abuse. When provided by a contractor, Project Connect struggled to enroll families, but now that it is operated by CFSA, the agency reports that the program has been at capacity since January 2020. The agency reports 46 families served, and 26 cases closed, with 9 families having disengaged and 17 having completed the program in FY 2021. Of course the longer-term outcomes of the program in terms of sobriety and child maltreatment remain to be seen and I hope CFSA will be reporting on them.

But the other services provided in CFSA’s Prevention Services Plan are reaching few people.  According to the FY 2021 Needs Assessment, only 8% of the families referred to DBH received services. Similarly, only 8% of clients referred to the Department of Health home visiting programs, Parents as Teachers and Healthy Families America (HFA, the other DOH-run home-visiting program,) received services. Most of these referrals were either rejected as not appropriate or withdrawn because the family did not engage. According to CFSA’s oversight responses, CFSA referred 159 families to Mary’s Center for home visiting services through the HFA and PAT models in FY 2021, but only 26 of these families were served. CFSA paid over $160,000 to Mary’s Center to provide PAT in 2021; we don’t know how many of the 26 families received PAT or completed the program, since data on PAT and HFA are combined. Several other programs included in the prevention plan served between 0 and 4 families, according to the oversight responses.

At the same time as CFSA was paying $160,000 to enroll 26 families in PAT, parents and children who wanted basic behavioral health services such as cognitive-behavioral therapy and medication management could not get them because of the crisis in the District’s mental health system that affects all residents who must rely on Medicaid to access services. I hope the Council addresses this crisis. But regardless, there is no gain in accessing federal money to serve no-one. CFSA might as well spend this money on services families need, whether or not they are approved for Title IV-E funding.

Another set of services that is sorely needed for CFSA families are services to address domestic violence.  According to CFSA’s 2021 Needs Assessment, of 123 child welfare professionals, the largest percentage (64%) ranked domestic violence (DV) as a prevalent risk factor among their clients. It is encouraging that the 2021 Quality Services Reviewers found three-quarters of the families with DV in in-home cases were receiving services. But some of these services were provided by the CFSA social worker themselves, presumably because services were not available. Moreover, the reviewers found that accessing the agency’s one DV specialist for consultation was a challenge for social workers and that case managers for only six of the 16 families reviewed were able to obtain such a consultation. I hope that the Committee will choose to add funding for at least one more DV specialist to make sure that caseworkers can benefit from a real expert to determine what their clients need and link them with services. The Needs Assessment also indicates that there is a general shortage of DV services in the District, which I hope the Council will address.

Early care and education is one service which has great potential to prevent maltreatment recurrence among families with in-home cases, but has been largely ignored by CFSA.  Guaranteeing a slot in a high-quality preschool like Educare in Ward 7 for every preschool-aged child involved in an in-home case might do more to prevent child abuse and neglect than any other single strategy. We know that high-quality early care and education prevents child abuse and neglect by multiple pathways: easing parental stress, providing family support and parenting education, increasing monitoring by mandatory reporters (at Educare children are checked for abuse daily), and simply reducing the amount of time a child is alone with caregivers and vulnerable to abuse. And indeed, multiple studies link early care and education with reductions in child maltreatment. I hope the Committee will work with CFSA, the Mayor and OSSE to ensure that all children with in-home cases receive high-quality early care and education.

Foster care is not yet a truly safe haven where youth in CFSA custody can heal from past trauma and address educational deficits.

When CFSA takes the drastic step of removing a child from their home, it has the obligation to make sure the child is placed together with siblings, in the home of either a known relative or family friend if possible, and with all the necessary supports, including mental health services, the best healthcare (including covid-19 vaccines) and educational and vocational supports. And whenever reunification is not possible, CFSA should stop at nothing to support permanency with real or fictive kin. But CFSA is falling short in these areas. Often agency leaders seem to lack the creativity, passion, and outside-the-box thinking that is necessary to make foster care the safe haven that CFSA advertises.

Foster care: CFSA continues to lack appropriate placements for older youth and those with significant behavioral health needs.

The lack of suitable placements for older youth and those with more serious behavioral health needs continues to be a crisis leading to placement disruptions, abscondence, and further deterioration in the mental health of our most vulnerable youth. This issue has been covered in depth the Children’s Law Center in their written testimony. In general, I agree with their findings and recommendations on building an adequate placement array but I would add that CFSA may have to consider adding one or more therapeutic group homes as well as increasing its supply of professional foster parents. There are simply not many potential foster parents who are dedicated and gifted enough to take on these very challenging young people.

Too few foster youth are receiving the behavioral health services they need.

Only 18 children were receiving therapy at CFSA in the first quarter of FY 2022, out of the 600+ children in foster care, according to CFSA’s oversight responses. That means CFSA’s four in-house therapists are being paid to provide therapy to only 18 children, so that each therapist is seeing fewer than five children a week. CFSA did not report on the number of children receiving therapy outside of the agency, but the low number receiving in-house therapy is concerning. Moreover, according to the 2021 Needs Assessment, the percentage of children recommended for therapy who received it went down from 69% in FY 2020 to 40% in the first half of FY 2021. I understand there is a citywide crisis in mental health services, with a catastrophic shortage of providers, not to mention quality, cultural competence and turnover, as the Children’s Law Center explains in its written testimony. I join the CLC in urging that this Committee work with the Committee on Health and the rest of the Council to fix the District’s behavioral health system. However, until this reform can take place, CFSA must not waste the resources it has allocated for behavioral health for its foster care youth.

I do appreciate, however, that CFSA has added two popular evidence-based therapeutic modalities – Dialectical Behavior Therapy (DBT) and Eye Movement Rapid Desensitization Therapy (EMDR) – through its contract with MBI Health. And I’m also happy that CFSA has included parents of children in foster care in its contract with MBI. However, I’m disappointed that MBI served only 16 of the 28 children and parents referred during FY 2020.

CFSA needs to find creative housing solutions to keep siblings together in foster care and to enable children to be placed with kin in foster care, guardianship or adoption.

According to the 2021 Needs Assessment, the Agency has only 50 licensed providers to care for three or more children in foster care. However, there are 194 foster children in a family of three or more siblings, which indicates the need for more foster parents with the capacity and willingness to take groups of three or more siblings.  CFSA should look for creative, out-of-the box ideas tor increasing placements for sibling groups. For example, CFSA could seek a public-private partnership to create a community of homes for foster parents who take in large sibling groups, in the mode of SOS Children’s Villages in Illinois and Florida. Perhaps this could be included as part of a development plan for a parcel owned by the city.

CFSA also needs to be more creative and proactive in finding housing for relatives who want to take in children who have been removed from their families, temporarily or permanently. CFSA’s oversight responses state what we already know: “For DC-based kin, the ongoing lack of affordable housing in the District continues to impact the families’ ability and/or willingness to provide licensed kinship care.” And it’s not just kinship care but also permanency. I recently heard of a teenager being pressured to accept guardianship with a foster parent with whom she is not bonded, even though a relative is willing and available but has been unable to find suitable housing. This is unacceptable. As it did with Wayne Place for youths leaving foster care, CFSA should work with the private sector to create housing for relatives who are providing a home for children in foster care – housing like Plaza West, a building for grandparents raising children that was created without CFSA involvement. It is not acceptable to force children into guardianship with unrelated foster parents because relatives cannot find housing.

CFSA is not making sufficient efforts to ensure educational success for foster youth.

Education outcomes for District foster youth are truly horrendous. Foster youth aged 15-21 for whom Grade Point Average (GPA) information was available had a median GPA of 1.98 in the last academic year, according to the oversight responses.  And only 68% of the foster youth who were eligible to graduate high school in June 2021 graduated or got a GED by that date. The blame for this abysmal school performance should not be placed entirely on CFSA: most of these children were probably struggling academically when they were removed from home. After all, many of these children came into foster care with a history of chronic absenteeism and school transfers. But if CFSA is going to remove children, it needs to take responsibility for improving their educational performance regardless of what it was before.

There are some things CFSA can do to improve educational performance among foster youth that have drawn little attention. For one, CFSA needs to make sure that foster parents are involved with the schools that the children in their custody attend. It is well-known that home-school communication is critical to school success. But when I was a social worker at a private agency working with Maryland foster parents of CFSA youth, many foster parents I worked with had never even been to the children’s schools, especially when these schools were in the District. They certainly did not attend Back to School Nights and parent-teacher conferences. Foster parents should be told that attendance at these events and regular communication with the schools is required. Secondly, CFSA needs to end the practice of pulling kids out of school for a whole day in order to attend one medical, dental, or court appointment. When I was working in the system, I found that family support workers usually made appointments during school hours because they were busy after school taking youths to family visits or therapy. For the same reason, they usually made these appointments in the middle of the day, ensuring the maximum loss of school time. Requiring foster parents to take children to these appointments might help solve this problem; it should clearly be their job anyway.  These two steps, requiring foster parent involvement and stopping system-caused school absenteeism, would be a good place to start in improving foster children’s school performance. Monitoring the performance of the tutoring provider is another; I’ve heard too much over the years about incompetent tutors.  

OYE Vocational specialists must be replaced.

The 2022 Needs Assessment states “CFSA has identified a gap for career preparation and available employment supports for youths.” That’s putting it mildly! In FY 2019 CFSA eliminated OYE’s Career Pathways unit and replaced it with the LifeSet program, which is not dedicated to career preparation or staffed with vocational specialists. There are no vocational training specialists at CFSA, only college specialists. As a result, there are NO youth currently enrolled in vocational training programs, according to the 2022 oversight responses. Around the country and here In the District there is a growing recognition that college is not for everyone, especially for those who are not likely to complete it. Many jobs requiring vocational training or apprenticeships provide a path into the middle class and a much better option than college for youths with poor academic skills. At this time of unprecedented labor shortages, it is a shame that the agency is not taking advantage of this opportunity to get our young people into good jobs. In the Needs Assessment CFSA indicates it is working with the Department of Employment Services to address this gap; the Committee should encourage the agency to address it with the urgency and intensity it deserves.  

CFSA has neglected its responsibility get foster youth vaccinated

As I have written, CFSA seems to be prioritizing parental consent, even when not required by law, over the health of foster children and containment of Covid-19 in the District of Columbia. Moreover, it appears that the agency been reluctant to educate older foster youth about the benefits of vaccines. They don’t even know how many foster children have been vaccinated. And they have not reported how many have gotten Covid-19. This is not acceptable.

Conclusion: CFSA appears to have lost interest in its primary mission of protecting abused and neglect children.

In conclusion, CFSA continues to struggle to carry out its primary mandates of investigating allegations of abuse and neglect and responding appropriately with in-home supervision and support and foster care when necessary. Yet, despite these struggles, CFSA is eager to add more responsibilities to its plate. As the agency explains in its oversight responses, it wants to “transform from a child welfare system to a child and family well-being system.” This sounds great on first hearing but does not bear closer scrutiny. Child and family well-being are dependent on all the health, education and human services agencies in the District of Columbia. CFSA is having enough trouble accessing the services of these agencies for its current clients. Why not concentrate on performing its core duties rather than expanding them? I must acknowledge that CFSA is being encouraged on this misguided path by the federal Children’s Bureau, which has included the agency in its partnership to do exactly what CFSA is proposing. But just because it is being promulgated by the feds does not make it a wise policy.

The expansion into primary prevention through creation of the Family Success Centers is a prime example of this desire to broaden CFSA’s mission when the agency struggles to perform its core responsibilities adequately. Prevention of child maltreatment is not in the original mandate of child welfare agencies, and for good reason. If anything, child maltreatment prevention is normally conceptualized as a public health function, which is why home visiting programs are generally provided by health departments.  More and more jurisdictions, including our neighbors in Maryland and specifically Baltimore, are investing in Family Connects, which provides a hospital visit from a nurse to every newborn to assess risk and refer to appropriate services. Family Connects has been shown by randomized controlled trials to reduce emergency room visits and hospital stays by 50% in the first year of life and CPS investigations by 44% in the first two years of life. The jurisdictions that have adopted Family Connects understand that neighborhood family support centers will never reach the most at-risk children, whose parents are too mentally ill, impaired by drugs, or overwhelmed to recognize that they need help.

I have some ideas about why CFSA (and the Children’s Bureau for that matter) appears to have lost interest in its core mandate of protecting children and providing a safe haven for those who must be removed from their homes. But until we figure out how to prevent child maltreatment, and even after we do, there will still be maltreated children who need to be protected. CFSA may have lost interest in these duties, but it is up to the Committee and the entire Council to remember our most vulnerable children and make sure the agency performs its core mandates.  














3 thoughts on “Struggling to achieve its mission, but wanting to expand it: CWM’s 2022 Performance Oversight Testimony on CFSA

  1. Thank you for this Marie. Unfortunately this hits very close to home. Recently, while following up with a CPS In-Home services social worker for a 25yrs old mother of 5 children under 5yrs old, who has been recurrently reported for abuse and neglect of all children by friends, family members and neighbors, I was told to step away from helping the mother and the children so their situation worsens enough so that she can bump the case to investigation… Being told that their daily suffering of physical and emotional abuse and neglect at the hands of their mentally ill and drug user mother is not enough for the system to act and help them, shattered my heart to pieces.
    These children deserve better! The system has really lowered the standards to what’s acceptable for a child, especially a black child, to endure daily before we decide to do better for them and that is not right.
    The moral obligation to protect at risk children falls on all of us as a society, but when the society does it’s part in reporting and rallying around their most fragile members and the system that’s designed to protect them closes its eyes, one has to wonder what’s left for them.

    Like

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