Testimony before the DC Council, CFSA Oversight Hearing, February 25, 2021

Good afternoon! Thank you for the opportunity to testify before the Committee today.  My name is Marie Cohen, and I write the blog, Child Welfare Monitor DC, as well as Child Welfare Monitor, which focuses on national issues. I am also a former social worker in CFSA’s foster care system.  My testimony is based on the data that CFSA has been sharing on its new data dashboard, as well as their performance oversight responses and published reports. The most recent dashboard data were uploaded last week and pertain to the quarter that ended in December. I’ll also be making some remarks about CFSA’s efforts around in-home services and prevention, leaving my friends at FAPAC and Children’s Law Center to talk about foster care.. 

My testimony makes a  few major points. 

  • There was a drastic drop in calls to the CFSA hotline starting last March following the closure of schools and the imposition of a stay-at-home order by the Mayor. Total calls were 25 percent lower in March through December 2020 than in the same months of 2019. The number of calls gradually returned to almost normal by December, after CFSA provided training to schools in how to detect abuse and neglect in a virtual environment. The number of investigations, and the number of findings of abuse or neglect, followed the pattern of hotline calls. 
  • CFSA does not currently have valid data on the number of in-home cases opened each month so we cannot tell if that has been affected by the pandemic. But point-in-time data shows the number of children being served in their homes dropped about six percent from 1,333 on December 31, 2019 to 1,250 on that date in 2020. 
  • Foster care entries displayed a surprising trend during 2020. There was a big decrease in foster care entries before the pandemic, and since then quarterly entries have bounced up and down. 
  • Foster care exits declined by 24 percent between March and December, perhaps reflecting court and service delays due to the pandemic, but the gap seems to be closing, with exits actually eclipsing the previous year in October and December.
  • The total number of children in foster care declined from 771 on December 31, 2019 to 662 on December 31, 2020, for a decrease of 14 percent. The fiscal year decrease of 13 percent is larger than for any other year since FY 2014. We do not know the extent to which this accelerated decline in the foster care rolls reflects policy and practice changes, demographic changes in the city, or other factors, but it does not appear to reflect the loss of hotline reports due to COVID-19. Such a big decrease in foster care caseloads raises concerns about whether children’s safety is being compromised.
  • The total number of children served in foster care and in their homes declined by nine percent between December 2019 and December 2020. This is a decrease of almost 10 percent in one year in the total number of children served by CFSA. 
  • About 65 percent of children served by CFSA are being served in their homes rather than in foster care, but we know too little about the services they and their parents are receiving. The oversight responses show a large dropoff between referral and receipt of services, and nothing about completion. Moreover, CFSA does not report on how many parents receive basic psychiatric, therapy, drug treatment and domestic violence services provided by DBH and other agencies. We know that quality and availability are both issues for these services. 
  • CFSA has invested in Family Success Centers as its strategy for the prevention of child abuse and neglect before they occur. These centers seem to be off to a good start and are offering a large menu of services geared at strengthening families. But these centers make no special effort to engage those who need them most, who are traditionally hardest to engage. 
  • Several policy recommendations are suggested by these findings. These include: training alternative reporters for child maltreatment; collecting and sharing data on children diverted to kinship care and their outcomes over time; reviewing CFSA policies and practices to make sure they are not compromising child safety; recognizing the critical role of DBH services for CFSA clients, including parents and those with in-home cases; adding a prevention program that is targeted to the children most at risk of being maltreated, and ensuring speedy implementation of the Children’s Ombudsperson Act.

My observations are discussed in more detail below.

Hotline: There was a drastic drop in hotline calls after pandemic closures, with calls gradually approaching normal levels by December 2020

Almost as soon as the pandemic took hold and stay-at-home orders were issued, child advocates around the country began to express fears that abuse and neglect would increase due to parental stress and economic hardship. Research has suggested that family violence spikes during natural and economic disasters. At the same time, school closures raised fear that child abuse and neglect would go undetected as children stayed home away from the eyes of teachers and others who might report suspicions of abuse or neglect. And indeed, in the District as around the country, calls to the child abuse hotline dropped drastically relative to last year, especially in April and May, just after the shutdown of school and the imposition of a stay-at-home order.  School closures were likely the main cause for this drop, as school and childcare personnel made 43 percent of the calls in FY 2019–and only 36 percent of calls in FY 2020.  But the summer, when teachers are not seeing students anyway and reports go down, looked more like a normal year.  It is as if summer started in April and did not end until August. There is usually an uptick in reports in September and especially October after children return to school and teachers get to know them. This occurred in FY 2020 but was smaller than in FY 2019. But reports began to approach their normal level in November and December. CFSA credits the guidance they developed (in the form of a webinar and a participant guide) to be used to train teachers teaching virtually about how to spot abuse and neglect in a virtual environment. In total, the number of hotline calls dropped from 15,456 between March and December 2019 to 11,579 in the same months in 2019–a difference of 25 percent.

Figure One

Some commentators around the country have wondered if the loss of some reports from teachers might be a good thing because some of these reports were trivial and should not have been made. If only the frivolous reports were being suppressed, the number of reports accepted for investigation would remain similar across the two years. This was not the case. The pattern of hotline calls accepted for investigation followed closely the pattern of all calls to the hotline.

Figure Two

The number of investigations that was substantiated followed a similar pattern to that of reports and accepted investigations. The total number of investigations that was substantiated decreased from 1,053 in March to December 2019 to 808 in March to December 2020, a decrease of 23.2 percent, similar to the percentage decrease in hotline calls. 

Figure Three

We do not know how many in-home cases were opened in 2020 but we do know that the in-home caseload declined significantly between CY 2019 and CY 2020.

When child maltreatment is substantiated, CFSA can place the child in foster care (opening an out-of-home case), open an in-home case, or not open a case at all and refer the family to a collaborative. One might expect fewer cases of both types to open during the pandemic due to the decline in hotline calls.  CFSA does not currently have valid data on in-home case openings, so we do not know the effects of pandemic on this indicator. (Data on in-home case openings posted earlier has been removed due to technical problems). Point-in-time data shows that the number of children served in their homes dropped about six percent from 1333 on December 31, 2019 to 1250 on that date in 2020. And the number of families served in their homes dropped about seven percent from 510 to 473. 

Table One: Number of Children and Families Served In-Home

December 31, 2019December 31, 2020
Children1,3331,250
Families510473

Foster care entries decreased before the start of the pandemic; not so much afterwards.

It is not surprising that hotline calls, investigations, substantiations and in-home case openings all declined in the wake of the pandemic and associated closures. The big surprise is that foster care entries did not display the same pattern. Entries into foster care started out low in January, dropped in February and actually rose in March, April and May of 2020 before dropping sharply in June and a bit more in September. The total number of children placed in foster care declined from 261 in March through December of 2019 to 181 in March through December of 2020.

Figure Four

Looking at quarterly data over time shows that the big decrease in foster care entries appears to have occurred before the onset of the pandemic. It took place during the last two quarters of FY 2019. Foster care entries bounced up and down for the last five quarters, actually increasing last spring when the pandemic began. The data suggest that there was a renewed push to “narrow the front door” of foster care starting in the third quarter of Fiscal Year 2019. And indeed, CFSA’s Communications Director stated that the fall in foster care entries reflected CFSA’s “continued commitment to keep children out of foster care by supporting families in their homes.” Could an increased use of kinship diversion have contributed to these numbers? We won’t know until CFSA starts reporting data on the use of this practice. 

Figure Five

It appears that there were some delays in the achievement of permanency for foster youths in the first few months after the pandemic, as evidenced by declining foster care exits, but the agency appeared to be closing the gap in the first quarter of FY 2021.

There has been widespread concern around the country that covid-19 would create delays in the achievement of permanency for foster youth. Family reunifications could be delayed by court closures, cancellation of in-person parent-child visits and increased difficulty facing parents needing to complete services in order to reunify with their children. Court delays could also hamper exits from foster care due to adoption and guardianship. And indeed fewer children did exit foster care every month from March to September, especially in May and June, than in the same months in 2019. However, the difference between the two years declined in July and August and almost disappeared by September, and the pattern reversed in October and December, so perhaps the agency and court were able to clear the backlog. The total number of children exiting foster care declined from 357 during the period from March through December 2019 to 272 in the same months of 2020. 

Figure Six

A large (14 percent) decline in the number of children in foster care occurred in 2020. 

The total number of children in foster care on the last day of Calendar Year 2019 was 798. It declined to 694 by December 30, 2020, for a decrease of 14 percent. This does not seem to be a consequence of the pandemic, as entries and exits decreased by a similar amount in March to December 2020 relative to 2019. The number of children in foster care on the last day of the fiscal year has declined every year since FY 2012. However, the percentage drop in the foster care rolls (13 percent) was greater than in any other year since FY 2014. Such an accelerated decline always raises questions about whether child safety is receiving adequate consideration.

Figure Seven

The total number of children served both in-home and in foster care declined from 2,104 on December 31, 2019 to 1,912 on December 31, 2020, a decrease of 9 percent.  Out of these 1912 children, 662 (34.6 percent) were being served in foster care and 1,250 (65.4 percent) were being served in their homes. It is important to note that this is a decrease of almost 10 percent in one year in the total number of children served by CFSA, rather than a shift in the percentage being served from foster care to in-home. The reason for this drop is not totally clear but may reflect pre-pandemic policy and practice changes for foster care and pandemic induced reporting declines for in-home services.

Table Two: Children Served in Foster Care and In-Home

DateFoster CareIn-HomeTotal (% Difference from Previous year)
December 31, 2019771 (36.6%)1333 (63.4%)2,104 (1.7%)
December 31, 2020662 (34.6%)1250 (65.4%)1,912 (9.1%)

We know too little about the services received by the parents, as well as children served in their homes.

I have talked a lot about numbers but not at all about the content and quality of services, and I’ll focus on in-home services here. CFSA’s oversight responses provide a list of services provided to families with an open investigation, in-home case, and out of home case combined, not separately for each group. The responses indicated that 910 families were referred to these various services but only 544 were served in FY 2020. We have no idea how many people completed these services, but it is probably a lot less. Moreover, CFSA did not report at all on how many parents received basic psychiatric, therapeutic and drug treatment services, or domestic violence services. CFSA depends on DBH for mental health and drug treatment services and nonprofits for domestic violence services. The DBH services are often of poor quality and all of these services are often in short supply with long waits. CLC discussed the unmet behavioral health needs of children in foster care; the same applies to children in in-home care and especially their parents, who need these services in order to reunify safely with their children.

The big worry is that if the services provided to parents are not effective, cases will be closed without parents having made the changes necessary to be able to keep their children safe. Therefore, we are likely to see these families in the system again, with more harm done to their children. However, there is encouraging news from the latest Quality Service Review (QSR) Report about the In-Home Administration’s improved performance  on providing supports and services to families. 

CFSA seems to have made a good start in implementing the Family Success Centers but needs to do more to engage the families that are most at-risk and hardest to engage.

The Family Success Centers appear to be off to a good start in offering a diverse menu of family strengthening services close at hand for parents in Wards 7 and 8. However, it is not likely that they are going to reach the families that need them most. Families at higher risk are traditionally difficult to engage and reach with services. If CFSA really wants to make a serious effort toward prevention, it will need to target families that are identified as at high risk of child maltreatment.

One example of such a program is Hello Baby, which was pioneered in Allegheny County Pennsylvania, home of Pittsburgh and the visionary child welfare leader Marc Cherna, who has since retired. Allegheny already had Family Success Centers, and they already know that they do not reach the families that need them most. Allegheny County decided to offer a universal support program to all parents of newborns.  The program has three tiers, with the least at-risk families being offered services such as a “warmline,” texting services, and website. The middle tier is connected with Allegheny’s equivalent of the Family Success Centers. And the most at-risk group receives a peer mentor and a benefits navigator or case manager who work together to ensure the family receives the services they need. To assign parents to tiers, Allegheny County uses a predictive algorithm based on a highly advanced “data warehouse” that integrates data across multiple county agencies.

Policy Suggestions

The information outlined above points to several recommendations for CFSA and the Council

  1. Although calls to the CFSA hotline seemed to approach normal levels in December, the total hotline calls between March and December dropped by 25 percent between 2019 and 2020 . Moreover, a nearly 10 percent drop in the total number of children served by CFSA may reflect in part the loss of these reports. CFSA should consider training alternative reporters outside schools: These might include postal and delivery workers and animal control officers, because child maltreatment often coincides with maltreatment of pets. This strategy is recommended by the family violence researcher Andrew Campbell, who has spoken at more than one event under the auspices of Children’s National Medical Center. 
  2. The CFSA dashboard provides no information on kinship diversion–not surprising because CFSA has so far not collected this data. This is an omission that needs to be corrected. The new CFSA policy requires the collection of some data on each diversion and the circumstances surrounding it. These data need to be available on the CFSA dashboard, but we also urge CFSA to make it a matter of policy to track these children regularly and provide regular updates via the dashboard or a public report. 
  3. CFSA should review its policies, practices and data to make sure that it is not compromising child safety in the rush to reduce the foster care rolls through kinship diversion or changed CPS practices. 
  4. The Council must recognize that CFSA relies on DBH for some of the most important services to parents and children and must be willing to allocate funding to improve the services offered by DBH in general. They also need to inform the council about the adequacy of current Domestic Violence services to meet the need among their clients. CFSA must start collecting data on the number of clients receiving these services and the amount of services they receive.
  5. CFSA should consider adding a more targeted prevention program that reaches out to parents  at risk of abuse and neglect but are not yet known to CFSA. This would probably involve developing a predictive model based on data from CFSA as well as other agencies. 
  6. The Council is to be congratulated for authorizing the creation of an Ombudsperson office for children. The implementation of this office should not be delayed as it will be very helpful in ensuring that CFSA continues to improve its performance even in the absence of the Court Monitor after the LaShawn case is closed. Moreover, I hope that with the resources provided the Ombudsperson can do a better job than I can in analyzing the data shared by CFSA.

Thank you for the opportunity to testify. I hope this testimony is helpful in your important work.

This testimony was modified on February 26, 2021 to reflect a CFSA’s clarification to hotline data included in the agency’s oversight responses. It was modified again on June 2, 2021 to clarify the foster care caseload data.

Hotline calls, investigations, substantiations, and services still gravely suppressed by pandemic

In August, I wrote about the drastic decline in reports to CFSA’s hotline, investigations, and substantiated abuse and neglect allegations in the wake of the Covid-19 emergency, which closed schools and resulted in increased social isolation for children. CFSA has released data from June through October 2020, and the same trends are continuing. Reports, investigations, substantiations, and in-home case openings are down drastically. Foster care entries have decreased as well, but that drop seems to have occurred mainly before the pandemic. With plans for reopening schools up in the air, it is long past time to worry about the children who are not being seen in school or child care and to find alternative ways to reach them until schools and childcare centers are fully open. Moreover, these frightening data lend support to those calling for schools to reopen soon–especially for children of elementary-school age or younger, who are incapable or less capable of seeking help.

In the District, Mayor Muriel Bowser declared a public health emergency on March 11, 2020 and schools closed for in-person classes on March 13. After a two-week spring break, online learning began on March 24 and the stay-at-home order went into effect on April 1. Online learning ended on May 29, nearly a month early, and the same day that the District entered Phase One of reopening. Schools started on a virtual basis again on August 31. In its public-facing Dashboard, CFSA posts data for each quarter 45 days after the quarter ended. The data for the July through September quarter were posted on November 13, 2020. Using this data, we compared the numbers of reports, investigations, dispositions, in-home case openings and foster care placements since the pandemic with the numbers during the same months of 2019.

Reports to the Hotline

Hotline calls are generally a family’s first contact with CFSA and thus the earliest indicator of the effects of the pandemic. Figure 1 shows the number of hotline reports per month in FY 2019 and 2020. In FY 2019, the number of reports increased every month until May, dropped to a much lower level in July and August when schools were closed, and then bounced up in September with the opening of schools. The pandemic year of 2020 looked very different. The number of calls fell from February to March with the closure of schools, followed by a much larger drop in April, with the number of calls staying fairly flat until a modest rise in September with the opening of school. It’s as if summer vacation started in March, with a slight increase of reports when school started again.

Comparing the months across years shows that in January and February 2020, before the pandemic shutdown began, there were actually more hotline calls than there were in the same months of 2019, suggesting that the year would have seen increased reports if not for the pandemic. But in every month of the pandemic, the number of hotline calls in 2020 was considerably less than its counterpart in 2019. (The actual numbers are provided in Table 2 at the bottom of this post.) The biggest year-to-year differences were in April and May 2020, after the pandemic emergency began, when calls were down by 64 percent and 67 percent respectively over the same months in the previous year. In July and August, the differences between 2019 and 2020 were less drastic, which is to be expected because schools are normally closed during the summer months. But still reports were down by nearly a quarter in both July and August 2020 from the previous year. The total number of hotline calls received between March and September (roughly the period affected by covid-19) fell from 14,245 in 2019 to 9,780 in FY 2020, a decrease of 31 percent.

It is likely that the school closures were a major reason for the drop in hotline reports. Many schools, especially in the poorest areas, struggled to engage many of their students in distance learning last spring; some students were missing for the entire quarter. In addition, signs of maltreatment may be harder for teachers to observe online, although a virtual platform does allow them to observe incidents in the home that might otherwise go unreported. Moreover, DCPS closed several weeks early, offering not even virtual education in June. The lower level of reports even in the summer months may be due to families being more isolated due to the pandemic, spending less time with friends, neighbors, and extended family members who might report suspected abuse or neglect, as well as putting off visits to doctors, another common reporting source.

While monthly data on reporting source are not available, annual data shown in Table 1 support the hypothesis that a decline in reports from school personnel was a major factor behind the fall in reports overall. In 2019, presumably a fairly “normal” year, school and childcare personnel made 42.9 percent of all reports to the hotline. This is larger than the national percentage of 21 percent for these groups in FY 2018, probably because the District requires schools to report to the hotline all students who have more than 10 unexcused absences during a school year. These data show that these groups made a smaller share of reports in the recently completed Fiscal Year 2020 (in which more than half of the school year was virtual) than in FY 2019. In FY 2019, childcare and school personnel made 7,704 reports, which was 43 percent of all reports to the hotline. But in 2020 they made only 5,006 reports, which was only 36 percent of all reports. Counselors, therapists and social workers also made fewer reports in FY 2020, probably reflecting services that were suspended and or transitioned to a virtual platform. Their reports dropped from 2,342 to 1,702, or 13 percent of reports, which was not a large percentage change. On the other hand, law enforcement and medical personnel made an increased number and share of reports. Law enforcement personnel made 1,938 reports in 2020, a slight increase over the 1,891 reports they made in FY 2019. Their share of total reports increased from about 11 percent to 14 percent of all reports. Medical personnel made 965 reports in FY 2020, a big increase from the 866 reports they made the previous year, and their share of reports increased from five to seven percent. Friends and neighbors made fewer reports, but these reports were a slightly higher fraction–about 14 percent) of those received. Clearly no group could make up for the missing reports from teachers, so the total number of reports for the year was 14,046, down from 17,960 in 2019. The increasing number and share of reports due to law enforcement and medical personnel reflects their status as essential workers who have continued to see District residents in person. There have been anecdotal reports from many areas that maltreatment cases that do come to the attention of child welfare tend to be more severe; this may reflect the increased role of these reporters, who are more likely to see children who are seriously injured, and the reduced role of teachers, who are often said to report concerns that do not rise to the level of abuse or neglect.

Table 1: Hotline Reports by Source, 2019 and 2020

Reports accepted for investigation

A hotline call can be screened out as not meeting the requirements for an investigation, referred to another agency, or accepted for investigation. The number and percentage of reports accepted for investigation is shown below in Table 2.  The percentage of hotline calls accepted was higher each month during the pandemic period (especially in May and June) than in that same month of the previous year. This pattern suggests that the reports made during the lockdown tended to be more serious, with the less serious reports less likely to be made. Such a trend has been observed in other jurisdictions where data have been analyzed in more depth, as reported in my national blog, Child Welfare Monitor.  As mentioned above, some commentators have suggested that teachers in particular make many reports that do not merit investigation. Virtual schooling may have screened out some of this “noise.” CFSA data provide evidence for a small winnowing effect but one that was far from enough to make up for the drastic drop in the number of reports.

Table 2: Hotline Calls Accepted for Investigation

Completed and Substantiated Investigations

In addition to the number of calls accepted for investigation each month, CFSA also reports on the number of investigations completed each month. This is a different number because investigations can take a month or sometimes even longer to complete. So we can expect a time lag in observing the effects of the pandemic on the number of investigations completed. Also there is a small number of investigations that are not completed, as explained on the dashboard. These of course are included as part of total, but not completed, investigations.

Figure 2 shows a similar pattern of differences in completed investigations as shown in Figure 1 for reports, with the time lag delaying the effect by a month. In 2019, completed investigations mostly increased from January through June and then fell through September. In the pandemic year of 2020, the number of completed investigations fell precipitously in April and May, with the onset of the pandemic, drifted slightly upward through August, and fell slightly in September.

Turning to the numbers, in the pre–pandemic months of January and February 2020, the number of investigations was 24 percent and 36 percent higher than it was in January and February 2019. (Table 2 below the text shows the numbers and percentage changes.) It appears that the agency was on track to have more reports and investigations in 2020 than in 2019, if not for the pandemic. Completed investigations fell in April but it is not until May that the number of investigations completed in FY 2020 dropped below that of FY 2019. Once the number of investigations began to fall, however, it dropped like a stone. In May, only 230 investigations were completed compared to 565 in 2019–a drop of 59 percent. There were 56 percent fewer investigations completed in June 2020 than in June 2019. The gap between FY 2019 and FY 2020 lessened in July but was still large at 39 percent, reflecting the fact that many of these investigations would have begun in the first half of June, when school was still in session in 2019 but not 2020. It was only in August and September that the year-to-year difference declined to 21 percent and 18 percent respectively, reflecting the time lag between reports and completed investigations. It is worth noting that the year-to-year difference was still significant even in those months. This presumably reflects the continuing suppression of hotline reports during the summer of the pandemic. The total number of investigations completed between April and September (roughly the period affected by covid-19) fell from 2,716 in 2019 to 1,787 in FY 2020. That was a decrease of 25 percent–somewhat less than the difference in reports, reflecting the fact that a higher fraction of reports was investigated in 2020.

An investigation can have several possible results. It can result in a finding of “inconclusive,” meaning the evidence is insufficient to prove maltreatment despite some indications it occurred; “unfounded,” which means “there was not sufficient evidence to conclude or suspect child maltreatment has occurred,” or “substantiated,” indicating that the evidence supports the allegation of maltreatment. (See the CFSA Data Dashboard for the full definitions of these terms as well as of “incomplete investigations.”) As shown in Figure 3, the monthly trends and yearly differences were very similar to those for investigations in general. The total number of substantiated investigations for April through September dropped from 643 in FY 2019 to 420 in FY 2020, a decrease of 35 percent. The percentage of investigations that was substantiated during that period stayed almost exactly the same from year to year at approximately 24 percent.

In-home cases opened

When an abuse or neglect allegation is substantiated, several things may happen, depending on the perceived level of risk to the child or children in the home. The agency may take no action, refer the family to a community-based collaborative, open an in-home case, or place the child or children in foster care. As Figure 4 shows, there was a drastic drop in in-home cases opened between March and April, coinciding with the closing of schools and the pandemic emergency. Case openings dropped 48 percent in April, 54 percent in May and 74 percent in June compared with the previous fiscal year.[2] Data were not available for the quarter ending September 30, 2020. Presumably the trend in new case openings reflects in large part the trend in substantiated allegations; the patterns appear similar but not identical in the two measures. The total number of in-home cases opened in the pandemic months of March to June dropped from 533 in March-June 2019 to 267 in the same months of 2020–a decrease of 50.0 percent.

Source: CFSA Data Dashboard, available at https://cfsa.dc.gov/service/cfsa-data-dashboard
Note: In-Home Data not available for July-September 2020

Foster Care Entries

It is not surprising that hotline calls, investigations, and substantiations all declined in the wake of the pandemic and associated closures. The big surprise is that foster care entries do not display the same pattern. There was a big drop in foster care entries in February 2020–before the pandemic closures hit. Foster care entries actually rose in March, April and May of 2020 before dropping sharply in June and a bit more in September. True, monthly entries into foster care were always lower in 2020 than in 2019, though only by one child during the month of July. The total number of children placed in foster care declined from 193 in March through September of 2019 to 119 in March through September of 2020.

But the big decrease in foster care entries appears to have occurred before the onset of the pandemic, as Figure 6 shows. The number of entries into foster care was falling throughout FY 2019, aside from slight rises in May and August. There was actually somewhat of a rebound in the spring pandemic quarter, while the summer quarter entries fell back to the January-March levels.

The downward trend in foster care placements that began before the pandemic may have been due to policy or practice changes. As we mentioned in an earlier post, the data suggest that there was a renewed push to “narrow the front door” of foster care starting in the third quarter of Fiscal Year 2019. As we reported then, CFSA’s Communications Director indicated that the fall in foster care entries reflected CFSA’s “continued commitment to keep children out of foster care by supporting families in their homes.” Of course, we do not know if placements would have been higher in the absence of the pandemic; perhaps the school closures and pandemic orders did suppress foster care entries somewhat. But clearly, the pandemic has had a more obvious effect on the opening of in-home cases, resulting in a big decrease in in-home case openings. This makes sense if we assume that CFSA had become more likely before the pandemic to open in-home cases in lieu of foster care cases.

Exits from Foster Care

Commentators around the country have expressed concern that covid-19 would create delays in the achievement of permanency for foster youth. Family reunifications could be delayed by court closures, cancellation of in-person parent-child visits and increased difficulty facing parents needing to complete services in order to reunify with their children. Court delays could also hamper exits from foster care due to adoption and guardianship. The monthly data in Figure 7 show that fewer children did exit foster care every month from March to September, especially in May and June, than in the same months in 2019. The difference between years declined in July and August and almost disappeared by September, so perhaps the agency and court were able to clear the backlog. The total number of children exiting foster care declined from 261 during the period from March through September 2019 to 178 in the same months of 2020, a difference of 83 children or 32 percent. A small part of the reduction is due to the City Council’s decision to allow older youth to stay in foster care instead of aging out during pandemic. There were 27 exits by emancipation in the third and fourth quarters of FY 2019 and only 10 in the second half of FY 2020. But this difference does not account for most of the drop in foster care exits during the pandemic period.

Figure 8 shows the trends in total foster care caseload over time, which reflects both entries and exits. The total number of children in foster care on the last day of Fiscal Year 2020 was 695, compared to 798 on September 30, 2019, for a decrease of 13 percent. This reflects a total of 217 entries and 321 exits during the year. [1] (The percentage declines are listed in Table 7 at the bottom of this post). Combining Dashboard data with previously published data shows that the number of children in foster care on the last day of the fiscal year has declined every year since FY 2012. However, the 13 percent fall during 2020 was greater than in any other year since FY 2014. It appears that this decline happened mostly before the pandemic. Comparing data from March to September of 2019 and 2020 shows that 74 fewer children entered foster care and 68 fewer children exited it, suggesting that the pandemic had little effect on the total foster care caseload.

Conclusion

The release of fourth-quarter FY 2020 data on CFSA’s data dashboard shows a continuation of the trends that were displayed in the second-quarter data released in August. The pandemic and its associated closures had the expected downward effect on calls to the child abuse hotline, investigations, substantiated maltreatment reports, and in-home case openings. What was not expected was that although foster care entries fell in FY 2020, most of that fall occurred before the pandemic and appeared to be due to other factors, such as policy and practice changes. It appears that by suppressing reports and investigations, the pandemic probably suppressed the opening of in-home cases more than it reduced removals into foster care. But in any case, it resulted in a loss of protective services for children. Child Welfare Monitor DC has long been urging CFSA to do more to reach the children who may be suffering behind closed doors through means like working with schools to track down no-shows, launching a public awareness campaign about child abuse and neglect, educating non traditional reporters to spot signs of abuse and neglect, and reaching out to at-risk families known to the system. These ideas are discussed in my national blog, Child Welfare Monitor. With no clear plan for reopening schools, it is hoped that CFSA will now make this their top priority. Moreover, the data are sobering enough to support a return to school soon for children of elementary school age or younger as soon as possible because school is such a crucial safety net for abused and neglected children.

[1] The total is 694 rather than 695, which presumably reflects a small inconsistency in counting of entries and exits.

[2] There was an anomaly in the in-home case data that casts some doubt on the accuracy of the case opening numbers. We are awaiting clarification from CFSA.

Additional Tables

Table 2: CFSA Hotline Reports by Month, FY 2019 and FY 2020

Table 3: Investigations by Month, FY 2019 and FY 2020

Table 4: In-Home Cases Opened by Month

Note: Data not available for July-September 2020

Table 5: Foster Care Entries by Month

Table 6: Foster Care Exits by Month, FY 2019 and FY 2020

Figure 7: Children in Foster Care on Last Day of Fiscal Year

The CFSA Performance Oversight Hearing: Progress and Problems

Screen Shot 2020-02-17 at 3.32.03 PMThe annual oversight hearing on the Child and Family Services Agency took place on February 12, 2020. The hearing lasted over six hours and covered a wide variety of topics and perspectives. The testimony painted a mixed picture of considerable progress along with continuing concern about major issues including the availability of placements meeting the needs of some of the more difficult-to-serve clients. Much of the testimony centered around CFSA’s responses to the committee’s oversight questions that were submitted in advance. These are a very useful resource that can be compared from year to year. Readers can watch the hearing here.

  • Widespread Praise for CFSA: The last to testify, CFSA director Brenda Donald heralded a year of accomplishment, including planning and getting approval for a five-year Title IV-E Prevention Plan under the new Family First Prevention Services Act, creating the local Families First DC program, reducing the scope of monitoring under the LaShawn class action lawsuit, settling its new arrangement for delivering foster care, fully implementing its in-house mental health unit, and gearing up for new child welfare information system. As she pointed out, CFSA is currently considered to be a national leader in child welfare. Many other witnesses also praised CFSA for these accomplishments or others.
  • Foster Care Numbers: Contrary to national trends, the number of youth in foster care continued to fall in the District since a year ago. Director Donald testified that there were only 796 children in care at the end of 2019 and 1357 were being served in their homes. Reunifications increased from 197 in 2018 to 227 in FY 2019 and the number of children aging out of care fell from 63 to 53. CFSA expects further declines because of the emphasis on front-end prevention, according to Director Donald, as well the agency’s continuing efforts to reduce the length of stay in foster care. Donald did not mention the movement of low-income families into Maryland due to rising rents in the District, which may be an even more important factor behind the continued declines at a time when the national foster care total has been rising.
  • LaShawn Exit Plan: Court Monitor Judy Meltzer of the Center for the Study of Social Policy reported that CFSA and CSSP have agreed on a revised exit plan in the 30-year-old LaShawn vs. Bowser class action lawsuit. The new plan removes 56 of the exit standards; 23 remain to be achieved. As part of the revised plan, CFSA committed to adding several types of placements and it has already satisfied most of these commitments, as described below.
  • Lack of appropriate placements: CFSA continues to struggle with a lack of placements for the young people with the most serious disabilities and behavioral problems, as described in testimony from CSSP’s Meltzer  and witnesses from the Children’s Law Center (CLC). As a result, 31 children spent a total of 60 nights at the agency between April and November 2019. The number of children staying overnight more than doubled between FY 2018 and 2019, as Aubrey Edwards-Luce of the Children’s Law Center pointed out in her valuable written testimony. The number of children staying at the Sasha Bruce emergency shelter also more than doubled. About 100, or one in every eight children, had stayed in an emergency shelter or respite home in FY 2019. Moreover, about 22% of children in care had three or more placements, the same number as the previous year, which suggests a lack of appropriate placements for some children.
  • Additions to Placement Array: CFSA has made some progress in expanding the array of placements that can accommodate children with more severe problems. The agency has contracted with Children’s Choice for 36 therapeutic foster homes for youth with intensive needs; added two “Stabilization Observation Assessment Respite (SOAR) professional foster homes, with a total of four beds, to serve high-needs children; secured six congregate care placements for children with autistic spectrum disorders, and added six additional behavioral therapeutic congregate care placements.
  • Foster Parent Retention and Supports: Judith Sandalow of the Children’s Law Center urged CFSA to focus on retention as well as recruitment of foster families by improving its support for foster parents. Margie Chalofsky of the Foster and Adoptive Parent Advocacy Center (FAPAC) suggested several improvements to foster parent supports, including on-call and timely crisis support, which has not been consistently available through the current resources; more therapy for foster youth; and a mechanism for foster parents to evaluate social workers. Interestingly, Cheryl Brissett Chapman of the National Center for Children and Families gave a dissenting position on retention, arguing that foster parents need to take a break after two therapeutic youths. She also reminded listeners that many foster homes are lost when foster parents adopt the youths in their care and that should not be considered a problem.
  • Education and Employment: Data on education and employment outcomes cited by Aubrey Edwards-Luce from CFSA’s oversight responses continues to be very concerning, although the high school graduation rate among CFSA foster youth actually increased from 67% in FY 2018 to 73% in FY 2019, based on corrected data submitted later by CFSA. The Grade Point Average (GPA)  of the 84 (out of 186) high-school aged children in care for whom this figure was available was only 1.69. Nearly 10% of high school students in CFSA care dropped out in FY 2019. And nine of the 40 foster youth who enrolled in college in FY 2019 dropped out, based on corrected data from CFSA. Moreover, less than half the young people enrolled in vocational programs completed them.
  • Youth aging out: Edwards-Luce pointed out that CFSA’s data on living arrangements of youth aging out of care are deceptive. CFSA reported that only four of the 49 youths who aged out of foster care in FY 2019 exited to unstable housing situations, which it defines being homeless, in a shelter, or incarcerated. However, CLC believes that “the agency improperly defines transitional housing, college dorms, staying with friends, and DDS placements as “stable living arrangements.” If those arrangements are considered unstable, 32 out of the 49 youths who aged out were in unstable housing.
  • Office of Youth Empowerment: CFSA touted its status as the first public agency to be awarded a three-year $10 million grant fromYouth Villages to implement the evidence-based and much-praised YV LifeSet program. But CLC’s Edwards-Bruce expressed concern about the elimination of OYE’s Career Pathways program, which served 113 youths in FY 2019, and its replacement by the LIfeSet Program, which served only 49 youths in the firsts quarter of  FY 2020. According to CFSA’s Annual Progress and Services Report, YV Lifeset requires participant buy-in, and youths who do not wish to participate will receive similar services to those provided under Career Pathways. Moreover, there is some reason for concern that the LifeSet funding may be supplanting rather than supplementing local funds, as discussed below.
  • Aftercare: In her very enlightening oral and written testimony, Marcia Huff of the Young Women’s Project described her experience running CFSA’s aftercare program in a contract that lasted from 2017 to 2019. In a nutshell, Huff found that “the vast majority of the youth we worked with were unprepared to succeed when they emancipated from care at age 21.” Among the depressing data she cited about the young people entering her program: 51% were unemployed; 9% were employed 15 hours or less; and only 20% were employed full-time; 31 out of 75 were homeless or couch surfing; 32% were in temporary housing, and only 9% were in permanent housing with a long-term voucher or rent that was sustainable based on employment; 56% had one or more children; 27% needed help managing marijuana or other drugs; 58% had unresolved mental health issues that interfered with progress in employment and housing; 17% had no GED or high school diploma; and 36% had no bank or deposit account of any kind. Lack of housing was a major obstacle to engagement with the program and progress toward goals and kept many participants in a state of crisis. Lack of child care was a huge obstacle for parenting youth. Huff’s testimony, which should be essential reading for anyone who cares about foster youth, recommended first and foremost that the agency needs to “start young and go deep” to prepare youth for life after care because “by the time they are 20 it is nearly too late and it is extremely hard to turn things around.”
  • Youth Services Reprogramming: Human Services Committee Chair Brianne Nadeau asked about the reprogramming of $449,782 allocated for teen youth services to support for the court monitor in LaShawn, which was not included in the FY 2019 budget. Donald testified that this money was saved by bringing youth aftercare in-house, without any loss of service capacity.  If true, this would point to an appalling inflation of the contract price, which seems unlikely. This writer cannot help wondering whether this money may have instead been replaced by the grant to implement YVLifeSet and hopes Chairwoman Nadeau will look into that possibility.
  • Kinship Care: Several witnesses celebrated the new Close Relative Caregiver Subsidy, including Donte Massey, whose testimony last yea sparked the creation of this program. Massey reported that the program is helping him raise his younger siblings. Stephanie McClellan of the DC Kincare Alliance asked the Council to remove the requirement that a caregiver must wait six month to receive the subsidy. This results in an actual eight-month rate which is a hardship for cash-strapped caregivers. She also asked the Council to consider emergency funding to eliminate the current waiting list. The longstanding Grandparent Caregiver Subsidy also received praise from caregiver Vernita Grimes, who credited program staff with providing emotional and moral, as well as financial, support .
  • Social Worker Support: Wayne Enoch, president of the union local representing 400 workers at CFSA, expressed his members’ concern about worker safety from attacks by clients, even in the office. The union is seeking for a “viable health and safety committee” to work with management on a long-term solution to this problem.  Worker turnover is a concern for CFSA. Social workers complain about work-life balance, support from supervisors, and micromanagement rather than pay and promotions. Despite the problems, Enoch hailed Brenda Donald for her commitment to workers’ well-being and to working with the union through the Labor Management Partnership Council.  He noted that CFSA has appointed a Wellness Coordinator to boost well-being among its workers. He said that other agencies should follow CFSA’s example of labor-management cooperation.
  • Latino Families: Isabelle Suero-Stackl of the Latin American Youth Center (LAYC) argued that CFSA is not meeting the needs of the Latin American community.  Although LAYC has a contract to deliver foster care including case management to Latino families, all of these families are initially managed by CFSA, and most are served directly by CFSA. Moreover, in-home services to all families are provided by CFSA, which may be a problem for a family that does not speak English. Instead, Suero-Stackl recommended that CFSA should assign all Latino families to LAYC as soon as they come into in-home or out-of-home care.
  • Changing nature of foster youth: Both Director Donald and Dr. Cheryl Brissett Chapman of the National Center of Children and Families (NCCF) cited changes in foster youth. They are seeing more young children with aggressive behaviors than in the past. Dr Chapman of NCCF, which manages all of the Maryland foster homes that house about half of the District’s foster youth. had some interesting observations from a long career in child welfare. Unlike the “parentified” children seen in the crack epidemic, who acted as parents to their own parents and their siblings, many of today’s children coming into care are accustomed to be treated by their parents as peers. When they come into foster care, they are not ready to treat foster parents respectfully as adults, and many older, veteran foster parents cannot cope with disrespectful behavior. Surprisingly, placement disruptions are most frequent for children aged 9 through 12, and it is this disrespect that is causing many of the disruptions.
  • CFSA Mental Health Unit: the new mental health unit to provide initial services to youth coming into care seems to have be achieving its goals of allowing CFSA to screen and evaluate children more quickly and get them into therapy sooner.  This unit works with children for six to nine months. Donald testified that CFSA has issued a contract for ongoing mental health services for some children with specialized needs and to serve some parents.
  • Child Protective Services: The number of substantiated investigations went up slightly in FY 2019, as did the number of removals, which Deputy CFSA Director Robert Matthews suggested might be due to the elimination of Family Assessment as an alternative response to investigation. He also mentioned that the quality of investigations is improving as indicated by the agency’s Quality Service reviews.  However, one representative of a charter school raised concerns about the quality of CFSA responses to reports alleging child abuse and neglect. In his written testimony, Christopher Nace of the DC International School mentioned two families that were the subject of repeated and serious reports to CFSA, none of which resulted in actions that protected the children. In the case of the first child, staff reported concerns ranging from sexualized language and behaviors, physical abuse, educational neglect and sex trafficking. none of which resulted in any change in the child’s situation. In the other case, school personnel reported concerns about a family 11 times between 2016 and 2020 on issues including domestic violence witnessed by school staff, children being left alone all night, alcohol and drug abuse in the home, children being driven to school by intoxicated parents, concerns about drug distribution, physical abuse that left bruises; and fights in which weapons were drawn and students were kicked out of the house. Nace recommended that CPS investigations should take into account past allegations as well as the present one and that CFSA should collaborate more extensively with schools and other agencies involved in the lives of children and consider adding regular “check-ins.”
  • Families First DC: The Committee heard from many of the organizations that have received grants to start Family Success Centers under Families First DC, CFSA’s new primary prevention initiative. The grantees have been chosen and given money for a year of planning. The centers are to launch early in Fiscal Year 2021.All of the grantees praised the support of CFSA and the provision of a year to plan their programs with input from community residents. Grantees expressed their excitement about this program.
  • Transparency and Responsiveness: After last year’s hearing, where representatives of several organizations lamented a decline in transparency and community involvement by CFSA, both the Children’s Law Center and the Foster and Adoptive Parent Advisory Council (FAPAC) noted that CFSA had become more open and responsive to feedback from advocates and foster parents in the last year.
  • Ombudsman Proposal: Several witnesses, including Aubrey-Luce of CLC, reiterate the need to move forward the proposal of establishing an independent Ombudsperson for CFSA in order to spur the needed improvements.

This year’s oversight testimony highlighted agency’s ability under the leadership of Brenda Donald to accomplish major initiatives. Of more doubt to this writer is how many of these initiatives actually improve children’s lives. Some of the most important testimony highlighted the major problems that still plague the District’s foster care system, especially the lack of appropriate placements for the hardest to serve children and the lack of effective approaches to enhancing education and employment outcomes for foster youth. As I have written before, CFSA’s vaunted success in getting the first Family First plan approved is of limited utility given the extreme limitations on services available for funding. However, CFSA responded in an email to this writer that “CFSA’s implementation of Family First//// is not designed to produce immediate results. ” Instead, “Family First has created the momentum for the District to look at our referral pipelines, assess the systems we have in place to ensure referral connections are made timely and, have targeted conversations to determine if we have the right services available to meet children and their families’ needs.”

The abysmal outcomes for older foster youth and those who have aged out (while consistent with those around the country) indicate that there is much room for improvement. And the transfer of $450,000 in services to older youth in order to pay for the court monitor’s oversight is particularly concerning considering the great needs of these youth. However, some of the new initiatives, such as the addition of new placements for children with greater needs, the creation of in-house mental health services, and the establishment of Family Success Centers are likely to make life better for children in CFSA care and in the community.

Director Donald’s concluded by expressing her gratitude to the Mayor for supporting CFSA in its request for funding for its new initiatives. She did not however, point out that  parents and youths involved with CFSA rely on other systems, like behavioral health and child care, in order to achieve their goals. Many parents rely on mental health and drug treatment services provided by the Department of Behavioral Health (DBH) to get their children back or keep their children at home–and these services are characterized by waiting lists, high turnover, and insufficient capacity. CFSA has attempted to compensate for DBH deficiencies by creating its own mental health unit for children in care, and is expanding that unit to serve their parents as well, but parents and children with in-home cases will still be relying on services funded by DBH. Youth who have aged out need these services as well, including help in managing their use of marijuana and other drugs, as mentioned in testimony by the Young Women’s Project. Parents with in-home and out-of-home cases, as well as parenting youth in foster care and aging out, all struggle to find and pay for child care. In order to ensure that CFSA can achieve its goals, the generosity of the Mayor must extend to other systems as well.

This post was updated on February 25, 2020 to incorporate corrections and comments from CFSA.

CFSA’s “Family First” Plan shows limits of new law

PuttingfamiliesfirstDCOn October 29, 2019, the Child and Family Services Agency (CFSA) became the first child welfare agency to have its Title IV-E Prevention Plan approved by the federal Administration on Children and Families (ACF).  This plan, called Putting Families First in DC, describes how CFSA plans to implement the Family First Prevention Services Act (“Family First”). .While it is encouraging that the District was successful in gaining federal support for its plan, it is disheartening that there will be very little expansion of services under this new legislation, and that Family First will have no impact on the shortage of critically needed mental health services for parents.

Family First widened the population of children and families that can be served under Title IV-E of the Social Security Act from children in foster care to children who are “candidates for foster care” and their families.  A “candidate for foster care” is defined as a child who is identified in the jurisdiction’s prevention plan is being at “imminent risk of entering foster care” but who can remain safely at home or in a kinship placement if services are provided.  Each state sets its own definition of a candidate for foster care in its Title IV-E plan. CFSA has chosen a fairly broad definition, which includes many types of families that have been investigated by CFSA after an allegation of child abuse or neglect

Most interestingly, CFSA has chosen to include as “candidates for foster care” children of pregnant or parenting youth who are in foster care or have left foster care within five years. The inclusion of these families is particularly significant because it allows services to families in which abuse or neglect has not taken place. Rather than preventing the recurrence of abuse or neglect (known as “tertiary prevention”) this extends  the use of Title IV-E funds to preventing the first occurrence to a high-risk population (known as “secondary prevention”).  This  represents a more “upstream” approach, which many experts and child welfare leaders have long been arguing deserves more support.

However, the effects of this expansion of the eligible population are drastically constrained by the severe limitation on what services can be provided under Family First. The Family First Act extends the use of Title IV-E funds to services designed to prevent placement of children in foster care. Three categories of services are allowed: “in-home parent skill-based services,” mental health services, and drug treatment. (“Navigation” services to kin who are caring for children are also covered). So far, so good. But when specific services are considered, things become complicated.

As I described in earlier posts, the decision of Congress to make Medicaid the payer of last resort rules out using Title IV-E to fund many mental health and drug treatment programs that are crucial to keeping families together safely. And Congress’ decision to limit reimbursement to programs that are included in a Title IV-E Prevention Services Clearinghouse rule out support for many promising and supported programs that jurisdictions are already using or might want to use to support their struggling families.

Through a Program Instruction, ACF recently gave states an option to claim “transitional payments” for services that have not yet been approved by the clearinghouse, by conducting an “independent systematic review” of such services. But the funding will be cut off if the Clearinghouse decides not to approve the service, and it is not clear if any states will use this option. The District of Columbia has elected not to do so. As a result, after all the hoopla, the District is claiming only one evidence-based prevention service for funding under Family First! That is the Parents as Teachers (PAT) home visiting program, which is already being provided by the DC Department of Health using federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funds. CFSA will be using local dollars, matched by federal Title IV-E funds, to add slots to this program to meet the needs of its foster care candidates and their parents.

It is worth noting that the evidence on PAT’s potential to prevent child maltreatment or its recurrence not very compelling.  The California Clearinghouse for Evidence Based Practices in Child Welfare (CEBC, the leading organization of its kind) rates it as only “promising” (not “supported” or “well supported”) on primary prevention and does not even rate it on prevention of maltreatment reduction. Since the CEBC rated the program, a new study was released testing the potential of PAT to reduce maltreatment among parents who already have been found neglectful or abusive. The study found no overall effect, though they did find that there was a reduction in maltreatment reports for parents who were not depressed and did not have a significant history with Child Protective Services–in other words, the easiest-to -treat minority of the population of parents involved with CPS.

It is also strange that CFSA has not adopted the home visiting program that has shown the strongest evidence by far of preventing child abuse and neglect. That is the Nurse Family Partnership (NFP) , which is the only program to have been given a rating of 1 (“Well Supported by Research Evidence”) by the CEBC for the prevention of child abuse and neglect. NFP is designed for first time teenage mothers only; it would be a natural for teen parents in foster care and other teen parents citywide. It is a shame that DC’s Department of Health has not chosen to invest in this program and that CFSA has followed suit.

It is likely that CFSA will eventually receive Title IV-E support for a second service. Motivational Interviewing (MI) was approved by the Title IVE Prevention Services Clearinghouse after CFSA had already submitted its plan. MI is a method of counseling to facilitate behavior change, especially regarding substance abuse. It is typically delivered over one to three sessions.  However, CFSA has included Motivational Interviewing in its plan as a “cross-cutting” program rather than a program addressing substance abuse. The agency states that it intends to use MI as a “core component” of its case management model, rather than a two-or-three-session freestanding program. Brenda Donald, CFSA’s director, told the Chronicle of Social Change that she expected to be able to claim IV-E reimbursement for case management once it was added to the clearinghouse. Other jurisdictions are moving in the same direction, according to the Chronicle.

CFSA included in its Family First Plan other programs eligible for Title IV-E funding but is not planning to claim federal funds for these programs because they are already supported by federal funds. Also included are several services that have not yet been approved for Family First funding and are supported by Medicaid or local dollars. It’s a large array of programs, none of which will be supported by Title IV-E funds except PAT and perhaps MI.

So under Family First, Title IV-E dollars are being used to expand one home visiting program in the District and perhaps can be used to match funds spent on case management if CFSA succeeds in making the case that the use of the MI approach makes case management reimbursable. In the meantime, District parents with children at risk of foster care placement are desperately seeking needed services, especially mental health services to treat their mental disorders, such as depression and Post Traumatic Stress Syndrome (PTSD) that contribute to child abuse and neglect.  As recently reported by the District of Columbia’s Citizen Review Panel (CRP), there is such a shortage of basic  mental health services for parents that social workers are doing therapy themselves and also trying to substitute alternative services that may not be as effective, such as telemedicine or yoga. Lack of appropriate mental health services and long waiting lists were major themes of CFSA’s 2019 Quality Service Review, as reported by the CRP.  Poor quality of Medicaid-funded services and rapid turnover of providers are also problems that plague CFSA-involved parents and their social workers.

What a difference Family First could have made if its funds could be used to augment the supply of Medicaid-funded basic mental health services such as medication management, individual and group therapy! How many families could be strengthened if the Clearinghouse had included, or was considering, newer and exciting evidence-based mental health services like EMDR and Mindfulness Based Stress Reduction that may not be covered by Medicaid! Without federal help through Family First, parents involved with CFSA continue to wait for services they need to parent their children safely.

Another problem for CFSA lurks down the road. As CFSA describes in its plan, the law requires that 50% of IV-E spending be for practices that are “well-supported” as defined by the Act. But most of the “well-supported” practices that CFSA is using are funded by Medicaid in the District. If the Medicaid-funded programs cannot be counted as part of CFSA’s total Family First expenditures (which ACF has suggested will be the case), CFSA will not be able to show that it is spending 50% on “well-supported” practices. Congress has already passed the Family First Transition Act, which delays implementation of this requirement to 2024, with a requirement that by 2022 states have to show 50% of practices as “supported” or “well supported.” But what will happen then? The Chronicle voices the hope that more practices would have made it to the well-supported list by that time. We shall see.

With all the fanfare around Family First and CFSA’s large investment of time in developing this plan, it seems clear that the agency is gaining few resources in return for the large  burden of showing compliance with Family First.  It’s ironic that CFSA must provide extensive documentation to ACF regarding services that are getting no funds under the act. CFSA and other jurisdictions should press for amendments that make Family First more likely to achieve its objective of supporting parents to improve their parenting and keep their children safely at home.

Washington Post on foster care: old tropes and false narratives

The Donald R. Kuhn Juvenile Center in Julian, W.Va., where Geard Mitchell, now 17, spent part of his childhood. A lawsuit says 10 states’ agencies tasked with caring for children failed, “jeopardizing their most basic needs.” (Sarah L. Voisin/The Washington Post)
Image: Washington Post

A note to readers: This first substantive post on Child Welfare Monitor DC is unusual because it focuses on national, not local issues. However, it is important for a local blog to comment on the coverage offered by our local newspaper of record, the Washington Post, and that is why this piece is included in this blog.

Foster care has finally made it to the front page of the Washington Post, and a sad story it is. The story highlights the growing crisis in many states due to the increase in drug addiction bringing in its wake a cascade of child removals into foster care, outstripping the supply of  foster homes and other placement. The problems outlined in the article are real and urgent, but the analysis and prescriptions offered in the article and subsequent editorial reveal the authors’ lack of understanding of the issues, which results in the repetition of false narratives and common misleading tropes.

The Post‘s front-page article focused on a growing crisis caused by increased drug addiction among parents, especially the opioid crisis. The author, Emily Wax Thibodeaux, zeroed in on West Virginia, one of the epicenters of the crisis. She introduced us to Arther Yoho, a young man who spent more than two years in a detention center because there was no foster parent available to take him in. Locked up with 27 juveniles with criminal convictions, Arther was failed by the system that was supposed to protect him.

Thibodeaux reports that other desperate states are using emergency shelters, hotels and out-of-state institutions to house youth for whom there is no foster family home available. This is tragic and true, and I wrote about it in a recent post, although the placement of foster youth in detention centers along with criminally charged youth may be unique to West Virginia with its cataclysmic foster care crisis. Thibodeaux reports Oregon’s use of refurbished detention centers to house foster youth, which is certainly not ideal but is quite different from housing them with juvenile offenders. In any case, Thibodeaux is right to point out that many young people in foster care are being placed in inappropriate (and often harmful) placements because appropriate ones are not available.

However, Thibodeaux takes an unwarranted conceptual leap by linking the placement of children in inappropriate facilities to states’ use of congregate care, a term used to connote placements that are not families. These include what are generally known as group homes, as well as residential treatment centers, which are part of the accepted continuum of care for foster youth. While detention centers are never appropriate for foster youth who have not been charged with a crime, group homes and residential treatment centers may be the appropriate placement, often for a limited time, for some youths in foster care. These are the young people who cannot be maintained in a regular foster home because of their defiant, violent, or self-destructive behavior. Many of these children might be able to “step down” to foster care after spending time at a therapeutic residential facility.  It is possible that some of these young people could be helped in a professional therapeutic foster home staffed by salaried and trained foster parents, an approach that is gaining increasing interest, but programs so far are few and small and not likely to meet the need for therapeutic placements.

Thibodeaux cites the common trope that “Compared with foster children living with families, those housed in congregate care settings are more likely to drop out of high school, commit crimes and develop mental health problems.” That is very true. But it is a matter of correlation, not causation. It is the younger and less damaged children who end up in foster homes in the first place. Not surprisingly, they are likely to have better outcomes. Concluding that congregate care causes the negative outcomes may well be akin to concluding that fire trucks cause fire damage since buildings that have been visited by fire trucks are far more likely than typical buildings to have sustained fire damage. We don’t have a body of research on what happens to children with similar risk factors who spend time in foster homes compared to those who spend the same amount of time in group homes.

Thibodeaux appears to be unaware that some of the states with the lowest proportions of children in congregate care are those that are struggling the most with inappropriate placements. Washington and Oregon are among the states with the highest proportions of foster children placed in families as opposed to congregate care facilities, according to federal data cited in a recent report from the Annie E. Casey Foundation. Both states have been the subject of disturbing media reports that foster youth are staying in hotels, offices and substandard and abusive out-of-state facilities. That’s not surprising, since appropriate options are not available.  In Washington, ten years of group home closures led to the current crisis. The director of Washington’s child welfare agency has requested funding to expand the capacity of therapeutic group home beds to accommodate the children who are now staying in hotels and offices. The director of Oregon’s agency has cited a reduced number of treatment beds as a cause of children being sent to substandard and abusive out-of-state facilities.

By implying that all congregate care placements are inappropriate, Thibodeaux lays the groundwork for false conclusions about policy. Rather than saying that states need to beef up their therapeutic options, whether they are professionally-trained therapeutic foster parents or therapeutic group homes or residential treatment centers, Thibodeaux suggests that the new Family First Prevention Services Act, which makes it more difficult to obtain federal reimbursement for congregate care stays, may solve the problem.

Actually, the Family First Act may well make things worse. By making it harder to license therapeutic group homes, there is reason to fear that Family First will exacerbate the placement crisis. This has already happened when group homes closed in in jurisdictions like Oregon, Washington, New York City, and Baltimore. In California, the closure of group homes due to their Continuum of Care “reform” (a predecessor of the Family First Act) has resulted in, according to one veteran service provider, “fewer kids in group homes, but only because there are fewer group homes and counties have inappropriately been pushing challenging, difficult-to-manage youth into lower levels of care.”

The Washington Post followed Thibodeaux’ article with an editorial, “The Crisis in Foster Care,” which repeated and further distorted some of Thibodeaux’s questionable statements. Where Thibodeaux reported that 71% of foster children aged 12 to 17 are in congregate care placements in West Virginia (a high number to be sure), the editorial page erroneously stated that seven in ten of all foster children are in such foster care placements. That is a huge difference as older children are much more likely to be in such placements.

The opinion writers go on to repeat Thibodeaux’ misleading statement from the Casey Foundation about children in group homes doing worse than those in foster homes. However, they also cite discouraging outcome data about children growing up with foster parents. Because both options seem bad, the opinion writers suggest that “the least-bad option for many children” may be staying or reuniting with their parents, “unless there is abuse in the home. “They go on to cite one of the most persistent tropes of all that child protective services workers “often remove minors from neglectful parents who, while a far cry from being good caregivers, may still be better than group homes.”

The trope that child neglect is “less than ideal parenting” is belied by some of the stories that have come out of West Virginia and other states in the throes of the opioid crisis. We’ve all heard the stories: infants born addicted to drugs to mothers unable to care for them,  children who lost their parents and even their extended families due to opioid overdoses, children abandoned at home without food while parents seek drugs, children strapped in cars while their parents get high, babies and toddlers who ingest heroin, alcohol or meth; children whose parents are incarcerated due to substance abuse or dealing; and more. This is not “imperfect parenting” but something much worse. Living with an addicted parent is has a host of negative consequences that may be lifelong and is in itself considered an Adverse Childhood Experience (ACE).

One article from the Seattle Times documents the impact of the drastic increase in infants born addicted to drugs when they reach school age. “[The lives of children who grow up with drug-abusing parents are marked frequently by the presence of police, the constant fear of a mother or father’s incarceration and the likelihood of sudden death by overdose — all traumas shown to impede brain development and learning.”

To add insult to injury, the Post did not even seek to find out what is happening in its own back yard. Only two weeks before Thibodeaux’s article, a hearing was held in the 30-year-old LaShawn class action case to discuss the current placement crisis in the District of Columbia. The Judge referred to a letter from the court monitor that 31 children, including seven children between eight and ten years old, experienced a total of 60 overnight stays at the Child and Family Services Agency between April and November of 2019. All of these children had challenging behaviors that excluded them from existing placements. The agency director acknowledged that the District needs more therapeutic placements (either in family or group settings) for these children. The District is in the process of developing  a new group home and “a couple of” professional foster parents. The District is a small jurisdiction and its crisis is dwarfed by that of West Virginia, but its 60 office stays deserved a mention in our hometown paper.

The Washington Post‘s treatment of foster care illustrates the consequences of letting reporting and editorial staff without subject matter expertise tackle a complex subject like foster care. Repeating false narratives and tropes from alleged authorities is easy and saves time. But it does not help readers to understand what is wrong and what is needed and on the contrary leads them to look for “solutions” that may make things worse.

 

 

Welcome to Child Welfare Monitor DC

Welcome to Child Welfare Monitor DC. Since leaving my job in the District of Columbia’s child foster care system in 2015, I’ve been writing about national issues in child welfare through my blog, now called Child Welfare Monitor. I have not focused on local issues, using my participation on the Citizen Review Panel for child welfare as the platform for my local child advocacy work. 

With my decision to leave the Citizen Review Panel, I’ve decided I needed a local platform to focus on specific issues around child welfare in the District and I’ve created Child Welfare Monitor DC. My goals are twofold.

  • First, in view of the almost total absence of press coverage of child welfare in the District, I want to inform people of about what’s going on in the District of Columbia child welfare system. In the coming months, I’ll write about CFSA’s implementation of the Family First Act, the upcoming  oversight and budget hearings, reports and hearings in the LaShawn case, and the suit filed by DC Kincare Alliance regarding CFSA’s use of kinship diversion, among other issues. I’ll cover new publications that come out of CFSA, new reports from the court monitor and other outside agencies and other resources, events and policy changes that won’t be covered anywhere else. 
  • Secondly, I want to convey my own unique point of view. Those of you who read Child Welfare Monitor will know that I take a child-centered approach to child welfare. I think that CFSA, like most other large systems, has gone too far in its focus on parents’ rights at the expense of child safety. I’m also concerned about foster care and the lack of parenting many wards of the state receive, whether they are in foster homes or other facilities. And of course I’m concerned about the current placement crisis, which would clearly be much worse if all the substandard foster homes were shut down. These and other concerns will come out in my writing, but if you disagree with me, I hope you will still appreciate the factual reporting that you will also find in my blog. 

If you want to know more about me, check out the About page of this website. And I hope you will subscribe to this blog by clicking on the Follow icon on the right-hand corner of my home page.

Marie K. Cohen